【作者】 王欢；

【导师】 贺忠江； 陈松；

【作者基本信息】 天津医科大学 ， 眼科学， 2008， 硕士

【摘要】 目的青光眼是一种严重的不可逆的致盲眼病,但由于种种条件的限制,大量青光眼患者得不到及时的诊断和治疗,即使发达国家约有一半的患者未被查出。因此,在人群中进行青光眼筛查显得极为重要。然而,迄今为止筛查青光眼的理想模式尚无定论。国产最新型的微型计算机视野计YDS 301(简称YDS)是一种新的、功能齐全的视野检查仪器,其四点阈值程序是专门为青光眼筛查设计的。本研究用该视野计与国际最新型的微型计算机视野计Octopus 101(简称Octopus)进行临床对比,进而探讨YDS在临床中对快速筛查青光眼性视野缺损的诊断价值。对象和方法1.选择符合入选标准的各年龄段的正常人接受常规眼科检查,如裂隙灯显微镜、眼底镜检查,用日本CANON TX-10型非接触式眼压计测量眼压,并用YDS四点阈值程序进行视野检查。经统计学处理得出各年龄段的正常参考值。2.选择符合入选标准的青光眼患者均接受常规眼科检查,如裂隙灯显微镜、眼底镜检查,用日本CANON TX-10型非接触式眼压计测量眼压。并在同一天内分别先后进行上述两种视野计的视野检查,顺序随机。其中YDS选用四点阈值程序,Octopus选用G1 TOP程序,并分别在定性、定量、定位和每眼检测时间等方面进行对比分析。YDS四点阈值程序的视野检查结果根据本试验通过正常人群检查和统计学处理结果确定的正常参考值进行判断。OctopusG1 TOP程序的视野检查结果参照Johnson的标准判断。结果1.YDS检测的正常人平均光敏感度(MS)20岁以上者,随年龄增加而降低,平均每10岁MS降低1.126 dB;小于20岁者MS介于20岁年龄段和30岁年龄段之间。各年龄段内比较,鼻侧MS高于颞侧MS,差异不具有显著(P＞0.05)。下方MS高于上方MS,41-50岁具有显著差异(P＜0.05),其余各年龄段差异不具有显著(P＞0.05)。各年龄段男女之间MS比较,均无显著差异(P＞0.05)。各年龄段左右眼之间MS比较,均无显著差异(P＞0.05)。2.YDS和Octopus的对比结果定性诊断:以Octopus为准,YDS的敏感性和特异性分别为92.5%和83.3%,两种视野计的符合率为90.6%。定位诊断:四个象限均符合者为48眼,约占63.9%,三个象限符合者为20眼,约占26.3%,仅两个象限或一个象限符合者为7眼,约占9.8%,未见四个象限均不符合者。定量诊断:YDS的MS和平均缺损(MD)与Octopus的MS和MD的相关系数分别为0.869和0.865。两种视野计的定量指标皆非常相关,P＜0.01。二者的一致性完全达到国际上视野计之间的对比标准。最突出的差别是每眼检测时间,分别为50.433s和143.983s,具有显著差异(P＜0.01)。Octopus的检测时间是YDS的3倍,YDS可以在1分钟内完成,Octopus平均需要3分钟。结论1.YDS四点阈值程序通过对正常人视野的MS等视野指数进行测定,建立了各年龄阶段的正常参考值。本试验得出的正常参考值的特点与其它类型视野计的正常参考值的特点基本吻合。2.YDS四点阈值程序同Octopus相比较,具有较强敏感性和特异性,两种视野计具有很高的符合率,而且二者的定量指标也具有很高的一致性。同时,YDS的检测时间非常短暂,是目前国内外现有视野计中最快者。因此YDS四点阈值程序适用于青光眼的视野筛查,可以成为一种在人群中筛查青光眼的良好方法。3.尽管国产YDS视野计存在着发光二级管式视野计的固有弊病,但它在快速筛查青光眼性视野缺损中所体现出的快速性,是其他视野计所不能达到的。同时它具有很高的性能/价格比值,特别适于我国医疗市场各级医院的需求。更多还原

【Abstract】 ObjectiveGlaucoma is one kind of serious irreversible blinding ophthalmopathy, but as a result of many conditions ’ limit, the massive glaucoma patients can not obtain the prompt diagnosis and the treatment, even if half patients can not be diagnosed in the developed countries. Therefore, glaucoma screening in the crowd appears the great importance. However, there is not an ideal pattern in screening glaucoma until now. The domestical newest perimeter YDS301 (i.e. YDS) is a function complete and new perimeter. Its four points threshold procedure is specially designed for glaucoma screening. This research carries on the clinical contrast with this perimeter and the international newest perimeter Octopus101 (i.e. Octopus), and discusses the diagnostic value of rapid screening of glaucoma visual field defect with YDS.Methods1. Choice various age sections normal person who conforms to the selected standard to accept the convention ophthalmic testing, like the slit lamp microscope, the ophthalmoscope inspection, and non-contact type intraocular pressure measures the quantity intraocular pressure with Japanese CANON TX-10. And carries on the vision field inspection with the four points threshold procedure. Obtains the normal reference value in various age sections after statistics processing.2. Choice glaucoma patients who conform to the selected standard to accept the convention ophthalmic testing, like the slit lamp microscope, the ophthalmoscope inspection, non-contact type intraocular pressure. And carries on two kinds of perimeters’ inspections in the same day, the order is trabant. YDS selects four points threshold procedures, Octopus selects G1TOP procedure. Carries on the contrastive analysis separately in qualitation, localization, quantization and each examination time. The four points threshold procedure judgments according to the normal value which definites through the normal crowd inspection and statistics processing result. The G1TOP procedure refers to Johnson’s standard.Results1. The YDS examines the normal person above 20 years old, the older the lower MS, average every 10 years old reduce 1.126 dB; smaller than 20 year old of MS is situated between 20 year old of age section and 30 year old of age section. In various age sections, the nose side MS is higher than the temple side MS, the difference is not obviously (P>0.05).The interior side MS is higher than the superior MS, 41-50 years old have the remarkable difference (P<0.05). Between various age sections men and women and between various age sections left eye and right eye MS do not have obviously the difference (P>0.05).2. Qualitative diagnosis: as the standard of the octopus, the YDS sensitivity and the specificity respectively is 92.5% and 83.3%. The local diagnosis has the very high coincidence rate. Quantitative diagnosis: Between the YDS and the Octopus MS and MD correlation coefficient respectively are 0.869 and 0.865, P < 0.01. The two’s uniformity completely achieves the international standard between perimeter’s contrast. The most prominent difference is each examination time: 50.433s and 143.983s, P < 0.01. YDS needs lees than 1 minute, Octopus average needs 3 minutes.Conclusions1. The YDS four points threshold has established the normal reference value. This experiment obtains the normal reference value’s characteristic and the other type perimeter’s normal reference value’s characteristics are basically concordance.2. The YDS four points threshold procedure has the very high uniformity with the Octopus. The examination time is short, it is the fastest one in the present perimeters. Therefore the YDS four points threshold procedures is suitable for glaucoma’s vision field screening, may become a good method in screening glaucoma in the crowd.3. Although the YDS has inherent disease about the illumination second-level tubular perimeter’s, but it manifests the rapidity in the fast screening glaucoma vision field damage, the other machines cannot achieve. Moreover it has the very high performance/price-proportion, is suitable for all levels of hospitals in our country medical service market.更多还原