术后眼压正常的原发性开角型青光眼中央角膜厚度与视神经受损关系

Relationship between the central corneal thickness and optic nerve damage progress in patients with glaucoma with low intraocular pressure after surgery

目的探讨手术后眼压达正常的原发性开角型青光眼（primary open angle glaucoma，POAG）患者中央角膜厚度（Central Comeal Thickness，CCT）与视野、视神经损害进展的关系。方法对127例施行小梁切除术的原发性开角型青光眼患者进行角膜测厚、视野检查及海德堡视网膜断层扫描（HRT-2）。根据CCT将127例患者分成两组：第一组CCT〈540μm（n=59），第二组CCT≥540μm（n=68）。手术后1个月开始检查，随访2年，对所得数据进行分析。结果两组术后2年除了视盘面积（DA）无差异外，其平均视野缺损值（MD）、视杯面积（CA）、最大视杯深度（MxCD）、杯盘面积比（C／DAR）、盘沿面积（RA）、视杯形态测量（CSM）、平均视网膜神经纤维厚度（mRNFLT）与首诊比较差异均有统计学意义（P〈0．05），且第一组上述指标的进展均较第二组加快（P〈0．05）。结论原发性开角型青光眼患者即使手术后眼压控制正常，其视野及视神经仍出现继续损害，角膜厚度薄者视野及视神经的损害更明显。

Objective To explore the association between the central corneal thickness and visual field and optic nerve damage progression in patients with primary open angle glaucoma with low intraocular pressure after surgery.Method 127 patients receiving trabeculectomy were measured with ultrasonic pachymetry, field analyzer and Heidelberg Retinal Tomography-2 （HRT-2）. The sample was split into two groups： Group One CCT〈540 μ m（n=59） and Group Two CCT≥ 540 μ m（n=68）. Examinations were done one month after the surgery and follow-up visits made for two years before analysis were made on the data. Result Two years after surgery, there was no significant difference between the two groups for the disk area （DA） ,but comparisons in the two groups for mean deviation （MD） ,the cup area （CA） ,the maximum cup depth,the cup/disk area ratio （C/D AR）,the rim area （RA） ,the cup shape measure （CSM） and the mean RNFL thickness （mRNFLT） were statistically different with those in initial （P 〈 0.05 ）, and the above indexes in Group One made faster progression than those in Group Two （ P 〈 0.05 ）. Conclusion Patients with primary open angle glaucoma were at great risk for visual field and optic nerve progression if they maintain low intraocular pressure after surgery and patients with thinner comea were at even greater risk.