【摘要】 目的对正常眼压性青光眼(NTG)患者,前瞻性评估视盘出血和视网膜神经纤维层缺损及盘周萎缩弧之间的形态学关系。方法患者行每月1次眼底照相,眼底立体照相和计算机图像分析系统定性及定量评估视盘出血与神经纤维层缺损及萎缩弧的关系。结果NTG出血组37位患者42只眼有50处眼底视盘出血,出血眼中有35只有神经纤维层缺损,发生率83.3%(35/42)。非出血组35位患者40只眼中神经纤维层局限缺损为21个,发生率52.5%(21/40),两组间神经纤维缺损发生率无统计学意义(χ2=1.403,P=0.236,P>0.05)。出血组和非出血组两组间β区萎缩弧的发生率差异有统计学意义(χ2=7.008,P=0.008,P<0.01),出血组β区萎缩弧面积(2.05±0.88)mm2,非出血组β区面积(1.42±0.53)mm2,两组比较有统计学意义(t=-2.785,P=0.008)。β区萎缩弧范围在出血组(164.00±49.87)°,非出血组(128.42±40.04)°,两组间比较有统计学意义(t=-2.618,P=0.012,P<0.05))。随诊中出血组和非出血组盘沿丢失发生率组间比较有统计学意义(χ2=5.802,P=0.016,P<0.01),但组间比较随诊视野损害的发生率则无统计学意义。结论NTG中视盘出血和神经纤维层缺损及萎缩弧之间有密切的关系。随诊中发现出血组较非出血组有更多的盘沿丢失和萎缩弧面积改变,提示NTG视盘出血是疾病进展的危险因素。更多还原

【Abstract】 Objective To study prospectively the morphological relations among hemorrhage of optic disc, defect of retinal nerve fiber layer, and peripapillary atrophy in normal-tension glaucoma (NTG). Methods Qualitative and quantitative methods were applied to evaluate the relations among hemorrhage of optic disc, defect of retinal nerve fiber layer, and peripapillary atrophy by using stereo ocular fundus photography and computer analyzer systems. Results In 37 patients (42 eyes) in NTG hemorrhage group, 50 hemorrhagic spots at optic disc was found, including coloboma of retinal nerve fiber layer in 35 eyes (83.3%)(35/42). In 35 patients (40 eyes) in non-hemorrahge group, partial coloboma of retinal nerve fiber layer was found in 21 eyes (52.5%)(21/40). The difference of incidence of coloboma of retinal nerve fiber layer between the two groups was not significant (χ2=1.403, P=0.236). The incidence of atrophic arc in hemorrhage group differed much from which in non-hemorrhage group (χ2=7.008, P=0.008). The area of atrophic arc at βsection in hemorrhage group [(2.05±0.88)mm2] was significantly different from which in non-hemorrhage group [(1.42±0.53)mm2] (t=-2.618, P=0.012). In the follow-up period, the difference of incidence of disc-rim loss between hemorrhage and non-hemorrhage group was significant, (χ2=5.802, P=0.016); while the difference of the incidence of visual field defect between the two groups was not. Conclusion In eyes with NTG, hemorrhage of optic disc, coloboma of retinal nerve fiber layer and atrophic arc are closely related. More disc-rim loss and changes of atrophic-arc area in hemorrhage group in the follow-up period suggests that hemorrhage of optic disc is the risk factor of development of NTG.更多还原