急性原发性闭角型青光眼不同病程视野损害特点及影响因素

Visual Field Characteristics and the Factors That Affect Them in Different Stages of Acute Primary Angle Closure Glaucoma

目的：探讨急性原发性闭角型青光眼（APACG）不同病程视野损害的特点及其影响因素。方法：病例对照研究。连续收集2015年9月至2016年9月于中山大学中山眼科中心确诊为APACG的患者。根据临床特征将患眼分为临床前期组、药物缓解期组、慢性期组，根据APACG急性发作持续时间将药物缓解期组及慢性期组患者分为急性发作持续时间7 d以内组及7 d以上组。选择同期在门诊体检者中年龄、性别相匹配的健康成年人作为正常对照组。记录所有对象临床特征，使用Humphrey 750型视野分析仪30-2 SITA-Standard标准阈值程序进行视野检查。比较各组间临床特征和视野检查结果，并分析眼压、杯盘比（C/D）、房角粘闭范围、急性发作时最高眼压、急性发作持续时间与视野平均偏差（MD）、视野指数（VFI）、模式标准差（PSD）等的相关性。采用卡方检验、独立样本t检验、方差分析、秩和检验及Spearman相关分析进行数据分析。结果：共纳入正常对照组20例（20眼），APACG患者74例（74眼），其中临床前期组24例，药物缓解期组28例，慢性期组22例。4组间VFI值和MD值总体差异有统计学意义（F=60.588、61.018，P 〈 0.001），组间两两比较发现慢性期组MD值和VFI值显著小于其他3组（P 〈 0.008），药物缓解期组MD值和VFI值显著小于正常对照组（P 〈 0.008）。4 组间PSD值总体差异有统计学意义（F=60.022，P 〈 0.001），组间两两比较发现慢性期组的PSD值均显著大于其他3组（P 〈 0.008），临床前期组和药物缓解期组PSD值均显著大于正常对照组（P 〈 0.008）。药物缓解期组MD值、VFI值与急性发作持续时间均呈中度负相关（r=-0.653，P 〈 0.001；r=-0.547，P=0.003），PSD值与急性发作持续时间呈中度正相关（r=0.579，P=0.001）；慢性期组MD值、VFI值与急性发作持续时间呈中度负相关（r=-0.441，P=0.044；r=-0.531，P=0.011），与C/D呈中度负相关（r=-0.632，P=0.002；r=-0.633，P=0.002）。药物缓解期组急性发作持续时间7 d以内者的MD值和VFI值均大于急性发作持续时间7 d以上者（Z=-2.998，P=0.003；Z=-2.639，P=0.008）。结论：APACG急性发作后，药物缓解期组和慢性期组存在视野损害，且慢性期组视野损害较重。视野损害主要与急性发作持续时间有关。

Objective： To investigate the characteristics of visual field defects in different stages of acute primary angle／ closure glaucoma （APACG） and determine the factors that affect them. Methods： Patients with APACG were consecutively recruited in this case-control study from September 2015 to September 2016. Accordingto the clinical features, the affected eyes were staged into three groups： preclinical, remission, and chronic. Age- and gender-matched healthy adults were included as normal controls. The clinical data of all subjects were recorded, and visual field tests using the Humphrey Ⅱ 750 perimeter with 30-2 SITA-Standard full threshold strategy were performed in all subjects. The clinical and visual field data of all groups, including mean deviation of visual field （MD）, visual field index （VFI） and pattern standard deviation of visual field （PSD） were compared and correlations among them were explored. The data were analyzed by Pearson correlation, Chi-square test, independent samples t test, ANOVA, Kruskal-Wallis test. Results： Twenty normal controls （20 eyes） and 74 APACG patients （74 eyes） were recruited. Among APACG patients,24 were in the preclinical group, 28 were in the remission group, and 22 were in the chronic group. There were no significant differences in age or gender among the four groups. Comparisons of MD and VFI of all groups showed that the MD and VFI of chronic group were the worst among all groups （P〈0.008）, and the MD and VFI of remission group were significantly worse than the normal controls （P〈0.008）. Comparison of PSD of all groups showed that the PSD of chronic group was the largest among all groups （P〈0.008）, and the PSD of remission group and preclinical group were larger than the normal controls （P〈0.008）. The MD and VFI of the remission group were negatively correlated with duration of the acute attacks （r=-0.653,P〈0.001; r=-0.547, P=0.003）, while PSD was positively correlated with duration of the acute attacks（r=0.579, P=0.001）. The MD and VFI of the chronic group were negatively correlated with the duration of acute attacks （r=-0.441, P=0.044; r=-0.531, P=0.011） and the cup to disc ratio （r=-0.632, P=0.002;r=-0.633, P=0.002）. The MDs and VFIs in the remission group in which the duration of the acute attacks lasted less than 7 days were better than those in which the attacks lasted more than 7 days （Z=-2.998,P=0.003; Z=-2.639, P=0.008）. Conclusions： Visual field defects can occur after APACG attacks, and the severity of the defects was associated with duration of the attacks. Shortening the duration of acute attackscould reduce visual field defects.