【摘要】 目的：分析海德堡视网膜断层扫描仪II（HRTII）和Humphrey视野计检查平均视野缺损（mean defect, MD）间的相关性及其临床价值。 方法：闭角型青光眼患者69例117眼，按照国际闭角型青光眼分类法分为可疑原发性房角关闭（primary angleclosure suspect, PACS）38眼，原发性前房角关闭（Primary angleclosure, PAC）53眼和原发性闭角型青光眼（primary angleclosure glaucoma, PACG）26眼，利用HRTⅡ和Humphrey视野计检查正常人30例60眼和各类闭角型青光眼患者的视盘形态、视网膜神经纤维层（RNFL）厚度和视野，获得视杯面积、视盘面积、盘沿面积、视杯容积、盘沿容积、杯盘面积比、线性杯盘比、平均视杯深度、最大视杯深度、视杯形态测量、视杯高度变异轮廓、平均视网膜神经纤维层厚度、视神经纤维层横截面积和MD等参数，对比分析正常人和各类闭角型青光眼患者之间的各参数的差异。并将各类闭角型青光眼的HRTⅡ的各参数与MD进行相关性分析。 结果：HRTⅡ和Humphrey视野计检测对照组与PACS、PAC和PACG 4组间各视盘参数和MD差异具有统计学意义(P<0.01)。对照组中LCD和MD呈直线相关，PACS组中DA、CA和MD呈直线相关，PAC中CA，RA，CV，CDAR，HVC和MD呈直线相关。经逐步回归筛选的变量中，CV和HVC是其中2个有意义的参数，PAC组中CV和HVC与MD之间的Pearson相关系数为0.290和0.301，得出CV和HVC与MD之间回归方程：Y=4.475 X1+5.338 X2 0.480 (Y表示MD，X1表示CV，X2表示HVC)。结论：HRTII和Humphrey视野检查参数在新的闭角型青光眼分类具有一定的临床价值，MD与CV和HVC相互参照分析有助于判断闭角型青光眼的发展。
【关键词】 原发性闭角型青光眼；视野；视盘；视网膜神经纤维层；参数
Clinical analysis of the parameters detected by HRTⅡ and Humphrey perimetry in the new international classification of angleclosure glaucoma
XinGuang Yang1, Bin Guo2, Zhao Liu3, JingNi Yu1, Pei Li1, JianRong Liu1, HanMin Li1, QianLi Ma1
Foundation item: Health Department Research Foundation of Shaanxi Province, China (No.06D17)
1 Shaanxi Ophthalmic Medical Center, the Fourth Hospital of Xian City, Xian 710004, Shaanxi Province, China; 2 Department of Ophthalmology, No.81 Hospital of PLA, Nanjing 210002, Jiangsu Province, China; 3 College of Medicine, Xian Jiaotong University, Xian 710061, Shaanxi Province, China
AbstractAIM: To study the visual field defects with Humphrey perimetry and the optic disc parameters of HRT in patients classified with the international angleclosure glaucoma classification, and to analyze the relationship among the HRTII parameters and mean defect (MD).
METHODS: Totally 117 eyes of 69 patients were divided into 3 groups: primary angleclosure suspect (PACS, 38 eyes), primary angleclosure (PAC, 53 eyes) and primary angleclosure glaucoma (PACG, 26 eyes) according to the international angleclosure glaucoma classification method. Sixty eyes of 30 volunteers without eye diseases and the above 117 eyes were examined by HRTⅡ and Humphrey Field Analyzer, and cup area (CA), disk area (DA), rim area (RA), cup volume (CV), rim volume (RV), cup/disk area ratio (CDAR), linear cup/disk ratio (LCDR), mean cup depth (MCD), maximum cup depth (max CD), cup shape measure (CSM), height variation contour (HVC), mean RNFL thickness (MRNFLT), RNFL cross sectional area (RCSA) and mean defect (MD) values were obtained from the report papers. The differences of parameters between normal eyes and glaucoma eyes in 3 groups and the relationship among MD and HRTⅡparameters in each group were analyzed with statistic software.
RESULTS: Among the normal volunteer group and PACS, PAC, PACG group, there were significant differences of parameters of HRTⅡ and MD value of Humphrey perimetry (P<0.01). The regression analysis showed that a linear relationship existed between LCD and MD in normal eyes, among DA, CA and MD in PACS group, and among CA, RA, CV, CDAR, HVC and MD in PAC group. With a multiple sieving stepwise regression method, CV and HVC were selected for 2 variables in the regression equation. The Pearson correlation coefficients between CV, HVC and MD were 0.290 and 0.301 in PAC group, respectively, and the regression equation was Y=4.475 X1+5.338 X2 0.480, where Y was MD, X1 was CV and X2 was HVC.
CONCLUSION: There are clinical values of HRTII and Humphrey perimetry in the new international classification of angleclosure glaucoma, and the crossreference analysis between MD and CV, HVC may be helpful to evaluate the development of PACG.
KEYWORDS: primary angleclosure glaucoma; visual field; optic disc; retinal nerve fibre layer; parameter
Yang XG, Guo B, Liu Z, et al. Clinical analysis of the parameters detected by HRTⅡ and Humphrey perimetry in the new international classification of angleclosure glaucoma. Int J Ophthalmol(Guoji
Yanke Zazhi)2008;8(11):22392243
0引言
原发性闭角型青光眼（primary angle closure glaucoma, PACG）已成为不可逆性致盲性眼病的重要原因之一，由于我国人种的差异和眼球解剖结构的因素造成PACG的发生率较高，闭角型青光眼与开角型青光眼的比例约为3.7∶1，PACG致盲率为30.7％，其中有90%为治疗不及时或治疗不当所致[15]。我国眼科学界传统的将PACG分为急性和慢性两大类，前者又分为临床前期、前驱期、急性发作期、慢性期及绝对期。但是由于临床中有很多病例缺乏详细的前期病史和相关临床资料，所以对该病具体分类的临床实践和研究缺乏可操作性，需要有一种新的PACG分类方法[6 8]。Foster等[9]提出了原发性闭角型青光眼的ISGEO（国际地域性和眼科流行病学组）分类系统，将PACG分为可疑原发性房角关闭(primary angleclosure suspect, PACS）、原发性前房角关闭（primary angleclosure, PAC）和PACG。这种新的分类和定义指导临床预防和治疗闭角型青光眼已越来越显示出其简洁和可操作性的优点[7, 8, 10]，临床上所谓的PACG早期干预和可疑青光眼实际中没有具体定义，但主要为PACS和PAC。新的分类方法更加强调了青光眼性视神经乳头改变和视网膜神经纤维层在分类中的作用，简化了以往基于PACG症状和不同机制分类的复杂性，并与传统的分类方法有一定的对应，对指导临床闭角型青光眼的预防和处理有积极的意义。我们对这3类PACG患者和对照眼进行海德堡视网膜断层扫描仪II(HRTII)视乳头分析和Humphrey视野检查分析，探讨其在国际新的闭角型青光眼分类诊断中的价值。
1对象和方法
1.1 对象 对照组为未查出眼病的体检人员30例60眼，女13例26眼，男17例34眼；实验组为2007 01/2008 03青光眼患者69例117眼，男26例46眼，女43例71眼，年龄57.7±13.8岁。其中PACS组38眼，PAC组53眼和PACG组26眼。对照组纳入标准：(1)18岁以上；(2)双眼最佳矫正视力≥0.5；(3)双眼屈光度球镜6.00～+6.00D，屈光参差<3.00D；(4)除屈光不正外无其他眼病；(5)双眼眼压均<21mmHg，双眼C/D<0.3且双眼差值<0.2；(6)标准自动静态视野检查正常MD≤1dB且无青光眼视野改变特征(固视丢失率<20%、假阳性率<33%)。排除标准：(1)有糖尿病史或控制不佳的高血压病史；(2)有青光眼家族史；(3)具有如下1个或多个视野表现：视野检查结果不可靠(假阳性率>33%，固视丢失率>20%)；或视盘有出血、盘沿切迹或盘沿变窄，视盘周围有视网膜脉络膜萎缩区；或双眼C/D比值差0.2以上；(4)伴有其他活动性眼病；(5)先天性眼部异常；(6)曾行内眼手术(包括白内障)；(7)曾行视网膜手术(包括外垫压及视网膜光凝)。ISGEO分类诊断标准：(1)PACS指前房角隐窝处房角宽度为原发性异常狭窄的眼，其周边部虹膜的位置接近于但未接触到后部色素小梁网;(2）PAC指具有解剖的窄前房角和已有周边虹膜阻塞小梁网的体征，如虹膜周边前粘连、眼压升高、虹膜节段状萎缩、晶状体青光眼斑等;(3）PACG指PAC眼发生青光眼性视神经乳头改变和（或）视网膜神经纤维层改变，Humphrey750型自动视野计检查具有典型青光眼性视野缺损如旁中心暗点、鼻侧阶梯、弓型暗点和颞侧视岛等。研究对象排除标准：(1)近视度数>5.00D；(2)屈光间质混浊明显，影响视盘图像质量者；(3)青光眼视野改变已达晚期，无法行静态视野检查者；(4)身体健康状况较差或理解力困难无法进行视野检查者。各组年龄和屈光度经MannWhitney U检验分析，对照组年龄为(52.1±16.6)岁，屈光度为( 0.73±1.24)D，实验组年龄为(57.7±13.8)岁（与对照组比较Z=1.452， P=0.164），屈光度为( 0.55±2.24)D（与对照组比较Z=1.152，P=0.308），其差异均无统计学意义。
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