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目的比较原发性开角型青光眼(POAG)和原发性闭角型青光眼(PACG)的早期视神经损害特征和视野损害特点的差异。设计前瞻性病例系列。研究对象早期POAG患者23例(30眼),早期PACG患者22例(30眼)。方法进行静态视野和偏振激光扫描仪GDx ECC检查。分别比较两组间GDx ECC各个参数和视网膜神经纤维层缺损(RNFLD)类型(弥漫性、局限性)的差异。在组间分别比较视野参数、视野检测光标点对点的光敏度丢失。主要指标GDx ECC参数及其RNFLD类型、视野参数、视网膜光敏度丢失。结果两组中GDx ECCTM参数除了上方均值和对称性以外,其余各个参数在两组间的差异均有统计学意义。弥漫性RNFLD在POAG和PACG中的比例分别为40%和10%(P＜0．05),局限性RNFLD分别为53%和63%。视野指数中PSD和CPSD在两组间差异有统计学意义(P＜0．05)。在视野检测的点对点比较中,早期PACG的局部光敏度丢失在颞上方视野中较早期POAG严重(P＜0．05)。结论早期POAG有较多弥漫性RNFLD,而早期PACG主要表现为局限性RNFLD。早期PACG在颞上方的局部光敏度丢失较早期POAG严重,这与其RNFL缺损特征相一致。POAG和PACG不同的发病机制可能是导致RNFL损害特征和视野损害特点差异的原因。(眼科,2007,16:28-32)
Objective To compare the characteristics of early optic nerve damage and visual field damage between primary open angle glaucoma (POAG) and primary angle closure glaucoma (PACG). Design prospective case series. Twenty-three patients (30 eyes) had early POAG and 22 patients (30 eyes) had early PACG. Methods Static field and polarization laser scanner GDx ECC inspection. Differences between the GDx ECC parameters and the type of retinal nerve fiber defect (RNFLD) (diffuse, localized) were compared between the two groups. Comparison of visual field parameters between groups, visual field detection point-to-point sensitivity of the cursor is lost. GDx ECC parameters and their RNFLD type, visual field parameters, loss of retinal photosensitivity. Results The GDx ECCTM parameters of the two groups except for the above mean and symmetry, the other parameters in the two groups were statistically significant. The proportion of diffuse RNFLD in POAG and PACG was 40% and 10%, respectively (P <0.05), and the limitations of RNFLD were 53% and 63%, respectively. There was significant difference between the two groups in PSD and CPSD in visual field index (P <0.05). In the point-to-point comparison of visual field detection, the early loss of local photosensitivity of early PACG was severe in the superior temporal superior field of POAG (P <0.05). Conclusions The early stage of POAG has more diffuse RNFLD, while the early stage of PACG mainly presents as limited RNFLD. Early PACG in temporal superior local photosensitivity loss of POAG was severe, which is consistent with its RNFL defect characteristics. The different pathogenesis of POAG and PACG may be responsible for the differences between RNFL damage characteristics and visual field damage characteristics. (Ophthalmology, 2007,16: 28-32)