A comparative study on visual field defect in low tension glaucoma

The mode of visual field defect and the change of intraocular pressure (IOP) were analyzed between progressive low tension glaucoma (LTG) and non-progressive LTG. Maximum IOP and phasic fluctuation in IOP during the follow-up period in progressive cases were significantly higher than those in non-progressive cases (p less than 0.01). This greater range in phasic fluctuation may lead to the development of glaucomatous damage. Analysis of the pattern of visual field defect revealed significantly greater frequency of dense defects within 10 degrees of the fixation area in progressive cases. Another analysis on the mode of visual field damage between progressive LTG and POAG demonstrated higher frequency of focal progression of the damage. These results suggest that there are some different etiological factors among progressive LTG, non-progressive LTG and POAG, while focal anatomical weakness at the optic nerve head also influences the development of damage in some case of progressive LTG.     

原发性开角型和低压性青光眼早期视野及视网膜神经纤维层损害…

探讨原发性开角型青光眼和低压性青光眼早期视野损害及视网膜神经纤维层缺损的特点。     

原发性开角型和低压性青光眼早期视野及视网膜神经纤维层损害的比较

目的探讨原发性开角型青光眼（ｐｒｉｍａｒｙｏｐｅｎ－ａｎｇｌｅｇｌａｕｃｏｍａ，ＰＯＡＧ）和低压性青光眼（ｌｏｗｔｅｎｓｉｏｎｇｌａｕｃｏｍａ，ＬＴＧ）早期视野损害及视网膜神经纤维层缺损的特点。方法应用ＱＺＳ－２型自动视野计全阈值程序对２６例（４１只眼）早期ＰＯＡＧ和１３例（１５只眼）早期ＬＴＧ进行定量视野测定，所有患者散瞳做视盘和视网膜神经纤维层照像，分析视网膜神经纤维层缺损的类型和程度。结果早期ＰＯＡＧ和ＬＴＧ视野损害多表现为局限性视网膜光敏感度下降，少数表现为弥漫性光敏感度下降，视野损害主要位于中心视野，少数可合并周边视野损害。中心视野平均光敏感度和短期波动与正常对照组之间差异有显著性，两型青光眼早期视野损害和视网膜神经纤维层缺损的类型及损害部位分布差异无显著性。结论早期ＰＯＡＧ和ＬＴＧ视野损害特征及视网膜神经纤维层缺损形态一致     

Topography and fluorescein angiography of the optic nerve head in primary open-angle and chronic primary angle closure glaucoma.

PURPOSE: The purpose of this study is to correlate optic nerve head topography with fluorescein angiography of the optic nerve head in patients with primary open-angle glaucoma (POAG), chronic primary angle closure glaucoma (CPACG), and normal controls. METHODS: This was an institution-based, cross-sectional, case-control study of 30 consecutive patients each with POAG or CPACG, which were compared with 30 age- and sex-matched controls. The fluorescein angiograms undertaken in one eye of each of the 90 subjects were then analyzed both qualitatively and quantitatively. RESULTS: The mean age of controls (group 1) was 51.73 +/- 9.6 years, patients with CPACG (group II) was 53.26 +/- 9.5 years, and patients with POAG (group III) was 54.5 +/- 10.4 years. The mean deviation and corrected pattern standard deviation on Humphrey visual field analyzer, respectively, were -1.51 +/- 2.01 dB and 2.09 +/- 1.04 dB the in control group, -9.4 +/- 9.3 dB and 5.32 +/- 4.02 dB in the CPACG group, and -11.27 +/- 7.7 dB and 7.57 +/- 5.34 dB in the POAG group. There was no significant difference in the disc areas between the three groups (analysis of variance [ANOVA], p = 0.157). All circulatory parameters were delayed in both glaucoma groups compared with controls with the disc filling time (ANOVA, p = 0.001) and the choroidal filling time being significantly delayed (ANOVA, p = 0.006). The Moorfield regression analysis showed good correlation with the pattern of disc fluorescence in all quadrants in cases of CPACG and POAG. CONCLUSION: The optic nerve head and choroidal circulation was delayed in both patients with POAG and those with CPACG, which correlates with loss of neuroretinal rim and retinal nerve fiber layer on the Heidelberg Retina Tomograph II (HRT). Patients with POAG showed diffuse damage with significant rim loss, whereas patients with CPACG showed marked sectorial abnormalities (superotemporal and the inferior-temporal) on fluorescein angiography and HRT. One possible reason for this discrepancy could be sectorial ischemia occurring in cases of CPACG as a result of a sudden rise of intraocular pressure causing disc and visual field damage.     

Absolute filling defects of the optic disc in fluorescein angiograms in glaucoma--a retrospective clinical study

BACKGROUND: Analysis of clinical importance of the size of filling defects in fluorescein angiograms in primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG), ocular hypertension and subjects with physiological excavations in comparison to visual field loss, optic nerve head morphology and hemodynamics. PATIENTS AND METHODS: 75 patients (POAG, NTG, ocular hypertension) and 10 healthy subjects with physiological excavations were included in this study. In digitized video fluorescein angiograms (Scanning Laser Ophthalmoscope) the size of absolute filling defects of the optic disc was quantified in the early venous phase and expressed by percentage of the optic disc. Visual fields were obtained by conventional static perimetry (Humphrey 24-2) and graded in stages of glaucoma visual field defects (Aulhorn I-V). Optic disc excavations were evaluated as cup-to-disc-area-ratios. RESULTS: The filling defects correlated with the visual-field loss stages of Aulhorn and the visual field indices MD (mean deviation), PSD (pattern standard deviation) and CPSD (corrected pattern standard deviation). There was no correlation with the index SF (short-term fluctuation) and with systemic hemodynamics (blood pressure, perfusion pressure) or the IOP. Absolute filling defects correlated with the cup-to-disc-area-ratio in NTG. The absolute filling defects were larger in patients with glaucoma (POAG, NTG) in comparison to patients without glaucomatous visual field loss (ocular hypertension, glaucoma-like discs). No difference of filling defects was found in the glaucoma group (POAG, NTG). Patients with NTG had larger excavations and lower systolic blood pressures than patients with POAG. CONCLUSION: The size of fluorescein filling defects may be useful as a parameter for the evaluation of an ischemic lesion of the optic nerve head. Absolute filling defects may differentiate POAG from ocular hypertension and NTG from glaucoma-like discs without field defects. The results support the hypothesis that in POAG and NTG disturbances of the circulation result in similar filling defects of the optic disc and visual field loss.     

OCT血管成像在原发性开角型青光眼早期诊断中的应用

目的：探讨光学相干断层扫描( optical coherence tomography,OCT)血管成像技术对原发性开角型青光眼( primary open angle glaucoma,POAG)早期诊断的价值。方法：观察31例31眼早期POAG患者视盘血流情况。以分光谱振幅去相关 OCT血管成像技术测量视盘周围毛细血管密度及视盘大血管直径,分析与患者视网膜神经纤维层厚度及视野平均缺损度的相关性。结果：视盘上方毛细血管平均密度为7.34±1.40根/mm,与上方视网膜神经纤维层平均厚度呈正相关(P<0.05);视盘下方毛细血管平均密度为7.76±1.34根/mm与下方视网膜神经纤维层平均厚度呈正相关(P<0.05)。视盘大血管平均直径为94.71±11.20μm,与视野平均缺损度呈正相关(P<0.05)。结论：OCT血管成像可以方便无创观察青光眼患者视盘血流情况,可以作为原发性开角型青光眼早期诊断的参考指标。     

原发性开角型青光眼血流动力学研究

目的：探讨原发性开角型青光眼（primary open angle glaucoma,POAG)眼血流动力学的变化, 分析眼血流与视野、视力、眼压、杯盘比的关系。方法：利用彩色多普勒成像（color Doppler imaging,CDI)技术检测POAG患者与正常人各30例59眼的球后血流状态,其中10例,10眼行眼底荧光血管造影（fundus fluorescein angiography,FFA)检测。结果：POAG眼血流速度明显降低（P＜0．01）,血流速度与视功能具有相关性。POAG组表现FFA异常：早期视盘弱荧光,相对性、绝对性视盘局部充盈缺损, 后期视盘强荧光。结论：POAG患者视盘及视网膜血液供应不良,与视神经损害和视野缺损密切相关,首次提出CDI技术检测标准化,实现检测结果的可比性。     

Fluorescein filling defects of the optic nerve head in normal tension glaucoma, primary open-angle glaucoma, ocular hypertension and healthy controls

BACKGROUND: To evaluate fluorescein filling defects of the optic nerve head in normal tension glaucoma (NTG), primary open-angle glaucoma (POAG), ocular hypertension (OHT) and controls. METHODS: Forty patients with NTG (mean age 55 +/- 10 years), 40 patients with POAG (mean age 55 +/- 11 years), 40 patients with OHT (mean age 53 +/- 13 years), and 40 age-matched controls (mean age 54 +/- 11 years) were included in a prospective study. Video fluorescein angiograms were performed by means of a scanning laser ophthalmoscope. The extent of absolute filling defects of the optic nerve head was assessed (as a percentage of the disc area) using digital image analysis. Visual fields were tested by automatic static perimetry (Humphrey Field Analyzer, programme 24-2). RESULTS: Absolute filling defects were significantly larger in patients with NTG (12.2 +/- 15.5%) and POAG (12.9 +/- 13.1%) compared to patients with OHT (1.2 +/- 3.6%) and healthy controls (0.1 +/- 0.5%) (p < 0.0001). The area under the receiver operating characteristic (ROC) curve was 0.806 for NTG vs healthy controls, and 0.812 for POAG vs OHT. Absolute filling defects are significantly correlated to the global indices mean deviation (r = -0.63, p < 0.0001), pattern standard deviation (r = 0.61, p < 0.0001), and corrected pattern standard deviation (r = 0.62, p < 0.0001) and significantly correlated to horizontal (r = 0.50, p < 0.0001) and vertical (r = 0.53, p < 0.0001) cup-to-disc-ratios. CONCLUSIONS: Fluorescein filling defects of the optic disc representing capillary dropout are present in NTG and POAG. The extent of these filling defects is correlated to visual field loss and morphological damage. Fluorescein angiography may be useful in the diagnosis and management of NTG and POAG.     

原发性开角型青光眼视乳头盘沿高度与视野的一致性研究

探讨原发性开角型青光眼（开青）相对视乳头盘沿高（ｎｅｕｒａｌ ｒｉｍ ｄｅｐｈｔｈ,ＮＲＤ）与视野检查结果的一致性。方法利用计算机图像分析技术测量开青患者颞下方的ＲＮＤ值,比较ＮＲＤ值较大部位与视野缺损较重部位的一致性。结果早、中期开青患者有视野缺损或视野缺损较重部位所对应区域的ＮＲＤ值较无视野缺损或视野缺损较轻部位所对应区域的ＮＲＤ值明显增大,且５４只眼中有４６只眼的ＮＲＤ值较大部位与视野缺损较     

Nerve fiber layer and optic disc fluorescein defects in glaucoma and ocular hypertension

Photographs of the optic discs and fluorescein angiograms of 31 patients with open-angle glaucoma and 43 patients with ocular hypertension were evaluated for nerve fiber layer (NFL) defects and absolute fluorescein filling defects. All of the glaucomatous eyes showed both defects. Of the 43 ocular hypertensive eyes, in which both NFL and absolute fluorescein filling defects were evaluated, 9% had only NFL defects, 19% had only fluorescein filling defects, 14% had both defects, and 58% had neither defect. The percent area of fluorescein defect in the optic disc increased with severity of NFL defect in glaucoma and ocular hypertension. This study confirms the relationship of fluorescein filling defects and NFL defects to glaucomatous abnormalities and thus the association between vascular damage to the optic nerve and axon loss in glaucoma. The earliest objective evidence of glaucomatous damage can be detected with a combination of NFL evaluation and optic disc fluorescein angiography.     

Visual field defect and perfusion of the juxtapapillary retina and the neuroretinal rim area in primary open-angle glaucoma

• Background: At this time little information is available about the relationship between glaucomatous visual field defects and impaired blood flow in the optic nerve head. The purpose of this study was to examine blood flow of the juxtapapillary retina and the rim area of the optic nerve head in primary open-angle glaucoma with a borderline visual defect. • Methods: Juxtapapillary retinal and neuroretinal rim area blood flow was measured by scanning laser Doppler flowmetry (SLDF). The visual field was evaluated by static perimetry (Octopus-G1). The optic nerve head was assessed on 15° color stereo photographs. We examined 116 eyes of 91 patients with POAG with controlled IOP and 66 eyes of 44 healthy individuals. The POAG group was divided into eyes with a mean defect lower than 2 dB (POAG group I) and in eyes with a mean defect equal to or greater than 2 dB (POAG group II). The mean age of POAG group I and POAG group II was 55±11 years and 57±10 years, respectively. The mean age of the control group was 45±15 years. The eyes of POAG group I had an average C/D ratio of 0.71±0.18 with an average mean defect of the visual field of 0.97±0.68 dB; the eyes of POAG group II had an average C/D ratio of 0.80±0.17 with an average mean defect of the visual field of 8.2±6.0 dB. The intraocular pressure on the day of measurement in POAG group I was 18.2±3.7 mmHg, in POAG group II 17.6±4.0 mmHg, and in the control group 15.1±2.5 mmHg. For statistical analysis, age-matched groups of 32 normal eyes of 32 subjects (mean age 52±10 years) were compared to 18 glaucomatous eyes of 18 patients (POAG group I, mean age 55±11 years) and 59 glaucomatous eyes of 59 patients (POAG group II, mean age 55±10 years). • Results: In the eyes of POAG group I and POAG group II, both juxtapapillary retinal blood flow and neuroretinal rim area blood flow were significantly decreased compared to an age-matched control group: neuroretinal rim area “flow” POAG group I −65%, POAG group II −66%; juxtapapillary retina “flow” POAG group I −52%, POAG group II −44%. All eyes of the POAG group I (MD<2 dB) and 56 of 61 eyes of the POAG group II (MD>=2 dB) showed a retinal perfusion lower than the 90% percentile of normal blood flow. We found no correlation between reduction of juxtapapillary or papillary blood flow and mean defect in POAG eyes. • Conclusion: Glaucomatous eyes with no defects or borderline visual field defects as well as glaucomatous eyes in an advanced disease stage show significantly decreased optic nerve head and juxtapapillary retinal capillary blood flow. Received: 2 December 1996 Revised version received: 7 February 1997 Accepted: 27 March 1997     

Relationship between optic nerve head microcirculation and visual field loss in glaucoma

PURPOSE: To study the relationship between optic nerve head blood flow velocity and visual field loss in patients with primary open-angle glaucoma (POAG) and normal tension glaucoma (NTG). METHODS: This study included 44 eyes of 44 patients with POAG and 44 eyes of 44 patients with NTG. To evaluate optic nerve head blood flow velocity, the square blur rate (SBR) was measured by means of laser speckle flowgraphy. The correlation between SBR and Humphrey visual field indices was evaluated with linear regression analysis. RESULTS: In the NTG group, the average SBR at the superior and inferior temporal neuroretinal rim was positively correlated with mean deviation (MD) (r = 0.349, p = 0.020). The SBR at the superior or inferior temporal neuroretinal rim was positively correlated with the sum of the total deviations in the corresponding hemifields (r = 0.299, p = 0.049; r = 0.354, p = 0.019, respectively). The correlations between SBR and MD did not differ statistically between the NTG and POAG groups; however, no significant correlation between SBR and visual field indices was observed in the POAG group. CONCLUSION: These results suggested that the change in the circulation of the optic nerve head may be related to visual field damage in the NTG group but may be less involved in visual field damage in the POAG group.     

原发性开角型青光眼视乳头旁脉络膜萎缩区的双眼对照研究

目的研究单眼视野缺损的原发性开角型青光眼患者双眼间视乳头旁脉络膜萎缩区（PPA）的出现频率和面积大小差异。方法利用计算机图像分析系统对视乳头立体照相进行测量,比较40例单眼视野缺损的原发性开角型青光眼患者双眼间PPA的发生率及大小差异。所有入选患者的屈光度（等效球镜）均在-3．00-＋3．00D之间。结果视野缺损眼的视杯面积、杯盘面积比均大于视野正常眼,差异有统计学意义（视杯面积：t=5．332,P〈0．01;杯盘面积比：t=5．126,P〈0．01）。视野缺损眼的α区面积略大于视野正常眼,差异有统计学意义（t=3．02,P=0．0045）;双眼间β区面积差异无统计学意义（S：13．5,P=0．426）;双眼α区与β区的发生率均存在一致性（α区：Х^2=0．00,P=1．000;β区：Х^2=1．2857,P=0．2568）。结论在排除了-3．00D以上的中高度近视眼人群后,单眼视野缺损的原发性开角型青光眼α区、β区的有无和13区的大小均不能很好地反映双眼间视野缺损的差异。     

Fluorescein angiographic features of choroidal insufficiency in anterior ischemic optic neuropathy

Anterior ischemic optic neuropathy(AION) is known to be caused by circulatory disturbance in the anterior optic nerve(AON). Because the AON shares blood supply from the paraoptic short posterior ciliary artery with peripapillary choroid, the authors investigated the angiographic evidences of combined choroidal insufficiency in patients with acute AION. Fundus fluorescein angiograms from 30 eyes from 28 patients with acute AION were enrolled in this study. The diagnosis of acute AION was based primarily on angiographic evidences of filling delay of optic nerve head and the various clinical features, such as decreased visual acuity, visual field defects, afferent pupillary defect, and optic disc swelling. Angiographic evidences of combined choroidal filling delay were as follows: 1) circular or localized filling delay of peripapillary choroid in 15 eyes (50%), 2) generalized filling delay of posterior pole in 11 eyes (36.7%), 3) filling delay of unilateral choroid divided by watershed zone in 5 eyes (16.7%), and 4) choriocapillary filling delay in 10 eyes (33.3%). In this study, various types of choroidal insufficiency in patients with AION were observed, which helped us to differentiate AION from the other various diseases of the anterior optic nerve.     

Three dimensional analysis of the lamina cribrosa in glaucoma

BACKGROUND/AIM: Structural changes in the lamina cribrosa have been implicated in the pathogenesis of glaucomatous optic atrophy. The aim of this study was to determine a measure the surface variability of the cup floor in normal subjects and patients with glaucoma. METHODS: A sample of age matched normal subjects (NN), patients with low tension glaucoma (LTG), and primary open angle glaucoma (POAG) were included in the study. The glaucoma groups were matched for the severity of the visual field loss. Mean 10 degree topographic images of normal and glaucomatous eyes from the Heidelberg retina tomograph were imported into ERDAS image processing software where topographic analysis of the cup floor could be assessed. Each image was processed using customised spatial filters that calculated the surface depth variation in localised neighbourhood areas across each image. The local change in depth across the cup floor surface was determined and compared between the three clinical groups. RESULTS: The depth variation in the cup floor was largest in normal subjects followed by LTG and POAG. Highly statistically significant differences in surface depth variability of the cup floor existed between normal and LTG (p = 0.005), between normal and POAG (p<0.0001), and between LTG and POAG groups (p<0.0001). The variability and skewness of depth difference across the optic cup floor were also significantly different between the three clinical groups. CONCLUSION: A new parameter quantifying depth variations in the cup floor significantly discriminated between groups of normal and glaucoma patients. This new parameter may contribute to a better understanding of the pathogenesis of the glaucomatous optic nerve damage in different types of glaucoma.