【作者】 陈伟；

【导师】 吴玲玲；

【作者基本信息】 浙江大学 ， 眼科学， 2004， 硕士

【摘要】 目的 观察青光眼与正常眼以及原发性开角型青光眼(primary open angle glaucoma，POAG)、正常眼压性青光眼(normal tension glaucoma，NTG)与慢性原发性闭角型青光眼(chronic primary angle-closure glaucoma，CACG)视盘的吲哚青绿眼底血管造影表现的异同。 方法 应用Heidelberg共焦激光扫描眼底血管造影仪(Heidelberg retina angiograph，HRA)，对青光眼患者47例80只眼(POAG 18例31只眼；NTG 14例27只眼；CACG 15例22只眼)及正常对照组44例44只眼行吲哚青绿眼底血管造影(indocyanine green angiography，ICGA)和荧光素眼底血管造影(fundus fluorescein angiography，FFA)同步检查，比较青光眼与对照组及青光眼各组间视盘旁萎缩(peripapillary atrophy，PPA)(包括α带、β带)以及视盘ICGA表现的差异。 结果 (1)α带发生率与面积、PPA总面积青光眼组均比对照组大(分别为：x~2=7.446，p=0.006；t=4.332，p=0.000；t=1.979，p=0.050)，β带发生率与面积两组无统计学差异。不同类型青光眼之间：α带面积、 浙江人学硕卜学位论文P队总面积均有组lbJ差异(分别为:介6.812，p=0.002;F=3.438，p=0.036)，其中POAG组与NTG组均比CACG组大(分别为:a带面积比较t=一3 .540，厂0.001;拼一3.170，尸一0.003;pPA总面积比较t=2.978，尸=0.005;户2.780，p一0.009)，PoAG组与NTG组。带面积、PPA总面积、则无统计学差异(分别为:拼一0.011，p一 0.991;t=o.148，p一0.883);不同类型青光眼之间已带发生率与面积无统计学差异(xZ一1.756，p一0.416;介1.362，p一0.262)。 〔2)在造影晚期相中，发现了两种类型的视盘旁ICG充盈缺损:其一为视盘旁低荧区，其特点为与视盘边缘不相连，中间间隔一狭窄的正常背景ICG荧光，其中一部分可发现在早期相中有相应的低荧光区。视盘旁低荧区的发生率及面积在青光眼中更大(分别为:x胜5.437，p一0.020;t=2.499，p=0.014);在不同类型青光眼中则无差异;视盘旁低荧区的发生率及面积与年龄正相关，与屈光度负相关:视盘旁低荧区面积与a带面积、日带面积及PPA总面积呈正相关。其二为与视盘边缘相连的低荧光晕环，表现为与视盘边缘紧紧相连，而且围绕整个视盘的周径。低荧光晕环在青光眼与对照组及青光眼各组的发生率无统计学差异;低荧光晕环的发生率与年龄呈正相关，与屈光度无相关性;低荧光晕环发生率与视盘旁低荧区发生率无相关性。p带面积与视野MD负相关，其余指标与视野MD未发现相关性。 结论青光眼比正常眼更易发生视盘旁的脉络膜血管灌注不足，CACG病人也发生了视盘旁的血供减少，但不如POAG与NTG的改变明显，提示了CACG视神经病变发病机制中血管因素的参与的程度较POAG与NTG为轻。更多还原

【Abstract】 PURPOSE To investigate the characteristics of the blood supply of optic disk in glaucomatous eyes by indocyanine green angiography (ICGA) and whether indocyanine green angiographic anormalies of optic disk are different among chronic primary angle-closure glaucoma (CACG), primary open angle glaucoma (POAG) and normal tension glaucoma (NTG).METHODS 80 eyes of 47 patients with glaucoma (31 eyes of 18 patients with POAG , 27 eyes of 14 patients with NTG and 22 eyes of 15 patients with CACG ) and 44 normal eyes of 39 control subjects were tested by simultaneous ICGA and fluorescein angiography (FFA) with Heidelberg retina angiograph (HRA). The occurrence and extent of peripapillary atrophy and indocyanine green angiographic anormalies of optic disk were compared between glaucoma and control group, and among the three types of glaucoma as well.RESULTS The occurrence and area of alpha zone atrophy andthe area of total peripapillary atrophy was higher and bigger in glaucoma group than in control group. There was significant difference in the areas of alpha zone atrophy and total peripapillary atrophy among the three types of glaucoma. The areas of alpha zone atrophy and total peripapillary atrophy were bigger in POAG and NTG eyes than in CACG eyes. There was no difference in the areas of alpha zone atrophy and total peripapillary atrophy between POAG and NTG eyes. There was no significant difference in the occurrence and area of beta zone atrophy among the three types of glaucoma. Two types of peripapillary defects were identified in the late-phase ICGA. The first was hypofluorescent area in the peripapillary region. It was bigger and more common in eyes with glaucoma. There was no difference in the occurrence or extent of hypofluorescent areas among the three types of glaucoma. Its occurrence and extent correlated with age and refractive error. Its extent correlated with alpha zone peripapillary atrophy and beta zone peripapillary atrophy. The second defect was hypofluorescent halo adjacent to and extending around the full circumference of the optic disk margins. There was no difference in the occurrence between glaucoma and control group, and among the three types of glaucoma as well. Its occurrence correlated with age. There was no correlation in the occurrence between hypofluorescent area and hypofluorescent halo. The area of beta zone atrophy correlated with the mean deviation of the visual field. There was no correlation between the mean deviation of the visual field and other parameters.CONCLUSIONS The decreased vascularity in the peripapillary choroidal circulation occures more frequently in glaucoma eyes than innormal eyes. It also occures in CACG eyes , but less apparently than in POAG and NTG eyes, which suggestts the extent of vascular factors involved in the development of the optic disk damage in CACG is less than POAG and NTG .更多还原