早期开角型青光眼的视网膜神经纤维层缺损及相关临床特点

The retinal nerve fiber layer defect and its related clinical features in early primary open-angle glaucoma

目的 观察早期原发性开角型青光眼 (primaryopen angleglaucoma ,POAG)及正常眼压性青光眼 (normaltensionglaucoma,NTG)的弥漫性及局限性视网膜神经纤维层缺损 (retinalneverfiberlayerdefect,RNFLD)的分布及相关的临床特点。方法 通过对立体眼底像的观察 ,明确 81例POAG及 70例NTG的RNFLD类型 ,分析弥漫性及局限性RNFLD在两型青光眼中的分布 ,比较两型RNFLD患者未治疗的最高眼压及视盘出血发生比例的不同。结果 81例POAG中 ,78例出现RNFLD ,其中弥漫性RNFLD 5 0例 ,局限性RNFLD 2 8例。 70例NTG中 ,弥漫性RNFLD 2 7例 ,局限性RNFLD 43例 ,两型青光眼的RNFLD的分布相比较 ,差异有显著性 (χ2 =9 6 3,P <0 0 1)。POAG中弥漫性RNFLD组与局限性RNFLD组的眼压分别为 (2 8 78± 5 41)mmHg(1mmHg =0 133kPa)及 (2 6 2 1± 5 15 )mmHg ,差异有显著性 (t=2 0 4,P <0 0 5 ) ;NTG中弥漫性RNFLD组与局限性RNFLD组的眼压分别为 (19 19± 1 90 )mmHg及 (17 79± 1 95 )mmHg ,差异有显著性 (t =2 94,P <0 0 5 )。视盘出血发生比例 ,POAG组为10 / 78,NTG组为 18/ 70 ,差异有显著性 (χ2 =4 0 0 ,P <0 0 5 ) ;POAG组中弥漫性RNFLD为 3/ 5 0 ,局限性RNFLD为 7/ 2 8,两者相比差异有显著性 (χ2 =4 2 2 ,P

Objective To investigate the distribution of diffuse and local retinal nerve fiber layer defects (RNFLD) and their clinical features in early primary open angle glaucoma (POAG) and normal tension glaucoma (NTG). Method The types of RNFLD in 81 cases with POAG and 70 cases with NTG were observed, the distribution of diffuse and local RNFLD were analyzed, and the maximum untreated intraocular pressure (IOP) and the history of optic disc hemorrhage between the two types of RNFLD in the two glaucomatous groups were compared. Results RNFLD appeared in 78 of 81 cases with POAG, 50 of them were diffuse and 28 were local; 27 of diffuse and 43 of local RNFLD were found in 70 cases with NTG. The IOP was (28 78±5 41) mm Hg in the diffuse and (26 2±5 2) mm Hg in the local type in POAG ( t =2 04, P <0 05), and (19 2±1 9) mm Hg and (17 8±2 0) mm Hg, respectively in NTG ( t =2 94, P <0 05). The incidence of disc hemorrhage was 10/78 and 18/70 in POAG and NTG, respectively (χ 2=4, P <0 05). That was 3/50 in the diffuse and 7/28 in the local type in POAG (χ 2=4 22, P <0 05), and 3/27 and 15/43, in NTG respectively (χ 2=4 91, P <0 05). There were no statistic differences in the diffuse type between the POAG and NTG groups (χ 2=0 15, P >0 05), and neither were in the local type (χ 2=1 31, P >0 05). Conclusion The diffuse RNFLD tends to be distributed in POAG, while the local RNFLD tends to be distributed in NTG. The maximum IOP in the eye with diffuse RNFTD is higher than that in the eye with local RNFLD, either in POAG or NTG group. The occurrence of disc hemorrhage is higher in the eye with local RNFLD than that in the eye with diffuse RNFLD in the two groups respectively. There are differences in clinical features between the two types of RNFLD in early POAG and NTG.