青光眼快速筛查的初步研究

目的　为了有效地进行青光眼筛查,对用于检测眼压、前房、视神经、视野4个方面的简易、快速方法,进行特异性及敏感性的评价。方法　利用4个周末,每日筛查约200人次。眼压检测使用笔式眼压计,前房深度测定采用VanHerick法,视神经检查采用非散瞳眼底照像,由专家阅片;视野检查采用阈上值定性筛查程序,采用倍频视野计（frequencydoublingperimeter,FDP）、Octopus123及Humphery605自动视野计。筛查阳性者需进行青光眼的全面检查,如自动视野的阈值检查、立体眼底及视网膜神经纤维层（retinalnervefiberlayer,RNFL）照像。结果　在734位被筛查者中,开角型青光眼55例（占7.5%）,闭角型青光眼59例（占8.4%）,可疑青光眼98例（占13.4%）。青光眼患者中,眼压>21mmHg(1mmHg=0.133kPa)者34例（占29.8%）。其中开角型青光眼的视神经、视野异常率分别为94.5%、67.3%;闭角型青光眼的前房、视野、视神经异常率分别为89.8%、72.9%、45.8%。结论眼底照像并由专家评估是开角型青光眼筛查的最有效方法。前房检查在我国青光眼筛查中必不可少。自动视野阈上值筛查特异性低,FDP可能是快速筛查特异性较好的方法。

A pilot study on rapid glaucoma screening

Objective To screen glaucoma effectively and rapidly and evaluate the specificity and sensitivity of the method. Methods 734 subjects were screened in 4 weekend days. All subjects underwent intraocular pressure (IOP) examination with Tonopen, anterior chamber depth measurement with Van Herick method, fundus photography without pupil dilatation and supra threshold perimetry with Frequency Doubling Perimeter (FDP), Octopus and Humphery automatic perimeter. The cases with positive results in the above examinations should undertake threshold perimetry and fundus stereo photography for the evaluation of the retinal nerve fiber layer (RNFL). Results Of the 734 subjects with complete data, there were 55 cases with open angle glaucoma (7 5%), 59 angle closure glaucoma (8 4%) and 98 glaucoma suspects (13 4%). The IOP of 34 patients was >21 mm Hg in all the glaucomatous patients (29 8%). The abnormal rates of optic nerve and visual field were 94 5% and 67 3% respectively in the patients with open angle glaucoma. The abnormal rates of anterior chamber, visual field and optic nerve were 89 8%, 72 9% and 45 8% respectively. Conclusions The most efficient method for screening open angle glaucoma is fundus stereo photography with evaluation by an expert. Anterior chamber evaluation is necessary in screening glaucoma. Supra threshold perimetry has limited specificity, and FDP might be a promising method in screening glaucoma with relatively good specificity.