【摘要】：第一部分：老年原發(fā)性青光眼低對比度視力與HRT—Ⅱ盤沿參數(shù)及黃斑閾值的相關(guān)性 目的研究老年原發(fā)性青光眼患者在不同發(fā)展時(shí)期低對比度視力的改變特點(diǎn),初步探討低對比度視力與海德堡視網(wǎng)膜斷層成像儀Ⅱ型(HRT-Ⅱ)測得的顳側(cè)盤沿參數(shù)及黃斑閾值在青光眼不同時(shí)期有無相關(guān)性,探討低對比度視力檢查能否成為檢測老年青光眼中心視功能損害的有效方法。 方法選擇老年原發(fā)性青光眼患者46例(88眼),正常對照組23例(40眼)。對所有受試者行屈光矯正后,采用多功能視力測量儀檢查測得100%、25%、10%和5%4個(gè)對比度視力,應(yīng)用德國產(chǎn)Humphrey—750i型視野分析儀的中心30-2程序及黃斑閾值視野(MTP)檢測程序進(jìn)行靜態(tài)閾值視野檢查,根據(jù)中心30-2視野平均缺損(MD)將青光眼患者分為早期組23例(45眼)和中晚期組23例(43眼)。用海德堡視網(wǎng)膜斷層成像儀Ⅱ型進(jìn)行視乳頭掃描分析,選擇顳側(cè)盤沿面積(RA)、顳側(cè)盤沿容積(RV)兩個(gè)視盤參數(shù)。分析青光眼早期組、中晚期組及正常對照組之間各對比度視力有無統(tǒng)計(jì)學(xué)差異(P0.05)；分析青光眼早期組、中晚期組各低對比度視力與HRT-Ⅱ測得的顳側(cè)RA、RV有無相關(guān)性及與MTP的平均光敏感度(MS)有無相關(guān)性,。 結(jié)果對照組、青光眼早期組及中晚期組25%、10%及5%對比度視力均依次下降,三組間總體比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)；青光眼早期組各低對比度視力較對照組下降,但差異無統(tǒng)計(jì)學(xué)意義(P0.05)；25%低對比度視力與顳側(cè)RV呈負(fù)相關(guān)(r=-0.301,P0.05)；25%、10%低對比度視力與MTP的MS呈負(fù)相關(guān)(r=-0.307；r=-0.298；,P均0.05),中晚期組各低對比度視力較對照組和早期組均下降,差異有統(tǒng)計(jì)學(xué)意義(P0.05),10%、5%低對比度視力與顳側(cè)RA呈負(fù)相關(guān)(r=-0.361；r=-0.318,P均0.05)、與顳側(cè)RV呈負(fù)相關(guān)(r=-0.303；r=-0.377,P均0.05),10%、5%低對比度視力與MTP的MS呈負(fù)相關(guān)(r=-0.314；r=-0.397,P均0.05)。 結(jié)論老年原發(fā)性青光眼病情進(jìn)展導(dǎo)致低對比度視力下降,與盤沿結(jié)構(gòu)參數(shù)和黃斑光閾值相關(guān)的低對比度視力的對比度水平逐漸降低,早期與中晚期患者不同低對比度視力與HRT-Ⅱ顳側(cè)盤沿參數(shù)RA、RV及黃斑閾值有相關(guān)性,對比度視力檢查結(jié)合視乳頭結(jié)構(gòu)檢測及其它視功能檢查能夠?qū)η喙庋壑行囊暪δ艿牟∏樵u估和監(jiān)測提供重要依據(jù)。 第二部分：老年原發(fā)性青光眼黃斑閾值與HRT—Ⅱ盤沿參數(shù)的相關(guān)性 目的研究原發(fā)性青光眼老年患者各發(fā)展時(shí)期并結(jié)合青年患者早期的黃斑閾值變化特點(diǎn),分析老年黃斑閾值與視盤盤沿結(jié)構(gòu)改變的相關(guān)性,探討黃斑閾值在檢測老年青光眼中心視功能方面的客觀性和可靠性。 方法選擇原發(fā)性青光眼老年患者51例(97眼),青年患者22例(40眼),老年正常對照組23例(40眼)。對所有受試者行屈光矯正后,采用Humphrey—750i型視野分析儀進(jìn)行靜態(tài)閾值視野檢查,選擇中心30-2程序及黃斑閾值視野(MTP)檢測程序,根據(jù)中心30-2視野平均缺損(MD)將青光眼患者分為老年早期組23例(45眼),老年中晚期組28例(52眼),青年早期組22例(40眼)。采用海德堡視網(wǎng)膜斷層成像儀Ⅱ型(HRT-Ⅱ)進(jìn)行視乳頭結(jié)構(gòu)分析,測得顳側(cè)盤沿面積(RA)、盤沿容積(RV)兩個(gè)視盤參數(shù)。統(tǒng)計(jì)分析老年早期組、中晚期組及正常對照組之間黃斑閾值有無統(tǒng)計(jì)學(xué)差異(P0.05)；分析青光眼各組MTP的平均光敏感度(MS)與HRT-Ⅱ測得的顳側(cè)盤沿參數(shù)RA、RV有無相關(guān)性。 結(jié)果黃斑閾值在對照組、老年早期組及老年中晚期組依次下降,三組間總體比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)；老年早期組黃斑閾值與對照組比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)；MTP的MS與顳側(cè)RA、RV無相關(guān)性(P0.05)；老年中晚期組MTP的MS較對照組和老年早期組均下降,差異有統(tǒng)計(jì)學(xué)意義(P0.05),MTP的MS與顳側(cè)RV呈正相關(guān)(r=0.308,P0.05)；青年早期組黃斑閾值與顳側(cè)RA、RV無相關(guān)性(P0.05)。 結(jié)論隨著老年青光眼患者病情發(fā)展,黃斑閾值逐漸升高,中晚期患者黃斑閾值與HRT-Ⅱ顳側(cè)盤沿參數(shù)RV有相關(guān)性。黃斑閾值檢測在老年早期診斷方面不夠敏感,但在中晚期患者的隨訪監(jiān)測及病情評估方面有效。
[Abstract]:Part one: correlation between low contrast visual acuity and HRT - II disc rim parameters and macular thresholds in elderly primary glaucoma.
Objective to study the characteristics of low contrast visual acuity at different developmental stages in the elderly patients with primary glaucoma, and to explore the correlation between the temporal disc edge parameters and the macular threshold of the low contrast visual acuity and the Heidelberg retina tomography II imaging instrument (HRT- II) in different periods of glaucoma. It is an effective method to detect visual impairment in senile glaucoma patients.
Methods 46 cases (88 eyes) and 23 cases (40 eyes) of the normal control group were selected and 23 cases (40 eyes) of the normal control group. After the refractive correction of all subjects, the 100%, 25%, 10% and 5%4 contrast visual acuity were measured by the multifunction visual instrument. The center 30-2 program and the macular threshold field of vision (MTP) were detected by the German Humphrey 750i field analyzer. The program carried out static threshold visual field examination, divided glaucoma patients into early group 23 cases (45 eyes) and middle and late group 23 cases (43 eyes) according to the center 30-2 visual field defect (MD). The visual papilla scanning of the Heidelberg retina tomography type II was used to select the temporal disc along surface product (RA), and the temporal disc along the volume (RV) two disc parameters. There was no significant difference in contrast between the early light eye group, the middle and late group and the normal control group (P0.05). Analysis of the early glaucoma group, the low contrast visual acuity of the middle and late stage group and the temporal RA of the HRT- II, the correlation of RV and the mean light sensitivity of MTP (MS) had no correlation.
Results in the control group, the visual acuity of 25%, 10% and 5% in the early and middle stage groups decreased in turn, and there was a significant difference between the three groups (P0.05). The low contrast visual acuity in the early glaucoma group was lower than the control group, but the difference was not statistically significant (P0.05); 25% low contrast visual acuity was negatively correlated with temporal RV (r=-0.301, P0. 05); (05) 25%, 10% low contrast visual acuity was negatively correlated with MS of MTP (r=-0.307; r=-0.298; P 0.05). The low contrast visual acuity of the middle and late group decreased compared with the control group and the early group, the difference was statistically significant (P0.05), 10%, 5% low contrast vision was negatively correlated with the temporal RA (r=-0.361; r=-0.318, P 0.05), and was negatively correlated with the temporal RV (r=-0.303). ; r=-0.377, P all 0.05), 10%, 5% low contrast visual acuity was negatively correlated with MS of MTP (r=-0.314, r=-0.397, P 0.05).
Conclusion the progression of primary glaucoma in the elderly leads to low contrast visual acuity, the contrast of low contrast visual acuity associated with the parameters of the disc and the Huang Banguang threshold, and the correlation between the low contrast visual acuity and the HRT- II temporal disc along the parameters RA, RV and macula threshold in the early and middle stage patients, and the contrast vision examination. Examination combined with the examination of optic disc structure and other visual function tests can provide important basis for the assessment and monitoring of the central visual function of glaucoma.
The second part: the correlation between macular threshold and HRT - II disc parameters in elderly patients with primary glaucoma.
Objective to study the characteristics of the changes in the early macular threshold of the elderly patients with primary glaucoma and to analyze the correlation between the age-related macular thresholds and disc disc changes, and to explore the objectivity and reliability of the macular threshold in the detection of the central visual function of the elderly glaucoma.
Methods 51 elderly patients with primary glaucoma (97 eyes), 22 young patients (40 eyes) and 23 elderly normal controls (40 eyes) were selected. After refraction correction, the static threshold visual field examination was performed by Humphrey 750i visual field analyzer, and the center 30-2 program and the macular threshold visual field (MTP) detection program were selected, according to center 30-2. The average visual field defect (MD) was divided into 23 cases (45 eyes) of the early aged group, 28 cases (52 eyes) in the middle and advanced age group and 22 cases (40 eyes) in the early young group. The optic papillary structure analysis was carried out by the Heidelberg retina tomography II (HRT- II). The temporal disc area (RA) and the disc along volume (RV) two disc parameters were measured. Statistics and analysis of the elderly There was no statistical difference in the macular threshold between the early group, the middle and late group and the normal control group (P0.05), and the mean light sensitivity (MS) of MTP in each group was correlated with the parameters RA and RV of the temporal disc, which was measured by HRT- II.
Results the macular threshold in the control group, the early aged group and the middle and late aged group decreased in turn, and there was a significant difference between the three groups (P0.05). The macular threshold of the early aged group was significantly different from the control group (P0.05); the MS of MTP and the temporal RA, RV were not correlated (P0.05), and the MS in the middle and late elderly group was more than the control group and the control group. In the early age group, the difference was statistically significant (P0.05). The MS of the MTP was positively correlated with the temporal RV (r=0.308, P0.05), and there was no correlation between the macular threshold and the temporal RA and RV (P0.05) in the early young group.
Conclusion with the development of the elderly glaucoma patients, the macular threshold increased gradually. The macular threshold was correlated with the HRT- II temporal disc along the parameter RV. The macular threshold detection was not sensitive to the early diagnosis of the elderly, but it was effective in the follow-up monitoring and evaluation of the patients in the middle and late stages.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2011
【分類號】：R775.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 楊鳳娟,董雅儒,劉殊;原發(fā)性閉角型青光眼的視覺電生理及對比敏感度變化[J];吉林大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2004年03期

2 劉姝;宋躍;王霽雪;吳雅臻;;原發(fā)性急性閉角型青光眼患者對比敏感度及色覺改變[J];吉林大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2007年02期

3 盧寧,張承芬;對比敏感度檢查[J];國外醫(yī)學(xué).眼科學(xué)分冊;1991年03期

4 袁援生,戴維葭,曾令柏;青光眼黃斑光閾值的研究[J];昆明醫(yī)學(xué)院學(xué)報(bào);1997年04期

5 許育新;朱美玲;張曉萍;廖榮豐;朱強(qiáng);;原發(fā)性慢性閉角型青光眼與正常眼HRT-Ⅱ視盤形態(tài)結(jié)構(gòu)的對比研究[J];臨床眼科雜志;2007年04期

6 方華;鄧如芝;;早期原發(fā)性開角型青光眼對比度視力研究[J];實(shí)用醫(yī)學(xué)雜志;2009年17期

7 崔靖;賀忠江;高慧娟;;老年硬化性青光眼的臨床研究[J];天津醫(yī)藥;2010年05期

8 陸穗,陳振謙,郭露萍,楊瑞明;原發(fā)性開角型青光眼與高血壓的關(guān)系[J];現(xiàn)代臨床醫(yī)學(xué)生物工程學(xué)雜志;2003年03期

9 孫霞,劉磊,楊文利,周躍華;原發(fā)性開角型青光眼視盤及視網(wǎng)膜血流的研究[J];眼科新進(jìn)展;2001年05期

10 王華,王平寶,黃佩剛,劉雙珍,楊昌全,周明敏;黃斑閾值檢測在早期青光眼診斷中的應(yīng)用[J];眼科新進(jìn)展;2003年02期

，

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