动静态自动组合的视野检查法:神经性眼病和青光眼标准视野检查法的替代方法

Objectives:To create a fully automated,combined perimetry program consisting of a static examination and a kinetic examination,and to compare the results of this test with standard static and kinetic visual fields(VFs).Methods:Fifty-six patients(74 eyes)undergoing neuroophthalmic or glaucoma evaluationwho had standard static or kinetic perimetry examinations underwent the combined perimetry test.This automated,combined test,performed on the Octopus 101 perimeter,consisted of a static tendency-oriented perimetry examination and a preprogrammed kinetic examination.Three masked physician reviewers independently classified all of the VFs.The VF pairs were considered a match if the consensus descriptions of the standard and combined VFs matched.Results:Thirty seven eyes underwent evaluation for neuroophthalmic disease(comparison standard test,20 static and 17 kinetic)and 37 for glaucoma(comparison standard test,17 static and 20 kinetic).The VP pairs matched in 32 eyes(86%)in the neuroophthalmic group and 28(76%)in the glaucoma group.On inspection by a fourth reviewer,many of the nonmatching VF pairs were those for which a consensus was not reached,but still conveyed similar information.Two glaucomatous eyes demonstrated central scotomata not delineated by the combined examination findings.Two subtle nasal steps were detected solely by the combined examination.The combined test ranged in time from 6 to 12 minutes per eye.Conclusions:The Octopus 101 perimeter can be used to create an automated test that combines the advantages of static and kinetic perimetry and produces equivalent results while not requiring examiner expertise.

Octopus101GKP动静态自动视野计在原发性开角型青光眼诊断中的应用

目的评估Octopus101 GKP动静态自动视野计在原发性开角型青光眼（POAG）诊断中的应用价值。方法 对2006年10月-2007年3月在我院门诊确诊的30例POAG患者及34例正常人分别进行Octopus101GKP动静态自动视野计的GKP及TOP程序的检查。分析比较这两组受试者的视力、眼压、眼底C／D值及联合检查所得的平均缺陷度（MD）、丢失方差（LV）、不同视标参数下等视线的面积和检查时间等参数。结果 POAG组的平均视力、平均眼压和眼底平均C／D值与正常对照组相比差异均有显著性（P均=0．000）；两组的眼压（IOP）与平均缺陷度及等视线面积均无相关性；Ⅲ4e与Ⅰ2e两种不同的视标参数对POAG患者检出的等视线面积差异有显著性（P=0．000）；POAG组的平均检查时间为（307．78±134．50）s，明显高于正常对照组的（228．12±75．33）s（P=0．001）；正常对照组静态视野检查所得的平均缺陷度和丢失方差明显小于POAG组（P均=0．000）；静态视野检查的敏感性为80％，特异性为45％；动态视野检查的敏感性为86％，特异性为63％；两者联合检查敏感性为90％。结论 Octopus101GKP动静态自动视野计可同时完成静态及动态视野检查，通过反应时间减少个体差异，提高检查结果的准确性；同时还可通过改变视标大小、背景光明暗、视标移动速度提高POAG早期缺损检出的可能性，大大提高了POAG检出的敏感性，对于一些早期有小的周边缺损的患者更具优势。

儿童视野检查面临的困难及研究进展

视野检查是眼科疾病诊断和治疗的一种十分重要的检测工具,但对于儿童,由于各方面限制因素,如配合度差、理解力弱等,进行视野检查、获取可靠的视野结果仍是一项十分严峻的挑战。国际上用于儿童视野检查的方法各式各样,如基于成人设计的视野检查,包括静态视野检查法、动态视野检查法、应用新的检测策略,以及目前专门针对各种无法顺利进行视野检查的儿童设计的先进检查技术。目前针对儿童设计的视野检查方法从保持儿童固视、提高专注力、减少检查时间等方面进行了改善,使儿童能够更好地配合及完成视野检查,及时识别视野缺损;针对正常儿童、婴儿以及有认知障碍的儿童应采取不同的检查方法、算法以及进行大样本数据收集以获取可靠视野结果。本文就近年来儿童视野检查的各种方法进行综述,剖析不同方法的优缺点,为临床及研究中提高检查准确性、获取更可靠的视野结果提供帮助,促进研究者们针对儿童视野检查方法进行更多的研究,以期在此基础上有新的突破。

中央角膜厚度与青光眼患者视野及视盘损害进展的相关性研究

Aims: To determine whether central corneal thickness (CCT) is a significant pr edictor of visual field and optic disc progression in open angle glaucoma. Metho ds: Data were obtained from a prospective study of glaucoma patients tested with static automated perimetry and confocal scanning laser tomography every 6 month s. Progression was determined using a trend based approach called evidence of ch ange (EOC) analysis in which sectoral ordinal scores based on the significance o f regression coefficients of visual field pattern deviation and neuroretinal rim area over time are summed. Visual field progression was also determined using t he event based glaucoma change probability (GCP) analysis using both total and p attern deviation. Results: The sample contained 101 eyes of 54 patients (mean (S D) age 56.5 (9.8) years) with a mean follow up of 9.2 (0.7) years and 20.7 (2.3) sets of examinations every 6 months. Lower CCT was associated with worse baseli ne visual fields and lower mean IOP in the follow up. In the longitudinal analys is CCT was not correlated with the EOC scores for visual field or optic disc cha nge. In the GCP analyses, there was a tendency for groups classified as progress ing to have lower CCT compared to nonprogressing groups. In a multivariate analy ses accounting for IOP, the opposite was found, whereby higher CCT was associate d with visual field progression. None of the independent factors were predictive of optic disc progression. Conclusions: In this cohort of patients with establi shed glaucoma, CCT was not a useful index in the risk assessment of visual field and optic disc progression.

通过限制精氨酸饮食延缓回旋状萎缩患者的视力下降

目的：对所有年龄组视网膜和脉络膜回旋状萎缩的患者，量化通过坚持限制精氨酸饮食长期降低血浆鸟氨酸水平对视功能的影响。 方法：对27例回旋状萎缩患者进行长期观察研究，其中17例遵守了限制精氨酸饮食而另外10例没能遵守。我们进行了视网膜电流图反应的平均变化率、视网膜电流图闪光反应以及动态和静态视野检查。

Octopus 101型视野计在检测缺血性视神经病变中的观察

目的 评价Octopus 101型自动视野计动态和静态程序在检查前部缺血性视神经病变（MON）中各自的优缺点,探讨两种视野检查方法在AION疾病中的临床应用价值.方法 对2006年6月至2008年9月经北京协和医院门诊确诊的45例MON患者进行Octopus自动视野计动态视野检查和中心30°及周边60°静态自动视野的检查.分析比较患者静态程序中的平均缺陷度（MD）、丢失方差（LV）、动态程序中不同视标参数下等视线的面积及反应延迟时间（RT）及其与年龄的相关性等.结果 AION可出现各种与视神经相关的视野缺损,较常见的有鼻侧缺损（25%）、下半偏盲（20.83%）和盲点相连的下方束状缺损（20.83%）,动态视野检查有不同程度的等视线内陷,Ⅲ-4e与Ⅰ-2e两种不同的视标对MON患者检出的等视线面积差异有统计学意义（P＜0.01）;Ⅰ-2e视标更多地发现了周边视野的缺损.结论 Octopus 101自动视野计可以在同一视野计上先后完成静态及动态视野的检查.临床上对于可能既累及中心30°,又累及周边视野的如AION等疾病,有必要联合动、静态视野检查法,以更准确地捕捉到30°视野范围内的暗点及周边视野的压陷,且能最大限度地发挥了检查视标标准化、检查结果量化的优势.