正常眼压性青光眼确诊时各指标间病变程度的关系  

Clinical features and the relationships among them of newly diagnosed normal pressure glaucoma

作　　者：任泽钦[1] 李美玉[1] 乔荣华[1] 刘丽娜[1] 王捷[1] 

机构地区：[1]北京大学第一医院眼科,100034

出　　处：《中国实用眼科杂志》2004年第1期15-19,共5页Chinese Journal of Practical Ophthalmology

摘　　要：目的　考察正常眼压性青光眼 (normalpressureglaucoma ,NPG)患者确诊时的临床表现 ,探讨各指标间病变程度的关系。方法　 10 5例NPG患者 ,分析眼压曲线的平均状态、波动幅度和双眼对称性 ,观察视野和眼底C/D垂直径比值、盘沿缩窄和视网膜神经纤维层 (RNFL)改变。结果　眼压曲线双眼对称 ,总体波动水平位于 16mmHg上下 ,最高值在 10AM ,最低值在 10PM ,但10PM最低值高于年龄可比的正常人群的平均眼压 (P <0 0 1)。单值眼压分布位于 10～ 2 1mmHg ,峰值与谷值相差约 4mmHg。视野在 5 5例患者为单眼损害 ,在 14 9眼的视野损害中 ,绝大多数损害形态和部位与眼压升高的原发性开角型青光眼 (hp -POAG)相符合 ,但旁中心损害侵入中心固视区者约占 2 2 % ,而在轻度损害中约占 1/3。眼底C/D值右眼为 0 77± 0 15 ,左眼为 0 71± 0 16,二者均大于一般群体上限和早期hp -POAG患者的C/D值 (P <0 0 1) ,但在不同程度损害的视野中差异不显著 (P >0 10 ) ,盘沿缩窄和RNFL缺损的发生率分别为 5 0 %以上和 60 %以上 ,二者差异不显著 (P>0 0 5 )。结论　NPG患者的眼压在绝对值、波动幅度和双眼对称性上均与正常眼压各指标相一致 ,对诊断无定性价值。确诊时眼底C/D值大于早期hp -POAG的C/D值 。Objective To observe the clinical features and to investigate their relationships of newly diagnosed normal pressure glaucoma(NPG).Methods 105 patients with newly detected NPG were recruited for the present retrospective and noncomparative study.The average levels,fluctuating amplitudes,and bilateral symmetry of intraocular pressure(IOP) within diurnal IOP curves were examined,visual fields measured,and stereoscopic fundus photographs assessed for the vertical cup-disc diameter ratio,the thinning and/or notch of neuroretinal rims,and retinal nerve fiber layer defects(RNFLD).Results The overall curvilinear patterns of the diurnal IOP curves were assumed to be one-hump shaped.The symmetry appeared in binocular behaviors.The mean levels lied around 16mmHg,with the maximum at 10Am and the minimum at 10Pm,which was still higher than the mean value from the normal age-comparative population(P<0.01).The individual IOP measurements were distributed in a range of 10～21mmHg,and there was a difference about 4mmHg between the peak and the trough.Of all the patients 55 had the damages to monocular visual field,and the field defects in most of 149 eyes were in loss patterns and loss localities typically identical to those in eyes with high pressure-POAG.The paracentral damages involving the central fixation areas occurred in twenty two percent of all the eyes with visual losses,and even reached up to 1/3 in mild severity stage.C/D ratios were 0.77±0.15 of right eye and 0.71±0.16 of left eye,respectively,greater than those found in both the normal population with the upper limit and patients with newly detected high pressure-POSA(P<0.01).Otherwise the differences between the different field conditions were not statistically significant (P>0.10).The rim thinning and/or notch and RNFLD had the prevalence of over 50% or over 60%,respectively,with no statistical significance between them(P>0.01).Conclusions The IOP had the same absolute heights,fluctuating amplitudes,and binocular symmetries derived from the diurnal curves

关 键 词：正常眼压性青光眼 眼压曲线 病变程度 视野前诊断 视网膜神经纤维层 

分 类 号：R775.1[医药卫生—眼科]