正常眼压性青光眼中眼压与视野间的关系

目的 :探讨正常眼压性青光眼 (normalpressureglaucoma ,NPG)的眼压、视野和相互关系。方法 :分析 98例新诊断NPG患者的眼压曲线和视野状态。结果 :眼压曲线呈单峰式波动 ,双眼对称 ,总体平均水平位于 16mmHg上下 ,波动幅度 <2mmHg。患者男性眼压均值右眼为15 70± 2 5 7mmHg、左眼为 15 46± 2 %41mmHg ,女性右眼为 16 5 2± 1 97mmHg、左眼为 16 45± 2 0 1mmHg ,眼压与年龄相关不显著 (P >0 0 5 )。患者各相应年龄组的眼压均高于正常老年人 (分别P <0 0 2 ,P <0 0 1,P <0 0 0 1)。在 98例患者 196眼的视野中 ,5 2例患者为单眼损害 ,14 4眼的视野损害在损害形态和部位上与眼压升高的原发性开角型青光眼 (hp -POAG)相符合 ,但旁中心损害侵入中心固视区者约占 2 2 2 2 %。在两眼视野损害相对轻重的划分中 ,视野损害不同分级状态下眼压的平均值、最高值和波动差二者间差异不显著 (P >0 0 2 ) ,单侧视野损害患者患眼与对侧眼眼压差异不显著 (P >0 0 5 ) ,但同侧视野损害较重且眼压较高眼数的构成比最大 ,约占 5 5 1%(P <0 0 1)。结论 :NPG患者的眼压状态在单值水平、波动幅度和双眼对称性上均与一般群体生理眼压相一致 ,但平均眼压高于年龄可比的正常老年人。视野损害特征与hp -POAG相符合 ,     

OCT在正常眼压性青光眼患者中的应用研究

目的:探讨正常人、NTG患者、可疑NTG患者视盘周围视网膜神经纤维层(retinal nerve fiber layer,RNFL)的变化特点并分析光学相干断层扫描成像仪(optical coherence tomography,OCT)检查各参数诊断(normal tension glaucoma,NTG)的能力。方法:用OCT检查46例(80眼)NTG患者,43例(80眼)可疑NTG患者,40例正常人(80眼)视盘周围RNFL厚度,对OCT参数进行受检者操作特性曲线(ROC曲线)分析。结果:OCT参数(average.Thick,Avg.Thi)等在NTG患者、可疑NTG患者和正常人3组间差异有统计显著性意义(F=14.17-123.03,P<0.05)。区分NTG和正常人时OCT检查诊断准确性最高的参数Avg.Thi的受检者操作特性曲线下面积(AUC)明显大于区分可疑NTG和正常人时OCT检查诊断准确性最高的参数Avg.Thi的AUC(P<0.01)。结论:NTG患者视盘周围RNFL的厚度较正常人和可疑NTG患者变薄。OCT检查能够帮助诊断NTG,OCT检查区分NTG和正常人的能力要高于区分可疑NTG和正常人的能力。     

健康体检中的正常眼压性青光眼

目的 探讨健康体检人群中的正常眼压性青光眼（normal tension glaucoma,NTG）的发病率及视野改变,为NTG的筛选提供有益的经验。方法 对健康体检眼底检查中发现的461例813眼视盘有异常改变者,应用Humphrey 750型电脑视野分析仪检查,采用中心30-2程序自动检测,对结果异常者进行随访复查。结果 461例中141例224眼视野有异常表现,占30.59%,其中62例112眼表现出青光眼特征性视野改变,被诊断为正常眼压性青光眼,占总检查人数的13.45%,占视野异常者的43.97%。结论 健康体检中,NTG有相当比例的发病率。电脑视野计的应用对NTG的早期诊断和早期视野损害的认识,提供了一种较为敏感的检查手段。     

正常眼压性青光眼诊断中存在的问题

患者具有典型的青光眼视盘损害、视野缺损、前房角开放、眼压正常，并排除眼部或全身性疾病引起的视神经病变，即可诊断为正常眼压性青光眼。准确的眼压测量、两次以上24小时眼压曲线描记以及对眼部和全身可能原发疾病的排除在诊断过程中至关重要。     

重新认识"正常眼压性青光眼"

正常眼压性青光眼(NTG)几乎是青光眼领域里最难以诊断的疾病,难点在于青光眼性视神经病变(GON)的症状和体征缺乏特异性,因此对NTG的重新认识实际上是对GON的重新认识。NTG虽然具有GON的表现,但其发病机制与眼压并无明确的关系,而一些病理因素引起的放射状视盘周围毛细血管网(RPCs)血流异常或轴浆流异常等所导致的...     

正常眼压性青光眼(一)

正常眼压性青光眼(Normal tension glaucoma,NTG)一词纯属描述性词汇,过去曾称之为低眼压性青光眼(low tension glaucoma,LTG),除眼压未超过统计学正常眼压上界外,其他临床表现与原发性开角型青光眼(POAG)相似.NTG是否为POAG的一种类型,或为一个独立的临床单位,尚有争议.临床上,正常眼压性青光眼的诊断是比较困难的.治疗亦较为棘手,因其发病机制尚未明确.     

正常眼压性青光眼的诊断及治疗

正常眼压性青光眼由于发病隐匿,症状不典型,与原发性开角型青光眼临床症状相似,因此诊断治疗较为困难,并常被忽视.本文对其临床特点、诊断及治疗最新进展进行综述,以期对正常眼压性青光眼有更深入了解和进行更有效的治疗.     

尼莫地平治疗正常眼压性青光眼23例

目的 观察尼莫地平对正常眼压性青光眼的治疗作用。方法 将46例正常眼压性青光眼患者随机分成尼莫地平组和维生素B1组，治疗6个月及1年后，观察中心视力、眼压、视野的变化。结果 尼莫地平组视野缺损有不同程度改善，而维生素B1视野缺损保持原状有进展。结论 口服尼莫地平对改善正常眼压性青光眼的视野缺损有一定疗效。     

正常眼压性青光眼的研究现状

正常眼压性青光眼(normal tension glaucoma,NTG)长期以来是一备受争议的话题.关于其发病机制,各学说均提出了有利证据,如NTG患者跨筛板压增大;筛板较为薄弱,对眼压的耐受力较差;氧化应激反应导致小梁网退行性改变及视网膜神经节细胞凋亡;眼部血流动力学异常;颈内动脉对视神经的机械压迫等.各因素之间既...     

正常眼压性青光眼

正常眼压性青光眼患者的眼压在统计学眼压的正常范围之内,却有典型的青光眼性视野缺损及与之相关的视盘改变。故发病隐匿,常造成不可逆的视神经损害。现代研究认为其发病机制是机械因素、血管因素、自身免疫因素等多种因素的共同作用。降眼压是必要的措施,眼压降低30%以上对其病变有利。与此同时,改善视神经血流供应和保护视神经的药物正被关注。     

Focal ischaemic normal pressure glaucoma versus high pressure glaucoma

In a total group of 130 patients with Normal Pressure Glaucoma (NPG) twenty-six were classified as Focal Ischaemic NPG (FINPG). This subgroup has a typical defect at the disc with a comparable visual field defect in the corresponding half of the visual field. Visual field defects are more often seen in the upper than the lower half of the visual field. The defects in the upper half are on the average larger (stage 1.6) than those in the lower half (stage 0.9). Abnormalities of the chamber angle were observed in 12% of these patients, the same percentage as in the normal population. Hypertension and/or cardiovascular disorders were found significantly more frequently in FINPG patients (65.4%) than in a control group of High Pressure Glaucoma (HPG) patients (22.2%). Of the local vascular risk factors, papillary haemorrhages (46%) and choroidal sclerosis (30%) were seen significantly more frequently in FINPG than in HPG (11% and 0% respectively). The total amount of peripapillary atrophy (PPA) in FINPG and HPG is the same, but the distribution is clearly different: in FINPG there is more PPA on the side of the papillary defect. Wide veins were observed in a high percentage of cases in both groups. FINPGs were found to be more frequently progressive (38.5%) than had been thought at first. Recognition of subgroups in NPG, and of risk factors, has already made it possible to make a better prognosis in some types of NPG.     

正常眼压性青光眼与原发性开角型青光眼24小时眼压曲线的比较

目的 通过24 h眼压的测量来深入分析比较正常眼压性青光眼(NTG)与原发性开角型青光眼(POAG)的眼压曲线特征.方法 前瞻性病例对照研究.收集2006年4月至2009年4月在上海市闸北区北站医院和复旦大学附属眼耳鼻喉科医院门诊就诊的NTG患者131例及POAG患者102例,测量24 h眼压,用非接触性眼压计从8 am起每隔2 h测一次眼压,0 am至6 am之间测得的为唤醒后即刻坐位眼压.主要观察指标为眼压波动曲线、平均眼压、峰值时间及眼压、谷值时间及眼压和眼压波动值.采用独立样本t检验和卡方检验比较各指标在两组之间的差异.结果 NTG组双眼平均眼压为(14.2±2.1)mmHg,低于POAG组[(19.9±3.5)mmHg];NTG组双眼峰值眼压为(17.0±2.4)mmHg,低于POAG组[(24.7±4.3)mmHg];NTG组双眼谷值眼压为(11.8±2.2)mmHg,低于POAG组[(16.5±3.1)mmHg];NTG组双眼眼压波动值为(5.2±1.8)mmHg低于POAG组(8.2±3.1)mmHg];两组的平均眼压、峰值、谷值及眼压波动值的差异均有统计学意义(t=-14.52、-16.44、-13.16、-8.90,P均＜0.01).NTG组63.3%患者、POAG组73.5%患者的峰值眼压位于门诊工作时间以外;尤其是NTG组有51.5%患者、POAG组有64.7%患者的峰值位于0 am至6 am时间段,两组差异有统计学意义(X2=8.150,P=0.017).结论 NTG及POAG患者24 h眼压曲线的变化规律具有相似性,是诊断和个体化治疗方案制订的依据,并可用作治疗随访中评价疗效和调整方案的重要参考指标.     

漫谈眼压与青光眼的临床

眼压是青光眼最重要最易监控的临床指标,必须强调其测量的精确性。高眼压症、原发性开角型青光眼、正常眼压性青光眼和慢性闭角型青光眼都有其各自的特点以及独特的与眼压的关系。本文试从眼压的角度,结合近年来国外重要的多中心临床研究结果,讨论高眼压症和几种常见青光眼的临床诊治思路。     

Diurnal variation of intraocular pressure in suspected glaucoma patients and their outcome

Background A case-controlled prospective study was conducted to evaluate the diurnal variation of intraocular pressure (IOP); the mean, the amplitude of variation and the peak and trough times of pressure readings in the suspected open-angle glaucoma patients as compared with a control group. We also looked at the outcome of these suspects after diurnal variation of IOP measurements. Methods Diurnal variation of intraocular pressure was measured in 202 eyes of suspected open-angle glaucoma patients and 100 control eyes, at 4-hourly intervals for 24 hours (phasing). Based on the phasing results, optic disc changes and visual field defects, the patients were diagnosed as primary open angle glaucoma (POAG), normal tension glaucoma (NTG), ocular hypertension (OHT), or physiologic cup (PC), or still remained as glaucoma suspects due to inconclusive diagnosis. The last group (glaucoma suspects) was then followed up 6-monthly for their eventual outcome. Results The highest percentage of suspected glaucoma patients had peak (maximum) readings in the mid-morning (10–11 a.m.) and trough (minimum) readings after midnight (2–3 a.m.); the highest percentage of control group had peak readings in the late evening (6–7 p.m.) and trough readings after midnight (2–3 a.m.). The mean amplitude of variance was 6 mm Hg in suspected glaucoma group and 4 mm Hg in the control group. After ‘phasing’, 18.8% of the suspected glaucoma patients were diagnosed as POAG, 16.8% as NTG, 5% as OHT, and 28.7% as physiologic cup; 30.9% remained as glaucoma suspects. After 4 years follow-up, 70% of the glaucoma suspects still remained as glaucoma suspects, 6.7% developed NTG and another 6.7% POAG; 16.6% were normal. Conclusions Serial measurement of IOP ( phasing) in a 24-hour period is still needed, in order not to miss the peak and the trough IOP readings in suspected open-angle glaucoma patients, which helps in better management of glaucoma. Among 30.9% of patients who remained as glaucoma suspects after the initial phasing, 13.4% developed NTG/POAG over a period of 4 years. This paper was presented in part at the 19th Congress of Asia Pacific Academy of Ophthalmology (APAO), Bangkok, Thailand, 28 November-3 December 2003. The authors have no financial support in the writing of this paper.     

早期正常眼压性青光眼的弥漫性视敏度缺失

目的 :研究早期正常眼压性青光眼 (normaltensionglaucoma ,NTG)的中心视野是否存在视敏度的弥漫性缺失。方法 :对临床确诊的 3 0例 (5 2只眼 )早期NTG病人 ,与 3 5例 (60只眼 )正常人群进行年龄匹配 ,比较两组人群之间 3 0°视野的中心 2 4°范围内的 10个最敏感点视敏度的差别。视敏度检测采用Humphrey自动视野仪 3 0 -2程序。结果 :早期NTG组与正常人群年龄匹配组之间年龄平均差别为 11天 (P =0 992 ) ,两组视力平均差别为 0 0 4(P =0 65 8) ,瞳孔大小平均差别为 0 11mm (P =0 2 93 ) ,眼压平均差别为 2 0 9mmHg (1mmHg =0 13 3kPa) (P =0 15 8)。通过对两组 10个最敏感点对比研究后发现早期NTG组病人比正常人群年龄匹配组平均低 1 0到 2 0dB (P <0 0 0 1) ,并且每组有 78 5 7%～92 86%的正常人群年龄匹配组的视敏度值要高于早期NTG组。结论 :早期NTG病人的视敏度显著下降 ,下降视敏度区域累及视野中最敏感位点 ,并且在局限性视野缺损的基础上伴有弥漫性的缺失。     

首诊漏诊、误诊青光眼29例临床分析

目的:呼吁眼科医师对眼压的足够重视。方法:回顾分析经视力、眼前段(含前房角)、眼底、眼压、视野、视觉电生理等检查诊断为青光眼,却在首诊以来的眼科病历中无眼压测量记录的29例患者的临床资料。结果:青光眼29例全部被漏诊或误诊。结论:对40岁以上的眼科患者和不同年龄的高度近视等原发性开角型青光眼的高危人群应常规进行眼压测量并记录,避免对青光眼的漏诊、误诊和医疗纠纷的产生。     

正常眼压性青光眼的24小时眼压测量临床价值

目的 评估24h眼压测量在正常眼压性青光眼中的意义,以更好地指导临床应用.方法 于2008年1月至2011年2月正常眼压性青光眼(NTG)患者共86例(86只眼)入选本研究,应用非接触眼压计自清晨8:00开始至第二天清晨8:00,每两小时测量一次,共12次;采用A型超声波角膜测厚仪对中央角膜厚度进行测定.结果 所有86只眼的24h眼压测量值中,29只眼(33.7％)在正常范围内且昼夜眼压波动小于5 mm Hg,而57只眼(66.3％)出现异常.所有患者昼夜眼压曲线中眼压低谷值为(13.78±1.39) mm Hg眼压高峰值为(18.52±1.81) mm Hg,分别出现于18:00～20:00和夜间2:00.根据24 h最高眼压是否高于21 mm Hg分为高眼压组和低眼压组,两组年龄差异显著有统计学意义,而中央角膜厚度无明显差异.结论 24 h眼压测量应作为正常眼压性青光眼患者诊断的常规检查,能提高夜间眼压高峰及昼夜波动过大的检出率,避免漏诊误诊的发生.     

Impact of intraocular pressure fluctuations on progression of normal tension glaucoma

AIM: To investigate short- and long-term intraocular pressure (IOP) fluctuations and further ocular and demographic parameters as predictors for normal tension glaucoma (NTG) progression. METHODS: This retrospective, longitudinal cohort study included 137 eyes of 75 patients with NTG, defined by glaucomatous optic disc or visual field defect with normal IOP (<21 mm Hg), independently from therapy regimen. IOP fluctuation, mean, and maximum were inspected with a mean follow-up of 38mo [standard deviation (SD) 18mo]. Inclusion criteria were the performance of minimum two 48-hour profiles including perimetry, Heidelberg retina tomograph (HRT) imaging, and optic disc photographs. The impact of IOP parameters, myopia, sex, cup-to-disc-ratio, and visual field results on progression of NTG were analyzed using Cox regression models. A sub-group analysis with results from optical coherence tomography (OCT) was performed. RESULTS: IOP fluctuations, average, and maximum were not risk factors for progression in NTG patients, although maximum IOP at the initial IOP profile was higher in eyes with progression than in eyes without progression (P=0.054). The 46/137 (33.5%) eyes progressed over the follow-up period. Overall progression (at least three progression confirmations) occurred in 28/137 eyes (20.4%). Most progressions were detected by perimetry (36/46). Long-term IOP mean over all pressure profiles was 12.8 mm Hg (SD 1.3 mm Hg); IOP fluctuation was 1.4 mm Hg (SD 0.8 mm Hg). The progression-free five-year rate was 58.2% (SD 6.5%). CONCLUSION: Short- and long-term IOP fluctuations do not result in progression of NTG. As functional changes are most likely to happen, NTG should be monitored with visual field testing more often than with other devices.