夜间眼压测量在原发性开角型青光眼诊断中的作用

Role of Nocturnal Intraocular Pressure Monitoring in Diagnosis of Primary Open Angle Glaucoma

【目的】探讨夜间眼压测量在原发性开角型青光眼(POAG)诊断中的作用。【方法】连续性收集具有典型青光眼视神经损害但日间多次眼压测量值均≤21mmHg的门诊POAG患者,共30例59眼。对所有患者行夜间多次眼压测量、光学相干断层扫描仪、视网膜断层扫描仪及Humphrey视野检查。【结果】30例(59眼)中14例28眼(46.7%)夜间眼压值>21mmHg(HPG组),16例31眼(53.3%)夜间眼压正常(NPG组)。HPG组和NPG组的眼压高峰均出现在夜间(5:00和2:00);HPG组各时间点眼压明显高于NPG组(P=0.033～0.000);且眼压波动幅度大于NPG组(P=0.011);HPG组和NPG组间的视盘结构参数、视网膜神经纤维层厚度和视野缺损无统计学差异。【结论】眼压是鉴别HPG和NPG的最重要因素,夜间眼压测量在POAG的诊断及鉴别诊断中有重要作用。

【Objective】 To investigate the role of nocturnal intraocular pressure （IOP） monitoring in the diagnosis of primary open angle glaucoma （primary open angle glaucoma, POAG）. 【Method】 Fifty-night eyes from 30 out-patients with glaucomatous optic nerve damage and diurnal IOP monitoring ≤21 mmHg were included. Nocturnal IOP monitoring, optical coherence tomography （OCT）, Heidelberg retina tomography （HRT） and Humphrey visual field were performed to all of the included subjects. 【Result】 In nocturnal IOP monitoring, the IOP was more then 21 mmHg in 14 patients （28 eyes, 46.7%）, who were classified into hypertension open angle glaucoma group （HPG）. Another 16 patients （31 eyes, 53.3% ） with IOP still under 21 mmHg were classified into normal pressure glaucoma group （NPG）. The peak of IOP occurred at 5： 00 am and 2： 00 am in HPG and NPG groups, respectively. Compared with the NPG group, the base line of IOP （P = 0.033 ～ 0.000） and the amplitude of IOP fluctuation （P = 0.011） were significantly higher in HPG group. There were no significant differences in parameters of OCT and HRT, and visual field defects. 【Conclusion】 IOP is the most important factor in identifying HPG and NPG, and nocturnal IOP monitoring is influential in the diagnosis of POAG.