高度近视伴原发性开角型青光眼视乳头及视网膜神经纤维层改变的分析

目的分析伴有高度近视的开角型青光眼(primary open angle glaucoma,POAG)的视乳头形态及视网膜神经纤维层改变,探讨其早期诊断方法。方法(1)收集20例(38只眼)高度近视合并POAG患者资料(A组),与随机抽取的20例(36只眼)中度近视合并POAG患者的资料(B组),以及20例(40只眼)低度近视合并POAG患者的资料(C组)进行对照,比较初次就诊时3组患者间视野缺损、视网膜神经纤维层缺损(retinal nerve fibre layer de-fect,RNFLD)、最高眼压值及矫正视力等指标的差异;(2)观察3组患者的眼底照片并分析各组的临床特点。结果(1)A组患者中、重度视野缺损和RNFLD的比例明显高于B、C组,矫正视力低于B、C组;(2)高度近视患者视乳头、视网膜的特异性变化及视乳头周围的特征性改变等,干扰了对青光眼的早期诊断;(3)高度近视患者常规进行散瞳检查或眼底照相是诊断早期青光眼的重要手段及方法。结论在合并高度近视的POAG临床检查及诊断时,应注意其视野的缺损、RNFLD,并避免与高度近视视乳头、视网膜的特异性变化及视乳头周围的特征性改变相混淆,正确认识高度近视本身及合并POAG时的临床特点,有助于POAG的早期诊断。

A Clinical Analysis of Retinal Nerve Fiber Layer Defect and Optic Disc of High Myopia with Primary Open Angle Glaucoma

Objective To analysize changes of retinal nerve fiber layer defect and optic disc and to explore the bases of early diagnosis of high myopia(HM) combined with primary open angle glaucoma(POAG).Methods(1)Patients and eyes with POAG were divided into 3 groups:group A with HM 38 eyes of 20 cases),group B with medium myopia(36 eyes of 20 cases) and group C with low myopia(40 eyes of 20 cases).Their visual field defect,retinal nerve fiber layer defect(RNFLD),the maximum intraocular pressure and corrected visual acuity were detected and compared.(2)The stereo photos of the HM POAG were observed directly,and their clinical characteristics were reviewed.Results(1)On baseline information,the patients of group A obviously suffered more serious visual field defects and RNFLD than cases in group B and C,and the corrected visual acuity in group A was lower than that in the two other groups.(2)The specific fundus changes at the papilla and its surrounding retina of the HM patients interfered with the early detection of glaucoma.The dilatation of pupil to examine the fundus and the use of stereo photos were the main measures to elevate the detectable rate of glaucoma. Conclusion During the clinical examination and detection,high myopia with primary open angle glaucom,recognizing the early clinical characteristics of HM combined with that of POAG may help us to improve the proficiency of HM POAG early detection.