视盘大小与青光眼

在青光眼诊断中,视盘大小的评价是一个重要而又容易被忽视的部分.采用测量方法不同,视盘大小结果也有差异.视盘的实际大小可因种族而有所变化,也可能与其他一些人口统计学因素有关.此外,视盘大小也与视盘和视网膜神经纤维层的结构变异有关.这些与视盘大小相关的变化,可能会影响患者的青光眼易感性或对青光眼的诊断.     

限定地区人群为基础的视盘旁萎缩弧形态学研究

目的评估限定地区人群为基础的视盘旁萎缩弧情况。设计限定地区人群为基础的横断面研究。人群5324个参与者中4439个人入选到本研究中,应答率为83.4%。最低年龄在40岁以上。其中农村人群为1973人(44.4%),城市人群为2466人(55.6%)。方法应用佳能彩色眼底照相机对眼底视盘拍照后,进行视盘形态学的评估。眼底照相机的放大倍数通过计算视盘的面积得到矫正。结果4163张清晰的眼底照片入选到本研究中,其中2955人(70.98%)有α区,平均面积为(0.729±0.629)mm2(0.053～13.719mm2)。α区的大小和年龄相关(r=0.194,p=0.000<0.001)。同时和近视的程度相关(r=-0.094,p=0.000<0.001)。男性和女性之间萎缩弧α区大小无明显统计学差异(p=0.045,95%CI:0.706,0.752)。而872人有β区(20.95%),平均值为(1.985±2.223)mm2(0.102～14.999)mm2。β区的大小和年龄相关(r=0.144,p=0.000<0.001)。和近视的程度相关(r=-0.556,p=0.000<0.001)。男性和女性之间的β区大小无明显差异(p=0.096,95%CI:-0.548,0.045)。α区和β区面积大小与人群的裸眼视力,最佳矫正视力有关。两种萎缩弧均易发于视盘的颞侧,其次为颞下、颞上,最少发生在视盘鼻侧。结论α区和β区各自在人群中的发生率为70.98%和20.95%。由于β区多发于青光眼人群,β区的正常人群研究资料可能对青光眼的早期发现有重要意义。     

农村人群视网膜血管直径与视盘参数的关系:邯郸眼病研究

目的 评价中国北方农村30岁及以上成年人群视网膜血管直径(RVD)与视盘参数(ODP)之间的关系。设计以人群为基础的横断面研究。研究对象中国北方农村30岁及以上成年人群(邯郸眼病研究人群)6830例基线人群中纳入符合条件的受试者4137例(60.6%),其中包括4097例非青光眼和40例原发性开角型青光眼(POAG)。方法采用视网膜血管直径测量软件(IVAN)测量RVD,包括视网膜中央动脉直径当量(CRAE)和视网膜中央静脉直径当量(CRVE)两个指标;采用海德堡视网膜断层扫描(HRTII)获得不同维度的ODP指标,包括视杯面积(CA)、盘沿面积(RA)、最大视杯深度(MCD)。单因素及多因素分析研究人群中的RVD与不同ODP之间的关系。主要指标CRAE、CRVE、CA、RA、MCD。结果单变量分析显示,较窄的RVD与较大的CA(P<0.001)、较小的RA(P<0.001)、较深的MCD(P<0.001)显著相关。多元线性回归分析显示,CRAE与CRVE(P<0.001,β=0.50)、MCD(P=0.001,β=-3.7)、糖尿病(P=0.043,β=-2....     

青光眼视盘定量分析的研究进展

视盘形态学研究在青光眼的诊断和治疗中具有相当重要的作用，随着计算机像处理技术的不断发展，应用计算机进行眼底图像分析将以前的定性检查变为定量测定。近十年来，世界上有一批用于青光眼视盘定量分析的仪器及软件相继问世，本文对其中较新的研究作一综述。     

青光眼视神经损伤进展的视盘形态学危险因素

本从C／D值、盘沿面积、盘周萎缩区、视网膜血管直径以及视盘出血等方面综述了青光眼视神经损伤进展的视盘形态学危险因素。     

在非青光眼人群中血压与视盘结构的关系

血压水平是原发性开角型青光眼发病的非眼压性危险因素之一,高血压病、血管痉挛和急性低血压被认为是潜在的危险因素。但人群为基础的流行病学研究结论并不一致。为研究非青光眼人群中血压水平与视盘结构的关系,作者对希腊北部Thessa-loniki地区60岁以上人群随机样本2554人进行     

兔眼放射状视神经切开术后视盘的形态学改变

目的观察兔眼放射状视神经切开术（RON）后视盘的形态学改变。方法 40只健康成年家兔随机分为正常对照组及术后1、2、4周组,每组10只兔。手术组兔眼行RON后,分别于术后1、2、4周行眼底照相,用IPP5.0软件测量视盘面积、视盘水平径和垂直径,并行常规组织病理学检查。结果所有RON手术均成功,术中未见严重玻璃体积血和视网膜脱离,仅RON手术部位有少量出血。RON术后1周组的视盘面积和垂直直径较正常组增大（P〈0.01）,术后2周组与1周组比较差异无统计学意义（P〉0.05）,术后4周组与其他组两两比较差异均有统计学意义（P〈0.01）。组织病理学检查可见,术后1周组RON手术部位可见淋巴细胞和单核细胞浸润,术后2周组和术后4周组手术部位被大量胶原成分填充。结论兔眼RON术后视盘直径和面积增大,可为RON的作用机制提供实验依据。     

Comparison of optical coherence tomography and fundus photography for measuring the optic disc size

PURPOSE: To assess the agreement and repeatability of optic nerve head (ONH) size measurements by optical coherence tomography (OCT) as compared to conventional planimetry of fundus photographs in normal eyes. METHODS: For comparison with planimetry the absolute size of the ONH of 25 eyes from 25 normal subjects were measured by both OCT and digital fundus photography (Zeiss FF camera 450). Repeatability of automated Stratus OCT measurements were investigated by repeatedly measuring the optic disc in five normal subjects. RESULTS: Mean disc size was 1763 +/- 186 vertically and 1632 +/- 160 microm horizontally on planimetry. On OCT, values of 1772 +/- 317 microm vertically (p = 0.82) and a significantly smaller horizontal diameter of 1492 +/- 302 microm (p = 0.04) were obtained. The 95% limits of agreement were (-546 microm; +527 microm) for vertical and (-502 microm; +782 microm) for horizontal planimetric compared to OCT measurements. In some cases large discrepancies existed. Repeatability of automatic measurements of the optic disc by OCT was moderately good with intra-class correlation coefficients (ICC) of 0.78 horizontally and 0.83 vertically. The coefficient of repeatability indicating instrument precision was 80 microm for horizontal and 168 microm for vertical measurements. CONCLUSIONS: OCT can be used to determine optic disc margins in moderate agreement with planimetry in normal subjects. However, in some cases significant disagreement with photographic assessment may occur making manual inspection advisable. Automatic disc detection by OCT is moderately repeatable.     

Assessment of the optic disc to measure neuroprotection

In early glaucoma, axonal loss and optic disc change occur in the absence of detectable changes in psychophysical measurements, such as those obtained from standard automated perimetry. Accurate assessment of the anatomy of the optic disc is therefore necessary to document change. The measurement of optic disc topography with scanning laser ophthalmoscopy has been shown to be accurate, reproducible, diagnostically valid, and an accurate reflection of the underlying anatomic status of the optic disc and retinal nerve fibre layer. Validated techniques have been developed to detect change over time in the surface topography of the optic disc. Ultimately, real-time in vivo analysis of the health of retinal ganglion cells should provide the best method of assessing the advisability and adequacy of treatment and the potential value of neuroprotective therapies.     

Rates of visual field progression in distinct optic disc phenotypes

Background: To determine if optic disc phenotype is correlated with the rate of glaucomatous visual field progression. Design: Retrospective cohort. Participants or Samples: Treated glaucoma patients. Methods: The optic disc stereophotographs of glaucoma patients were reviewed by two investigators masked to all clinical and perimetric data. Each disc was classified as focal ischaemic, myopic, senile sclerotic and generalized enlargement. Visual field progression (defined as at least two adjacent test points in the same hemifield progressing by more than 1.0 dB/year at P < 0.01) was evaluated using automated pointwise linear regression. Main Outcome Measures: Association between optic disc phenotypes and other clinical variables and rates of visual field progression. Results: 264 optic disc stereophotographs (127 generalized enlargement, 41 focal ischaemic, 54 myopic and 42 senile sclerotic) were evaluated. In the univariate analyses, it was found that patients with senile sclerotic discs were older (p = 0.002) and those with generalized enlargement had better baseline visual field mean deviation (p < 0.001) and higher intraocular pressure (p = 0.006) compared with the other groups. More disc haemorrhages were detected in the focal ischaemic and senile sclerotic groups (p = 0.010). After adjusting for other risk factors (intraocular pressure, age, central corneal thickness, disc haemorrhage), there were no differences among groups regarding the risk (p = 0.58) and velocity (p = 0.21) of visual field progression. Conclusions: Visual field progression was similar among the four optic disc phenotypes in treated glaucoma after adjusting for other known risk factors. The division of disc appearance into clinical phenotypes does not appear to provide independent information regarding the risk of progression in clinical practice.     

青光眼随诊时视盘出血的意义

青光眼随诊时采用系列眼底照相、计算机图像配比法是发现与追踪视盘出血（dischemorrhages,DH）及其相关改变的较好方法。观察DH对于青光眼病情随访、调整目标眼压及其他治疗方案具有重要意义。目前认为,DH是青光眼视网膜神经纤维层缺损加重及视野损害进展的重要危险因素,甚至认为是青光眼病情进展的先兆体征或标志。它可能是青光眼治疗不充分或未达到目标眼压的指征,对此应密切进行视神经形态与视野随访,并及时实施有效的降眼压治疗。（国际眼科纵览,2012,36：289—292）     

视盘的有效评估:与杯盘比的对比

青光眼是一种以进行性视盘变化和视野损失为特征的眼压相关性疾病。杯盘比在过去40a来都是评价视盘青光眼性改变的标准方法。然而我们却发现是一些小视盘的患者有典型青光眼性视野损失,而一些大视盘的患者却没有视野损失。杯盘比的检查效力和可重复性都低于一些新的检查方法。视盘损伤可能度分级(DDLS)是一种衡量视盘盘沿面积、并且校正了视盘大小等影响因素的新型视盘评价方法。DDLS也许是评价青光眼视盘的更为优化的方法。     

Correlation of optic disc morphology and ocular perfusion parameters in patients with primary open angle glaucoma

Purpose: Little information is available about the relationship between glaucomatous visual field defects, morphological changes of the optic disc and ocular blood flow. In this study, ocular blood flow parameters were correlated with parameters of optic nerve head (ONH) morphology and visual field performance in a cross‐sectional study. Methods: A total of 103 patients with primary open angle glaucoma were included. Choroidal and ONH blood flow was assessed using laser Doppler flowmetry. Retinal blood velocities and retinal vessel diameters were measured with laser Doppler velocimetry and a Retinal Vessel Analyzer, respectively. To evaluate the ONH morphology, fundus photographs were taken and confocal laser scanning tomography was performed. Results: Among all measured ocular hemodynamic parameters, the ONH blood flow was most strongly correlated to structural parameters of ONH damage and visual field loss. Reduced retinal vessel diameters were only slightly correlated with the degree of glaucomatous damage. Conclusion: Reduced blood flow in the ONH was associated with increasing amount of visual field defect and morphological changes of the ONH. Retinal vessel diameters were only marginally associated with glaucomatous optic nerve damage. Based on retinal vessel diameter determination alone, it is not possible to assess whether reduced retinal blood flow is causative or secondary in glaucoma.     

Comparison between laser scanning tomography and computerised image analysis of the optic disc

AIMS: To study the interchangeability of the measurements of the optic disc topography obtained by one computerised image analyser and one confocal laser tomographic scanner. METHODS: One eye of 28 patients with glaucoma or glaucoma suspects was studied. All cases had simultaneous stereoscopic disc photographs taken with the fundus camera Topcon TRC-SS and optic disc examination with the Heidelberg retina tomograph (HRT) during the same visit. The optic disc photographs were digitised and analysed with the Topcon ImageNet (TI) system. Three variables of the optic disc topography provided by the TI and the HRT were compared--cup volume (CV), rim area (RA), and cup area to disc area ratio (CA/DA). RESULTS: The mean values of CV and RA provided by the TI (0.52 (SD 0.32) mm3 and 1.58 (0.39) mm2, respectively) were greater (p < 0.01) than the mean values of CV and RA determined by the HRT (0.32 (0.25) mm3, and 1.33 (0.47) mm2, respectively). The mean value of CA/DA provided by the TI (0.42 (0.14)) and the HRT (0.42 (0.18)) was similar (p = 0.93). Correlation coefficients between measurements obtained by the two methods ranged from 0.53 to 0.73. CONCLUSION: There was a significant discrepancy in the measurements of rim area and cup volume of the optic disc obtained by a computerised image analyser and a laser scanning tomograph.     

介绍一种青光眼视盘损伤估测法

目的介绍青光眼视盘损伤可能性估测法(DiskDamageLikelihoodScale,DDLS),应用于同一检查者及不同检查者间,评估其对青光眼视盘损伤估测值的变异度及一致性。方法同一检查者及不同检查者分别对10例(20眼)原发性开角青光眼(primaryopen-angleglaucoma,POAG)进行3次视盘大小测量值(垂直径)及DDLS分期。结果在10例(20眼)POAG中,2位检查者的视盘垂直径测量值的变异系数分别为3.30%和4.41%。2位检查者3次估测DDLS视盘损伤分期的一致性为75%;检查者1自身3次DDLS分期的一致性为90%;检查者2自身3次分期的一致性为85%。结论DDLS对于分析青光眼性视盘损害具有变异度低及不同检查者间一致性高的特点。     

Congenital anomalies of the optic disc

Although anomalies affecting the optic nerve head are usually clinically innocuous, they can sometimes cause significant symptoms and lead to visual loss. It is important to be able to recognize even the relatively benign lesions in order to differentiate them from other more threatening lesions or disease processes which they may clinically resemble. An awareness of the clinical appearance of disc anomalies is especially important in the differential diagnosis of optic nerve glaucomatous changes. Some anomalies cause various types of visual field loss which, if the actual disc lesion is not recognized, may lead to unnecessary neurologic evaluation or even to intracranial surgery. The optic nerve changes in acquired myopia and in the congenital tilted disc syndrome should be clearly defined and differentiated: high (pathologic) myopia may be highly progressive with many dangerous secondary sequelae, while the latter anomaly is stationary. Finally, there is a group of conditions, collectively termed “elevated anomalies of the disc,” which must be considered in the differential diagnosis of papilledema and potentially dangerous intraocular tumors, particularly retinoblastoma. This review provides a clinicopathologic correlation comparing the characteristics of the normal optic disc to those of the most important congenital anomalies of the disc.