原发性开角型青光眼与正常眼压性青光眼神经功能损伤及其结构特征研究  

The function-structure impairment pattern of optic nerves in primary open-angle glaucoma and normal-tension glaucoma

作　　者：汪星朦 孙兴怀 戴毅 孔祥梅 陈宇虹 Wang Xingmeng;Sun Xinghuai;Dai Yi;Kong Xiangmei;Chen Yuhong(Department of Ophthalmology,Eye &ENT Hospital of Fudan University,NHC Key Laboratory of Myopia (Fudan University),Laboratory of Myopia,Chinese Academy of Medical Science,Shanghai 200031,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院眼科国家卫生健康委员会,中国医学科学院近视眼重点实验室,上海200031 [2]中国科学技术大学附属第一医院眼科

出　　处：《中华眼科杂志》2018年第11期811-819,共9页Chinese Journal of Ophthalmology

基　　金：国家自然科学基金(81430007).

摘　　要：目的研究原发性开角型青光眼(POAG)与正常眼压性青光眼(NTG)早、中、晚期视野缺损和视网膜神经纤维层(RNFL)丢失的特点,并分析结构与功能对应特征。方法横断面研究。选取2008年2月至2017年5月在复旦大学附属眼耳鼻喉科医院眼科就诊的POAG患者(POAG组)、NTG患者(NTG组)以及健康志愿者(对照组)进行Humphrey 24—2标准自动视野检查和视网膜相干光层析成像术(OCT)检查,患者组按视野的平均缺损值分为早、中、晚期。将视野模式偏差图和视盘按Garway-.Heath六区法分区,即按照RNFL走行特点将两者分为6个对应区域。采用Kruskal—Wallis检验比较对照组与患者组早、中、晚期每个区域视野平均缺损和盘周RNFL厚度值的差异,采用Pearson相关系数分析每个区域视野平均缺损和盘周RNFL厚度的相关性。结果POAG组84例(84只眼),男女比例为43:41,年龄(45±15)岁,早、中、晚期分别为35、20、29只眼;NTG组69例(69只眼),男女比例为33:36,年龄(49±13)岁,早、中、晚期分别为30、20、19只眼;对照组23名(23只眼),男女比例为16:17,年龄(44±10)岁。3组性别、年龄、矫正视力差异均无统计学意义。(1)POAG早期上、下半侧视野缺损差异无统计学意义,中期下半侧缺损比上半侧严重(t=21.62,P=0.000),晚期上半侧比下半侧严重(￡=~3.28,P=0.003);NTG各期上、下半侧视野缺损间差异均无统计学意义(均P>0.05)。对照组上周弓区、上旁弓区、下周弓区、下旁弓区、颞侧区及中心区视野平均缺损(反对数值)分别为O.87(0.63~1.11)/L、0.74(0.61~0.83)/L、0.72(0.55~0.97)/L、0.65(0.51-0.87)几、0.69(0.57-0.97),L、0.82(O.54-0.93)/L。POAG组早、中、晚期与对照组视野平均缺损比较差异有统计学意义(均P<0.05)的区域是:早期为上旁弓区[0.61(0.18~0.92)/L,H=21.58];中期为上周弓区、上旁弓区[0.61(0.15~0.87),L、0-21(0.00~0.78)/L,H=25.99、34.911;晚期为上周弓区、上旁弓区、下周弓区�Objective To investigate the characteristics of impairment of the visual field (VF) and retinal nerve fiber layer (RNFL) and the differences of progression pattern of early,middle and late stages of primary open-angle glaucoma (POAG)and normal-tension glaucoma (NTG),and to analyze the correspondence of structure and function.Methods Cross-sectional study.POAG patients,NTG patients and healthy volunteers who were enrolled from February 2008 to May 2017 at Department of Ophthalmology,Eye & ENT Hospital of Fudan University,underwent basic ophthalmic examination,Humphrey central 24-2 threshold test and optical coherence tomography.Patients were divided into early,middle and late stages according to the mean defect (MD) index of the VF test.According to the RNFL distributional characteristics,the pattern deviation map and RNFL were divided into 6 sectors.The differences of each sector's MD and RNFL thickness in the healthy group and groups of patients at 3 stages were analyzed using the Kruskal-Wallis test,and the correlation of MD and RNFL thickness of each sector was analyzed using the Pearson coefficient.Results In the POAG group,there were 84 cases (84 eyes) including 35 eyes of early stage,20 eyes of middle stage and 29 eyes of late stage,with a male/female ratio of 43:41,aged (45± 15) years.In the NTG group,69 cases (69 eyes) included 30 eyes of early stage,20 eyes of middle stage and 19 eyes of late stage,with a male/female ratio of 33:36,aged (49± 13) years.The control group had 23 cases (23 eyes),with a male/female ratio of 16:17 and an age of (44± 10) years.There was no significant difference in male/female ratio,age or best corrected visual acuity among the three groups.(1) In the middle stage of POAG,the VF defects of inferior hemi-fields were more severe than the superior (t=21.62,P=0.000),which was opposite to the late stage of POAG (t=-3.28,P=0.003).In each stage of NTG,there was no significant difference between two hemi-fields.In the control group,the MD values(antilog) of VF in the superior periph

关 键 词：青光眼 开角型 眼内压 视野 神经纤维 

分 类 号：R775[医药卫生—眼科]