国际闭角型青光眼新分类中Humphrey视野及HRT-Ⅱ参数的相关性

Clinical analysis of the parameters detected by HRT-Ⅱ and Humphrey perimetry in the new international classification of angle-closure glaucoma

目的:分析海德堡视网膜断层扫描仪-II(HRT-II)和Hum-phrey视野计检查平均视野缺损(mean defect,MD)间的相关性及其临床价值。方法:闭角型青光眼患者69例117眼,按照国际闭角型青光眼分类法分为可疑原发性房角关闭(primary angle-clo-sure suspect,PACS)38眼,原发性前房角关闭(Primary an-gle-closure,PAC)53眼和原发性闭角型青光眼(primary angle-closure glaucoma,PACG)26眼,利用HRT-Ⅱ和Hum-phrey视野计检查正常人30例60眼和各类闭角型青光眼患者的视盘形态、视网膜神经纤维层(RNFL)厚度和视野,获得视杯面积、视盘面积、盘沿面积、视杯容积、盘沿容积、杯盘面积比、线性杯盘比、平均视杯深度、最大视杯深度、视杯形态测量、视杯高度变异轮廓、平均视网膜神经纤维层厚度、视神经纤维层横截面积和MD等参数,对比分析正常人和各类闭角型青光眼患者之间的各参数的差异。并将各类闭角型青光眼的HRT-Ⅱ的各参数与MD进行相关性分析。结果:HRT-Ⅱ和Humphrey视野计检测对照组与PACS、PAC和PACG4组间各视盘参数和MD差异具有统计学意义(P<0.01)。对照组中LCD和MD呈直线相关,PACS组中DA、CA和MD呈直线相关,PAC中CA,RA,CV,CDAR,HVC和MD呈直线相关。经逐步回归筛选的变量中,CV和HVC是其中2个有意义的参数,PAC组中CV和HVC与MD之间的Pearson相关系数为0.290和0.301,得出CV和HVC与MD之间回归方程:Y=4.475X1+5.338X2-0.480(Y表示MD,X1表示CV,X2表示HVC)。结论:HRT-II和Humphrey视野检查参数在新的闭角型青光眼分类具有一定的临床价值,MD与CV和HVC相互参照分析有助于判断闭角型青光眼的发展。

AIM： To study the visual field defects with Humphrey perimetry and the optic disc parameters of HRT in patients classified with the international angle-closure glaucoma classification, and to analyze the relationship among the HRT-II parameters and mean defect （MD）. METHODS： Totally 117 eyes of 69 patients were divided into 3 groups： primary angle-closure suspect （PACS, 38 eyes）, primary angle-closure （PAC, 53 eyes） and primary angle-closure glaucoma （PACG, 26 eyes） according to the international angle-closure glaucoma classification method. Sixty eyes of 30 volunteers without eye diseases and the above 117 eyes were examined by HRT-Ⅱ and Humphrey Field Analyzer, and cup area （CA）, disk area （DA）, rim area （RA）, cup volume （CV）, rim volume （RV）, cup/disk area ratio （CDAR）, linear cup/disk ratio （ LCDR）, mean cup depth （MCD）, maximum cup depth （max CD）, cup shape measure （CSM）, height variation contour （HVC）, mean RNFL thickness （MRNFLT）, RNFL cross sectional area （RCSA） and mean defect （MD） values were obtained from the report papers. The differences of parameters between normal eyes and glaucoma eyes in 3 groups and the relationship among MD and HRT-Ⅱ parameters in each group were analyzed with statistic software. RESULTS： Among the normal volunteer group and PACS, PAC, PACG group, there were significant differences of parameters of HRT-Ⅱ and MD value of Humphrey perimetry （ P 〈 0.01 ）. The regression analysis showed that a linear relationship existed between LCD and MD in normal eyes, among DA, CA and MD in PACS group, and among CA, RA, CV, CDAR, HVC and MD in PAC group. With a multiple sieving stepwise regression method, CV and HVC were selected for 2 variables in the regression equation. The Pearson correlation coefficients between CV, HVC and MD were 0. 290 and 0. 301 in PAC group, respectively, and the regression equation was Y= 4. 475 X1 ＋ 5. 338 X2- 0. 480, where Ywas MD, X1 was CV and X2 was HVC. CONCLUSION： There are clinical values OT HRT-Ⅱ and Humphrey perimetry in the new international classification of angle-closure glaucoma, and the cross-reference analysis between MD and CV, HVC may be helpful to evaluate the development of PACG.