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目的研究原发性开角型青光眼(POAG)、正常眼压性青光眼(NTG)与正常大陷凹眼的视乳头旁脉络膜萎缩区(PPA)的差异及其与视野的关系。方法利用计算机图像分析系统对拍摄的视乳头立体图像进行测量,比较42例(42只眼)POAG、40例(40只眼)NTG与45例(45只眼)正常大陷凹眼之间PPA的发生率及大小差异,分析PPA的有关参数与视乳头结构指标、视野分级之间的相关性。所有入选患者的屈光度(等效球镜度数)均在+3.00~-3.00D之间。结果正常大陷凹组、POAG组及NTG组α区的出现率分别为85.4%、100.0%、95.0%,β区的出现率分别为19.1%、48.9%、37.5%,POAG组和NTG组的α区和β区的出现率均大于正常大陷凹组,差异均有统计学意义(P<0.05)。正常大陷凹组、POAG组及NTG组β区面积分别为(0.08±0.25)、(0.24±0.36)、(0.14±0.21)mm2,POAG组的β区面积大于正常大陷凹组,差异有统计学意义(P<0.05)。三组的α区面积差异无统计学意义(Chi-Square=4.534,P=0.104)。而POAG组与NTG组间上述各指标及α区和β区出现率的差异均无统计学意义(P>0.05)。青光眼患者视乳头结构指标与视野相关分析结果表明,杯/盘比值与视野受损分级之间有较强相关性(r=0.5624,P<0.01)。而α区面积、β区面积与视野受损分级之间均为低相关性(α区:r=0.246,P<0.01;β区:r=0.2302,P<0.01)。有无青光眼性视野缺损相关因素的Logistic回归分析结果显示,在包括年龄、性别、屈光度、杯/盘比值分级指标及α区面积和β区有无的多个因素中,仅年龄和杯/盘比值分级指标被证实为两个可能的影响因素。结论排除了-3.00D以上的中高度近视人群后,POAG和NTG患者的α区和β区出现率及β区面积虽与正常大陷凹者有所不同,但其与视野缺损程度的相关性较传统的视乳头结构指标低,在两组青光眼患者间也未见明显差异。由此认为PPA不能作为诊断POAG的独立指标,也不能作为POAG与NTG的鉴别诊断指标。
Objective To investigate the difference of optic choroidal atrophy (PPA) between primary open angle glaucoma (POAG), normal tension glaucoma (NTG) and normal sagittal pits and its relationship with visual field. Methods A computerized image analysis system was used to measure stereoscopic images of the papilla. Comparison of PPA between 42 eyes (42 eyes) POAG, 40 eyes (40 eyes) NTG and 45 eyes (45 eyes) normal pits The incidence and size differences, analysis of PPA related parameters and structural parameters of optic disc, visual field classification between the correlation. Refraction of all patients (equivalent spherical power) are between + 3.00 ~ -3.00D. Results The incidence rates of α region in normal pouch group, POAG group and NTG group were 85.4%, 100.0% and 95.0%, respectively. The incidences of β region were 19.1%, 48.9% and 37.5% in POAG group and NTG group respectively The incidences of a and β were higher than those in normal sag group, with significant differences (P <0.05). The area of β in normal puddle group, POAG group and NTG group were (0.08 ± 0.25), (0.24 ± 0.36) and (0.14 ± 0.21) mm2, respectively. The area of β area in POAG group was larger than that in normal pothole group Statistical significance (P <0.05). There was no significant difference in the area of α in the three groups (Chi-Square = 4.534, P = 0.104). However, there was no significant difference between POAG group and NTG group (P> 0.05). Glaucomatous optic disc structure index and visual field correlation analysis showed that there was a strong correlation between cup / disc ratio and visual field damage classification (r = 0.5624, P <0.01). There was a low correlation between the area of α, the area of β, and the impaired visual field (α: r = 0.246, P <0.01; β: r = 0.2302, P <0.01). Logistic regression analysis of factors associated with or without glaucomatous visual field revealed that among age, sex, diopter, cup / plate ratio grading, and alpha-zone area and beta-zone presence, only age and cup / plate The ratio rating indicator has been confirmed as two possible influencing factors. Conclusion The exclusion of -3.00D above the high myopia crowd, POAG and NTG patients, the incidence of α and β area and β area, although with the normal pits are different, but its correlation with the extent of visual field defects More traditional indicators of optic disc structure is low, no significant difference between the two groups of patients with glaucoma. Therefore, PPA can not be used as an independent indicator of POAG diagnosis, nor as a differential diagnosis of POAG and NTG indicators.