青光眼视神经病变而自动视野计检查正常的患者身心和结构损害的检测

Objective: To compare the prevalence of structural and psychophysical abnormalities in normal eyes and eyes with glaucomatous optic neuropathy (GON) and normal standard automated perimetry (SAP). Methods: Complete examination,SAP,short-wavelength automated perimetry (SWAP),frequency doubling technology (FDT),scanning laser polarimetry (GDx-VCC),and optical coherence tomography (OCT) of the peripapillary retinal nerve fiber layer (RNFL),optic disc,and macula were performed. Glaucomatous optic neuropathy was defined as cup-disc asymmetry between fellow eyes of greater than 0.2,rim thinning,notching,excavation,or RNFL defect. All eyes had normal SAP. Abnormal measurements on OCT,GDx-VCC,SWAP,and FDT were defined as those outside 95% normal limits. Eyes were stratified into 3 groups based on the OCT-generated vertical cup-disc ratio: mild,moderate,and advanced cupping (cup-disc ratio of < 0.4,0.4-0.7,and >0.7,respectively). Receiver operating characteristic curves were developed to assess sensitivity and specificity of structural and functional assessments. Results: Forty-seven eyes of 47patients (25 with GON and 22 normal) were enrolled (mean± SD age,58± 16 years; range,25-83 years). Compared with normal eyes,eyes with GON had significantly worse mean deviation and pattern standard deviation by means of SWAP and FDT (P=.02-.05); OCT-derived mean and superior and inferior RNFL thickness (P=.008,< .001,and .05,respectively); mean macular thickness (P=.01),rim volume,rim area,cup-disc ratio,and cup area (all P< .001); and GDx-VCC nerve fiber indicator and inferior average (P=.03). There was a significantly (P=.008,.002,.003,and .01,respectively) greater prevalence of abnormalities identified by SWAP,FDT,OCT and GDx-VCC in eyes with advanced cupping (43% ,43% ,57% ,and 57% ,respectively) compared with mild cupping (0% ) and moderate cupping (9% ,5% ,19% ,and 33% ,respectively). Conclusions: Eyes with GON and normal results of SAP have significantly greater structural and psychophysical abnormalities than do normal eyes evaluated by means of OCT,GDx-VCC,SWAP,and FDT. Eyes with increased vertical cup-disc ratio are more likely to manifest such abnormalities on advanced diagnostic testing.

血流研究和血清学实验评价青光眼的诊断:一项先导性研究

BACKGROUND AND OBJECTIVE: To evaluate the prevalence of hemodynamically signif icant carotid artery stenosis, peripapillary blood flow, and serologic abnormali ties in a pilot study among patients with glaucoma. PATIENTS AND METHODS:All sub jects underwent complete eye examination, standard automated perimetry, carotid Doppler ultrasonography, serum laboratory testing, and scanning laser Doppler fl owmetry (SLDF). Subjects were subdivided into two groups based on glaucoma subty pe (normal-tension vs primary openangle glaucoma) and severity (mild vs moderat e-advanced). RESULTS: Twenty eyes of 20 patients with associated glaucomatous v isual field loss were enrolled. No significant differences in age, gender, intra ocular pressure, systemic comorbidity, number of antiglaucoma medications, and p rior filtration surgery were observed between the groups based on the type and s everity of glaucoma. The prevalence of clinically significant (>70%) carotid st enosis, mean peripapillary blood flow assessed by SLDF, mean erythrocyte sedimen tation rate, mean hematocrit, mean hemoglobin, and positive FTA-ABS was similar in both groups. Severity of glaucomatous damage as determined by visual field m ean defect did not correlate with the degree of carotid artery stenosis (R2< 0.0 001, P = 0.99) or peripapillary blood flow derived from mean SLDF (R2=0.000 5, P =0.92). CONCLUSION: Data from this pilot study demonstrate that the prevalence o f hemodynamically significant carotid stenosis, peripapillary blood flow, and se rologic abnormalities are similar in patients with normal-tension and primary o pen-angle glaucoma, and do not correlate with glaucoma severity.

可调节角膜补偿的扫描激光偏振测量法对不典型双折射图像的定量评估

PURPOSE: To define the clinical characteristics of atypical birefringence imag es and to describe a quantitative method for their identification. DESIGN: Prosp ective, comparative, clinical observational study.METHODS: Normal and glaucomato us eyes underwent complete examination, standard automated perimetry, scanning l aser polarimetry with variable corneal compensation (GDx-VCC), and optical cohe rence tomography (OCT) of the macula, peripapillary retinal nerve fiber layer (R NFL), and optic disk. Eyes were classified into two groups: normal birefringence pattern (NBP) and atypical birefringence pattern (ABP). Clinical, functional, a nd structural characteristics were assessed separately. A multiple logistic regr ession model was used to predict eyes with ABP on the basis of a quantitative sc an score generated by a support vector machine (SVM) with GDx-VCC.RESULTS: Sixt y-five eyes of 65 patients were enrolled. ABP images were observed in 5 of 20 ( 25%) normal eyes and 23 of 45 (51%) glaucomatous eyes. Compared with eyes with NBP, glaucomatous eyes with ABP demonstrated significantly lower SVM scores (P< .0001,< 0.0001, 0.008, 0.03, and 0.03, respectively) and greater temporal, mean , inferior, and nasal RNFL thickness using GDx-VCC; and a weaker correlation wi th OCT generated RNFL thickness (R2=.75 vs. 27). ABP images were significantly c orrelated with older age (R2=.16, P=.001). The SVM score was the only significan t (P< .0001) predictor of ABP images and provided high discriminating power betw een eyes with NBP and ABP (area under the receiver operator characteristic curve =0.98). CONCLUSIONS: ABP images exist in a subset of normal and glaucomatous eye s, are associated with older patient age, and produce an artifactual increase in RNFL thickness using GDx-VCC. The SVM score is highly predictive of ABP images .