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目的比较降眼压前后原发性慢性闭角型青光眼(PACG)与原发性开角型青光眼(POAG)的视盘结构改变,了解两者间筛板顺应性是否存在差异。设计前瞻性对比研究。研究对象PACG 36例49眼和POAG 35例49眼。方法眼压降低前全部患者进行海德堡视网膜断层扫描(HRT-Ⅱ)及Humphrey静态视野检查。根据病情选择手术、激光或药物治疗,使眼压降至正常范围。眼压降低后1个月重复HRT检查和视野检查。比较POAG和PACG眼压降低前后HRT视盘参数的变化,采用多元线性逐步回归法校正治疗前眼压、眼压降低幅度、年龄、杯盘比等因素影响。主要指标眼压降低前后HRT视杯面积、盘沿面积、视杯容积、平均视杯深度的差值。结果PACG及POAG组的视杯面积、视杯容积、平均视杯深度等指标在眼压降低后均明显降低(P<0.05),盘沿面积在眼压降低后均明显增加(P<0.05)。视杯面积、盘沿面积、视杯容积、平均视杯深度在眼压降低前后的差值两组间无显著性差异(P>0.05)。眼压降低前后这4个参数的差值与跟压降低幅度及杯盘比有关(P<0.05);与年龄及治疗前眼压无关(P>0.05)。结论眼压降低后青光眼视盘形态结构有一定回复;但在PACG和POAG间,视盘形态结构回复的程度无明显差异,PACG和POAG的筛板顺应性可能无差异。
Objective To compare the changes of optic disc structure in patients with primary chronic angle-closure glaucoma (PACG) and primary open-angle glaucoma (POAG) before and after intraocular pressure reduction (IOP) to find out whether there is any difference in compliance between the two plates. Design prospective comparative study. The subjects were 49 cases of PACG in 36 cases and 49 cases of POAG in 35 cases. Methods All patients underwent intraocular pressure (HEI) retina tomography (HRT-II) and Humphrey static field examination before IOP reduction. According to the condition of surgery, laser or drug treatment, the intraocular pressure to the normal range. One month after IOP reduction, HRT and FOV were repeated. The changes of parameters of HRT optic disc before and after POAG and PACG were compared. The factors of pre-ocular pressure, intraocular pressure (IOP) reduction, intraocular pressure (IOP), cup and disk ratio and other factors were corrected by multivariate linear stepwise regression. The main indicators before and after the reduction of intraocular pressure HRT cup area, disc area, cup volume, the average cup depth difference. Results The indexes of optic cup area, cup volume and average cup depth in PACG and POAG group were significantly decreased after IOP decreased (P <0.05), and the area of disc area increased significantly after IOP decreased (P <0.05) . The differences of cup area, disc area, cup volume and average cup depth before and after the decrease of IOP were not significantly different between the two groups (P> 0.05). The difference of the four parameters before and after the decrease of IOP was related to the decrease of hemorheology and cup-to-cup ratio (P <0.05), but not to the age and pre-treatment IOP (P> 0.05). Conclusions There is a certain recovery of optic disc morphology after glaucoma reduction in patients with reduced intraocular pressure. However, there is no significant difference in the recovery of optic disc morphology between PACG and POAG. There may be no difference in compliance between PACG and POAG.