青光眼阈值视野缺损的计分方法评价

目的：评价青光眼视野缺损计分方法的有效性和可靠性。方法：采用AGIS(Advanced Glaucoma Intervention Study)研究组推荐的计分方法并稍加改动对9l例(91眼)青光眼患者的视野进行计分，分析视野缺损计分值与C／D比、平均缺损(mean defect，MD)值及缺失方差（loss variance，LV)值的关系和相关性。结果：视野缺损计分值越大，C／D比、MD值及LV值亦越大，视野缺损计分值与C／D比呈明显的正相关（r=0．8712)，其相关系数大于MD值和LV值与C，D比的相关系数。结论：视野缺损计分法较视野指数能更准确地反映青光眼视神经损害情况，能对青光眼视野损害的程度进行量化表达。     

青光眼Humphrey视野检查结果计分评价

目的 研究视野缺损计分对青光眼视野缺损评价的有效性与可靠性.方法 对25例30只眼原发性开角型青光眼患者进行海德堡视网膜断层扫描仪(HRT-Ⅱ)视盘检测和Humphrey视野检查,研究HRT视盘参数、视野平均缺损(MD)和视野缺损计分(VFDS)间的关系和相关性.结果 VFDS与MD间呈明显正相关;二者都与HRT视盘参数有相关性,VFDS的相关系数大于MD的相关系数.结论 VFDS与视盘客观检查结果相符,比MD更能准确反映青光眼视野缺损.     

倍频视野计在青光眼视野缺损评估中的应用

目的评价倍频视野计(FDP)在青光眼视野缺损评估中的作用.方法对93只受检眼(30例轻度青光眼、37例中度青光眼、26例重度青光眼、20例正常对照)进行FDP全阈值检查,将同时进行的Humphrey视野计(HFA)视野检查结果作为标准进行对照,评估其检查时间、平均偏差(MD)、图形标准偏差(PSD)与校正图形标准偏差(CPSD)间的关系.结果FDP全阈值检查的时间为轻度青光眼(4.31±0.47)min、中度青光眼(5.06±0.49)min、重度青光眼(5.50±0.63)min、正常对照(4.04±0.47)min,HFA检查时间为(16.41±1.88)min.FDP各组与HFA间的检查时间的差异均有显著性(P＜0.01).FDP全阈值结果的MD、PSD与HFA的MD、CPSD间的相关系数分别为轻度青光眼0.86(P＜0.01)和0.63(P＜0.01),中度青光眼0.95(P＜0.01)和0.72(P＜0.01),重度青光眼0.99(P＜0.01)和0.87(P＜0.01).结论FDP全阈值检查不仅可快速诊断青光眼,而且可对轻度、中度、重度青光眼视野缺损进行准确的评估,在评估指标中MD为最佳.     

青光眼视野缺损分级方法

视野检查是现代青光眼诊断、治疗、疗效评价和随访的核心,根据视野缺损程度进行分级对评估青光眼病情至关重要,目前国际上视野分级方法多种多样,从动态视野计的缺损形态分级发展到定性分级、半定量和定量分级,各有特点和适用范围.尽管目前还缺乏一种得到公认的标准分级方法,但这些不同设计的视野评估方法为临床提供了多样化的选择,可以针对不同的用途对视野进行各种分级比较.如何选用合适、简单而又准确的分级系统去判断视野缺损程度,仍是一个棘手的问题.就评价视野缺损的各种分级方法进行综述,剖析不同方法的优缺点,为临床准确分析视野提供依据.     

单侧青光眼视野缺损患者假阴性反应的眼间差异

目的 探讨单侧青光眼视野缺损患者电脑视野检查假阴性反应率的眼间差异及相关因素。方法 选取2000年1月～2002年10月在青岛大学医学院附属医院眼科视野检查室行Octopus101自动静态视野检查的单侧青光眼视野缺损患者66例进行研究；比较患者眼间视力、眼压、杯盘比、检查时间及假阴性反应率、假阳性反应率、平均偏差、平均光敏感度的差异，并分析假阴性反应率的相关因素。结果 视野缺损眼与视野正常眼的假阴性反应率(FN)差异显著，且与检查的先后顺序无关，而两眼在视力、眼压、瞳孔直径等方面无明显差异；视野缺损眼平均偏差(MD)与FN相关，在MD越高的眼，FN越高；而正常眼MD与FN无关。结论 假阴性反应率可能与视野缺损有关；用假阴性反应率作为可靠性指数来监测受检者的专心程度、注意力集中程度，是不合适的。     

原发性开角型青光眼 HRT 视盘参数与视野缺损计分的关系

目的探讨原发性开角型青光眼(primary open an-gle glaucoma,POAG)病例的海德堡视网膜断层扫描仪(Hei-delberg retinal tomoscanner,HRT-Ⅱ)视盘参数与视野缺损计分的关系。方法对29例(30眼)POAG患者采用HRT-Ⅱ进行视盘检测;采用Humphrey视野计进行视野检查,运用AGIS计分系统并稍加改动对视野缺损情况进行计分,HRT参数包括视盘面积、视杯面积、盘沿面积、视杯容积、杯盘面积比、线性杯/盘比、平均视杯深度、视盘最大深度、平均视网膜神经纤维层厚度、视杯形态测量,将HRT视盘参数与视野计分进行相关统计学处理。结果HRT视盘参数中盘沿面积、视杯容积、杯盘面积比、平均视网膜神经纤维层厚度、视杯形态测量与视野缺损计分有直线相关关系。对视盘参数与视野计分进行逐步回归筛选变量时盘沿面积被选入,建立回归方程Y=12.351-5.123X(Y表示视野缺损计分,X表示盘沿面积)。结论POAG的视盘参数中盘沿面积与视野缺损计分关系最密切,视野缺损计分能对视野损害程度进行准确量化。     

晚期青光眼患者视野检查的可靠性分析

目的本文探讨晚期青光眼与早中期青光眼患者视野检测的可靠性是否存在显著性差异。方法以2002年4月至2003年12月随诊于我科的临床确诊为青光眼的患者作为研究对象,应用OCTOPUS101型视野计中G2/TOP程序对双眼进行视野检测。以每位患者有一次以上视野检查经历及裸眼视力≥0.5,瞳孔直径大于2.5mm作为入选标准。共157只眼(90位患者)入选;年龄25岁到79岁,男性29人、女性61人。结果以平均缺损指数(MD,meandefect)分组:MD≥15dB为晚期青光眼组;MD<15dB为早中期青光眼组。MD≥15dB组RF值35.73±3.69,显著高于MD<15dB组5.14±0.73(P<0.01);根据RF值进行分组:RF>15%为RF异常组;RF≤15%为RF正常组,RF异常组的MD值8.64±1.08显著高于RF正常组4.38±0.38(P<0.01)。晚期青光眼组患者假阴性率远高于早中期青光眼组。结论晚期青光眼患者视野检查的可靠性因子(RF)与早中期患者相比有显著差异,在视野损伤严重的患者,高RF值并不一定代表患者视野检查的可靠性差,相反,当青光眼损伤到一定程度,RF值随之增大,可能与损伤程度有关。高RF值来源于高的假阴性率,青光眼的加重导致假阴性率的增高。     

青光眼视网膜血流密度与视野缺损程度的相关分析

目的:探讨原发性慢性闭角型青光眼(chronic primary angle-closure glaucoma,CPACG)患者的视网膜血流密度(vessel density,VD)与视野缺损程度的相关性.方法:光学相干断层血管成像技术(optical coherence tomography angiography,...     

倍频视野计检测青光眼性视野缺损能力的研究

目的评估倍频视野计检测青光眼性视野缺损的能力以及与OCTOPUS101全自动视野计检查结果之间的相关性。方法应用倍频视野计的C-20—5筛选程序以及OC—TOPUS101全自动视野计的G2-TOP程序对23例正常对照者、20例早期青光眼患者、35例中晚期青光眼患者、11例高眼压患者及13例疑似青光眼患者进行视野检测。正常对照组、高眼压组及疑似青光眼组随机选择一眼进行测试，青光眼组选择具有较严重视野缺损的一眼进行测试。结果倍频视野计的C-20—5筛选程序在检测青光眼时ROC曲线下面积为0．925（敏感性85％，特异性91％），与OCTOPUS视野指数-平均缺损、偏离缺失之间的Pearson系数分别为0．702与0．429（P〈0．001），倍频视野计与OCTOPUS101视野计检查平均所需时间分别为1．00min与2．33min．2者之间有明显差异（P〈0．001）。结论倍频视野计检测青光眼性视野缺损具有良好的敏感性与特异性，与OCTOPUS101视野计的视野指数之间亦存在理想的相关性，而且前者比后者检测速度更快，使大规模人群筛查成为可能。     

Association between Nocturnal Blood Pressure Reduction and Progression of Visual Field Defect in Patients with Primary Open-Angle Glaucoma or Normal-Tension Glaucoma

Purpose To assess prospectively the relationship between nocturnal blood pressure reduction (dip) and progression of the visual field defect in patients with normal-tension glaucoma (NTG) or primary open-angle glaucoma (POAG).Patients and Methods The subjects studied were 38 patients with glaucoma (23 patients with NTG, 15 patients with POAG), in whom 48-h ambulatory blood pressure monitoring was conducted, who were followed for at least 4 years, and in whom reliable visual field tests were performed at least 5 times. The progression was determined by the mean deviation (MD) slope analysis system installed in the Humphrey field analyzer Statpac program. Glaucoma patients with a dip of <10% were assigned to the nondipper group, those with a dip of 10%–20% to the tipper group, and those with a dip of >20% to the extreme dipper group. The dipper group was defined as physiologic dippers, while the nondipper and the extreme dipper groups were defined as nonphysiologic dippers, to study the relationship between the disturbance of the dip and progression of the visual field defect.Results Thirteen patients showed significant progression, while 25 patients did not. There were no significant differences in the mean intraocular pressure and follow-up period between the patients with progression and those without progression. Half (7/14) of the nondippers, 20% (4/20) of the dippers, and 50% (2/4) of the extreme dippers showed progression, indicating a tendency of progression in the nondipper and the extreme dipper groups. The nonphysiologic dippers had a higher incidence of progression compared with the physiologic dippers (P = 0.05). Among the glaucoma patients in the nondipper and dipper categories only, those with progression had significantly smaller dips (P = 0.02).Conclusion These results suggest that disturbance in the physiologic dip may be involved in the progression of glaucoma. Jpn J Ophthalmol 2004;48:380–385 © Japanese Ophthalmological Society 2004     

一种评价青光眼视野损害的新方法——上下方Bjerrum区静态光阈值不对称

鉴于早期青光眼视野缺损具有上下方视野不对称特点,根据不对称视野计分可能发现早期青光眼视野损害。通过比较同一跟上下Bjerrum区相对应点群的平均光敏感度,分析54只已有早期或中期视野缺损的青光眼和105只正常眼的自动视野计资料。94.44%(51/54)的青光眼和92.38%(97/105)的正常眼被正确鉴定。此分析方法简单,对于检测青光眼视野缺损有较高的敏感性和特异性。     

剥脱性青光眼视盘视网膜神经纤维层厚度与视野缺损的相关性

探讨不同时期剥脱性青光眼（PXG）患者视盘视网膜神经纤维层（RNFL）厚度与视野缺损的相关性。方法：病例对照研究。连续性选取2013年1月至2018年1月在石家庄市第一医院青光眼科住院治疗的PXG患者97例（97眼），并将其分为早期PXG组28例，中期PXG组27例，晚期PXG组42例。另选择与PXG组匹配的正常志愿者32例（32眼）作为正常对照组。所有纳入对象均采用SD-OCT对视盘各区RNFL厚度进行扫描，采用单因素方差分析比较4组受检者视盘各区RNFL厚度差异，采用 Pearson相关分析对视盘RNFL厚度与视野平均缺损相关性进行分析。结果：正常对照组及早、中、晚期PXG组平均视盘RNFL厚度分别为（104±11）μm，（92±14）μm，（82±12）μm，（54±18）μm。4组受检者鼻侧、鼻上方、颞上方、颞侧、颞下方、鼻下方及平均RNFL厚度总体差异均具有统计学意义（F=24.38、36.40、47.84、8.70、95.46、54.75、82.28，均P<0.001）。进一步两两比较发现，正常对照组与早期PXG组颞上方、颞下方、鼻下方及平均视盘RNFL厚度差异有统计学意义（均P<0.05）；正常对照组与中期PXG组鼻侧、鼻上方、颞上方、颞下方、鼻下方及平均RNFL厚度差异有统计学意义（均P<0.05）；正常对照组与晚期PXG组各区RNFL厚度差异均有统计学意义（均P<0.001）。中、晚期 PXG组视盘平均RNFL厚度与视野平均缺损呈正相关（r=0.404，P=0.037；r=0.582，P<0.001）。结论：中、晚期PXG眼视盘平均RNFL厚度与视野缺损呈正相关，SD-OCT监测视盘RNFL厚度变化可以作为PXG诊断分期和随访的重要参考指标。     

Prognostic Factors for Progression of Visual Field Damage in Patients with Normal-Tension Glaucoma

Purpose

To evaluate the rate of progression and the prognostic factors of visual field damage in patients with normal-tension glaucoma (NTG).

Methods

Ninety-two NTG patients (92 eyes) were followed up for more than 2 years with topical antiglaucoma medications. All subjects were classified as having early damaged eyes with an initial mean deviation (MD) of ?6?dB or better, moderately damaged eyes with MD between ?6?dB and ?12?dB, and severely damaged eyes with MD of ?12?dB or worse, and survival data were analyzed using regression analysis based on the Cox proportional hazards model.

Results

The probability of visual field stability was significantly higher in patients with moderate damage than in those with severe damage (P = 0.035). The patients with early damage showed no difference in the probability of visual field stability compared with patients with moderate or severe damage. The progression of visual field damage was significantly associated with mean intraocular pressure (IOP) (P = 0.000) or IOP fluctuation (P = 0.002) during follow-up regardless of the severity of the initial visual field damage.

Conclusions

The rate of progression of visual field damage differed according to the severity of the initial visual field damage. IOP reductive medication may be effective in preventing glaucomatous visual field progression in patients with NTG. Jpn J Ophthalmol 2006;50:38–43 © Japanese Ophthalmological Society 2006     

慢性青光眼的视诱发电位

对51例96只慢性青光眼和51例102只正常眼进行了视诱发电位试验,发现青光眼组的VEP波幅(amplitude)较正常组显著降低(P<0.001),青光眼的VEP潜伏期(Latency)和波幅与垂直杯盘比(C/D)的大小有关,显示VEP对慢性青光眼的早期诊断有一定价值。     

No Apparent Association Between Ocular Perfusion Pressure and Visual Field Damage in Normal-Tension Glaucoma Patients

Purpose To investigate the correlation of ocular perfusion pressure (OPP) with general and localized visual field damage in normal-tension glaucoma (NTG) patients. Methods Correlations between OPP, blood pressure, age, intraocular pressure, refractive error, and extent of visual field damage in the eye with the worst mean deviation (MD) were investigated retrospectively in 94 eyes of 94 NTG patients. Visual fields were analyzed statistically with respect to 15 sectors betwen two age-matched groups of subjects with high or low OPP. Results Significant positive correlations were found between OPP and age (P < 0.001), blood pressure and age (P < 0.05), and MD and refractive error (P < 0.01). OPP had no significant correlation with MD or mean sensitivity in the visual field in any of the visual field sectors. Conclusion OPP and systemic blood pressure have no evident effect on the extent or pattern of visual field damage in NTG.     

Evaluation of Visual Field Test Parameters after Artificial Tear Administration in Patients with Glaucoma and Dry Eye

Purpose: To examine the effect of a single dose of artificial tear administration on automated visual field (VF) testing in patients with glaucoma and dry eye syndrome. Material and Methods: A total of 35 patients with primary open-angle glaucoma experienced in VF testing with symptoms of dry eye were enrolled in this study. At the first visit, standard VF testing was performed. At the second and third visits with an interval of one week, while the left eyes served as control, one drop of artificial tear was administered to each patient’s right eye, and then VF testing was performed again. The reliability parameters, VF indices, number of depressed points at probability levels of pattern deviation plots, and test times were compared between visits. Results: No significant difference was observed in any VF testing parameters of control eyes (P>0.05). In artificial tear administered eyes, significant improvement was observed in test duration, mean deviation, and the number of depressed points at probability levels (P?0.5%, P?1%, P?2) of pattern deviation plots (P?0.05). The post-hoc test revealed that artificial tear administration elicited an improvement in test duration, mean deviation, and the number of depressed points at probability levels (P?0.5%, P?1%, P?2%) of pattern deviation plots from first visit to second and third visits (P?0.01, for all comparisons). The intraclass correlation coefficient for the three VF test indices was found to be between 0.735 and 0.85 (P<0.001, for all). Discussion: A single dose of artificial tear administration immediately before VF testing seems to improve test results and decrease test time.     

Chronic Invasive Fungal Sinusitis Presenting as Inferior Altitudinal Visual Field Defect

A young male with acute blurring of vision (6/9) complained of an inferior altitudinal field defect in right eye. Clinical ophthalmological examination was normal. Magnetic resonance imaging (MRI) of the brain revealed the expansion and mucosal thickening of right posterior ethmoid and sphenoid sinuses and opacified right maxillary sinus. Surgical intervention (transethmoidal sphenoidotomy) and histopathological examination revealed chronic invasive granulomatous fungal sinusitis. Anti-fungal therapy led to resolution of visual complaints and restoration of visual field defects.