Lesk M R, Spaeth G L, Azuara-Blanco A, Araujo S V, Katz L J, Terebuh A K, Wilson R P, Moster M R, Schmidt C M
William and Anna Goldberg Glaucoma Service, Wills Eye Hospital, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania 19107-5598, USA.
Ophthalmology. 1999 May;106(5):1013-8. doi: 10.1016/S0161-6420(99)00526-6.
To detect and quantitate changes in optic nerve morphology after glaucoma surgery using the Heidelberg Retina Tomograph (HRT, Heidelberg Instruments, Heidelberg, Germany).
Nonconsecutive observational case series.
The authors prospectively enrolled 21 adult patients undergoing incisional glaucoma surgery for progressive glaucoma damage. Quantitative analysis of the optic nerve head by scanning laser tomography and automated perimetry were performed before and after glaucoma surgery.
Changes in optic nerve parameters were subjected to linear regression analysis with respect to percent of postoperative reduction of intraocular pressure (IOP), as well as with respect to age, refraction, preoperative cup:disc ratio, and change in visual field parameters.
Seventeen patients had pre- and postoperative images suitable for analysis. Mean IOP at the time of image acquisition before surgery was 30.5+/-12 mm Hg, and after surgery 11.8+/-5.2 mm Hg (mean follow-up, 26+/-7 weeks). Eleven of 13 (85%) patients having IOP reduction of greater than 40% showed improvement in optic disc parameters. All four patients with less than 25% reduction in IOP showed worsening of most parameters. Changes in optic disc parameters were highly correlated with percent IOP reduction and with age. The parameters in which change most strongly correlated with percent change of IOP were cup area, rim area, cup:disc ratio, and mean cup depth (each, P<0.005). The age of the patient correlated highly with change in maximum cup depth (P<0.005). Refraction and clinically determined cup:disc ratio correlated poorly with changes in measured optic disc parameters. Clinical improvement in visual fields was correlated with the degree of improvement of cup:disc ratio (P = 0.025).
Most patients showing a 40% lowering of IOP after glaucoma surgery show improved optic nerve morphology as measured by the HRT. The amount of improvement correlated highly with the percent reduction of IOP.
使用海德堡视网膜断层扫描仪（HRT，德国海德堡海德堡仪器公司）检测并定量青光眼手术后视神经形态的变化。
非连续观察性病例系列。
作者前瞻性纳入了21例因进行性青光眼损害而接受切开性青光眼手术的成年患者。在青光眼手术前后，通过扫描激光断层扫描和自动视野计对视神经乳头进行定量分析。
对视神经参数的变化进行线性回归分析，分析其与术后眼压（IOP）降低百分比的关系，以及与年龄、屈光不正、术前杯盘比和视野参数变化的关系。
17例患者有适合分析的术前和术后图像。手术前图像采集时的平均眼压为30.5±12 mmHg，手术后为11.8±5.2 mmHg（平均随访时间，26±7周）。13例眼压降低大于40%的患者中有11例（85%）视神经盘参数有所改善。所有4例眼压降低小于25%的患者大多数参数都恶化。视神经盘参数的变化与眼压降低百分比和年龄高度相关。与眼压变化百分比相关性最强的参数是杯面积、盘缘面积、杯盘比和平均杯深度（均P<0.005）。患者年龄与最大杯深度变化高度相关（P<0.005）。屈光不正和临床确定的杯盘比与测量的视神经盘参数变化相关性较差。视野的临床改善与杯盘比的改善程度相关（P = 0.025）。
大多数青光眼手术后眼压降低40%的患者，通过HRT测量显示视神经形态有所改善。改善程度与眼压降低百分比高度相关。
