急性原发性闭角型青光眼不同病程视野损害特点及影响因素

doi:10.3760/cma.j.issn.1674-845X.2018.02.002.

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摘要

目的：探讨急性原发性闭角型青光眼（APACG）不同病程视野损害的特点及其影响因素。方法：病例对照研究。连续收集2015年9月至2016年9月于中山大学中山眼科中心确诊为APACG的患者。根据临床特征将患眼分为临床前期组、药物缓解期组、慢性期组，根据APACG急性发作持续时间将药物缓解期组及慢性期组患者分为急性发作持续时间7 d以内组及7 d以上组。选择同期在门诊体检者中年龄、性别相匹配的健康成年人作为正常对照组。记录所有对象临床特征，使用Humphrey 750型视野分析仪30-2 SITA-Standard标准阈值程序进行视野检查。比较各组间临床特征和视野检查结果，并分析眼压、杯盘比（C/D）、房角粘闭范围、急性发作时最高眼压、急性发作持续时间与视野平均偏差（MD）、视野指数（VFI）、模式标准差（PSD）等的相关性。采用卡方检验、独立样本t检验、方差分析、秩和检验及Spearman相关分析进行数据分析。结果：共纳入正常对照组20例（20眼），APACG患者74例（74眼），其中临床前期组24例，药物缓解期组28例，慢性期组22例。4组间VFI值和MD值总体差异有统计学意义（F=60.588、61.018，P < 0.001），组间两两比较发现慢性期组MD值和VFI值显著小于其他3组（P < 0.008），药物缓解期组MD值和VFI值显著小于正常对照组（P < 0.008）。4 组间PSD值总体差异有统计学意义（F=60.022，P < 0.001），组间两两比较发现慢性期组的PSD值均显著大于其他3组（P < 0.008），临床前期组和药物缓解期组PSD值均显著大于正常对照组（P < 0.008）。药物缓解期组MD值、VFI值与急性发作持续时间均呈中度负相关（r=-0.653，P < 0.001；r=-0.547，P=0.003），PSD值与急性发作持续时间呈中度正相关（r=0.579，P=0.001）；慢性期组MD值、VFI值与急性发作持续时间呈中度负相关（r=-0.441，P=0.044；r=-0.531，P=0.011），与C/D呈中度负相关（r=-0.632，P=0.002；r=-0.633，P=0.002）。药物缓解期组急性发作持续时间7 d以内者的MD值和VFI值均大于急性发作持续时间7 d以上者（Z=-2.998，P=0.003；Z=-2.639，P=0.008）。结论：APACG急性发作后，药物缓解期组和慢性期组存在视野损害，且慢性期组视野损害较重。视野损害主要与急性发作持续时间有关。

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关键词 ：急性原发性闭角型青光眼, 病程, 视野, 影响因素, 急性原发性闭角型青光眼, 病程, 视野, 影响因素

Abstract：

Objective: To investigate the characteristics of visual field defects in different stages of acute primary angle\ closure glaucoma (APACG) and determine the factors that affect them. Methods: Patients with APACG were consecutively recruited in this case-control study from September 2015 to September 2016. Accordingto the clinical features, the affected eyes were staged into three groups: preclinical, remission, and chronic. Age- and gender-matched healthy adults were included as normal controls. The clinical data of all subjects were recorded, and visual field tests using the Humphrey Ⅱ 750 perimeter with 30-2 SITA-Standard full threshold strategy were performed in all subjects. The clinical and visual field data of all groups, including mean deviation of visual field (MD), visual field index (VFI) and pattern standard deviation of visual field (PSD) were compared and correlations among them were explored. The data were analyzed by Pearson correlation, Chi-square test, independent samples t test, ANOVA, Kruskal-Wallis test. Results: Twenty normal controls (20 eyes) and 74 APACG patients (74 eyes) were recruited. Among APACG patients,24 were in the preclinical group, 28 were in the remission group, and 22 were in the chronic group. There were no significant differences in age or gender among the four groups. Comparisons of MD and VFI of all groups showed that the MD and VFI of chronic group were the worst among all groups (P<0.008), and the MD and VFI of remission group were significantly worse than the normal controls (P<0.008). Comparison of PSD of all groups showed that the PSD of chronic group was the largest among all groups (P<0.008), and the PSD of remission group and preclinical group were larger than the normal controls (P<0.008). The MD and VFI of the remission group were negatively correlated with duration of the acute attacks (r=-0.653,P<0.001; r=-0.547, P=0.003), while PSD was positively correlated with duration of the acute attacks
(r=0.579, P=0.001). The MD and VFI of the chronic group were negatively correlated with the duration of acute attacks (r=-0.441, P=0.044; r=-0.531, P=0.011) and the cup to disc ratio (r=-0.632, P=0.002;r=-0.633, P=0.002). The MDs and VFIs in the remission group in which the duration of the acute attacks
lasted less than 7 days were better than those in which the attacks lasted more than 7 days (Z=-2.998,P=0.003; Z=-2.639, P=0.008). Conclusions: Visual field defects can occur after APACG attacks, and the severity of the defects was associated with duration of the attacks. Shortening the duration of acute attacks
could reduce visual field defects.

Key words： acute primary angle closure glaucoma disease course visual field affecting factor acute primary angle closure glaucoma disease course visual field affecting factor

收稿日期: 2017-06-19

基金资助:

国家自然科学基金（81670850）；广州市科技计划项目（201607010321）

通讯作者: 黄晶晶（ORCID：0000-0002-3009-8681），Email：hjjing@mail.sysu.edu.cn

引用本文:

徐迦南,陆鹏,代苗苗,林佳柳,黄文敏,黄晶晶. 急性原发性闭角型青光眼不同病程视野损害特点及影响因素[J]. 中华眼视光学与视觉科学杂志, 2018, 20(2): 72-. Jianan Xu, Peng Lu, Miaomiao Dai, Jialiu Lin, Wenmin Huang, Jingjing Huang. Visual Field Characteristics and the Factors That Affect Them in Different Stages of Acute Primary Angle Closure Glaucoma. Chinese Journal of Optometry Ophthalmology and Visual science, 2018, 20(2): 72-. DOI: 10.3760/cma.j.issn.1674-845X.2018.02.002.

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64	20(95)31060-3.
[4]	中华医学会眼科学分会青光眼学组. 我国原发性青光眼诊断和治疗专家共识（2014 年）. 中华眼科杂志, 2014, (5): 382-383. DOI: 10.3760/cma.j.issn.0412-4081.2014.05.022.
[5]	Matsuura M, Hirasawa K, Yanagisawa M, et al. Estimating the binocular visual field of glaucoma patients with an adjustment for ocular dominance. Invest Ophthalmol Vis Sci, 2016, 57(7):3276-3281. DOI: 10.1167/iovs.15-19024.
[6]	Saunders LJ, Russell RA, Kirwan JF, et al. Examining visual field loss in patients in glaucoma clinics during their predicted remaining lifetime. Invest Ophthalmol Vis Sci, 2014, 55(1):102-109. DOI: 10.1167/iovs.13-13006.
[1]	余敏斌, 周鄂生, 邓大明, 等. 原发性急性闭角型青光眼高眼压水平及持续时间对视力影响. 中国实用眼科杂志, 1999,17(9): 530-532.
[2]	梁远波, 吴作红, 王宁利, 等. 急性闭角型青光眼的临床体征与房角粘连程度的关系. 眼视光学杂志, 2006, 8(3): 177-179.DOI: 10.3760/cma.j.issn.1674-845X.2006.03.014.
[3]	Katz J, Tielsch JM, Quigley HA, et al. Automated perimetry detects visual field loss before manual Goldmann perimetry. Ophthalmology, 1995, 102(1): 21-26. DOI: 10.1016/S0161-
[7]	Sawaguchi S, Sakai H, Iwase A, et al. Prevalence of primary angle closure and primary angle-closure glaucoma in a southwestern rural population of Japan: the Kumejima Study.
	Ophthalmology, 2012, 119(6): 1134-1142. DOI: 10.1016/j.ophtha.2011.12.038.
[8]	Sihota R, Rao A, Gupta V, et al. Progression in primary angle closure eyes. J Glaucoma, 2010, 19(9): 632-636. DOI: 10.1097/IJG.0b013e3181ca7de9.
[9]	Bonomi L, Marraffa M, Marchini G, et al. Perimetric defects after a single acute angle-closure glaucoma attack. Graefes Arch Clin Exp Ophthalmol, 1999, 237(11): 908. DOI: 10.1007/
64	20(95)31060-3.
[4]	中华医学会眼科学分会青光眼学组. 我国原发性青光眼诊断和治疗专家共识（2014 年）. 中华眼科杂志, 2014, (5): 382-383. DOI: 10.3760/cma.j.issn.0412-4081.2014.05.022.
[5]	Matsuura M, Hirasawa K, Yanagisawa M, et al. Estimating the binocular visual field of glaucoma patients with an adjustment for ocular dominance. Invest Ophthalmol Vis Sci, 2016, 57(7):3276-3281. DOI: 10.1167/iovs.15-19024.
[6]	Saunders LJ, Russell RA, Kirwan JF, et al. Examining visual field loss in patients in glaucoma clinics during their predicted remaining lifetime. Invest Ophthalmol Vis Sci, 2014, 55(1):102-109. DOI: 10.1167/iovs.13-13006.
	s004170050385.
[10]	Loon SC, Chew PT, Oen FT, et al. Iris ischaemic changes and visual outcome after acute primary angle closure. Clin Exp Ophthalmol, 2005, 33(5): 473-477. DOI: 10.1111/j.1442-
[7]	Sawaguchi S, Sakai H, Iwase A, et al. Prevalence of primary angle closure and primary angle-closure glaucoma in a southwestern rural population of Japan: the Kumejima Study.
	Ophthalmology, 2012, 119(6): 1134-1142. DOI: 10.1016/j.ophtha.2011.12.038.
[8]	Sihota R, Rao A, Gupta V, et al. Progression in primary angle closure eyes. J Glaucoma, 2010, 19(9): 632-636. DOI: 10.1097/IJG.0b013e3181ca7de9.
[9]	Bonomi L, Marraffa M, Marchini G, et al. Perimetric defects after a single acute angle-closure glaucoma attack. Graefes Arch Clin Exp Ophthalmol, 1999, 237(11): 908. DOI: 10.1007/
90	71.2005.01064.x.
	s004170050385.
[10]	Loon SC, Chew PT, Oen FT, et al. Iris ischaemic changes and visual outcome after acute primary angle closure. Clin Exp Ophthalmol, 2005, 33(5): 473-477. DOI: 10.1111/j.1442-
[11]	Aung T, Looi AL, Chew PT. The visual field following acute primary angle closure. Acta Ophthalmol Scand, 2001, 79(3):298-300.
[12]	成霄黎, 马韶华. 首次青光眼发作后的视野变化. 山西医科大学学报, 2009, 40(9): 850-853. DOI: 10.3969/j.issn.1007-6611.2009.09.021.
[13]	Mansoori T, Viswanath K, Balakrishna N. Quantification of retinal nerve fiber layer thickness after unilateral acute primary angle closure in Asian Indian eyes. J Glaucoma, 2013, 22(1):26-30. DOI: 10.1097/IJG.0b013e3182311d9f.
[14]	Chew SS, Vasudevan S, Patel HY, et al. Acute primary angle closure attack does not cause an increased cup-to-disc ratio.Ophthalmology, 2011, 118(2): 254-259. DOI: 10.1016/
90	71.2005.01064.x.
	j.ophtha.2010.06.026.
[11]	Aung T, Looi AL, Chew PT. The visual field following acute primary angle closure. Acta Ophthalmol Scand, 2001, 79(3):298-300.
[12]	成霄黎, 马韶华. 首次青光眼发作后的视野变化. 山西医科大学学报, 2009, 40(9): 850-853. DOI: 10.3969/j.issn.1007-6611.2009.09.021.
[13]	Mansoori T, Viswanath K, Balakrishna N. Quantification of retinal nerve fiber layer thickness after unilateral acute primary angle closure in Asian Indian eyes. J Glaucoma, 2013, 22(1):26-30. DOI: 10.1097/IJG.0b013e3182311d9f.
[14]	Chew SS, Vasudevan S, Patel HY, et al. Acute primary angle closure attack does not cause an increased cup-to-disc ratio.Ophthalmology, 2011, 118(2): 254-259. DOI: 10.1016/
[15]	Liu X, Li M, Zhong Y, et al. The damage patterns of retinal nerve fiber layer in acute and chronic intraocular pressure elevation in primary angle closure glaucoma. Eye Sci, 2011,
26	(3): 154-160. DOI: 10.3969/j.issn.1000-4432.2011.03.006.
[16]	Aung T, Friedman DS, Chew PT, et al. Long-term outcomes in asians after acute primary angle closure. Ophthalmology, 2004,111(8): 1464-1469. DOI: 10.1016/j.ophtha.2003.12.061.
	j.ophtha.2010.06.026.
[17]	Liza-Sharmini AT, Sharina YN, Dolaboladi AJ, et al. Clinical presentation, severity and progression of primary angle closure in malays. Med J Malaysia, 2014, 69(1): 21-26.
[18]	Sharmini AT, Yin NY, Lee SS, et al. Mean target intraocular pressure and progression rates in chronic angle-closure glaucoma. J Ocul Pharmacol Ther, 2009, 25(1): 71-75. DOI:
[15]	Liu X, Li M, Zhong Y, et al. The damage patterns of retinal nerve fiber layer in acute and chronic intraocular pressure elevation in primary angle closure glaucoma. Eye Sci, 2011,
26	(3): 154-160. DOI: 10.3969/j.issn.1000-4432.2011.03.006.
[16]	Aung T, Friedman DS, Chew PT, et al. Long-term outcomes in asians after acute primary angle closure. Ophthalmology, 2004,111(8): 1464-1469. DOI: 10.1016/j.ophtha.2003.12.061.
10	1089/jop.2008.0061.
[19]	Sng CC, See JS, Ngo CS, et al. Changes in retinal nerve fibre layer, optic nerve head morphology, and visual field after acuteprimary angle closure. Eye (Lond), 2011, 25(5): 619-625. DOI:10.1038/eye.2011.31.
[20]	Lee JW, Lai JS, Yick DW, et al. Prospective study on retinal nerve fibre layer changes after an acute episode of phacomorphic angle closure. Int Ophthalmol, 2012, 32(6): 577-582. DOI:10.1007/s10792-012-9614-5.
[21]	Medeiros FA, Zangwill LM, Bowd C, et al. The structure and function relationship in glaucoma: implications for detection of progression and measurement of rates of change. InvestOphthalmol Vis Sci, 2012, 53(11): 6939-6946. DOI: 10.1167/iovs.12-10345.
[22]	袁援生, 钟华. 视野检查的临床应用(一). 眼科研究, 2006,24(3): 225-228. DOI: 10.3760/cma.j.issn.2095-0160.2006.03.001.
[17]	Liza-Sharmini AT, Sharina YN, Dolaboladi AJ, et al. Clinical presentation, severity and progression of primary angle closure in malays. Med J Malaysia, 2014, 69(1): 21-26.
[18]	Sharmini AT, Yin NY, Lee SS, et al. Mean target intraocular pressure and progression rates in chronic angle-closure glaucoma. J Ocul Pharmacol Ther, 2009, 25(1): 71-75. DOI:
[23]	方红雁. 急性闭角型青光眼的心理变化特征及心理护理干预.中华全科医学, 2009, 7(3): 273-275.
[24]	Andreatta W, Elaroud I, Nightingale P, et al. Long-term outcomes after acute primary angle closure in a White Caucasian population. BMC Ophthalmol, 2015, 15: 108. DOI: 10.1186/s12886-015-0100-5.
10	1089/jop.2008.0061.
[19]	Sng CC, See JS, Ngo CS, et al. Changes in retinal nerve fibre layer, optic nerve head morphology, and visual field after acuteprimary angle closure. Eye (Lond), 2011, 25(5): 619-625. DOI:10.1038/eye.2011.31.
[20]	Lee JW, Lai JS, Yick DW, et al. Prospective study on retinal nerve fibre layer changes after an acute episode of phacomorphic angle closure. Int Ophthalmol, 2012, 32(6): 577-582. DOI:10.1007/s10792-012-9614-5.
[21]	Medeiros FA, Zangwill LM, Bowd C, et al. The structure and function relationship in glaucoma: implications for detection of progression and measurement of rates of change. InvestOphthalmol Vis Sci, 2012, 53(11): 6939-6946. DOI: 10.1167/iovs.12-10345.
[22]	袁援生, 钟华. 视野检查的临床应用(一). 眼科研究, 2006,24(3): 225-228. DOI: 10.3760/cma.j.issn.2095-0160.2006.03.001.
[23]	方红雁. 急性闭角型青光眼的心理变化特征及心理护理干预.中华全科医学, 2009, 7(3): 273-275.
[24]	Andreatta W, Elaroud I, Nightingale P, et al. Long-term outcomes after acute primary angle closure in a White Caucasian population. BMC Ophthalmol, 2015, 15: 108. DOI: 10.1186/s12886-015-0100-5.