青光眼大视杯患者的消色差和短波长自动视野检查

Achromatic and short-wavelength automated perimetry in patients with glaucomatous large cups.

作者信息

Mansberger S L, Sample P A, Zangwill L, Weinreb R N

机构信息

Glaucoma Center and Department of Ophthalmology, University of California, San Diego 92093-0946, USA.

出版信息

Arch Ophthalmol. 1999 Nov;117(11):1473-7. doi: 10.1001/archopht.117.11.1473.

DOI:10.1001/archopht.117.11.1473

PMID:10565515

Abstract

OBJECTIVE

To evaluate visual function and optic disc features in patients with large cup-disc ratios (C/Ds).

METHODS

One eye of 86 patients with vertical C/Ds by contour of at least 0.8, who had undergone both standard achromatic automated perimetry (SAP) and short-wavelength automated perimetry (SWAP) testing, was selected retrospectively. Two masked glaucoma specialists independently graded stereoscopic photographs for vertical C/Ds, rim thinning, notching, excavation, optic disc hemorrhages, and nerve fiber layer defects. Visual fields were classified as abnormal if the glaucoma hemifield test result, corrected pattern standard deviation, or mean deviation was outside age-specific normal limits. Confocal scanning laser ophthalmoscopy was used to determine disc area.

RESULTS

SAP and SWAP results were abnormal in 44 (51%) and 52 (60%) of 86 patients, respectively. In patients with normal SAP results, SWAP results were abnormal in 14 (33%) of 42 patients. In patients with normal SWAP results, SAP results were abnormal in 6 (18%) of 34 patients. Small discs are associated with an abnormal SAP result (P = .01) and an abnormal SWAP result (P = .09). An increased vertical C/D greater than the qualifying level of 0.8 was associated with an abnormal SAP or SWAP result (P< or =.001). Rim thinning (P = .01) and disc hemorrhages (P = .04) were associated with an abnormal SAP result.

CONCLUSIONS

Many patients with large C/Ds have normal SAP and SWAP results. Compared with SAP, SWAP results were abnormal in a higher percentage of these patients. If a patient has a large C/D and normal SAP results, SWAP testing may detect functional loss earlier. If glaucoma is defined by both structural and functional loss, patients with large vertical C/Ds, normal SAP results, and abnormal SWAP results may have glaucoma. Longitudinal studies are needed to assess this hypothesis and determine whether these patients subsequently develop abnormal SAP results as well.

摘要

目的

评估大杯盘比（C/D）患者的视功能和视盘特征。

方法

回顾性选取86例垂直C/D轮廓至少为0.8的患者的一只眼睛，这些患者均接受了标准的消色差自动视野计（SAP）和短波长自动视野计（SWAP）检测。两名经过掩蔽的青光眼专家独立对垂直C/D、边缘变薄、切迹、凹陷、视盘出血和神经纤维层缺损的立体照片进行分级。如果青光眼半视野检测结果、校正模式标准差或平均偏差超出特定年龄的正常范围，则视野被分类为异常。使用共焦扫描激光检眼镜确定视盘面积。

结果

86例患者中，分别有44例（51%）和52例（60%）的SAP和SWAP结果异常。在SAP结果正常的患者中，42例患者中有14例（33%）SWAP结果异常。在SWAP结果正常的患者中，34例患者中有6例（18%）SAP结果异常。小视盘与异常的SAP结果（P = 0.01）和异常的SWAP结果（P = 0.09）相关。垂直C/D大于合格水平0.8与异常的SAP或SWAP结果相关（P≤0.001）。边缘变薄（P = 0.01）和视盘出血（P = 0.04）与异常的SAP结果相关。

结论

许多大C/D患者的SAP和SWAP结果正常。与SAP相比，这些患者中SWAP结果异常的比例更高。如果患者C/D大且SAP结果正常，SWAP检测可能更早发现功能丧失。如果青光眼由结构和功能丧失共同定义，垂直C/D大、SAP结果正常且SWAP结果异常的患者可能患有青光眼。需要进行纵向研究来评估这一假设，并确定这些患者随后是否也会出现异常的SAP结果。