眼压降低后原发性慢性青光眼视野的变化

Perimetry change of primary chronic glaucoma after intraocular pressure reduction

目的了解原发性开角型青光眼(POAG)和原发性慢性闭角型青光眼(PACG)在眼压降低后视野是否发生改变及相关因素分析。方法原发性慢性青光眼32例(44眼),其中PACG19例(25眼),POAG13例(19眼)。眼压治疗前及治疗后1个月全部患者均行Humphrey静态自动视野(HFA)24-2全阈值视野检查。比较眼压降低前后视野平均缺损(MD)、模式标准差(PSD)的变化,分析眼压降低幅度、年龄及视神经杯盘比与视野MD改变是否相关。结果治疗前MD为-13.58±9.31,治疗后MD为-12.08±8.37,治疗前后MD比较差异有统计学意义(t=3.35,P=0.002);治疗前后MD差值与眼压降低幅度呈正相关(r=0.341,P=0.027)。协方差分析结果表明,校正年龄和HRT的杯盘面积比后,治疗前后视野MD的改变与眼压降低幅度呈正相关(F=4.706,P=0.037)。结论原发性慢性青光眼眼压降低后视野有所改善,视野改善的程度与降压幅度有关。

Objective The goal of treatment for glaucoma was control of intraocular pressure （IOP） and improvement of visual function. Perimetry is one of evaluating indexs of visual function. This study was to compare the changes of visual field before and after IOP reduction in primary chronic glaucoma including primary chronic angle-closure glaucoma （PACG） and primary open angle glaucoma（POAG） and determine the factors associated with visual field changes. Methods This is a caseobservation study. Forty-four primary chronic glaucoma eyes were studied including 25 PACG eyes and 19 POAG eyes. All patients underwent regular eye examinations and visual field examination using Humphrey Field Analyzer with the program of 24-2 full threshold testing. Retinal alteration was evaluated by Heidelberg Retina Tomography- Ⅱ （ HRT- Ⅱ ）. Patients received medicine, laser or surgery therapy respectively according to the status of disease. Visual field was repeatedly detected one month after the IOP declined to less than 21 mmHg. Mean defect （MD） and pattern standard deviation （PSD） were compared before and after IOP reduction in primary chronic glaucoma. The correlation of lOP reduction, age, C/D area ratio with MD changes were analyzed. Results MD before and after IOP reduction was - 13.58 ± 9.31 and - 12.08 ±8.37 respectively, indicating that MD was improved significantly after IOP reduction（t =3.35 ,P =0. 002） ,but the difference of PSD showed insignificant change （7.36 ±3.88 vs 7.67 ±4.23,t = - 1. 396,P = 0. 170）. The changes of M D and extent of IOP reduction presented a positive correlation （ r = 0. 341 ,P = 0. 027）. Covariate analysis showed that no significant correlation between age or C/D with changes of MD （ F = 2.267,F=0. 399,P〉0. 05） ,but lOP reduction was still related with change of MD（F =4. 706,P =0.037）. Conclusion Visual field is improved after lOP reduction in primary chronic glaucoma,including both POAG and PACG.