Tezel G, Kass M A, Kolker A E, Wax M B
Department of Ophthalmology & Visual Sciences, Washington University School of Medicine, St. Louis, MO 63110, USA.
Ophthalmology. 1996 Dec;103(12):2105-13. doi: 10.1016/s0161-6420(96)30382-5.
The authors wished to determine whether characteristics of optic disc and parapapillary atrophy differ between eyes with ocular hypertension, primary open-angle glaucoma (POAG) and those with normal-pressure glaucoma, including a subset of patients with normal-pressure glaucoma with evidence of serum abnormalities of humoral autoimmunity.
Three hundred ninety-two eyes of 196 patients with ocular hypertension, 394 eyes of 197 patients with POAG, and 135 eyes of 68 patients with normal-pressure glaucoma were analyzed. Nerve fiber layer hemorrhage in the optic disc region, retinal arteriolar narrowing, and morphometric parameters of optic disc and parapapillary atrophy were investigated in these groups. Parapapillary atrophy was differentiated in two different zones (alpha and beta).
Nerve fiber layer hemorrhage and arteriolar narrowing were found more frequently in patients with normal-pressure glaucoma than in patients with POAG (P = 0.014, P = 0.004) and ocular hypertension (P < 0.0001, P < 0.0001). Zone beta was detected more often in patients with normal-pressure glaucoma than in those with ocular hypertension (P < 0.001) and POAG (P = 0.013). Although patients with normal-pressure glaucoma had more advanced neural rim loss and larger parapapillary atrophy, there were similar correlations between neural rim area and the area and extension of parapapillary atrophy in patients with normal-pressure glaucoma and POAG. Parapapillary atrophy parameters also were similar in different stages of neural rim damage in patients with normal-pressure glaucoma and POAG (P > 0.05). Optic disc characteristics were not different (P > 0.05) between the subgroups of patients with normal-pressure glaucoma.
The authors' findings support the idea that besides the enlargement of the area and extension of parapapillary atrophy that accompanies neural damage in glaucoma, the severity of the parapapillary atrophy also increases as assessed by the increase in zone beta in more damaged eyes. Furthermore, the final clinical appearance of optic nerve damage is similar among patients with POAG, normal-pressure glaucoma, and the subgroups of normal-pressure glaucoma, regardless of their possibly different mechanisms of neuropathy.
作者希望确定高眼压症、原发性开角型青光眼（POAG）患者与正常眼压性青光眼患者（包括一部分有体液自身免疫血清异常证据的正常眼压性青光眼患者）的视盘和视盘旁萎缩特征是否存在差异。
对196例高眼压症患者的392只眼、197例POAG患者的394只眼以及68例正常眼压性青光眼患者的135只眼进行分析。研究了这些组中视盘区域的神经纤维层出血、视网膜小动脉狭窄以及视盘和视盘旁萎缩的形态学参数。视盘旁萎缩分为两个不同区域（α区和β区）。
正常眼压性青光眼患者的神经纤维层出血和小动脉狭窄发生率高于POAG患者（P = 0.014，P = 0.004）和高眼压症患者（P < 0.0001，P < 0.0001）。正常眼压性青光眼患者中β区的检出率高于高眼压症患者（P < 0.001）和POAG患者（P = 0.013）。虽然正常眼压性青光眼患者的神经纤维层边缘丢失更严重且视盘旁萎缩更大，但正常眼压性青光眼患者和POAG患者的神经纤维层边缘面积与视盘旁萎缩面积及范围之间存在相似的相关性。正常眼压性青光眼患者和POAG患者在神经纤维层损伤的不同阶段，视盘旁萎缩参数也相似（P > 0.05）。正常眼压性青光眼亚组之间的视盘特征无差异（P > 0.05）。
作者的研究结果支持这样一种观点，即除了青光眼神经损伤伴随的视盘旁萎缩面积扩大和范围增加外，在损伤更严重的眼中，通过β区增加评估的视盘旁萎缩严重程度也会增加。此外，POAG患者、正常眼压性青光眼患者以及正常眼压性青光眼亚组患者的视神经损伤最终临床表现相似，无论其可能不同的神经病变机制如何。
