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目的:探讨合并高度近视和非高度近视的原发性开角型青光眼早期视野改变特点及其与视网膜神经纤维层缺损的关系。方法:利用Humphrey750型计算机自动视野计对17例(21眼)合并高度近视的POAG和16例(17眼)非高度近视的POAG及20例(25眼)单纯高度近视以及17例(19眼)正常组进行静态中心阈值视野检查,利用OCT进行视盘周围RNFL厚度检查。比较正常组、合并高度近视POAG组、非高度近视POAG组、单纯高度近视组视野缺损的总偏差概率图;比较正常组、合并高度近视的POAG组、非高度近视的POAG组以及单纯高度近视组的MD值、PSD值、上方、下方、鼻侧、颞侧平均光敏感度;比较正常组、合并高度近视的POAG组、非高度近视的POAG组以及单纯高度近视组的平均、上方、下方、鼻侧、颞侧RNFL厚度;分别分析合并高度近视的POAG组、非高度近视的POAG组以及单纯高度近视组各组内上方、下方、鼻侧、颞侧各象限RNFL厚度与视野对应部位的缺损之间的关系以及各组视野特点。结果:合并高度近视的早期POAG患者在总偏差概率图中多表现为普遍敏感性降低,而在模式偏差概率图则更多表现出POAG早期视野缺损;平均缺损值显著高于其它各组。合并高度近视的POAG患者无论平均光敏感度还是MD、PSD值均与其他三组有显著差异(P<0.05);单纯高度近视组与非高度近视的POAG组的各象限平均光敏感度的差异均有显著性(P<0.05)。合并高度近视的POAG组较非高度近视的POAG组以及单纯高度近视组RNFL厚度明显变薄;此三组较正常组RNFL厚度变薄;单纯高度近视组与非高度近视的POAG组的平均RNFL厚度及各象限RNFL厚度的差异均有显著性(P<0.05);各组四个象限RNFL厚度与视野对应部位的缺损相关。结论:在进行合并高度近视的POAG视野结果判定时要依靠模式偏差概率图,其特点是伴有生理盲点扩大和外移。OCT能够反映合并高度近视的POAG的RNFL厚度的改变,及RNFL厚度与视野缺损的相关性有助于在合并高度近视POAG中的临床诊断。
OBJECTIVE: To investigate the characteristics of early vision changes in primary open-angle glaucoma combined with high myopia and non-high myopia and its relationship with retinal nerve fiber layer defects. Methods: Seventeen eyes (21 eyes) with POAG of high myopia and 16 cases (17 eyes) of POAG with non - high myopia and 20 cases (25 eyes) of pure myopia and 17 cases (19 eyes) were examined by Humphrey750 computerized automatic fluoroscopy. In the normal group, static central threshold visual field examination was performed, and the thickness of RNFL around the optic disc was examined by OCT. Compared with normal group, POAG group, non-high myopia POAG group and simple high myopia group, the total deviation probability map of normal group, high myopia POAG group, non-high myopia POAG group and simple high myopia group MD value, PSD value, above, below, nasal, temporal average photosensitivity; compared with normal group, POAG group with high myopia, POAG group with non-high myopia and average, above, below, nasal Side and temporal RNFL thickness. The thickness of RNFL and the corresponding defect in the visual fields were analyzed respectively in POAG group, POAG group and simple high myopia group in each group with high myopia, upper, lower, nasal and temporal quadrant The relationship between the group and the visual field characteristics. Results: Early POAG patients with high myopia showed more general sensitivity reduction in the total deviation probability chart, but showed more early defect of POAG in the mode deviation probability map. The average defect value was significantly higher than the other groups. POAG patients with high myopia regardless of the average light sensitivity or MD, PSD values were significantly different from the other three groups (P <0.05); simple high myopia POAG group and non-high myopia average quadrant optical sensitivity differences Significance (P <0.05). The thickness of RNFL in POAG group with high myopia and non-high myopia group was significantly thinner than those in POAG group and simple high myopia group. RNFL thickness in these three groups was thinner than that in normal group. Mean RNFL thickness in POAG group And the RNFL thickness of each quadrant were significantly different (P <0.05). The quadrant RNFL thickness of each quadrant was related to the defect of corresponding site of vision. CONCLUSIONS: The POAG field of vision determination in combination with high myopia should rely on the model deviation probability map, which is characterized by the expansion and emigration of physiological blind spots. OCT can reflect changes in RNFL thickness in POAG with high myopia, and the correlation between RNFL thickness and visual field defect contributes to clinical diagnosis in POAG with high myopia.