原发性开角型青光眼视网膜神经纤维层检查的临床分析  

A clinical studies of the morphologicl changes of retinal nerve fibers layer in the primary open-angle glaucoma

作　　者：李嘉丽[1] 旷琳[1] 李国彦[2] 

机构地区：[1]武汉市第四医院眼科,430033 [2]武汉市第一医院眼科

出　　处：《临床眼科杂志》2004年第1期19-21,共3页Journal of Clinical Ophthalmology

摘　　要：目的　观察分析各期原发性开角型青光眼 (POAG)病例视网膜神经纤维层 (RNFL )的形态学改变 ,探讨其对 POAG的早期诊断、病情估计、治疗效果、预后判断等方面的临床意义。方法　 (1)随机选择 1992年～2 0 0 3年间青光眼专科门诊确诊为 POAG患者的眼底照相图片计 2 70例 (5 4 0只眼 ) ,进行回顾性统计分析。 (2 )按杯盘比值 (C/D)分为三组 :C/D<0 .6者为早期组 ,C/D=0 .6～ 0 .8者为进展期组 ,C/D>0 .8者为晚期组 ,观察各期POAG神经纤维层的形态学改变特点 ,进行分析评估。 (3)部分病例结合视野和 HRT 检查 ,对三种检查法的敏感性进行比较分析。(4 )视野检查用 75 0型 HU MPHREY视野分析仪 ,眼底照相用 TOPCON TRC- 5 0 VT型眼底照相机。结果　在早期组 30 3只眼中 96 .7% (2 93/30 3)为神经纤维层稀疏或裂隙样缺损 ,3.3% (10 /30 3)为裂隙状加楔形缺损。在进展期 2 17只眼中 89.8% (195 /2 17)为神经纤维层稀疏或裂隙样缺损 ,6 % (13/2 17)为裂隙样加楔形缺损 ,1.8% (4 /2 17)为裂隙样或楔形缺损加弥漫性萎缩 ,2 .3% (5 /2 17)为弥漫性萎缩 ,晚期 2 0只眼中 5 0 % (10 /2 0 )为弥漫性萎缩 ,2 0 % (4 /2 0 )为裂隙样及楔形缺损加弥漫性萎缩 ,裂隙样缺损加楔形缺损占 15 % (3/2 0 ) ,而梳状或裂隙样缺损仅?Objective Observation and analysis of the morphological changes of retinal nerve fiber layer in various stage of POAG.To probe into the significance of which about the early diagnosis of POAG,assessment of the state of illness,the effect of treatment,and to evaluate the prognosis of patients.Methods (1)Randomly selected the POAG fundus photos of glaucoma special.O.P.D.records from 1992～2003.There were 270 cases 540 eyes photos of fundus underwent the observation statistic and analysis.(2)According to the C/D ratio divided into three groups:the early group with the C/D<0.6,the advance group with the C/D 0.6～0.8,and the late group with the C/D>0.8.To observe the specific morphological changes of RNFL to each stage of glaucoma and underwent analysis and assessment.(3)A part of cases were made comparison for its sensitivity with the field analyzer and HRT examination.(4)Fundus photography took by TOPCON WT3 fundus camers,field examination made by 750 Humphrey Fiels Analyzer.Results (1)In the 303 eyes of early stage there were 96.7% (293/303) slit like nerve fiber layer defect,and 3.3%(10/303) slit like and combine with wedge shape defect.(2)In the 271 eyes of advance stage there were 89.8% (195/271) slit like defect,6%(13/217) slit like combine with wedge shape defect,1.8%(4/217) slit like or wedege shape defect combine with diffuse loss,and 2.3%(5/217) diffuse loss.(3)In the 20 eyes of late stage there were 50% (10/20) appearance of diffuse loss of RNFL,20% (4/20) slit like or wedge shape combine with diffuse loss,15%(3/20) slit like combine with wedge shape defect,and the slit like defect only 15%(3/20).Conclusions Fundus photography for examination of RNFL defect is an objective,reliable,and relatively low cost method.In can reflect the state of illness,observe the effect of treatment,assessment the prognosis condition,and as for the early glaucoma insperction it is more sensitive then field analyzer and HRT and thus it have great vlaue as early objective adjunct indicator of glaucoma.

关 键 词：原发性开角型青光眼 视网膜神经纤维层 预后 早期诊断 视野 弥漫性萎缩 

分 类 号：R775[医药卫生—眼科]