结合视野检测确诊青光眼模式的临床研究

目的探讨提高筛选并能早期诊断青光眼效率的有效方法。方法按照临床筛选可疑青光眼患者标准,门诊筛选出可疑青光眼者。采用横断面研究设计,应用Octopus-101型计算机自动视野计的G2程序,对来我院就诊的可疑青光眼患者进行中心30°阈值视野检测。统计分析视野异常情况,并随访统计确诊青光眼病例。结果取得完整可靠视野结果可疑青光眼者共75例(150只眼),视野存在异常者45眼,视野发生可疑改变52只眼,53只眼正常。青光眼确诊病例占可疑青光眼的34.67%。结论通过可疑青光眼患者视野异常情况的临床观察,筛选可疑青光眼后进一步临床检查、视野监测而进行青光眼确诊的筛查模式具有一定的可靠性,该模式能大大提高筛选及早期诊断青光眼的效率。     

可疑青光眼中心视野分析

用TBC－1微机中心视野分析仪对可疑青光眼537眼进行检查，发现有249眼出现了神经纤维束型视野缺损占46．4％，从灰度看（视野缺损总体积）绝大多数为早期改变。视野损害以Seidle暗点、生理盲点扩大及旁中心暗点为最多，在眼压与眼底两顶指征中，有一项有明显改变时视野损害的可能性也明显增多。     

Octopus视野计检测可疑青光眼

青光眼是一种严重致盲性眼病 ,可发病于各个年龄段 ,其病程隐匿 ,早期不易被发现 ,一旦发现已不是青光眼早期。视野改变在青光眼的早期诊断、治疗观察以及病情变化的判断方面都有重要意义。过去曾认为视野的旁中心暗点、鼻侧阶梯、Ｂｊｅｒｒｉｕｍ区的相对暗点是青光眼早期的特征性损害 ,但是结合眼底视神经检查时发现 ,有时已有明确的青光眼视神经损害 ,而视野检查包括用静态电脑视野计 ,却不能检测到相应的视野缺损。虽然是这样 ,但视野检测始终是最可靠的青光眼视功能检查法[1] ,随着科学技术的发展 ,自动视野计也在不断进步 ,实现了视…     

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.     

可疑青光眼杯盘比值与静态阈值视野改变的观察

目的 :观察静态阈值视野改变与可疑青光眼患者的年龄及临床判定的杯盘比大小的关系。方法 :对 2 0 7例 (3 90眼 )青光眼可疑患者 ,分为杯盘比值大于等于 0 6组和小于 0 6组 ;并按年龄分为 3 0岁以上组和 3 0岁以下组 (包括 3 0岁 ) ,采用Octopus 1～ 2～ 3型全自动静态阈值视野计分别进行了阈值视野测定。结果 :杯盘比值大于等于 0 6组视野异常率 (4 4 2 % )高于杯盘比值小于 0 6组 (3 9% ) ,两组相比差异有显著性 (P <0 0 5 )。3 0岁以下组 (包括 3 0岁 )视野异常率 (3 6 8% )与 3 0岁以上组 (4 5 2 % )相比差异无显著性 (P >0 0 5 )。结论 :可疑青光眼患者的年龄对阈值视野的改变不产生有意义的影响。从阈值视野改变的角度 ,杯盘比值 0 6作为青光眼的筛选标准是可行的     

可疑青光眼患者视野指数与眼底血管变化的关系

目的探讨可疑青光眼者眼底血氧饱和度的基本特征及其与视野指数的关系。方法采用横断面研究设计,对可疑青光眼者及正常对照者应用视网膜血氧饱和度测量仪测量眼底血氧饱和度,同时进行中心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）三个视野指数,以及视网膜血氧饱和度,并进行相关分析。结果可疑青光眼者与正常者MD存在统计学差异（P ＜0．05）;可疑青光眼者平均视网膜动脉血氧饱和度及视网膜鼻下支动脉血氧饱和度与正常者比较存在统计学差异（P ＜0．05）;可疑青光眼者视野检测的MD与NIA存在相关性,（r ＝0．368,P ＝0．045）。结论可疑青光眼者眼底血管可能发生了相应的变化,视网膜血氧饱和度状况与视野指数间存在一定联系。     

视网膜厚度分析仪与自动视野计检查可疑青光眼的结果分析

目的 评价可疑青光眼患者视网膜厚度分析仪与自动视野计检查结果的相符性.方法 对22例(39只眼)可疑开角型青光眼患者,分别行自动视野计和视网膜厚度分析仪(PTA)检查,分别记录视野、视盘参数及神经纤维层检查的结果.按照统计学概率等级(0.5-5%),以记分及记分差值对结果进行比较分析.结果 RTA和视野检查结果完全相符和基本符合者占84.62%,视野、视盘、神经纤维层及RTA4项检查的结果登记记分差别没有统计学意义(P＞0.05),这4项检查结果临床判别结论的等级分布也无显著差别(P＞0.05).结论 RTA与视野检查对青光眼诊断有较好的相符性.RTA有可能发现更早的青光眼性损害表现.     

原发性开角型青光眼与可疑青光眼患者后极部视网膜厚度分析的比较研究

目的 观察后极部视网膜厚度分析参数在原发性开角型青光眼与可疑青光眼患者间的差异。 方法 应用新型视网膜厚度分析仪对12例原发性开角型青光眼及11例可疑青光眼患者的后极部视网膜厚度进行了分析，对每一个球形指数进行了比较。 结果 中心凹形态偏差、中心凹校正厚度偏差、中心凹固视校正厚度偏差、中心凹中心厚度偏差、校正的中心凹中心厚度偏差、中心凹周围异常变薄区、后极部异常变薄区及后极部异常模式偏差在原发性开角型青光眼及可疑青光眼患者间差异有显著性的意义(P<0.05)。 结论 原发性开角型青光眼与可疑青光眼患者间存在后极部视网膜厚度形态参数的差异。 (中华眼底病杂志, 2002, 18: 113-115)     

四点阈值视野检查对快速筛查青光眼性视野缺损的诊断价值

目的探讨国产YDS301视野计（简称YDS）四点阈值程序对快速筛查青光眼性视野缺损的诊断价值。方法采用瑞士Octopus101型视野计（简称Octopus）和YDS对67例（75眼）青光眼患者分别进行视野检查。YDS选用四点阈值程序,Octopus选用G1TOP程序,分别在定性、定量和每眼检测时间方面进行对比分析。结果定性诊断：以Octopus为准,YDS敏感性和特异性分别为92.5%和86.4%。定量诊断：YDS与Octopus的平均敏感度和平均缺损的相关系数r分别为0.869和0.865。每眼检测时间分别为48.65s和141.64s（t=26.534,P〈0.01）,YDS比Octopus减少了约2/3时间。结论YDS四点阈值程序在快速筛查青光眼性视野缺损中与Octopus有很高的一致性,而且检测时间是目前国内外现有视野计中最短的。因此,YDS四点阈值程序适用于青光眼的视野筛查。     

Clinical analysis of screening and threshold visual field data for glaucoma detection

The value of clinical interpretation in differentiating between glaucomatous and normal fields from threshold (Humphrey Field Analyser) and screening (Henson CFS3000) measures was determined using a masked prospective experimental design. The visual field plots of 20 primary open-angle glaucoma (POAG) patients, 19 ocular hypertensive and 19 normotensive glaucoma suspects, and 21 age- matched normals measured with the Humphrey Field Analyser (Humphrey) and Henson CFS3000 (Henson) were categorised by two experienced clinicians. Significant differences in interpretation of the field plots were demonstrated between the two clinicians (χ^{2 McNemars}= 19–36; p<0.001). The sensitivity of clinical interpretation was shown to lie between 65 per cent and 90 per cent (dependent upon the individual clinician) for the Humphrey plots, but was as low as 40 per cent with the Henson plots. Specificity was, however, higher for the Henson overall, regardless of the clinician (between 90 per cent and 95 per cent) compared to the Humphrey (between 75 per cent and 100 per cent). These levels of sensitivity and specificity do not reach the levels reported when interpretation is based on the visual field indices alone. It was concluded that a screening instrument, such as the Henson, should only be employed for testing large unselected populations, in which the prevalence of glaucoma is low. Visual fields should not be judged in isolation, but in conjunction with measures of optic nerve and nerve fibre layer integrity, intra-ocular pressure and family history.     

Simulating binocular visual field status in glaucoma

AIMS—To simulate the central binocular visual field using results from merged left and right monocular Humphrey fields. To assess the agreement between the simulation and the binocular Humphrey Esterman visual field test (EVFT).
METHOD—59 consecutive patients with bilateral glaucoma each recorded Humphrey 24-2 fields for both eyes and binocular EVFT on the same visit. EVFT results were used to identify patients exhibiting at least one defect (<10 dB) within the central 20° of the binocular field. This criterion is relevant to a patient''s legal fitness to drive in the UK. Individual sensitivity values from monocular fields are merged to generate a simulated central binocular field. Results are displayed as a grey scale and as symbols representing defects at the <10 dB level. Agreement between patients failing the criterion using the simulation and the EVFT was evaluated.
RESULTS—Substantial agreement was observed between the methods in classifying patients with at least one defect (<10 dB) within the central binocular field (kappa 0.81; SE 0.09). Patients failing this criterion using the EVFT results were identified by the binocular simulation with high levels of sensitivity (100%) and specificity (86%).
CONCLUSIONS—Excellent agreement exists between the simulated binocular results and EVFT in classifying glaucomatous patients with central binocular defects. A rapid estimate of a patient''s central binocular field and visual functional capacity can be ascertained without extra perimetric examination.

     

标准白色视野与蓝／黄视野检测不同阶段青光眼视野的对比研究

目的比较自动标准白色视野计（white-on-white perimetry,啪w）和蓝／黄视野计（blue-on-bellow perimetry,B/Y）检测不同阶段青光眼视野损害的敏感性。设计横断面调查。研究对象青光眼患者42例（71眼）。方法采用HumphreyⅡ-750型自动视野计对青光眼患者进行B／Y及W｜W检查。根据晚期青光跟治疗研究（Advanced GlaucomaIntervention Study,AGlS）视野评分标准,将青光眼患者分早、中、晚三组,运用青光眼首选治疗研究（collaborative initial glaucoma treatment study,CIGTS）方法,对视野缺损进行评分。比较三组不同时期青光眼应用两种视野计检查,在视野平均缺损（Meandeviation,MD）、模式标准差（Pattern Standard Deviation,PSD）、CIGTS评分方面的差异。主要指标视野的平均缺损、模式标准差、CIGTS评分。结果两种视野计检查MD的均值结果在早、中期青光眼组,B／Y检测的MD（-8．65dB±3．89dB;-14．94dB±3．22dB）较w／W（-3．29dB±2．40dB;-10．04dB±2．73dB）低,t=9．21,P〈0．001及t=-4．89,P〈0．001;在晚期青光眼组,B／Y检测的MD（-22．07dB±2．64dB）较w／w（-25．20dB±5．48dB）高,t=3．93,P〈0．001。两种视野计检查PSD的均值结果,在早期青光眼组,B／Y检测的PSD（4．17dB±1．20dB）较W／W（3．22dB±2．90dB）高,t=2．12,P〈0．05;在中、晚期青光眼组,B／Y检测的PSD较W/W低（t=-3．04,P〈0．01,t=-2．96,P〈0．001）。两种视野计CIGTS评分的均值结果,在早期青光眼组,B／Y的CIGTS评分（5．35±3．83）较W/W（3．36±3．12）高,t=2．67,P〈0．05）;在中、晚期青光眼组,B／Y的CIGTS评分较W/W低,t-4131,P〈0．05及t=-4．02,P〈0．001。结论对于早期青光眼的视野检测,B/Y较W/W敏感,但对于中晚期青光眼,W/W视野较B／Y更敏感。对于早期青光眼及可疑青光眼采用B／Y视野检测较敏感,而对于中晚期青?     

口服弥可保前后青光眼视野缺损的比较

目的比较青光眼患者口服弥可保前后视野变化,评估弥可保对青光眼患者视野改善的作用.方法首先,筛选有视野缺损、眼压控制在21mmHg(1kPa=7.5mmHg)以下的25例49眼原发性开角型青光眼和27例52眼原发性闭角型青光眼患者,口服弥可保6个月,每日3次,每次500μg.然后,分别于用药3、6个月用静态自动电脑Octpus101型视野计进行视野检查.检查在半暗室下进行,检查程序采用G2(青光眼)30度灰度阈值59个点,背景光4asb;分别测试平均缺陷(MD)、丢失方差(LV)、刺激丢失方差(sLV)、可靠性因素(RF)及瞳孔变化.最后,记录结果并与用药前相比较.结果67.3%患者视野的平均缺损用药后3、6个月有不同程度好转,6个月变化显著.用药前与用药后3个月比较无显著性差异(P＞0.05);与用药后6个月比较有显著性差异(P＜0.05).用药后3、6个月比较也有显著性差异(P＜0.05).6个月视野缺损的平均改善率开角型青光眼组与闭角型青光眼组分别为51.65%、44.55%,2组间比较无统计学差异(P＞0.05).结论长期服用弥可保,对于眼压控制平稳的原发性开角型和原发性闭角型青光眼所致的视野缺损有明显改善.     

原发性开角型青光眼患者确诊时视野损害程度的相关因素分析

目的　分析原发性开角型青光眼（ｐｒｉｍａｒｙｏｐｅｎ-ａｎｇｌｅｇｌａｕｃｏｍａ,ＰＯＡＧ）患者确诊时的视野损害程度及其相关因素。方法　收集２０１４年５月至２０１５年１０月在我院门诊就诊的ＰＯＡＧ患者１１３例１１３眼。根据视野损害分级将患者分为早期视野损害组（视野损害０～１级）和中晚期视野损害组（视野损害２～５级）。对两组患者的确诊年龄、性别、身体质量指数、青光眼相关症状、家族史、高度近视、中央角膜厚度、眼压等相关因素进行统计分析。结果　早期视野损害组３１眼（２７．４３％）,中晚期视野损害组８２眼（７２．５７％）。早期视野损害组的确诊年龄为（５２．８１±１６．５７）岁,眼压为（２３．６７±１１．４４）ｍｍＨｇ（１ｋＰａ＝７．５ｍｍ-Ｈｇ）,与中晚期视野损害组的（４５．６２±１７．１２）岁和（３０．５８±１２．１３）ｍｍＨｇ相比,差异均有统计学意义（Ｐ＝０．０４７、０．００７）;早期视野损害组合并高度近视的患者比例（９．６８％）及有青光眼相关症状的患者比例（２９．０３％）均小于中晚期视野损害组（２９．２７％、５３．６６％）,差异均有统计学意义（Ｐ＝０．０２９、０．０１９）。早期视野损害组的性别比例、身体质量指数、家族史、中央角膜厚度与中晚期视野损害组相比,差异均无统计学意义（均为Ｐ＞０．０５）。眼压与患者确诊时的视野损害严重程度呈正相关（ｒ＝０．４１１,Ｐ＝０．０００）。结论　大多数ＰＯＡＧ患者确诊时已发生较严重的视野损害,高眼压、青光眼相关症状、合并高度近视、确诊时年龄偏低可能是ＰＯＡＧ患者确诊时发生较严重视野损害的危险因素。     

单眼视野损伤程度对青光眼患者双眼视野的影响

目的：探讨单眼视野丢失严重程度对原发性闭角型青光眼、原发性开角型青光眼和正常眼压性青光眼患者双眼视野缺损的影响。

方法：根据双眼单眼视野缺损的阶段,将120例青光眼患者和30例健康参与者分为正常、早期、中度或重度四个阶段。通过整合视野和Esterman双眼视野评估确定双眼视野。在组内和组间比较单眼和双眼视野参数。

结果：对于一只眼睛处于正常或早期阶段而另一只眼睛处于严重阶段的患者,双眼综合视野平均偏差分别为-2.8±1.1、-5.5±1.9dB,以及Esterman的平均得分分别为99.1%±1.7%和95.6%±4.7%。当双眼发展为中度或重度损伤(中度/中度,中度/重度或重度/重度)时,双眼综合视野平均偏差低于-6dB,中度/中度和中度/严重损伤组Esterman的平均得分分别为94.2%±6.0%、94.3%±4.9%,但当双眼处于重度损伤阶段时,Esterman的平均得分迅速从大于90%下降到68.4%±26.3%。

结论：如果一只眼睛处于正常或早期阶段,双眼视野可以保持相对完整。当双眼进展到中度或重度阶段时,通过双眼综合视野平均偏差测量的双眼视野缺损是显著的,并且仅当双眼进入严重阶段时才检测到显著的Esterman双眼视野缺损。     

Central 10-degree visual field change following trabeculectomy in advanced open-angle glaucoma

Purpose

To prospectively examine changes in the central visual field (VF) in patients with advanced open-angle glaucoma (OAG) with advanced late stage after trabeculectomy for 12 months.

Design

Prospective interventional case series.

Methods

In all, 27 eyes of 27 OAG patients at a single center with a best-corrected visual acuity (BCVA) of ≥40/200 and a mean total deviation of test locations of the 10-2 program of the Humphrey VF analyzer of ≤−20 dB preoperatively were enrolled. Intraocular pressure (IOP), VF parameters of the 10-2 program, and BCVA were examined for 12 months after trabeculectomy with mitomycin C. Slopes of VF parameters and their correlation with presumed risk factors were studied.

Results

IOP decreased from 19.7±5.8 to 9.7±2.6 mm Hg (P<0.001) over postoperative 1 year. The slopes of all VF parameters did not significantly differ from zero (P>0.33), and none of the presumed factors significantly correlated with the slopes of those parameters (P>0.14). There were two eyes (7%) and one eye (4%) with ≥2 lines of deterioration in BCVA (decimal fraction) at 1 and 12 months, respectively, after surgery with no apparent causes.

Conclusions

Trabeculectomy resulted in little change in the central 10-degree VF, but significant decrease in BCVA without apparent causes might occur approximately 5% of the cases.     

Central function and visual field damage in glaucoma

82 eyes of 82 patients with different types of glaucoma were examined with various psychophysical tests assessing central and paracentral function, including foveal temporal contrast sensitivity function, FM 100-Hue test, and foveal and parafoveal blue-on-yellow-sensitivity. For all eyes visual field tests were performed with the Humphrey-Field-Analyzer, program 30-2. Global visual field indices were calculated as follows: Mean Sensitivity MS, Mean Deviation MD, and Corrected Pattern Standard Deviation CPSD. Linear regression analysis and multiple regression analysis correcting for a possible influence of age between the central and paracentral criteria and the global indices was performed. For the entire study population highly significant correlations are present between foveal and parafoveal blue-on-yellow-sensitivity and MS, MD and CPSD. Whereas in the Normal Tension Glaucoma subgroup (19/82 eyes) no significant correlations are found, the subgroup of 35/82 eyes with markedly elevated intraocular pressure (30mmHg) shows highly statistically significant correlations between the low- and high-frequency end of the foveal temporal contrast sensitivity function and foveal and parafoveal blue-on-yellow-sensitivity and the global field indices. The results of the present study support the idea that there are two different mechanisms of glaucomatous damage, one which is pressure-dependent and one which may be pressure-independent. The pressuredependent mechanism is responsible for deficits of central or paracentral function which are correlated to overall visual field damage.