【摘要】 青光眼是进行性视网膜神经节细胞（retinal ganglion cells，RGCs）丢失引起视神经乳头及视野特征性改变的一组疾病，最终将导致不可逆视功能损害。早期诊断是疾病早期治疗使进行性视功能损害停止或延缓的关键。近年来出现的视神经结构检查及视神经功能检查方法与传统视野检查相比，可提高原发性开角型青光眼（primary open angle glaucoma，POAG）的早期诊断率。不同检查的联合应用可提高诊断的敏感性，在临床应用中可以根据敏感度及特异度的要求来选择相应的结构或功能检查方法。
【关键词】 原发性开角型青光眼；早期诊断；视神经结构检查；视功能检查
Early diagnosis of primary open angle glaucoma
Wei Jia, ShiSheng Zhang, Ling Wang
Foundation item:Supported by Shanghai Leading Academic Discipline Project（No.S30205）
Department of Ophthalmology, Ruijin Hospital Affiliated to Medical College of Shanghai Jiaotong University, Shanghai 200025, China
Abstract
Glaucoma is characterized by a progressive loss of retinal ganglion cells producing characteristic optic nerve head and visual field defects, which may eventually develop into irreversible visual functional defects. Early diagnosis is the key to treating the disease at an early stage to stop or delay the progression of visual functional defects. New technologies, including optic nerve and nerve fiber layer structural tests and visual functional tests, increased the diagnosis rate of primary open angle glaucoma at an early stage with comparion the classical standard automated perimetry. A combination of parameters from structural tests and functional tests can improve the sensitivity of glaucoma detection. The sensitivity and specificity desired for a particular clinical application will determine the selection of the particular diagnostic tests.
KEYWORDS: primary open angle glaucoma; early diagnosis; optic nerve structural tests; visual functional tests
0引言
青光眼是一组以进行性视网膜神经节细胞（retinal ganglion cells，RGCs）及其轴突的丢失为特征的不可逆性视神经病变，临床表现为视盘及视野的特征性改变［1］。目前对于青光眼的研究有以下3点共识：青光眼的早期诊断及病程进展的监测是眼科医师当前面临的主要挑战；结构与功能的检查对于青光眼的早期诊断及随访都是相当重要的；在视野缺损发现之前可能已经出现明显的RGCs的损害。原发性开角型青光眼（primary open angle glaucoma，POAG）因无明显自觉症状，不易被早期发现，因此对其的早期诊断显得尤为重要。我们就近年来常用的青光眼诊断与随访的结构及功能检查方法在POAG早期诊断中的应用作一综述。
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