对青光眼盘沿及视网膜神经纤维层监视的评价

An evaluation of monitoring neural rim and retinal nerve fiber layer in glaucoma

为了解青光眼盘治及RNFL改变的相互关系，评价各种眼底视神经监测方法的敏感性，本研究采用两种方法进行青光眼视神经的随诊监测，①常规法：并排投影显示法监测盘沿及RNFL的改变，②闪烁法：立体视下图象闪烁比较法监测盘沿的改变，将先后两次照的立体象对校正，交替显示两幅叠加好的立体象对，变化的部分有跳动感。随诊的青光眼、可疑青光眼451例，836只眼，平均随诊期2．8±1．3年。发现有盘沿改变者用常规法仅23例，而用闪烁法高达90例，其局限性、弥漫性最小改变量分别为0．032mm2及0．048mm2。用闪烁法对盘沿的监测与常规法对RNFLD监测的比较，对于局限性改变，采用闪烁法有盘沿丢失28例，其中12例不伴RNFLD的改变，而采用常规法有RNFLD改变者的17例，其中仅1例不伴有盘沿丢失。对于弥漫性改变者，采用闪烁法有盘沿改变的26例，其中不伴RNFLD改变者有20例。采用常规法有RNFLD改变者6例，此6例均伴有盘沿丢失。

The aims of this report were to understand the relationship between neural rim loss and retinal nerve fiber layer defects (RNFLD), and to evaluate the sensitivity of various methods for following up optic nerve damages in glaucoma. Two methods were used to evaluate the rim loss and RNFLD: 1. Routine method by parallel projecting serial photographs of an eye (a forlmer and a latter one) to evaluate the differences in neural rim, optic cup and RNFL. 2.Flicker comparison of 2 serial stereo photographs of an eye under stereo view was used to monitor the changes of neural rim by alternatively rapidly disp-laying the pairs overlapped correctly; if changes was present, jumping movement appears between alterna-tive views. 836 eyes of 451 patients with glaucoma and suspect glaucoma were followed with a mean of 2. 8±1. 3 years of follow-up. 23 cases of rim chan-ges were discovered by the routine method, 90 eyes of the changes by flick comparison. The smallest local and diffuse challges of rim loss were 0. 032mm2 and 0. 048mm2 respectively. Monitoring the rim chan-ges with flicker method and monitoring RNFLD with routine method werc compared. For changes of localized damage, 28 cases with rim loss were disco-vered with flicker method, in whom 12 cases were not accompanied by RNFLD changes, while, 17 cascs with RNFLD changes were discovered by routine me-thod, of,whom only did 1 case do not accompanied by rim loss. For changes of diffuse damage, there were 26 cases of rim loss discovered by the flicker method, of them 20 cases did not have any RNFLD changes. 6 cases had RNFLD changes discovered by routine method, and all of them had rim loss.