Burk R O, König J, Rohrschneider K, Noack H, Völcker H E
Universitäts-Augenklinik Heidelberg.
Klin Monbl Augenheilkd. 1994 Jun;204(6):504-12. doi: 10.1055/s-2008-1045474.
BACKGROUND The evaluation of optic disc topography is essential for the clinical diagnosis of primary open angle glaucoma. The purpose of this study was (1) to establish a computerized cluster formation of optic nerve head topography based on quantitative three-dimensional parameter values and (2) to describe the resulting clusters according to morphological appearance and visual fields. PATIENTS AND METHODS 337 optic nerve heads (glaucomatous optic neuropathy (n = 99), glaucoma suspects (n = 159), normals (n = 79) were analyzed using laser scanning tomography. A hierarchical cluster analysis was performed based on standardized variables (optic disc area, rim area, area-ratio, cup depth, cup steepness, height variations along the contour-line). Visual fields were tested by computerized static threshold perimetry. RESULTS A seven cluster solution met the optimizing criteria. The characteristic morphology of the clusters can be described as "normal" (N), "normal, large" (NL), "supernormal" (SN), "pseudonormal" (PN), "glaucoma-like-flat" (GF), "glaucoma-like-steep" (GS) and "macropapillary" (M). Visual fields were normal in 180 eyes. 99 eyes had glaucomatous field defects, 58 eyes revealed isolated relative scotomas < 10 db. Presence and degree of visual field defects varied within the automatically classified optic disc groups considerably. Visual field defects were found in 7.7% (SN), 8.3% (N), 18.8% (NL), 33.3% (M), 37% (PN), 64.7% (GF) and 83.3% (GS) respectively. Pseudonormal discs were characterized by a flattening of the height variations along the disc border. CONCLUSIONS (1) Optic nerve heads may be automatically classified based upon a combination of three-dimensional topographic variables. (2) Analysis of optic disc topography and computerized perimetry are supplementary tools in the evaluation of the glaucoma patient. Visual field defects may be present within any cluster. However, the likelyness of the presence of visual field defects differs considerably among the topometrically defined groups of optic nerve heads. Functional damage is to be expected in association with reduced height variations along the disc border, a small rim area and a steep cupping of the optic nerve head.
背景 视盘地形图评估对于原发性开角型青光眼的临床诊断至关重要。本研究的目的是：（1）基于定量三维参数值建立视神经乳头地形图的计算机聚类；（2）根据形态外观和视野描述所得聚类。
患者与方法 对337个视神经乳头（青光眼性视神经病变（n = 99）、青光眼可疑患者（n = 159）、正常人（n = 79））使用激光扫描断层扫描进行分析。基于标准化变量（视盘面积、盘沿面积、面积比、杯深、杯坡度、沿轮廓线的高度变化）进行层次聚类分析。通过计算机静态阈值视野计测试视野。
结果 七聚类解决方案符合优化标准。聚类的特征形态可描述为“正常”（N）、“正常，大”（NL）、“超常”（SN）、“假正常”（PN）、“青光眼样扁平”（GF）、“青光眼样陡峭”（GS）和“大视乳头”（M）。180只眼视野正常。99只眼有青光眼性视野缺损，58只眼有孤立的相对暗点<10 dB。在自动分类的视盘组中，视野缺损的存在和程度差异很大。视野缺损分别见于7.7%（SN）、8.3%（N）、18.8%（NL）、33.3%（M）、37%（PN）、64.7%（GF）和83.3%（GS）。假正常视盘的特征是沿视盘边界的高度变化变平。
结论 （1）可基于三维地形变量的组合对视神经乳头进行自动分类。（2）视盘地形图分析和计算机视野检查是评估青光眼患者的辅助工具。任何聚类中都可能存在视野缺损。然而，在地形学定义的视神经乳头组中，视野缺损存在的可能性差异很大。预计与视盘边界高度变化减小、盘沿面积小和视神经乳头杯状陡峭相关会出现功能损害。
