合并近视的原发性开角型青光眼视盘形态和视网膜神经纤维层改变

目的 探讨合并近视的原发性开角型青光眼(primary open-angle glaucoma with myopia,M-POAG)视盘形态和视网膜神经纤维层(retinal nerve fiber layer,RNFL)改变的特点及其临床意义。 方法 对38例63只合并近视[(－6.92±3.79)D]、高眼压性[(32.00±9.36) mm　Hg(1 mmHg=0.133 kPa)原发性开角型青光眼(primary open-angle glaucoma,POAG)作眼底彩色照相，利用计算机图像分析设备分析视盘形态及RNFL 缺损的变化，并与单纯原发性开角型青光眼(simple primary open-angle glaucoma,S-POAG)的相应临床检查资料进行比较。 结果 M-POAG视盘形态和RNFL萎缩除具有与S-POAG相同的一般表现外，尚有其特征性改变：视盘呈椭圆形(垂直或水平)、斜入及部分缺损形，色泽苍白；视杯形态各异，呈碟形(28.6%)、垂直形(25.4%)、倾斜形(23.8%)、锅形(9.5%)及局限与同心圆形等；盘沿面积及杯/盘横径比值显著低于S-POAG组(P<0.05，P＜0.001)。视盘凹陷偏心 多向下方。RNFL局限性萎缩主要出现在下方视网膜；弥漫性RNFL萎缩与合并高度近视的中后期POAG视野缺损密切相关(P<0.005)。 结论 M-POAG的视盘形态特征以及RNFL改变特点有助于在合并高度近视的POAG中的临床诊断。(中华眼底病杂志,2000,16:81-84)

The changes of the shapes of optic disc and retinal nerve fiber layer in primary open-angle glaucoma with myopia

Objective To investigate the features of optic disc formation and retinal nerve fiber layer(RNFL) changes in primary open angle glaucoma with myopia (M POAG). Methods On 63 eyes of 38 patients with M POAG were imaged of the fundus,and were evaluated with the microcomputer image analyser,and were compared with the simple POAG (S POAG) eyes. Results Variant features of the optic disc and RNFL atrophy were found in this M POAG eyes.The shapes of the optic disc were revealed to be vertically or horizontally oval,obliquely inserted and irregular,the color of the most of optic disc was pallor.The pattern of glaucomatous cupping was saucer like (28.6%),vertical (25.4%),oblique (23.8%),pot like (9.5%),and focally or concentrically cupped.The quotient of the neuroretinal rim area and horizontal C/D ratio were significantly lower than those in S POAG eyes (P<0.05,P<0.001).The focal point of the optic disc excavtions tended to be inferior.Most of the incidence in the focal atrophy of RNFL was located inferiorly,and the diffuse atrophy of RNFL was correlated positively with middle or late high myopia POAG eyes (P<0.005). Conclusion The variant features of the optic discs,glaucomatous cupping and RNFL atrophy formation in M POAG eyes found in this series might be helpful in clinical diagnosis.