Boland Michael V, Zhang Lei, Broman Aimee T, Jampel Henry D, Quigley Harry A
Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA.
Ophthalmology. 2008 Feb;115(2):239-245.e2. doi: 10.1016/j.ophtha.2007.03.086.
To compare the optic disc and visual field (VF) alterations in primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG).
Observational case series.
A total of 146 persons (217 eyes), 110 with POAG and 36 with PACG, recruited from a university glaucoma service.
Each subject underwent visual acuity measurement, applanation tonometry, gonioscopy, slit-lamp examination, dilated optic disc and retinal examination, axial eye length measurement, central corneal pachymetry, automated perimetry, optical coherence tomography (OCT) nerve fiber layer (NFL) examination, and Heidelberg Retina Tomograph (HRT) optic disc evaluation. Parameters of interest were studied by multivariate regression models.
Heidelberg Retina Tomograph parameters compared between POAG and PACG.
Primary open-angle glaucoma and PACG groups were similar in age, ethnic background, and treated intraocular pressure, but the PACG group had significantly more women, shorter eye length, more hyperopia, and a larger disc area (all Ps < 0.001). The VF average mean deviation (MD) did not significantly differ between POAG and PACG, but the PACG group had lower pattern standard deviation (PSD) for a given MD (P = 0.001). Although 3 HRT parameters differed somewhat between POAG and PACG (cup area, rim area, and cup-to-disc area ratio), they did not significantly differ after correction for multiple comparisons. Mean deviation and disc area were much more significant predictors of the HRT measures than was diagnosis. Similar results were obtained when using OCT NFL thickness as a structural measure of damage as opposed to MD as a functional measure. When controlling for MD, current IOP was not significantly associated with disc parameters in POAG.
When the amount of optic nerve damage is taken into account by adjusting for VF MD or OCT NFL thickness, those with POAG and PACG have no significant differences in optic disc topography. Visual field damage in PACG was more diffuse than that in POAG, as measured by a lower PSD for a given level of MD. There was no corresponding difference in the uniformity of structural damage as measured by OCT NFL thickness.
比较原发性开角型青光眼（POAG）和原发性闭角型青光眼（PACG）的视盘及视野（VF）改变。
观察性病例系列。
从一所大学的青光眼诊疗中心招募了146人（217只眼），其中110例为POAG，36例为PACG。
每位受试者均接受了视力测量、压平眼压测量、前房角镜检查、裂隙灯检查、散瞳后的视盘和视网膜检查、眼轴长度测量、中央角膜厚度测量、自动视野计检查、光学相干断层扫描（OCT）神经纤维层（NFL）检查以及海德堡视网膜断层扫描（HRT）视盘评估。通过多变量回归模型研究感兴趣的参数。
比较POAG和PACG之间的海德堡视网膜断层扫描参数。
POAG组和PACG组在年龄、种族背景及治疗后的眼压方面相似，但PACG组女性更多，眼轴较短，远视更多，视盘面积更大（所有P值均<0.001）。POAG和PACG之间的VF平均偏差（MD）无显著差异，但在给定的MD水平下，PACG组的模式标准偏差（PSD）较低（P = 0.001）。虽然POAG和PACG之间的3个HRT参数（杯面积、盘沿面积和杯盘比）有所不同，但在进行多重比较校正后，它们并无显著差异。与诊断相比，MD和视盘面积是HRT测量更显著的预测因素。与将MD作为功能测量指标相反，当使用OCT NFL厚度作为损伤的结构测量指标时，获得了相似的结果。在控制MD的情况下，POAG患者当前的眼压与视盘参数无显著相关性。
通过调整VF MD或OCT NFL厚度来考虑视神经损伤程度时，POAG和PACG患者在视盘地形图上无显著差异。以给定MD水平下较低的PSD衡量，PACG的视野损害比POAG更弥漫。以OCT NFL厚度衡量，结构损害的均匀性无相应差异。
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