开角型青光眼6a随诊结果分析120例

目的:观察治疗中的开角型青光眼患者视力、C/D比值、眼压和视野的长期变化。方法:1994-06/2000-06在北京协和医院眼科确诊并治疗的开角型青光眼患者进行回顾性分析。其中资料完整的120例(240眼),男57例(114眼),女63例(126眼);年龄9~76(平均46.5)岁。6a所有患者均追踪观察视力、C/D比值、并用Goldmann压平眼压计测眼压,应用Humphery630型静态视野计进行视野检查,检查的程序采用24~2,52个点灰度阈值图,背景光31.5asb,半暗室下进行,定期检查,间隔时间不超过1a。以象限将视野分为4个区域,分别计算每个区域dB阈值刺激敏感度,数据进行统计学分析。结果:整体视力每年有小的下降,但变化较小,就诊1a和6a后右眼和左眼的视力分别为0.84±0.41,0.94±0.93及0.88±0.32,0.84±0.29,比较无统计学差异,P>0.05。C/D比值随着时间有所增大,特别是后3a内变化明显,1,2,3,4a右/左眼的C/D比值,比较无统计学差异,P>0.05;5,6a右/左眼的C/D比值,与1a比较有显著性差异,P<0.05。多数患者眼压药物控制理想,用药前后整体比较有显著性差异,P<0.05。视野变化表现为各个象限的差异较大,颞下缺损最为显著,比较有统计学意义,P<0.05;同一象限的1a与2a及与6a比较有统计学意义,P<0.05。结论:开角型青光眼的视野改变可以指示眼部受病的程度,特别是病情的进展情况,并为预后和治疗提供重要依据。患者视力、C/D比值、眼压和视野的变化与疾病的控制有直接关系。

Analysis of 120 cases with primary open angle glaucoma in 6-year follow-up

AIM:To obverse the long term changes of visual acuity,cup/disk ratio,intraocular pressure and visual field in patients with primary open angle glaucoma who are being treated.METHODS:A retrospective review of case series was performed on 120 patients(240 eyes)diagnosed as primary open angle glaucoma and treated in Peking Union Hospital from June 1994 to June 2000.There were 57 male(114 eyes)and 63 female(126 eyes),aged from 9 to 76 years old(mean age 46.5 years old).In 6 years follow up,visual acuity,cup/disk ratio(C/D),intraocular pressure(IOP)with Goldmann applanation tonometer and visual field were measured in all patients.Visual field was tested using Humphrey 630 static perimeter,with program 24~2,52 spots gray threshold map and 31.5asb background light.The examination was carried out in half darkroom regularly,and the interval was less than 1 year.The visual field was divided into 4 quadrants,threshold stimulation sensitivity of every quadrant was calculated and statistic analysis was performed.RESULTS:Visual acuity declined every year,but it was tiny.Visual acuity of 1 year and 6 years after treatment were 0.84±0.41,0.94±0.93 and 0.88±0.32,0.84±0.29 respectively,and the differences were not statistically significant(P>0.05).C/D increased during these years,especially in the last 3 years.The differences in C/D value between right eye and left eye were not statistically significant(P>0.05)in the lst,2nd,3rd,4th year.In the 5th and 6th year,C/D value of the right and left eyes were significantly different compared with value of the 1st year(P<0.05).IOP was controlled well in most patients,and there were significant differences before and after medication treatment.Visual acuity changes were diverse in different quadrants,and the inferior-temporal defect was marked(P<0.05),differences between the 1st year and 2nd year and between the 1st year and the 6th year of the same quadrant were statistically significant(P<0.05).CONCLUSION:Changes of visual field in primary open-angle glaucoma can indicate the extent of ocular damage,especially the progression of the disease,and can provide important evidences for treatment and prognosis.There are direct relations between disease control and changes of visual acuity,C/D ratio,IOP and visual field of the patient.