原发性急性闭角型青光眼患者视神经的评估

Evaluation of optic nerve in patients with acute primary angle-closure glaucoma

目的:检测原发性急性闭角型青光眼患者视神经的形态及功能变化来评估视神经的损害情况。方法:对28例原发性急性闭角型青光眼患者行眼底照像、视野、视神经OCT扫描、图形视觉诱发电位等检查结果阳性率进行分析。结果:患者28例28眼中,能获取视神经图像25眼(89%),25眼中视盘颜色:正常9眼,充血水肿16眼,未出现苍白;C/D:<0.6者5眼,>0.6者1眼,不能分辨的有19眼;盘沿情况:正常6眼,不能分辨的有19眼;无法获取视神经图像3眼(11%)。视野检查:正常9眼(32%),出现视野损害的2眼(7%),因白内障视野检测无参考意义8眼(29%),假阳性率≥15%的2眼(7%),不能配合检查7眼(25%)。OCT视盘周围视网膜神经纤维层厚度检查:能测量的26眼(93%),其中神经纤维层厚度正常24眼,神经纤维层厚度局部变薄2眼。屈光间质严重混浊不能测量2眼(7%);P-VEP检查中P100波峰时正常的18眼(64%),峰时延长的10眼(36%)。P100波振幅正常的11眼(39%),振幅降低的17眼(61%)。结论:原发性急性闭角型青光眼急性大发作后视神经并不出现典型的青光眼损害,部分表现视盘充血水肿,对于视神经评估需要主观和客观检查进行综合评估,目前还没有更精确的一种评估方法。

AIM:To evaluate the damage to optic nerve by detecting the morphological and functional changes of optic nerve in patients with acute primary angle-closure glaucoma.METHODS:The correlation among the positive rates of fundus photography,visual field examination,optical coherence tomography(OCT)scan of the optic nerve,and pattern visual evoked potentials(P-VEP)were analyzed in 28 patients with acute primary angle-closure glaucoma affecting.RESULTS:Among 28 eyes of 28 patients,optic nerve images were obtained in 25 eyes(89%),optic disc color in 25 eyes:there were 9 normal eyes and 16 eyes with congestion and edema,without pallor;C/D:<0.6 in 5 eyes,>0.6 in 1 eye,and indistinguishable in 19 eyes;disk edge:6 eyes were normal,and 19 eyes could not be distinguished.Optic nerve images could not be obtained in 3 eyes(11%).Visual field examination:9 eyes(32%)were normal,2 eyes(7%)had visual field damage,8 eyes(29%)had no reference value due to cataract visual field examination,2 eyes(7%)had false positive rate≥15%,and 7 eyes(25%)could not cooperate with the examination.The retinal nerve fiber layer thickness around optic disc was measured by OCT in 26 eyes(93%),of which the thickness of nerve fiber layer was normal in 24 eyes and local thinning in 2 eyes.Severe opacification of refractive stroma could not be measured in 2 eyes(7%).PVEP showed that the peak of P100 was normal in 18 eyes(64%)and prolonged in 10 eyes(36%).The amplitude of P100 wave was normal in 11 eyes(39%)and decreased in 17 eyes(61%).CONCLUSION:After a major acute attack of primary angle-closure glaucoma,the optic nerve does not exhibit typical glaucomatous damage but may present with optic disc congestion and edema.Therefore,a comprehensive evaluation combining subjective and objective examination methods is necessary for optic nerve assessment,and currently,no more precise assessment method is available.