术后眼压正常的原发性开角型青光眼中央角膜厚度与视神经受损关系

目的 探讨手术后眼压达正常的原发性开角型青光眼(primary open angle glaucoma,POAG)患者中央角膜厚度(Central Corneal Thickness,CCT)与视野、视神经损害进展的关系.方法 对127例施行小梁切除术的原发性开角型青光眼患者进行角膜测厚、视野检查及海德堡视网膜断层扫描(HRT-2).根据CCT将127例患者分成两组:第一组CCT<540μm(n=59),第二组CCT≥540μm(n=68).手术后1个月开始检查,随访2年,对所得数据进行分析.结果 两组术后2年除了视盘面积(DA)无差异外,其平均视野缺损值(MD)、视杯面积(CA)、最大视杯深度(MxCD)、杯盘面积比(C/DAR)、盘沿面积(RA)、视杯形态测量(CSM)、平均视网膜神经纤维厚度(mRNFLT)与首诊比较差异均有统计学意义(P<0.05),且第一组上述指标的进展均较第二组加快(P<0.05).结论 原发性开角型青光眼患者即使手术后眼压控制正常,其视野及视神经仍出现继续损害,角膜厚度薄者视野及视神经的损害更明显.     

视野缺损计分与OCT测量RNFL厚度的关系

目的:探讨视野缺损计分值与视网膜神经纤维层损害的关系。方法:收集开角型青光眼患者30例30眼,分别进行OCT视网膜神经纤维层厚度及视野检查。根据视野结果进行视野缺损计分并分组。组间分析各象限视网膜神经纤维层厚度值与视野缺损计分,平均缺损(MD)的关系和相关性。结果:根据视野缺损计分将患者分为四组,上侧、下侧,平均视网膜神经纤维层厚度在组间有显著性差异(P=0.010,P<0.01,P<0.01)。四组间随视野缺损程度加重,上侧、下侧,平均视网膜神经纤维层厚度变薄。在重度缺损组视网膜神经纤维层厚度最薄。视野缺损计分与上、下、鼻、颞侧及平均视网膜神经纤维层厚度均明显负相关(r=-0.610,P=0.001;r=-0.779,P<0.01;r=-0.463,P=0.015;r=-0.500,P=0.008;r=-0.782,P<0.01),视野指数MD与上侧,下侧及平均RNFL厚度明显正相关(r=0.557,P=0.003;r=0.431,P=0.025;r=0.532,P=0.004)。结论:视野缺损计分对视野缺损的客观评估,与OCT测得的视网膜神经纤维层厚度的结果负相关,是反应青光眼视神经损伤的可靠的观察指标。     

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。     

多焦视网膜电流图对开角型青光眼正常半侧视野的检测分析

目的　了解多焦视网膜电流图( multifocal electroretinography,mERG)在原发性开角型青光眼早期诊断中的意义。方法　正常人28 例31 眼、Humphrey视野计检测仅表现半侧视野异常的原发性开角型青光眼26 例26 眼。分别行光学相干断层成像术、mERG检测。比较正常组、青光眼组不同视野侧视网膜神经纤维层厚度以及mERG二阶反应的潜时、反应振幅密度,分析正常组、青光眼组视野检测的平均敏感度与二阶反应潜时、反应振幅密度的关系。结果　正常组、青光眼组不同视野侧视网膜神经纤维层厚度(F=116.2,P=0.000)、二阶反应的潜时(F=104.3,P=0.000)、反应振幅密度的差异有显著性(F=76.4,P=0.000)。视野检测的平均敏感度与二阶反应的潜时有显著相关性(P<0.001),与反应振幅密度无显著相关(P>0.05)。结论　mERG能够反映青光眼视神经损害,其确切机制仍需进一步探讨。     

原发性青光眼及高眼压症患者中央角膜厚度的比较研究

目的 探讨用超声角膜测厚仪测量的急性原发性闭角型青光眼、慢性原发性闭角型青光眼、原发性开角型青光眼、高眼压症及正常人中央角膜厚度(central corneal thickness,CCT)的差异.方法 临床病例对照研究.对2010年2月至2011年11月在承德医学院附属医院眼科应用超声角膜测厚仪测量62例(107只眼)的CCT值.急性原发性闭角型青光眼16例(18只眼)、慢性原发性闭角型青光眼14例(26只眼)、原发性开角型青光眼10例(19只眼)、高眼压症6例(12只眼)及正常人16例(32只眼).采用单因素方差分析及SNK-q检验行统计分析.结果 各组CCT值:急性原发性闭角型青光眼(548.44±30.46)μm、慢性原发性闭角型青光眼(522.70±50.39)μm、原发性开角型青光眼(546.32±22.85) μm、高眼压症(585.67±21.22) μm、正常人(536.38±26.53)μm.组间比较差异有统计学意义(F=7.661,P＜0.01).两两比较显示:高眼压症与原发性青光眼组及正常人比较,差异有统计学意义;原发性青光眼各组及正常人两两比较,差异无统计学意义.结论 与正常人及原发性青光眼相比,高眼压症CCT较厚;原发性青光眼CCT与正常人相比差异无统计学意义;CCT与原发性青光眼类型无相关性.     

原发性开角型青光眼的中医分型与RNFL厚度改变及视野损害关系

目的:探讨原发性开角型青光眼(青风内障)中医辨证分型与视网膜神经纤维层厚度的改变及视野损害之间关系的临床研究。方法:对72例144眼原发性开角型青光眼患者,采用光学相干断层成像术对144眼作围绕视盘3.4mm的环形扫描,记录各个象限视网膜神经纤维层厚度,并采用进口Humphry视野分析仪作中30°全定量视野检测检查,同时根据中医理论对患者作中医辨证分型,观察二者之间的关系。结果:中医的证型与视网膜神经纤维层厚度改变类型有统计学意义,中医证型与视野损害的类型有统计学意义(P<0.05)。结论:视神经损害较严重多见于青风内障的虚证,视神经损害早期多见于实证,因此视神经损害的程度在一定的程度上给予中医辨证治疗一定的指导作用。     

OCT检测原发性开角型青光眼视网膜神经纤维层厚度与视野平均缺损的相关性分析

目的探讨OCT检测原发性开角型青光眼(POAG)视网膜神经纤维层厚度(RNFL)与视野平均缺损(MD)的相关性。方法分别采用Ze iss-Humphrey,Stratus TM,Version3.0 OCT和OCTOPUS101全自动电脑视野分析仪对正常组25例(36只眼)和青光眼组52例(81只眼)进行检测,将各个青光眼组中心30°视野内全视网膜MD和OCT检测的RNFL厚度值进行比较,并做相关性分析。结果青光眼组MD均高于正常组(P<0.01),中期和晚期青光眼组RNFL值均低于正常组(P<0.05)。所有被检测者视野MD与RNFL厚度呈负的直线相关(相关系数为-0.626,P=0.000);青光眼组MD与RNFL厚度呈负的直线相关(相关系数为-0.615,P=0.000);正常组MD与RNFL厚度无直线相关性(相关系数为-0.022,P=0.910)。结论MD与RNFL厚度有很好的直线相关性,通过OCT对RNFL厚度的检测,有助于了解和监测POAG对RNFL的损伤,是一种很有价值和潜力的青光眼客观辅助诊断方法。     

拉坦噻吗滴眼液治疗青光眼临床疗效观察

目的:评价拉坦噻吗滴眼液(适利加)降眼压治疗的有效性和安全性。方法:选取30例52眼原发性开角型/闭角型青光眼患者单用拉坦噻吗滴眼液,每晚1次,随访16wk,观察眼压、视野、平均视神经纤维层厚度及不良反应。结果:拉坦噻吗滴眼液能显著降低眼压(P=0.000),16wk后降眼压幅度的95%可信区间为10.31～13.92mmHg,但对视野及平均视神经纤维层厚度无改善(P>0.05),不良反应主要为眼睛轻度充血。结论:拉坦噻吗滴眼液能显著降低原发性开角型/闭角型青光眼患者的眼压,而且用药安全,依从性好。但短期随访并未发现其对视野及平均视神经纤维层厚度有改善。     

中央角膜厚度对压平眼压计测量值的影响

目的采用非接触式角膜内皮镜测量高眼压症与临床常见类型青光眼患者的中央角膜厚度central corneal thickness(CCT),并与正常人CCT平均值比较,探讨CCT对青光眼诊断、分类与治疗的指导意义.方法采用KONAN非接触式角膜内皮镜测量中央角膜厚度,Goldmann压平眼压计测量眼内压(IOP).将39例52眼原发性开角型青光眼(POAG),32例45眼慢性闭角型青光眼(CACG),18例29眼高眼压症眼(OHT),15例24眼正常眼压性青光眼(NTG),34例66眼可疑开角型青光眼(GS)的CCT和IOP值与173例322眼正常眼进行比较研究.所有资料输入计算机后在Windows操作环境下使用SPSS10.0统计软件进行统计分析.结果平均CCT值比较高眼压症(OHT)眼(600.21±24.20μm)＞POAG眼(574.37±31.92μm)＞正常对照眼(554.78±32.61μm)＞NTG眼(528.43±36.40μm).OHT、NTG、POAG眼与正常眼的CCT值有差异(F=9.629,P=0.000),CACG眼与POAG及正常眼CCT值均无差异(P=0.119).GS眼CCT值(564.72±31.96μm)较正常眼厚.CCT与IOP成直线正相关,眼压测量值的校正公式为眼压校正值(mmHg)=-(测得的角膜厚度μm-555μm)×(1/24).IOP经CCT校正后,OHT眼平均高估1.89mHg,NTG眼平均低估1.1mmHg,POAG眼平均高估0.80mmHg.根据经CCT校正后的IOP值,13.5%POAG眼重新诊断为NTG眼,34.5%OHT眼重新诊断为正常眼,16.7%NTG眼重新诊断为POAG眼.结论非接触式角膜内皮镜能准确地测量中央角膜厚度.OHT眼CCT较厚,而NTG眼CCT较薄.CCT测量对青光眼的分类与治疗有重要的指导意义,应作为OHT、NTG及GS的常规检查项目.     

角膜中央厚度对高眼压症和开角型青光眼眼内压测量值的影响

目的研究角膜中央厚度对高眼压症和原发性开角型青光眼病人的眼内压测量值的影响.方法对44例(88眼)临床诊断为高眼压症的患者,31例(61眼)原发性开角型青光眼患者及52例(104眼)与高眼压症患者屈光状态相近的正常人的角膜中央厚度及眼内压进行检测,用统计学方法比较3组的角膜中央厚度的差异及高眼压症患者的眼内压值与角膜中央厚度的相关关系.结果①高眼压症组的角膜中央厚度的平均值585.6±35.7μm明显高于原发性开角型青光眼(54.1±38.7μm)(P＜0.01)及正常对照组(535.5±29.4μm)(P＜0.01),而原发性开角型青光眼的角膜中央厚度与正常对照组相比无显著性差异(P＜0.05).②将高眼压症患者的角膜中央厚度与眼内压测量值进行简单线性相关分析,可见角膜中央厚度与眼内压测量值呈明显正相关,相关系数为0.636(P＜0.01).角膜中央厚度每增加50μm可使眼内压测量值升高约2mmHg.结论①高眼压症患者的角膜中央厚度明显大于原发性开角型青光眼和正常眼,高眼压症患者的角膜中央厚度与眼内压呈明显的正相关,提示高眼压症患者是由于角膜中央厚度高于正常范围而造成眼内压测量值的升高.②角膜中央厚度值可作为高眼压症及原发性开角型青光眼的诊断与鉴别诊断的重要依据.提示临床工作中,可将角膜中央厚度检测作为排除青光眼的常规检查手段.③当角膜中央厚度在520±50μm的范围内,眼压读数相对准确,如果角膜中央厚度超过570μm,眼压读数相应增高,这可能是高眼压症患者眼压测量值高于正常范围的重要原因之一.     

Optic disc area in different types of glaucoma

AIM: To evaluate the possible relationship of optic disc area with retina nerve fiber layer in different glaucoma subtypes. METHODS: One eye each was chosen from 45 patients with ocular hypertension, 45 patients with primary open angle glaucoma, 45 patients with pseudoexfoliation glaucoma and 45 healthy controls followed in our hospital. The records of the patients were reviewed retrospectively. Optic disc area and circumpapillary retina nerve fiber layer measurements were obtained using optical coherence tomography. Central corneal thickness was measured by ultrasound pachymetry. RESULTS: The median disc area in the patients with primary open angle glaucoma was significantly higher than the patients with ocular hypertension (2.19 vs 1.90 mm2, P=0.030). The median retina nerve fiber layer was thinner in the patients with primary open angle glaucoma and pseudoexfoliation glaucoma than the patients with ocular hypertension for superior, inferior and temporal quadrants. After adjustment for age, no difference in central corneal thickness was found between the groups. Greater disc area was associated with thicker retinal nerve fiber layer for superior, inferior and nasal quadrants in the patients with primary open angle glaucoma. There was no correlation between disc area and central corneal thickness measurements of the groups. CONCLUSION: Disc size affects the retinal nerve fiber layer thickness in eyes with primary open angle glaucoma and is a possible risk factor for glaucomatous optic nerve damage.     

薄角膜正常眼压性青光眼OCT检测与分析

目的 探讨薄角膜正常眼压性青光眼(NTG)患者视盘周围视网膜神经纤维层(RNFL)厚度及视盘结构的OCT特征.方法 采用OCT对21例(42只眼)中央角膜厚度(CCT)低于正常人群范围(＜500μm)的正常眼压性青光眼患者进行RNFL及视盘扫描,并根据其CCT值分为:组1(480μm≤CCT＜500μm)和组2(460μm≤CCT＜480μm),比较分析两组RNFL厚度、视盘参数及30.中心视野指数.结果 两组患者的OCT检测参数包括Avg.Thick、Savg、Iavg、Navg、Tavg差异无统计学意义(P＞0.05),Max-Min值差异有统计学意义(P＜0.05);视盘参数(垂直盘沿容积值等)、视野参数(MD、MS值)差异无统计学意义(P＞0.05).两组患者的RNFL平均厚度与视野平均缺损值MD呈强且负的直线关系(r=-0.602,P=0.000).结论 OCT能对NTG患者视盘及视网膜神经纤维层做出定量测量和分析,且与视野检测指标有良好的相关性,在NTG的早期诊断中有重要意义;薄角膜NTG患者的角膜厚度水平与视网膜神经纤维层缺损程度无明显相关.

Abstract：

Objective To investigate the thickness changes of peripapillary retinal nerve fiber layer (RNFL) in normal tension glaucoma (NTG) with thin cornea measured by optical coherence tomography (OCT).Methods Twenty-one NTG patients (42 eyes) with thin cornea were divided into two groups according to their central corneal thickness (CCT):group 1 (480μm≤CCT＜500μm) and group 2 (460μm≤CCT＜480μm),and analysis the different results of OCT scan and visual outcome in two groups.Results There were no significant differences in OCT parameters of Avg.,Thick,Savg,Iavg,Navg and Tavg among the two groups (P ＞0.05),while Max-Min was lower in group 2 (P ＜0.05);There were also no significant differences in the optic nerve head analysis results,visual field mean defect (MD) and mean sensitivity (MS) among two groups (P＞0.05).The average RNFL thickness and MD showed a strong and negative linear relationship(r =-0.602,P =0.000).Conclusions OCT can make quantitative measurement and analysis of optic disc and RNFL for NTG patients,and has a good correlation with vision field.It has important significance in the early diagnosis of NTG.For NTG patients with thin corneas,there is no significant correlation between the level of CCT and extent of retinal nerve fiber layer defect.     

Comparing glaucomatous optic neuropathy in primary open angle and primary angle closure glaucoma eyes by scanning laser polarimetry-variable corneal compensation

PURPOSE: To study the retinal nerve fiber layer thickness difference between high-tension primary open angle glaucoma (HT-POAG) and primary angle closure glaucoma (PACG) eyes using scanning laser polarimetry-variable corneal compensation (GDx VCC) in Taiwan-Chinese population; to evaluate the usefulness of the GDx VCC for detecting POAG and PACG eyes in Taiwan-Chinese population. PATIENTS AND METHODS: The study comprised 88 early to moderate glaucomatous eyes (one randomly selected eye from 47 HT-POAG patients and 41 PACG patients) and the control group consisted of 45 age-matched eyes from 45 normal individuals. Each subject underwent retinal nerve fiber layer thickness measurement by GDx VCC and Humphrey Field Analyzer visual field testing. Measured GDx VCC parameters were compared among groups. We also calculated the area under the receive operator characteristic (AROC) curve, corresponding sensitivity/specificity and best cut off value for each parameter in differentiating normal from POAG and PACG eyes. RESULTS: There was no significant difference between HT-POAG and PACG eyes in each parameter. The parameter with the best AROC curve for differentiating normal from POAG eye was nerve fiber indicator (AROC, 0.779; sensitivity=57.4%, specificity=100%; best cut off value >27). The parameter with the best AROC curves for differentiating normal from PACG eyes was temporal-superior-nasal-inferior-temporal average (AROC, 0.829; sensitivity=46.3%, specificity=100%, best cut off value <51.7). CONCLUSIONS: There was no significant difference between the HT-POAG and PACG eyes as far as the various parameters were concerned. GDx VCC shows fair discriminating ability in distinguishing normal from POAG and PACG eyes in Taiwan Chinese population.     

GDxVCC系统检测视网膜神经纤维层在青光眼早期诊断中的价值

目的 比较正常人和不同程度青光眼患者GDxVCC系统检测RNFL参数的不同,评价GDx各参数的敏感性、特异性,探讨GDxVCC系统检测视网膜神经纤维层在青光眼早期诊断中的价值.方法 对35例(35只眼)原发性开角型青光眼、33例(33只眼)慢性闭角型青光眼、27例(27只眼)急性闭角型青光眼以及年龄相匹配的36人(36只眼)正常人进行GDxVCC系统和静态视野检查.GDxVCC系统检查,视盘周围视网膜神经纤维层(retinal nerve fiber layer,RNFL)任一参数与系统内所附中国正常人数据库对比概率＜5%或NFI＞30或视网膜神经纤维标准偏差图上连续有10个超级像素概率＜5%定义为具有青光眼性视网膜神经纤维层结构损害,并判断为青光眼.结果 22只正常眼被判断为非青光眼(61.1%),82只青光眼被判断为青光眼(86.3%),RNFL参数椭圆平均值、上方平均值、下方平均值、TSNIT标准偏差、神经纤维指数,标准偏差图诊断青光眼的敏感性分别为48.4%、56.8%、48.4%、50.5%、62.1%,特异性分别为97.2%、100%、97.2%、94.4%、97.2%、61.1%.GDxVCC系统诊断早期、中期、晚期青光眼的敏感性分别为77.36%、95.83%、100%.结论 GDxVCC系统诊断早期青光眼的敏感性和特异性均高,而且RNFL参数中神经纤维指数的敏感性最高.

Abstract：

Objective To evaluate the usefulness of the scanning laser polarimeter with variable corneal compensation (GDxVCC) for glaucoma detection in a Chinese population,and to investigate the retinal nerve fiber layer (RNFL) thickness difference between normal subjects and glaucoma patients.Methods Thirty-six eyes of 36 normal subjects,33 eyes of 33 primary chronic angle-closure glaucoma patients,27 eyes of 27 primary acute angle-closure glaucoma and 35 eyes of 35 primary open-angle glaucoma patients were studied.The glaucoma patients were age-matched with the normal.The thickness of retinal nerve fiber layer was measured with GDxVCC.An eye was diagnosed as glaucoma,ifone of the parameters showed P＜0.05 on the results of the examination reports including four TSNIT parameters (the average of TSNIT,superior,inferior,and TSNIT Std.Dev.),nerve fiber indicator (NFI) ＞ 30,and at least 10 consecutive defects of superpels showed in deviation map (P ＜0.05).Results Of 22 normal eyes (61.1%) were diagnosed as non-glaucoma and 82 glaucomatous eyes (86.3%) were diagnosed as glaucoma by GDxVCC.Sensitivity of the average of TSNIT,superior,inferior,TSNIT Std.Dev.,NFI and the deviation map were 48.4%,56.8%,48.4%,50.5%,62.1% respectively and specificity were 97.2%,100%,97.2%,94.4%,97.2% and 61.1% respectively.Sensitivity of detection early,moderate and progression glaucoma by GDxVCC were 77.36%,95.83%,100% respectively.Conclusions GDxVCC is a valuable technology to detect retinal nerve fiber layer defect in early glaucoma.It is shown that the NFI has highest sensitivity.     

Central retinal artery resistive index and optical coherence tomography in assessment of glaucoma progression

AIM: To assess the relation between central retinal artery (CRA) resistive index (RI) and retinal nerve fiber thickness measured by optical coherence tomography (OCT) in assessment of disease progress in cases of open angle glaucoma. METHODS: Twenty-three patients with diagnosed open angle glaucoma were included in this study. They were examined by colored duplex ultrasonography of CRA with estimation of RI of CRA and ophthalmic artery (OA) with estimation of CRA/OA RI ratio as well as OCT measurement of the average retinal nerve fiber layer (RNFL) thickness in order to assess the disease progress. RESULTS: There was strong inverse relation between the increased RI in CRA as well as the increased CRA/OA RI ratio and the decrease in average RNFL thickness in cases of open angle glaucoma. CONCLUSION: Assessment of CRA RI can indirectly assess the vascular changes associated with glaucoma and can assess the degree of retinal atrophy helping in evaluating prognosis thus guiding the choice of treatment.     

OCT快速和重复扫描法在青光眼诊断中的可重复性研究

目的：评价应用光学相干断层成像术(OCT)快速和重复法测量视网膜神经纤维层(retinal nerve fiber layer,RNFL)厚度在诊断青光眼中的可重复性意义。

方法：应用Stratus OCT测量38例正常人和42例原发性开角型青光眼患者的RNFL厚度,分别应用快速和重复扫描两种方案来测量正常人和原发性开角型青光眼患者RNFL厚度,通过统计各组视盘区域中颞区、上区、下区和鼻区共四个象限的总体平均RNFL厚度的组内相关系数和变异性系数来进行重复性评估。

结果：在正常人和原发性开角型青光眼患者中,总体平均RNFL厚度和颞侧、上方、鼻侧、下方RNFL厚度,两组均未显示出差异; 而重复扫描方案较之快速扫描在视盘周围测出的平均RNFL厚度具有更高的ICC和更低的CV值,在颞区存在统计学差异(P=0.042),在颞区、鼻区、上区和下区中得出的RNFL厚度的ICC(CV值)如下：快速扫描分别为0.918(7.2%),0.831(6.82%),0.856(5.12%),0.911(7.19%); 而重复扫描的分别为0.927(3.21%),0.962(5.01%),0.909(6.02)%,0.869(4.67%),0.918(6.89%)。

结论：OCT测量RNFL厚度中应用快速和重复扫描在正常人和原发性开角型青光眼中均具有可重复性的价值,而重复扫描方案在评估RNFL厚度方面更为精确。     

Relationship between central corneal thickness and localized retinal nerve fiber layer defect in normal-tension glaucoma

PURPOSE: To determine whether central corneal thickness (CCT) is related to the extent of localized retinal nerve fiber layer (RNFL) defect at the initial examination of normal-tension glaucoma (NTG) patients. PATIENTS AND METHODS: Seventy-five eyes of 75 NTG patients showing localized RNFL defects on RNFL photographs and corresponding visual field defects at the initial visit to a glaucoma specialist were selected for this study. All participants completed refraction, Goldmann applanation tonometry, CCT measurement, stereoscopic disc photography, RNFL photography, and automated perimetry. Each patient's age, spherical equivalent, intraocular pressure, CCT, approximation of the RNFL defect to the fovea (angle alpha), circumferential width of the RNFL defects (angle beta), horizontal and vertical cup-to-disc ratios, and mean deviation of visual field were analyzed. RESULTS: In univariate and multivariate analyses, lower CCT was significantly associated with increased horizontal and vertical cup-to-disc ratios, decreased angle alpha, and increased angle beta. For a decrease of 10 microm of CCT, horizontal and vertical cup-to-disc ratios increased by 0.020, angle alpha decreased by 1.58 degrees, and angle beta increased by 1.71 degrees, respectively. CONCLUSION: CCT is a significant factor in predicting the extent of localized RNFL defect at the initial examination of NTG patients.     

中央角膜厚度与视网膜神经纤维层厚度关系在正常眼和高眼压患者之间的比较研究

目的通过角膜中央厚度分组,观察正常眼和高眼压患者的角膜厚度和视网膜神经纤维层（RNFL）厚度之间的关系,并通过相干光断层扫描成像（OCT）和偏振激光扫描仪联合个体化角膜补偿技术（GDx-VCC）检查高眼压患者是否存在RNFL的异常,并分析OCT和GDx-VCC测得的RNFL厚度之间的相关性。方法对眼压高于21 mm Hg（1 mm Hg=0.133 kPa）的患者测量其中央角膜厚度（CCT）,根据CCT值对眼压进行校正。OCTOPUS-101自动视野仪检查及视盘观察入选高眼压组患者180只眼,均予OCT、GDx-VCC测量视盘一周视网膜神经纤维层厚度,另设正常人180只眼作为对照,获得数据进行统计学分析。结果高眼压患者的平均CCT为（536.14±35.99）（433～609）μm,正常组患者的平均CCT为（516.68±38.27）（368～598）μm。根据平均中央角膜厚度555μm分组,组间平均视网膜神经纤维层厚度（Average RNFL）、上方（S）、下方（I）的RNFL厚度以及其它参数有显著性差异,高眼压组CCT≤555μm的患者平均视网膜神经纤维层厚度要低于CCT〉555μm的患者。结论高眼压患者RNFL厚度GDx-VCC与OCT的检测值低于正常人。高眼压组CCT与平均视网膜神经纤维层厚度正相关。GDx-VCC与OCT有着较好的一致性。     

Clock-hour laminar displacement and age in primary open-angle glaucoma and normal tension glaucoma

Background: To find out the relationship between laminar displacement and age between patients with primary open‐angle glaucoma and normal tension glaucoma. Design: Retrospective study conducted at a tertiary university hospital Participants or Samples: Twenty‐six eyes of 26 primary open‐angle glaucoma patients and 52 eyes of 52 normal tension glaucoma patients. Methods: Patients were scanned with a Stratus optical coherence tomography apparatus to measure the retinal nerve fibre layer thickness and to visualize the cross‐sectional laminar displacement of 12 clock‐hour segments, 30 degrees each. Depth1 was defined as the longest distance between the retinal pigment epithelium and the anterior laminar cribrosa surface, which represents the amount of laminar displacement. Main Outcome Measure: Partial correlation coefficients adjusted by mean deviation and intraocular pressure between (i) retinal nerve fibre layer thickness and age, and (ii) Depth1 and age. Results: In the primary open‐angle glaucoma group, strong negative correlations (approximately ?0.343 ～ ?0.738) were found between Depth1 and age. Eight of 12 clock‐hour segments' correlations were significant after Bonferroni correction (α = 0.0021; 24 comparisons). However, no significant correlations were found between Depth1 and age in the normal tension glaucoma group. When the correlation coefficients were compared between the two groups, eight clock‐hour segments showed significant differences after Bonferroni correction. Conclusions: The significantly different correlation between laminar displacement and age between primary open‐angle glaucoma and normal tension glaucoma patients may suggest a different role of the lamina cribrosa to the disease.