正常眼压性青光眼与高眼压性青光眼视神经图像分析的对比研究

Assessment of optic disc and retinal nerve fiber layer in normal-tension glaucoma and high-tension glaucoma patients

目的 探讨正常眼压性青光眼 (normal- tension glaucoma,NTG)与高眼压性青光眼 (high-tension glaucoma,HTG)视盘和视神经纤维层 (retinal nerve fiber layer,RNFL )损害的差异。 方法 选择具有青光眼性视神经损害或 RNFL 缺损、相应的视野缺损的青光眼患者 ,NTG至少 2次 2 4 h眼压曲线和多次眼压测量均≤ 2 1mm Hg(1mm Hg=0 .133k Pa) ,HTG的眼压至少 2次测量≥ 2 5 mm Hg。患者进行详细的眼科检查 ,同时用扫描激光偏振仪 (scanning laser polarimetry,SL P)、光学相干断层扫描 (opticalcoherence tomography,OCT)和海德堡视网膜成像仪 (Heidelberg retinal tomography,HRT)定量测定视盘形态和 RNFL厚度。比较两组视盘总体和相同象限测量参数。 结果 30例 NTG和 19例 HTG (共 4 9只眼 )患者的平均年龄分别为 (5 9.6± 8.6 )岁 (39～ 71岁 )和 (5 9.2± 12 .3)岁 (36～ 75岁 )。两组间视野缺损的平均偏差 (mean deviation,MD)差异不显著 (P>0 .0 5 )。HRT测量的视盘 C/ D面积比 ,除鼻侧象限外 ,NTG者视盘总体和上、下、颞侧 3个象限均显著大于 HTG者 (P<0 .0 5 ) ,而盘缘面积小于 HTG者 (P<0 .0 5 ) ;两组间其他视盘参数差异不显著。 3种激光扫描技术所测定的总体和象限 RNFL厚度 。

Purpose To evaluate differences in the pattern of optic disc and retinal nerve fiber layer (RNFL) damage in normal tension glaucoma (NTG) and high tension glaucoma (HTG) patients. Methods We enrolled 49 eyes of 49 patients:30 NTG (IOP≤21 mm Hg,1 mm Hg=0.133 kPa), 19 HTG(IOP≥25 mm Hg). Mean age was 59.2±12.3 (range, 36-75) for HTG patients, and 59.6±8.6(range, 39-71) for NTG patients. All patients underwent complete ophthalmic examination, achromatic automated perimetry (AAP), scanning laser ophthalmoscopy (SLO), scanning laser polarimetry (SLP), optical coherence tomography (OCT) and Heidelberg retinal tomography (HRT). All patients had glaucomatous optic nerve damage and abnormal AAP. Results There were no differences in mean deviation on AAP between NTG and HTG eyes ( P =0.37), while the corrected pattern standard deviation was larger in NTG than in HTG eyes ( P =0.014). Cup∶disc area ratios in global ( P =0.03) and three sectors ( P <0 05) except nasal sector were significantly larger in the NTG group, whereas rim area in global ( P =0.03) and three sectors ( P <0.05) except nasal quadrant obtained by SLO were smaller in NTG than in HTG eyes. The other numerical parameters obtained by three imaging technologies could not detect differences in the optic disc or RNFL anatomy between the two groups. Conclusions Cup∶disc area ratio was larger in patients with NTG than in those with HTG, whereas significant thinning of rim was associated with NTG eyes. The measurement of retinal nerve layer thickness in global and each quadrant was similar between two groups. More focal or segmental analysis of the data contained within SLO, SLP and OCT images are needed to detect localized differences in eyes with varying levels of IOP.