【摘要】 目的：探讨合并高度近视和非高度近视的原发性开角型青光眼早期视野改变特点及其与视网膜神经纤维层缺损的关系。方法：利用Humphrey750型计算机自动视野计对17例（21眼）合并高度近视的POAG和16例（17眼）非高度近视的POAG及20例（25眼）单纯高度近视以及17例（19眼）正常组进行静态中心阈值视野检查，利用OCT进行视盘周围RNFL厚度检查。比较正常组、合并高度近视POAG组、非高度近视POAG组、单纯高度近视组视野缺损的总偏差概率图；比较正常组、合并高度近视的POAG组、非高度近视的POAG组以及单纯高度近视组的MD值、PSD值、上方、下方、鼻侧、颞侧平均光敏感度；比较正常组、合并高度近视的POAG组、非高度近视的POAG组以及单纯高度近视组的平均、上方、下方、鼻侧、颞侧RNFL厚度；分别分析合并高度近视的POAG组、非高度近视的POAG组以及单纯高度近视组各组内上方、下方、鼻侧、颞侧各象限RNFL厚度与视野对应部位的缺损之间的关系以及各组视野特点。结果：合并高度近视的早期POAG患者在总偏差概率图中多表现为普遍敏感性降低，而在模式偏差概率图则更多表现出POAG早期视野缺损；平均缺损值显著高于其它各组。合并高度近视的POAG患者无论平均光敏感度还是MD、PSD值均与其他三组有显著差异(P＜0.05)；单纯高度近视组与非高度近视的POAG组的各象限平均光敏感度的差异均有显著性（P＜0.05）。合并高度近视的POAG组较非高度近视的POAG组以及单纯高度近视组RNFL厚度明显变薄；此三组较正常组RNFL厚度变薄；单纯高度近视组与非高度近视的POAG组的平均RNFL厚度及各象限RNFL厚度的差异均有显著性（P＜0.05）；各组四个象限RNFL厚度与视野对应部位的缺损相关。结论：在进行合并高度近视的POAG视野结果判定时要依靠模式偏差概率图，其特点是伴有生理盲点扩大和外移。OCT能够反映合并高度近视的POAG的RNFL厚度的改变，及RNFL厚度与视野缺损的相关性有助于在合并高度近视POAG中的临床诊断。
【关键词】 高度近视 原发性开角型青光眼 视野缺损 光学相干断层扫描
INTRODUCTION
Generally it is hard to find obvious symptoms for patients with myopic glaucomatous eyes, especially for those in the early stage. Some of them may suffer from visual deterioration or visual field losing, but those symptoms are usually neglected as the changes of myopia. So evaluating the glaucomatous changes in myopic eyes are difficult because the change in the optic disc and in the visual field can be modified by the myopic change itself, especially in the early stage[1, 2]. To find out the changes of central visual field and retinal structure in primary open angle glaucoma(POAG)with highly myopia, we used Humphrey 750 automated perimeter to test the static central visual fields and optical coherent tomography(OCT) to measure thickness of retinal nerve fiber layer(RNFL).
MATERIALS AND METHODS
Subjects A total of 70 patients 82 eyes with or without highly myopia were recruited from the Department of Ophthalmology of the First Affiliated Hospital of Kunming Medical College. Thirtynine patients 45 eyes were male, thirtyone patients 37 eyes were female. The age of the patients was varied from 15 to 81, with an average of 45±19 years. All participants of the study were divided into four groups: group 1, seventeen patients 21 eyes with POAG and highly myopia (refractive power more than 6.0 diopters, with obvious myopic degeneration in the fundus); group 2, sixteen patients 17 eyes with POAG but without highly myopia; group 3, twenty patients 25 eyes with merely highly myopia; group 4, normal control group with 17 patients 19 eyes (refractive power less than 1.0 diopters). By selection, the four study groups did not vary significantly in age (F＞0.05=14.27), gender(χ2=1.36，P＞0.05) and R/L (χ2=0.75，P＞0.05). Criteria for the diagnosis and strategies of POAG were the criteria commented by Chinese Glaucoma Interest Group in 1987. All the cases that might influence our findings, such as secondary glaucoma, primary retinal and optic nerve diseases, obviously turbid dioptric media, and other general or encephalic diseases were excluded.
Ophthalmic examinations included best corrected visual acuity(BCVA), slit lamp biomicroscopy, evaluation of introcular pressure (IOP) (Goldmann applanation tonometer),measurement of central corneal thickness using ultrasonic pachymetry (Phachymeter SP 2000, Tomey) , ocular biometry using Ascan ultrasonography, and angle of anterior chamber using Goldmann gonioscope and ultrasound biomicroscopy(ParadigmP40, Zeiss).
Table 1 The loss of total sensitivity in total deviation probability imagen（略）
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