Diehl D L, Quigley H A, Miller N R, Sommer A, Burney E N
Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21205.
Arch Ophthalmol. 1990 Apr;108(4):545-50. doi: 10.1001/archopht.1990.01070060093056.
We determined the prevalence of hemorrhage within 1 disc diameter of the optic nerve head by masked examination of stereoscopic color and red-free fundus photographs in a multilayer study of 1123 patients. At the first (baseline) examination, disc hemorrhages were present in none of the normal subjects (0 of 661), 0.44% (6/1377) of "glaucoma suspect" subjects, and 2.44% (3/123) of glaucomatous eyes. Disc hemorrhage prevalence in glaucomatous eyes was significantly higher than in normal or glaucoma suspect eyes. Glaucoma suspect eyes with disc hemorrhage, compared with matched suspect eyes without disc hemorrhage, had a larger mean vertical cup-disc ratio, an increased rate of nerve fiber layer atrophy 1 year following disc hemorrhage, and a higher rate of conversion to initial visual field loss (numerically higher conversion though not statistically significant). While the number of eyes with disc hemorrhages in this study is small, in a patient with glaucoma or ocular hypertension, disc hemorrhage appears to be associated with a greater likelihood of ongoing damage. The low disc hemorrhage prevalence in an unselected population limits its usefulness as a screening tool for glaucoma.
在一项针对1123例患者的多层研究中，我们通过对立体彩色和无赤眼底照片进行盲法检查，确定了视神经乳头1个视盘直径范围内出血的患病率。在首次（基线）检查时，正常受试者（661例中0例）、“青光眼可疑”受试者（1377例中0.44%，即6例）和青光眼患者（123例中2.44%，即3例）均未出现视盘出血。青光眼患者的视盘出血患病率显著高于正常或青光眼可疑患者。与无视盘出血的匹配可疑眼相比，有视盘出血的青光眼可疑眼平均垂直杯盘比更大，视盘出血1年后神经纤维层萎缩率增加，初始视野缺损转化率更高（虽然数值上更高，但无统计学意义）。虽然本研究中出现视盘出血的眼数较少，但在青光眼或高眼压患者中，视盘出血似乎与持续损害的可能性更大有关。在未选择的人群中视盘出血患病率较低，限制了其作为青光眼筛查工具的实用性。
