Greenfield D S, Siatkowski R M, Glaser J S, Schatz N J, Parrish R K
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Florida, USA.
Ophthalmology. 1998 Oct;105(10):1866-74. doi: 10.1016/S0161-6420(98)91031-4.
To determine the incidence of positive neuroradiologic studies in consecutive patients with glaucoma associated with normal intraocular pressure and to compare the psychophysical and clinical characteristics of these eyes with eyes with disc cupping associated with intracranial masses.
Retrospective case-controlled study.
Fifty-two eyes of 29 patients with glaucoma associated with normal intraocular pressure and 44 eyes of 28 control patients with compressive lesions were reviewed.
The medical records of consecutive glaucoma patients with normal intraocular pressure who underwent brain magnetic resonance imaging or computed tomography scanning as part of a diagnostic evaluation between January 1, 1985, and July 1, 1995, were reviewed. A masked reading of optic nerve photographs and visual fields was performed by one observer. A similar analysis was performed on a control group of consecutive patients with nonglaucomatous optic nerve cupping with known intracranial mass lesions.
The neuroradiologic findings, clinical characteristics, optic nerve head appearance, and patterns of visual field loss were compared between groups.
None of the patients diagnosed with glaucoma had neuroradiologic evidence of a mass lesion involving the anterior visual pathway. Compared to control subjects, patients with glaucoma were older (P = 0.0001), had better visual acuity (P = 0.002), greater vertical loss of neuroretinal rim tissue (P = 0.0001), more frequent optic disc hemorrhages (P = 0.01), less neuroretinal rim pallor (P = 0.0001), and more nerve fiber bundle visual field defects aligned at the horizontal midline (P = 0.0001). Visual acuity less than 20/40, vertically aligned visual field defects, optic nerve pallor in excess of cupping, and age younger than 50 years were 77%, 81%, 90%, and 93% specific for nonglaucomatous cupping associated with compressive lesions, respectively.
Anterior visual pathway compression is an uncommon finding in the neuroradiologic evaluation of patients with a presumptive diagnosis of normal-tension glaucoma. Younger age, lower levels of visual acuity, vertically aligned visual field defects, and neuroretinal rim pallor may increase the likelihood of identifying an intracranial mass lesion.
确定连续的眼压正常性青光眼患者神经影像学检查阳性的发生率，并比较这些患眼与伴有颅内肿物的视盘凹陷患眼的心理物理学和临床特征。
回顾性病例对照研究。
对29例眼压正常性青光眼患者的52只患眼以及28例患有压迫性病变的对照患者的44只患眼进行了评估。
回顾了1985年1月1日至1995年7月1日期间作为诊断评估一部分接受脑磁共振成像或计算机断层扫描的连续眼压正常性青光眼患者的病历。由一名观察者对视神经照片和视野进行盲法阅读。对一组连续的伴有已知颅内肿物病变的非青光眼性视神经凹陷患者进行了类似分析。
比较两组间的神经影像学检查结果、临床特征、视神经乳头外观和视野缺损模式。
诊断为青光眼的患者均无涉及前视觉通路的肿物病变的神经影像学证据。与对照组相比，青光眼患者年龄更大（P = 0.0001），视力更好（P = 0.002），神经视网膜边缘组织垂直丢失更多（P = 0.0001），视盘出血更频繁（P = 0.01），神经视网膜边缘苍白更少（P = 0.0001），且水平中线处对齐的神经纤维束视野缺损更多（P = 0.0001）。视力低于20/40、垂直对齐的视野缺损、视神经苍白超过凹陷以及年龄小于50岁对伴有压迫性病变的非青光眼性凹陷的特异性分别为77%、81%、90%和93%。
在前视觉通路压迫在疑似正常眼压性青光眼患者的神经影像学评估中是一个不常见的发现。年龄较小、视力水平较低、垂直对齐的视野缺损和神经视网膜边缘苍白可能增加识别颅内肿物病变的可能性。
