原发性开角型青光眼患者视野缺损和瞳孔的关系

目的：测量原发性开角型青光眼患者的瞳孔对光反射,探索青光眼患者视野缺损和瞳孔的关系。方法：连续选取2014－07／2015－10于我院就诊的原发性开角型青光眼患者86例115眼和健康个体16例23眼纳入本研究,所有受试者均接受全面的眼科检查、视野检查（ Humphrey , SITA Standard 24－2）和动态瞳孔测量（ MonCV3 Metrovision ）。依据视野检查结果和青光眼分期系统,将青光眼患者分为5个亚组,即1期亚组、2期亚组、3期亚组、4期亚组和5期亚组。瞳孔对光反射相关的测量指标包括：瞳孔直径（最小和最大瞳孔直径）、收缩和开大的潜伏时间、收缩和开大的持续时间、收缩和开大的速度、收缩幅度以及瞳孔收缩比例。使用SPSS 19．0统计软件包对测量结果进行统计分析。结果：青光眼组中4期亚组和5期亚组的最小瞳孔直径与对照组差异有统计学意义（P＝0．032,P＝0．014）;各组的瞳孔收缩速度相比,差异有统计学意义（ F＝648．675, P＜0．01）,其中5期亚组的瞳孔收缩速度小于其他亚组和对照组（P＜0．05）;3期、4期和5期亚组的瞳孔收缩比例与对照组差异有统计学意义（ P＜0．05）;瞳孔收缩速度、瞳孔收缩比例和最小瞳孔直径与青光眼的视野分期相关。结论：原发性开角型青光眼患者的瞳孔瞳孔收缩能力有所下降,瞳孔收缩能力的下降与视野缺损程度相关。     

合并高度近视的原发性开角型青光眼视野分析

目的探讨合并高度近视的原发性开角型青光眼（POAG）视野改变特点及其与视网膜神经纤维层（RNFL）缺损的关系。设计回顾性病例对照研究。研究对象合并高度近视的POAG组17例（21眼）、非高度近视的POAG组16例（17眼）、单纯高度近视非POAG组20例（25眼）以及正常组17例（19眼）。方法用Humphrey50型视野计进行静态中心阈值视野检查，利用相干光断层扫描术（OCT）进行视盘周围RNFL厚度检查。主要指标上方、下方、鼻侧、颞侧象限视野的平均光敏感度，MD值、PSD值；各象限RNFL厚度。结果合并高度近视的早期POAG患者总偏差概率图多表现为普遍敏感性降低，而模式偏差概率图则更多表现出POAG早期视野缺损；其平均缺损值显著高于其它各组。合并高度近视的POAG患者平均光敏感度、MD、PSD值均与其他三组有统计学意义差异（P〈0．05）；单纯高度近视组与非高度近视POAG组的PSD值及上、下象限平均光敏感度的差异均有统计学意义（P〈0．05），而鼻、颞象限平均光敏感度的差异均无统计学意义（P〉0．05）。合并高度近视的POAG组较非高度近视POAG组以及单纯高度近视组RNFL厚度明显变薄；此三组较正常组RNFL厚度变薄；单纯高度近视组与非高度近视的POAG组的平均RNFL厚度及上、下象限RNFL厚度的差异均有统计学意义（P〈0．05），而鼻、颞象限RNFL厚度的差异则无统计学意义（P〉0．05）；各组四个象限RNFL厚度与视野对应部位的缺损相关。结论在进行合并高度近视的POAG视野结果判定时要依靠模式偏差概率图。OCT显示的RNFL厚度与视野对应部位的缺损相关。（眼科，2007，16：24．28）     

Risk factors for progressive visual field loss in primary open angle glaucoma

PURPOSE: The aim of this study was to evaluate routine ophthalmic data to identify clinically useful risk factors for progressive visual field loss in patients with primary open-angle glaucoma (POAG) already receiving intraocular pressure-lowering treatments. METHODS: A retrospective cohort study design was used. Routine ophthalmic data for all subjects were obtained from case records with the knowledge that baseline clinical data had been collected in a standardised manner. Progression was defined according to the AGIS visual field defect scoring system. Variables evaluated as candidate risk factors for progression were assessed by survival analysis. Factors exerting a significant effect on survival were subsequently tested in a Cox proportional hazards model. RESULTS: A cohort of 108 eligible POAG patients was followed over an average of 3.6 years, with an average visual field intertest interval of 8 months. The incidence rate of progressive loss among the cohort was 5.4 cases per 100 person years. Increasing age was found to be independently associated with a small but significantly increased risk of glaucomatous visual field defect progression (hazard ratio 1.07, P=0.022), and a borderline association was also demonstrated with being male (hazard ratio 2.76, P=0.057). CONCLUSIONS: This retrospective investigation has provided preliminary information on factors associated with increased risk of progressive glaucomatous visual field loss that may inform clinical care strategies. Lack of concordance with other studies suggests that further prospective investigations are needed if risk stratification strategies are to be employed in caring for patients with chronic open-angle glaucoma.     

Interocular asymmetry of visual field defects in primary open angle glaucoma and primary angle-closure glaucoma

AIM: To compare the interocular asymmetry in visual field loss of patients with primary open-angle (POAG) and primary angle-closure glaucoma (PACG). METHODS: Subjects entering a prospective, randomised, controlled trial of intraoperative 5-fluorouracil in glaucoma surgery in Singapore were included. Preoperative visual field testing was performed using automated white-on-white perimetry (24-2 test pattern, threshold program, Mk II, Model 750, Zeiss-Humphrey, San Leandro, CA, USA). A minimum of two tests were required with mean deviation within 2 dB on two tests, fixation losses <20%, false positives <33%, and false negatives <33%. The second field was scored using AGIS II criteria and the 'mean asymmetry score' defined as the mean difference between eyes for both AGIS scores and global indices. RESULTS: In 230 subjects assessed (128 POAG, 102 PACG), mean interocular asymmetry of visual field loss was greater for the PACG group. The mean AGIS asymmetry scores for total (PACG=9.21+/-6.87 vs POAG=6.48+/-5.58, P=0.001), superior (PACG=4.31+/-3.39 vs POAG=3.35+/-3.13, P=0.035), and inferior (PACG=4.43+/-3.31 vs POAG=2.64+/-2.77, P<0.0001) areas and mean deviation (MD) asymmetry scores (PACG=6.89+/-13.22 vs POAG=1.66+/-16.97, P=0.012) were all significantly different. Interocular correlation of visual field loss for POAG was significant; total AGIS, r=0.27 (P=0.003), superior field AGIS, r=0.24 (P=0.008), inferior field AGIS, r=0.34 (P=0.0001), and MD, r=0.27 (P=0.003). In PACG, there was no significant correlation between eyes; total AGIS, r=-0.02 (P=0.85), superior field AGIS, r=-0.02 (P=0.82), inferior field AGIS, r=-0.17 (P=0.87), and MD, r=0.015 (P=0.89). CONCLUSION: There was a greater asymmetry of visual field loss between eyes, as measured by AGIS scores and MD, in PACG than that in POAG.     

中药川芎嗪治疗原发性开角型青光眼视功能损害的疗效

目的：探讨中药川芎嗪对原发性开角型青光眼的血液流变学、眼底荧光血管造影以及视功能的影响。方法：采用双盲、随机、安慰剂对照的方法对眼压已控制的原发性开角型青光眼１９例（３４眼）,其中治疗组１１例（１９眼）,对照组８例（１５眼）进行治疗前后血液流变学测定、眼底荧光血管造影、Ｈｕｍｐｈｒｅｙ视野检查以及模型视诱发电位（ＰＶＥＰ）检测。结果：用磷酸川芎嗪治疗后,患者全血粘度明显降低;眼底荧光血管造影各充盈时间明显缩短;Ｈｕｍｐｈｒｅｙ静态视野之总缺失（ＴＤ）、平均缺失（ＭＤ）明显减少,动态视野之Ｉ４ｅ等视线面积明显扩大;１００′、２５′、６′三种方格ＰＶＥＰ的Ｐ１潜伏期明显缩短。结论：磷酸川芎嗪可以降低原发性开角型青光眼患者的血液粘度;缩短眼底荧光血管造影各循环时间,改善血流动力学;改善青光眼的视功能损害     

The rate of visual field loss in untreated primary open angle glaucoma.

The mean rate of visual field loss in untreated primary open angle glaucoma was estimated by comparing the mean age at presentation of patients with early relative visual field loss with the mean age of those who presented with absolute field loss within five degrees of fixation. Analysis of the records of 177 patients indicated that the rate of field loss was related to the level of untreated intraocular pressure. For pressures of 21 to 25 mm Hg, untreated disease is likely to progress from early field changes to end stage in an average of 14.4 years. The same interval for pressures of 25 to 30 mm Hg was 6.5 years and for pressures over 30 mm Hg, 2.9 years. For untreated disease at pressures over 25 mm Hg the interval is estimated at 3.6 years and this is much shorter than the estimated period of 10 years under imperfect treatment and 38 years under optimum treatment identified in a prospective clinical trial of early trabeculectomy in patients with similar intraocular pressures at diagnosis.     

开角型青光眼图形视诱发电位与定量静态视野联合检测研究

目的 观察原发性开角型青光眼眼压、视野与Ｐ－ＶＥＰ Ｐ１００波潜时之间的关系。通过改变空间频率（１２０′、６０′、３０′）选择青光眼电生理学诊断最佳刺激参数。方法 对２４例（３０只眼）原发性性开角型青光眼进行眼压、定时静态视野及Ｐ－ＶＥＰ检测。分析眼压、定时静态视野Ｐ－ＶＥＰ Ｐ１００波潜时关系。检测结果进行统计学分析。结果 眼压、定时静态视野缺损程序与Ｐ－ＶＥＰ Ｐ１００波潜时变化呈正相关。高空     

Correlation between visual field and color Doppler parameters in chronic open angle glaucoma

The authors evaluated, by means of colour Doppler imaging, the blood flow in ophthalmic artery and posterior ciliary arteries in subjects with chronic open angle glaucoma. On the basis of the visual field indices (MD, SF, CPSD) the patients' eyes were divided in two groups: group A with better indices and group B with great damage. At the posterior ciliary arteries they found these values: PSV 10.264 ± 2.363 cm/s (group A) vs. 7.882 ± 1.251 cm/s (group B) (p < 0.008); RI 0.615 ± 0.065 (group A) vs. 0.695 ± 0.064 (group B) (p < 0.009). These data highlight a correlation between the visual field damage and the reduced supply of optic nerve head.     

原发性开角型青光眼和可疑开角型青光眼HRT视盘参数与视野缺损的相关性研究

目的探讨原发性开角型青光眼和可疑性开角型青光眼的视盘参数与视野平均缺损（Mean defect，MD）之间的相关性。方法用海德堡激光眼底扫描仪（HRT—Ⅱ）和自动视野计测定128只原发性开角型青光眼和78只可疑性开角型青光眼患者的视盘参数和静态视网膜光阈值。从视盘参数中选择盘沿面积（rim area，RA）、杯盘面积比（cup／disk area ratio，C/D AR）、视杯面积（cup area，CA）和平均视网膜神经纤维层厚度（mean retinal nerve fibre layer thickness，mRNFLT）与MD作相关分析和多元线性回归分析。结果两组间的视盘参数存在显著性差异（P〈0．001）。在原发性开角型青光眼组，RA、C/D AR和CA与MD之间均显著相关（P〈0．001）。其中盘沿面积每减少1mm^2，MD的绝对值将增加7．291dB；在可疑性开角型青光眼组，RA与MD之间显著相关（P〈0．001）。两组中mRNFLT与MD无明显相关性。结论在HRT-Ⅱ的各项视盘参数中，RA最能反映青光眼的视野平均缺损程度。     

Physical activity of patients with a primary open angle glaucoma

AIM: To assess physical activity (PA) including its intensity in primary open angle glaucoma (POAG). METHODS: PA was characterized by the use of questionnaires: Seven-Day Physical Activity Recall and Historical Leisure Activity Questionnaire. A questionnaire of 36 questions, developed by the authors, was used to assess the level of knowledge about glaucoma RESULTS: The study was conducted among 625 adults. The study group comprised 312 POAG patients aged over 40y, including 238 women (76%) and 74 men (24%). The control group consisted of 313 adults (>40 years old), including 202 (65%) women and 111 men (35%). The duration of current PA with an intensity of 4 metabolic equivalents (METs) was significantly shorter among people with POAG. PA in the past was significantly lower among people from the study group, regardless of gender. The level of glaucoma knowledge in patients with POAG was poor and significantly lower in men. CONCLUSION: Regular PA is an important and underestimated factor predisposing to the progression of POAG. There is a necessity to undertake educational and preventive actions with a view to modify the health behavior of glaucoma patients.     

Progression of visual field loss in open angle glaucoma in the Melbourne Visual Impairment Project

PURPOSE: To quantify the progression of visual field loss in participants with open angle glaucoma. METHODS: Cluster random samples of 3271 participants participated in this study. Each participant underwent a standardized ophthalmic examination, which included intraocular pressure measurement, Humphrey 24-2 Fastpac visual field testing and stereophotography of the optic disc. At baseline 118 participants were identified as possible, probable or definite open angle glaucoma and 74 (62.7%) of these were seen again at the follow-up examination. Progression of visual field loss was defined using three methods: the Advanced Glaucoma Intervention Study criteria, the modified Anderson criteria and the Blumenthal method. RESULTS: In total, 49% of subjects showed progressive visual field loss with at least one method. The Blumenthal criteria yielded the highest rate of progression (37%), followed by the modified Anderson method (33%) and the Advanced Glaucoma Intervention Study method (16%). The progressive visual field loss was associated with baseline glaucoma status (P = 0.02); 65% of the definite glaucoma progressed, compared with 57% of the probable glaucoma and 25% of the possible glaucoma. Participants who had been previously diagnosed with glaucoma had a higher rate of progression (54%) when compared with those who had not been diagnosed previously (47%). In total, 50% (four of eight) of those receiving glaucoma medication at baseline had progressive visual field loss; all were in the definite glaucoma category. CONCLUSION: Despite use of glaucoma medications the majority of glaucoma patients managed by their regular ophthalmologist experienced progressive visual field loss over a 5-year period.     

Multifocal pupillographic visual field testing in glaucoma

Purpose:  This preliminary study investigated a means of concurrently assessing the visual field defects of both eyes by recording pupillary responses to multifocal stimuli.
Methods:  Twenty normal subjects and 26 primary open angle glaucoma patients, age and sex matched, were examined by slit-lamp, Humphrey Field Analyser II achromatic 24-2 perimetry and fundus photography. The patients had moderate to severe fields in at least one eye. Two stereoscopically arranged displays presented an array of 24 stimulus regions per eye extending from fixation to 30 degrees eccentricity. Pupil responses were recorded by video cameras under infrared illumination. Four stimulus conditions were tested: each stimulus region containing either a single or a 2 × 2 array of patches, presented either steadily for 133 ms or flickered at 15 Hz for 266 ms. Mean presentation rate was 1/s/region. The 4-min duration stimuli were presented in 8 segments of 30 s. Segments did not need to be repeated unless more than 15% of a segment record was lost as a result of blinks or fixation losses.
Results:  The 48 stimuli produced 96 direct and consensual responses per subject. The single patch, non-flickered stimulus condition produced the best diagnostic performance, an area under the curve of 84%. The contraction amplitudes for that stimulus gave a median z-score of 3.2.
Conclusions:  The method produced diagnostic accuracy approaching that of automated perimetry, but unlike perimetry provides standard errors for every point in each field as well as information on response delay and efferent defects. Only one pupil needs to function to measure both visual fields.     

Autonomic dysfunction in unselected and untreated primary open angle glaucoma patients: a pilot study

PURPOSE: To investigate the presence of silent cardiac ischaemic episodes and the status of autonomic function in consecutive, newly diagnosed and untreated primary open-angle glaucoma patients. METHODS: Twenty-four consecutively diagnosed glaucoma patients and 22 age-matched controls were subjected to ambulatory 24-h blood pressure (BP) and electrocardiogram (ECG) monitoring by using Cardiotens-01 (Meditech Ltd). Based on the ECG recordings, heart rate variability (HRV) frequency domain parameters [low-frequency (LF), high-frequency (HF) and LF/HF ratio] were calculated and analysed in the two study groups. RESULTS: Glaucoma patients demonstrated higher LF and LF/HF values than normal subjects for both the active period (p=0.020 and 0.029) and the passive period (p=0.044 and 0.049 respectively). HRV parameters were similar in patients and controls suffering from silent cardiac ischaemia (p>0.05); however, glaucoma patients with normal ECG demonstrated higher LF and LF/HF values during the active period of the 24-h measurement period than control subjects characterized by the same cardiac activity (p=0.010 and 0.021 respectively). CONCLUSION: Independent of a history and/or clinical signs of cardiovascular disease, glaucoma patients exhibit abnormal autonomic function.     

Comparison of visual field tests in glaucoma patients with a central visual field defect

ObjectiveTo compare the 24-2 and 10-2 visual fields (VFs) and investigate the degree of differences between the 2 tests in glaucomatous eyes with central VF defects.DesignRetrospective study.ParticipantsIn all, 99 eyes of 99 glaucoma patients who underwent both the 24-2 VF and 10-2 VF tests within 6 months were enrolled.MethodsGlaucomatous eyes with damage involving a central VF defect were divided into 3 groups based on the average total deviation (TD) of 12 central points in the 24-2 VF test. The TD difference was calculated by subtracting the average TD of the 10-2 VF test from the average TD of 12 central points in the 24-2 VF test. The absolute central TD difference in each quadrant was defined as the absolute value of the TD value obtained by subtracting the average TD of 4 central points in the 10-2 VF test from the innermost TD in the 24-2 VF test in each quadrant.ResultsThe TD differences differed significantly between the severe group and the early and moderate groups ( p < 0.001). In the superonasal quadrant, the absolute central TD difference was significantly greater in the moderate group than in the early group ( p < 0.05). In the superotemporal quadrant, the absolute central TD difference was significantly greater in the severe group than in the other 2 groups ( p < 0.001).ConclusionsOur results indicate that the results of VF tests for different VFs can be inconsistent, depending on the degree of central defects and the VF quadrant.