微视野计对半侧视野损害的青光眼固视稳定性改变的评估价值

Assessment of microperimetry on fixation stability changes in glaucomatous eyes with hemifield defect

背景研究证实，与传统的视野计相比，微视野计可以发现更微小的青光眼视功能损害，但目前关于青光眼固视功能改变的研究较少。目的比较微视野计Maia与Humphrey视野计检测结果的相关性，探讨Maia微视野计对半侧视野损害的青光眼患者固视稳定性改变的评估价值。方法采用横断面研究设计，纳入2013年12月至2014年3月于北京大学第一医院应用Humphery视野计24-2程序检测为半侧视野缺损的青光眼患者35例35眼，同期纳入正常对照者30人30眼。分别接受Humphery（10-2）和Maia（expert 10-2）检测，分析青光眼患者Humphrey视野检测与Maia微视野计检测的相关性。然后进一步将Humphrey半侧视野正常者分为Maia正常组和Maia异常组，比较青光眼组与正常对照组、Maia正常组与Maia异常组固视稳定性的差异。结果Maia与Humphrey视野计检测的平均光敏感度间呈中度正相关（r=0．403，P=0．001），青光眼患者Maia平均阈值与Humphrey视野平均缺损（MD）值呈中度正相关（r=0．438，P=0．008）。青光眼组和正常对照组固视稳定性参数P1分别为（67±17）％和（87±10）％，P2分别为（70±16）％和（88±9）％，2个组的63％双曲线椭圆面积（BCEA）分别为（5．08±1．55）°2和（2．21±0．60）°2，95％BCEA分别为（14．74±6．04）°2和（2．86±1．17）°2，青光眼组的P1和P2值均明显低于正常对照组，而63％BCEA和95％BCEA值均明显高于正常对照组，差异均有统计学意义（t=-5．604、-4．831、9．885、11．086，均P=0．000）。Maia正常组和Maia异常组P1分别为（79±8）％和（63±17）％，P2分别为（81±10）％和（67±16）％，63％BCEA分别为（3．19±0．65）卵和（5．70±1．22）°2，95％BCEA分别为（9．10±2．60）°2和（19．35±5．01）°2，Maia异常组较Maia正常组P1、P2均明显降低，63％BCEA和95％BCEA均明显增加，差异均有统计学意义（t=-2．468，P=0．019；t=-2．371，P=0．024；t=5．514，P=0．000；t=5．575，P=0．000）。结论Maia微视野计与Humphery视野计在检测青光眼黄斑功能方面具有较好的相关性，Maia微视野计可发现半侧视野损害的青光眼患者固视稳定性下降。

Background Researches showed that microperimetry can exhibit more tiny visual function damage than conventional perimetry in glaucomatous eyes. However,the study on fixation stability of glaucoma is still rare until now. Objective This study was to compare the correlation between microperimetry Main （Macular Integrity Assessment） and Humphrey perimetry,and to investigate the changes of the fixation stability in glaucoma patients with hemifield defect. Methods This study proposal was approved by Medical Ethic Committee of Peking University First Hospital. A cross-sectional study was performed under the informed consent of each subject. Thirty-five eyes of 35 glaucoma patients with hemifield defect by 24-2 Humphrey perimetry were included in Peking University First Hospital from December 2013 to March 2014,and 30 eyes of 30 normal volunteers served as controls. Both Humphery （10-2） and Maia （expert 10-2） were performed on the subjects respectively and the correlation of the results between Humphery （10-2） and Maia（ expert 10-2） were analyzed. Then the patients with normal hemifield on Humphrey were assigned to Maia normal group and Maia abnormal group. Fixation stability differences were compared between glaucoma group and normal control group, and between Maia normal group and Maia abnormal group. Results The moderately positive correlation was found in the mean sensitivity between Maia microperimetry and Humphrey perimetry （r= 0. 403, P = 0. 001 ） , and the average threshold of Maia microperimetry was moderately positive correlated with the mean defect （MD） of Humphrey perimetry in glaucoma patients （r= 0. 438, P= 0. 008）. The fixation stability parameter P1 was （67±17）% and （87±10）% ,and that of P2 was （70±16）% and （88±9）% ; the 63% bicurve elipse area （BCEA） was （5.08±1.55）°2 and （2.21±0.60）°2 ,and the 95% BCEA was （14.74±6. 04）°2 and （2.86 ±1.17）°2 in the glaucoma group and normal control group, respectively, showing significant decreases of P1 and P2 and increases of 63% BCEA and 95% BCEA in the glaucoma group compared with the normal control group （t =-5.604,-4.831,9.885,11.086,all at P=0. 000）. In Maia normal group and Maia abnormal group,the P1 was （79±8）% and （63±17）% ,the P2 was （81±10）% and （67±16）% ,the 63% BCEA was （3. 19±0.65）°2 and （5.70±1.22）°2 and the 95% BCEA was （9. 10±2.60）°2 and （19.35±5.01）°2, respectively. Compared with the Maia normal group,the P1 and P2 were significantly lower, and 63% BCEA and 95 % BCEA were higher in the Maia abnormal group （t=-2.468,P=0.019;t=-2.371 ,P=0. 024;t=5. 514,P=0.000; t= 5. 575 ,P= 0. 000）. Conclusions Maia microperimetry and Humphrey perimetry yield a good correlation for glaueomatous macular function examination. In addition, Maia microperimetry showed that fixation stability decreased in glaucoma patients with hemifield defect.