青少年近视合并高眼压的静态阈值视野改变

目的：探讨合并高眼压青少年近视的静态视野改变的特点及其临床意义。方法：应用Octopus101型全自动视野计对45例(87只眼)青少年近视合并高眼压和36例(72只眼)正常眼压青少年近视进行定量视野测定，并分析其视野缺损形式及视野指数与眼压、屈光度的关系。结果：合并高眼压青少年近视的视野损害发生率明显高于正常眼压青少年近视。视野损害多表现为生理盲点扩大，特征性青光眼视野缺损。与正常眼压青少年近视有显著性差异。平均敏感皮MS值、平均缺损MD值、缺损变异LV值均与正常眼压青少年近视有显著性差异，且在正常眼压青少年近视组中，随着近视度数增加，MS值逐渐下降，MD及LV值逐渐升高。结论：高眼压是青少年近视人群中发展为青光眼性视野损害的一个重要因素。眼压应列为青少年近视的眼科常规检查项目。采用全自动视野计检测是早期发现青少年近视青光眼性视野损害的最敏感最有特异性的检查方法。     

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。     

夜间血压下降对开角型青光眼视神经损伤的影响

目的：探讨夜间血压下降与开角型青光眼和正常眼压性青光眼患者视神经损伤进展的关系。

方法：对我院眼科门诊确诊的开角型青光眼和正常眼压性青光眼患者51例51眼分别进行视野、OCT检查,进行平均视神经纤维层厚度、24h动态血压监测、24h眼压监测等检查,分析夜间血压过度下降与视野进展率的关系。

结果：根据夜间血压下降值(dip)进行分组,三组间有显著性差异的数值为平均缺损(MD)差值(P=0.032)、眼压峰值(P=0.003)、视野缺损计分差值(P=0.041)。在视野缺损进展组、视野缺损改善组、视野缺损不变组间,dip有显著性差异(P=0.028)。视野缺损进展组夜间血压下降值明显高于其他两组。夜间血压过度降低组视野缺损进展率明显高于不过度降低组(视野缺损进展率分别为50%,7%)。影响视神经纤维层(RNFL)厚度的相关因素为夜间最低平均动脉压和dip(P=0.011,P=0.032,R²=0.081); 影响MD值的相关因素为眼压波动(P=0.026,R²=0.115); 影响模式标准差(PSD)值的相关因素为眼压波动和dip(P=0.020,P=0.044,R²=0.141)。

结论：与开角型青光眼相比,正常眼压性青光眼患者中夜间血压过度下降的发生率较高。夜间血压过度降低组中视野损伤进展明显。视野缺损进展组夜间血压降低更明显。眼压波动与dip是正常眼压性青光眼和高眼压开角型青光眼的患者视神经损伤与视野缺损高危因素。     

自动静态视野随诊检查结果的可靠性研究

目的　探讨青光眼与疑似青光眼患者自动静态视野随诊检查结果的可靠性。方法回顾性分析 1994年 8月至 2 0 0 0年 6月 ,使用Octopus 1 2 3全自动静态视野计连续检测次数≥ 2次的青光眼患者 (82只眼 )和疑似青光眼患者 (80只眼 )的视野检测资料 ,根据检测次数分为A、B、C组 ,比较各组患者视野检测结果的假阳性反应率 (FP)、假阴性反应率 (FN)及可靠性因子 (RF)。结果依据瑞士Interzeag公司提供的参考标准 ,疑似青光眼患者组 197份视野检测结果中 ,不可靠视野检测结果 10份 (5 1% ) ;青光眼患者 2 15份视野检测结果中 ,不可靠视野检测结果 39份 (18 1% )。青光眼患者各组的假阴性反应率远高于疑似青光眼患者 (P <0 0 1)。结论　多数疑似青光眼患者自动静态视野随诊检查结果可靠 ,少数不可靠的视野检测结果属偶然现象 ;假阴性反应结果与青光眼患者视野状态有关。     

眼压降低后原发性慢性青光眼视野的变化

目的了解原发性开角型青光眼（POAG）和原发性慢性闭角型青光眼（PACG）在眼压降低后视野是否发生改变及相关因素分析。方法原发性慢性青光眼32例（44眼）,其中PACG19例（25眼）,POAG13例（19眼）。眼压治疗前及治疗后1个月全部患者均行Humphrey静态自动视野（HFA）24-2全阈值视野检查。比较眼压降低前后视野平均缺损（MD）、模式标准差（PSD）的变化,分析眼压降低幅度、年龄及视神经杯盘比与视野MD改变是否相关。结果治疗前MD为-13．58±9．31,治疗后MD为-12．08±8．37,治疗前后MD比较差异有统计学意义（t=3．35,P=0．002）;治疗前后MD差值与眼压降低幅度呈正相关（r=0．341,P=0．027）。协方差分析结果表明,校正年龄和HRT的杯盘面积比后,治疗前后视野MD的改变与眼压降低幅度呈正相关（F=4．706,P=0．037）。结论原发性慢性青光眼眼压降低后视野有所改善,视野改善的程度与降压幅度有关。     

灯盏细辛对眼压已控制青光眼患者视野的保护作用

-目的:探讨灯盏细辛对眼压已控制青光眼患者视野的保护作用。方法:选择有青光眼视野缺损,眼压控制在18mmHg以内的原发性青光眼患者24例40眼。按随机、双盲法予药物口服,药物分别为灯盏细辛片和安慰剂。患者每日口服3次,每次2片。2mo为一疗程,连续3个疗程,每2mo随访1次。试验结束由药物提供方拆盲并反馈信息。结果:①用药前后各疗程对照组和治疗组收缩压、舒张压、脉搏、眼压、C/D、视力均无显著性统计学差异(P>0.05),且所有患者用药过程中无明显不良反应。②治疗组用药6mo后的平均缺损(MD)、平均敏感度(MS)与用药前的MD、MS相比,差异有显著性意义(P<0.05)。③中晚期治疗组用药2,4,6mo后的MD、MS分别与用药前MD、MS相比差异均有显著性意义(P<0.05)。结论:降低眼压对部分青光眼患者的视功能有保护作用。灯盏细辛对原发性青光眼患者的视功能有一定的保护作用,且应用疗程越长,视野缺损改善越明显;而对于原发性中晚期青光眼患者,灯盏细辛改善视野更显著。灯盏细辛对血压、脉搏、眼压、视力、C/D比均没有影响。     

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.     

Ex-press青光眼引流器植入术对视野和视网膜神经纤维层厚度影响

目的：观察并分析Ex-press 青光眼引流器植入术对原发性开角型青光眼视野和视网膜神经纤维层厚度影响。
　　方法：选取原发性开角型青光眼患者14例24眼,均行Ex-press青光眼引流器植入术。收集术前裸眼视力、眼压、角膜内皮细胞计数、视野平均缺损( MD)、视野模式标准差(PSD)、视网膜神经纤维层厚度,术后1wk,1、3mo的裸眼视力、眼压,术后3 mo的角膜内皮细胞计数、MD、PSD、视网膜神经纤维层厚度,观察随访期间的并发症及相关处理,统计手术成功率。
　　结果：术前,术后1wk,1、3mo 裸眼视力分别进行两两比较,得出差异均无统计学意义(P>0.05),术后视力无明显下降。术后1wk,1、3mo眼压与术前降低,差异有统计学意义(P<0.05),且术后3mo内眼压保持平稳。术后3mo视网膜神经纤维层厚度和术前比较差异有统计学意义(P=0.018)。术后3 mo MD绝对值和 PSD 较术前相比,差异均无统计学意义(P>0.05)。术后3mo的角膜内皮细胞较术前减少,差异有统计学意义(Z=-2.585,P=0.01)。手术成功率：完全成功19眼(79%),条件成功2眼(8%),失败3眼(13%)。
　　结论：Ex-press青光眼引流器植入术术后短时间内可能会引起视网膜神经纤维层厚度变薄,稳定的降眼压效果能有效减缓视野进展,手术未影响视力,降眼压效果好,是治疗原发性开角型青光眼安全、有效的手术方法。     

青光眼中倍频视野检查与Octopus视野检查的相关性

目的 评价青光眼中倍频视野计（Frequency Doubling Technique FDT）与传统自动视野计Octopus检查结果的相关性。方法 35例正常对照，27例可疑青光眼患者，37例原发性开角型青光眼和50例正常眼压性青光眼患者进行FDT和Octopus检查。记录FDT视野检查的平均缺损（MeanDefect，MD）、图形标准偏差（Pattem Standard Deviation，PSI）），Octopus视野检查中的平均缺损、丢失方差（Loss Variance，LV）。应用线性回归分析计算回归方程及相关系数。结果 原发性开角型青光眼中，FDT-MD与Octopus-MD，FDT-PSD与Octopus-LV均显著相关（r=0．828，r=0．758，P均＜0．001）。正常眼压性青光眼中，FDT-MD与Octopus-MD，PDT-PSI）与Octopus-LV均显著相关（r=0．827，r=0．783，P均＜0．001）。结论 FDT检查的各指标无论在POAG还是NTG中均与传统自动视野计Octopus有很好的相关性。     

尼莫地平治疗正常眼压性青光眼23例

目的 观察尼莫地平对正常眼压性青光眼的治疗作用。方法 将46例正常眼压性青光眼患者随机分成尼莫地平组和维生素B1组，治疗6个月及1年后，观察中心视力、眼压、视野的变化。结果 尼莫地平组视野缺损有不同程度改善，而维生素B1视野缺损保持原状有进展。结论 口服尼莫地平对改善正常眼压性青光眼的视野缺损有一定疗效。     

Multifocal objective perimetry in the detection of glaucomatous field loss.

PURPOSE: To test the ability of a new type of multifocal objective perimetry to identify glaucomatous visual field defects. METHODS: A multichannel visual evoked potential was recorded using the ObjectiVision Accumap perimeter. One hundred patients (age, 62.2 +/- 9.8 years, mean MD -6.5 +/- 4.17 dB) with open-angle glaucoma and confirmed glaucomatous visual field defects were tested and compared with the normal database of 100 normal subjects (age, 58.9 +/- 10.7 years). Both eyes were tested, but for determining sensitivity the eye with the lesser field defect was chosen if both qualified. The amplitude and intereye asymmetry coefficient for each zone of the field were calculated. A mean amplitude and multifocal objective perimetry severity index was calculated for each subject. RESULTS: In 95 of 100 (95%) patients with glaucoma Humphrey field defects were correlated with visual evoked potential amplitude reductions identifying a cluster of three or more abnormal zones. In two of five remaining patients with glaucoma the defect was detected on the intereye asymmetry analysis. Topographic location was well correlated with Humphrey fields. Mean amplitude was significantly reduced in 86 of the glaucoma cases (86%). The glaucoma severity index was abnormal in 93 glaucoma cases and showed a correlation with Humphrey MD (r = 0.67 right eyes, 0.69 left eyes). In 37 glaucoma cases with no scotoma by definition in the fellow eye, 22 (59.4%) had an abnormal multifocal objective perimetry, whereas only eight had some other aspect of their Humphrey visual field flagged as abnormal. CONCLUSIONS: Multifocal objective perimetry can assess the visual field and identify glaucomatous visual field defects. It may have the potential for identifying defects earlier than conventional perimetry.     

药物降低眼压对正常眼压青光眼的治疗意义

目的　探讨对正常眼压青光眼人群合理用药降低眼压对视功能的保护作用。方法　对 18例 2 8眼正常眼压青光眼患者进行前瞻性研究。随机分成两组 ,一组为非治疗组 ;另一组为治疗组 ,予以 0 5 %噻吗心安治疗 ,每日 2次 ,随访时间为 3～ 4年 ( 4 1 18± 3 77)个月。采用Humphrey 63 0型视野分析仪的中心 3 0 2检查程序 ,观察和记录每次视野和眼压检查结果 ,并对数据进行相关分析。结果　治疗组眼压明显低于非治疗组 ,差异有显著性 (P <0 0 5 )。两组视野平均缺损深度均较观察前加深 ,对照组与观察前相比有显著性差异 (P <0 0 5 ) ,而治疗组的差异无统计学意义 (P >0 0 5 ) ,两组相比结果有非常显著性差异 (P <0 0 1) ;治疗组与对照组相比 ,出现新的视野缺损的人数比例明显低于后者(P <0 0 5 )。MD值与眼压存在明显相关关系 (r =0 92 ,P <0 0 1)。结论　眼压对正常眼压青光眼的视野改变有直接影响 ,合理用药降低眼压可以延缓正常眼压青光眼 (NTG)的视功能损害。除眼压外 ,还存在其他因素影响疾病发展。     

慢性青光眼患者不同程度视野缺损情况分析

目的:研究单眼视野已严重缺损的慢性青光眼患者对侧眼视野缺损情况,并分析其视野缺损的相关危险因素。方法:对47例单眼视野已严重缺损(视野缺损计分≥12分)的慢性青光眼患者[原发性慢性闭角型青光眼(primary chronic angle-closed glaucoma,PACG)23例和原发性开角型青光眼(primary openangle glaucoma,POAG)24例]的对侧眼视野进行视野缺损计分,分析对侧眼视力、最高眼压和平均眼压、年龄、屈光度、诊断、病程、性别及抗青光眼手术与否与对侧眼视野缺损计分的关系。应用Spearman相关分析分析上述因素与对侧眼视野缺损计分的相关性。结果:23例PACG患者中,对侧眼视野缺损情况为:无视野缺损者(计分为0分)4例,轻度视野缺损者(计分为1~5分)5例,中度视野缺损者(计分为6~11分)7例,严重视野缺损或终末期视野缺损者(计分为12~20分)7例。24例POAG患者中,对侧眼视野缺损情况为:轻度视野缺损者(计分为1~5分)4例,中度视野缺损者(计分为6~11分)9例,严重视野缺损或终末期视野缺损者(计分为12~20分)11例。PACG患者病程大于或等于10年...     

Visual field defects in high myopic glaucoma compared with moderate myopic glaucoma

PURPOSE: To demonstrate the visual field defects characteristic of high myopic glaucoma eyes. METHODS: Eighty-one high myopic glaucoma eyes (< or = -8 diopter(D)) and eighty moderate myopic glaucoma eyes(-3 D approximately -6 D) from patients under the age of 60 were enrolled in this study. Visual acuity, Mean Deviation (MD) of Humphrey visual field analyzer (HFA) central 30-2 program, and the pattern of central visual field defect especially at the early stage of glaucoma (MD > or = -10 dB) were compared between high and moderate myopic groups. RESULTS: HFA examination revealed significant differences in MD values between the high and moderate myopic groups (-11.8 +/- 8.9 dB and -8.4 +/- 6.9 dB, respectively, p = 0.02). Average logMAR visual acuity of the high myopic group was significantly worse than that of the moderate myopic group. The analyses of the pattern of visual field defects especially at an early glaucoma stage demonstrated that there was no specifically damaged area, such as cecocentral scotoma, in high myopic glaucoma subjects. The nasal upper area of the fixation point was the area most affected in both groups. CONCLUSIONS: High myopic glaucoma eyes demonstrated significantly lower MD and visual acuity compared to those of moderate myopic glaucoma eyes. However, at an early stage of glaucoma, no visual field defect characteristic of high myopia was observed.     

拉坦前列素滴眼液治疗真性小眼球继发闭角型青光眼的疗效观察

目的 探讨拉坦前列素滴眼液对真性小眼球继发闭角型青光眼的治疗效果.方法 系列病例研究.选择2009年6月至2010年7月在首都医科大学附属北京同仁医院眼科中心收治的真性小眼球继发闭角型青光眼5例共9只眼,使用了0.005%拉坦前列素滴眼液或激光虹膜周切后联合0.005%拉坦前列素滴眼液,随访观察3～16个月,对其视力及眼压、眼底及视野等进行了监测.结果 真性小眼球继发闭角型青光眼5例患者共9只眼在治疗后眼压控制在10～20mmHg之间,视力无下降,视野及眼底杯/盘比无进展.结论 使用0.005%拉坦前列素滴眼液治疗真性小眼球继发闭角型青光眼是安全有效地方法,避免了小梁切除术后可能出现的眼部并发症.

Abstract：

Objective To study the effect of latanoprost on the trealment of nanophthalmos combined angle closure glaucoma. Methods Clinical case series. From June 2009 to July 2010, in Beijing Tongren Eye Center and Beijing Tongren Hospital, five patients (9 eyes) diagnosed as nanophtalmos combined with angle closure glaucoma were treated with latanoprost eye drops and followed up 3 to 16 months for clinical evaluation. The clinical outcomes included visual acuity, IOP, fundus examination and visual field examination. Results In 9 eyes, the IOP was controlled under normal level. The visual acuity, fundus examination and visual field examination did not vary from the baseline.Conclusions Latanoprost eye drops is effective and safe in the treatment of nanophthalmos combined with angle closure glaucoma.     

可疑青光眼患者视野检测的表现特征及相关分析

目的 探讨可疑青光眼患者中心30°阈值视野检测的表现特征及其影响因素.方法 采用横断面研究设计,对就诊的可疑青光眼患者应用Octopus- 101型视野计进行中心30.阈值视野检测.统计分析平均视网膜光敏感度(MS)、平均视野缺损度(MD)及丢失方差(LV)视野指数,并进行视野指数影响因素相关分析.结果 可疑青光眼者不同眼别、不同性别间的视网膜光敏感度比较差异无统计学意义(P＞0.05);高眼压者与仅有可疑症状者视野指数比较差异有统计学意义(P＜0.05);杯盘比大者与可疑症状者视野指数比较差异有统计学意义(P＜0.05).Pearson相关统计分析显示:＞21 mm Hg的可疑青光眼者眼压与平均视网膜光敏感度存在负相关(r =-0.654,P＜0.05);＞21 mm Hg的可疑青光眼者眼压与平均视野缺损值存在正相关(r =0.792,P＜0.05).结论 可疑青光眼者的视网膜光敏感度不受眼别和性别的影响,可疑青光眼视野指数主要受可疑指标影响,存在杯盘比大或者眼压高者应慎重筛查并积极复查随诊.     

Association of Intereye Visual-Sensitivity Asymmetry With Progression of Primary Open-Angle Glaucoma

PurposeTo investigate the relationship between intereye visual field defect (VFD) asymmetry and subsequent VF progression in primary open-angle glaucoma (POAG).MethodsModerate-stage patients with POAG (226 eyes of 113 patients) with a single hemifield defect were followed for 8.7 years. Participants were categorized into three groups by initial VF pattern: (1) unilateral VFD, (2) bilateral VFD within same hemifield (superior–superior, inferior–inferior), (3) bilateral VFD within opposite hemifield (superior–inferior). The mean deviation (MD) difference between the intereye was defined as the intereye MD asymmetry index (iMAI). Intereye visual-sensitivity difference within the same hemifield was calculated as the intereye hemifield visual-sensitivity asymmetry index. Functional progression was detected by Glaucoma Progression Analysis. The overall rate of MD change and the association between new indices were evaluated by linear regression. A Kaplan-Meier survival analysis was performed and the factors associated with glaucoma progression were evaluated by Cox proportional hazard modeling.ResultsUnilateral VFD eyes and bilateral VFD eyes within opposite VF hemifield showed significant progression and faster rate of MD change compared with bilateral VFD eyes within same VF hemifield (71.1% vs. 45.9% vs. 21.1% [P = 0.001]; –1.27 dB/y vs. −0.64 dB/y vs. −0.32 dB/y [P = 0.001]). Unilateral VFD eyes showed the fastest time to VF progression compared with other groups (P = 0.002). A faster rate of MD change was associated with greater intereye MD asymmetry index (P = 0.001) and greater intereye hemifield visual-sensitivity asymmetric index (P = 0.031), which were significant risk factors for glaucoma progression (all P < 0.001).ConclusionsAmong POAG eyes with comparable hemifield VFDs, eyes without a corresponding hemifield defect in the fellow eye showed faster rates of progression compared with those with a corresponding hemifield defect.     

Correlation of age and intraocular pressure with visual field damage in patients with normal-tension glaucoma

OBJECTIVE: We investigated the correlation of age and intraocular pressure (IOP) with visual field damage in patients with normal-tension glaucoma (NTG) and asymmetric visual field defects. METHODS: A total of 88 NTG patients (176 eyes) were investigated. Patients in whom visual field defects were more severe in the eye with higher IOP than in the fellow eye were grouped as IOP-visual field-concordant patients, and the others as IOP-visual field-discordant patients. Mean 24-hour IOP was used as an indicator of IOP, and mean deviation (MD) as an indicator of visual field defects. Patients were also compared by age tertile. RESULTS: The IOP-visual field-concordant group comprised 53 of the 88 patients (60.2%), among whom the >70-years tertile had significantly greater absolute values for MD asymmetry. In contrast, no significant differences in asymmetry by age tertile were seen in the IOP-visual field-discordant group. CONCLUSION: Elevated IOP is a cause of visual field defects in many NTG patients. Among IOP-visual field-concordant patients, particular attention is required to visual field changes in the eyes of patients with higher IOP.