Objective To evaluate the influence of the location of retinal vessel trunk on neuroretinal rim width of inferior and superior sectors of optic disc, and explore its role in the diagnosis of glaucomatous optic nerve lesion. Methods The photographs of ocular fundus from 459 patients with clear location of retinal vessel trunk, including large disc in 131, medium disc in 145, horizontally oval disc in 75, and small disc in 108 were evaluated. Independent-sample t test was used to compare the difference of the superior and inferior rim widths between the higher-vessel group and the lower-vessel group, and to compare the difference of superior and inferior vessel distances between the narrow-superior-rim-width group and the narrow inferior-rim-width group. Results In most of the patients, or the ones with large and small disc, the ratio of superior rim width to summation of superior and inferior rim widths in the higher-vessel group（0.467plusmn;0.051，0.445plusmn;0.040，0.508plusmn;0.056）were less than which in the lowervessel group（0.500plusmn;0.066，0.474plusmn;0.062，0.546plusmn;0.048）, and the differences were significant（P=0.000, 0.045, 0.018）; the ratio of superior vessel distance to summation of superior and inferior vessel distance in the narrow-superior-rim-width group（0.510plusmn;0.051，0.508plusmn;0.055，0.512plusmn;0.036）were less than which in the narrow-inferior-rim-width group（0.528plusmn;0.045，0.533plusmn;0.048，0.534plusmn;0.045）, and the differences were significant（P=0.000, 0.046, 0.022）. Conclusions The position of optic disc vessel trunk influences its superior and inferior rim width. The rim closer to vessel trunk position has narrower width than which comparatively far away from the position. In patients with large, medium, horizontally oval optic disc, glaucoma optic nerve lesion would be considered if the optic disc has the shape of narrower inferior rim, broader superior rim, and vessel location in the superior half of the disc. In the ones with small disc, the optic disc with the shape of narrower superior rim, broader inferior rim, and vessel location in the inferior half of the disc may suggest glaucoma optic nerve lesion. (Chin J Ocul Fundus Dis, 2007, 23: 118-121)
ObjectiveTo observe the hemodynamic parameters of retrobulbar vessels of eyes with primary open-angle glaucoma (POAG) by using color Doppler imaging (CDI) technique. Methods Pertinent publications were retrieved from the PubMed of The National Library of Medicine, the ISI Web of Knowledge of The Institute for Scientific Information, and Cochrane Central Register of Controlled Trials. Case control studies involved POAG patients were included. Changes in retrobulbar blood flow parameters including peak systolic velocity (PSV), end diastolic velocity (EDV) and resistive index (RI) of the ophthalmic artery (OA), central retinal artery (CRA) and short posterior ciliary artery (SPCA) were evaluated by CDI. The searching time was from the data base established up to April, 2014. Meta analysis was used on the included articles, the mean difference (MD) along with 95% confidence interval (95% CI) of the blood flow parameters were calculated. ResultsTwenty-four articles were retrieved, including 1336 eyes as cases, 1102 eyes as controls. PSV of POAG eyes was statistically signiflcantly lower than controls in the OA (MD=-3.05, 95%CI:-4.49--1.61, P < 0.001), CRA (MD=-1.66, 95%CI:-1.95--1.38, P < 0.001), SPCA (MD=-0.87, 95% CI:-1.49--0.26, P=0.005). EDV of POAG eyes was statistically significantly reduced than controls in the OA (MD=-1.78, 95%CI:-2.14--1.41, P < 0.001), CRA (MD=-0.95, 95%CI:-1.17--0.74, P < 0.001), SPCA (MD=-0.53, 95%CI:-0.71--0.36, P < 0.001). Statistically significant increases in RI of POAG eyes than controls in the OA (MD=0.04, 95%CI: 0.03-0.05, P < 0.001), CRA (MD=0.06, 95%CI: 0.05-0.07, P < 0.001), SPCA (MD=0.04, 95%CI: 0.03-0.06, P < 0.001). ConclusionThis meta-analysis suggests that significant decreased velocity and increased resistance of retrobulbar blood flow are found in POAG eyes.
ObjectiveTo investigate the time relationship of the change, and diagnostic accuracy and sensitivity between retinal light threshold fluctuations (LTF) and retinal nerve fiber layer (RNFL) and ganglion cell complex(GCC) thickness on high-risk primary open-angle glaucoma (POAG). MethodsTotally 319 patients (319 eyes) with high-risk in POAG from the First Affiliated Hospital of Kunming Medical Universityand during December 2009 and December 2017, 50 healthy individuals (50 eyes) as control were collected in this longitudinal cohort study. Visual field and OCT were reviewed every 6 months on the high-risk group and every 12 months on the control group. High-risk groups inclusion criteria: vertical C/D≥0.6; early visual field defect (according to glaucoma visual field damage GSS2 quantitative grading standards, mean deviation and pattern standard deviation of central field exceeds the border as an early visual field defect); continuous repeatable results. The first field and OCT results in the absence of visual field defects and C/D≥0.6, which were conformed reliability indicators and removed learning effects as a baseline. When patients achieve POAG diagnosis criteria first time which was recorded as a turning point. And they were divided into early group meanwhile were ended of follow-up. After the last follow-up, the inspection data was segmented counted in yearly interval. The changes of LTF, thickness of RNFL and GCC during the follow-up period in the early POAG group and the control group were observed. The loss rate and change rate in each period were compared for the assessment of their trends with time. Followed by calculation of the area under receiver operating curves (AUC) to compare the predicted value of POAG and the sensitivity at 95% specificity in each period. ResultsAfter last follow-up, totally 67 patients 67 eyes (early POAG group, 37 males and 30 females) were entered the turning point. The mean follow-up of the early POAG group and the control group were 6.6 and 6.4 years. The average RNFL thickness was 79.05±8.09 μm, GCC thickness was 71.58±8.41 μm, LTF was −6.05±7.02 dB in early POAG group. The average RNFL thickness was 93.49±6.24 μm, GCC thickness was 79.72±6.32 μm, LTF was −0.31±0.58 dB in the control group. The differences of LTF and the thickness of RNFL and GCC were statistically significant (t=−5.97, −10.42, −5.60; P＜0.001). The AUC of RNFL, GCC thickness and LTF increased with time in the early POAG group. The sensitivity was gradually increased at 95% specificity: 5th year before to at turning point, RNFL thickness AUC was 0.15, 0.65, 0.71, 0.77, 0.85, 0.92, and sensitivity was 20%, 56%, 61%, 65%, 70%, 76%, respectively; GCC thickness AUC was 0.12, 0.53, 0.69, 0.74, 0.82, 0.90, and sensitivity was 14%, 53%, 69%, 74%, 82%, 90%, respectively; the AUC of LTF was 0.10, 0.21, 0.33, 0.75, 0.86, 0.91, and sensitivity was 7%, 17%, 44%, 65%, 78%, 87%, respectively. ConclusionsThe earliest time of structural functional damage of POAG is at the 4th year before confirmed, simultaneous RNFL diagnosis accuracy and sensitivity are better than GCC and LTF. The earliest time of visual functional damage of POAG is at the 2th year before confirmed, simultaneous LTF diagnosis accuracy and sensitivity are better than RNFL and GCC.
ObjectiveTo observe the differences in scleral lamina curvature (SLC) of patients with pseudoexfoliation glaucoma (PXG), primary open-angle glaucoma (POAG), and primary chronic angle-closure glaucoma (CPACG) were compared and analyzed and their significance was analyzed.MethodsA retrospective clinical study. From June 2017 to December 2020, 30 PXG (PXG group), POAG (POAG group) and CPACG patients (CPACG group) diagnosed at Eye Center of Cangnan County people's Hospital of Zhejiang Province (Cangnan Hospital Affiliated to Wenzhou Medical University) were included in the study. The age difference between the three groups of patients was statistically significant (t=17.925, P=0.001); gender composition ratio (χ2=2.158, P=0.276), intraocular pressure (t=4.993, P=0.078), and axial length (t=1.956, P=0.532), central corneal thickness (t=1.407, P=0.724), average visual field defect (t=2.725, P=0.496), optic disc retinal nerve fiber layer thickness (t=2.185, P=0.492) in comparison, the differences were not statistically significant (P＞0.05). The frequency-domain optical coherence tomography deep-enhanced imaging (OCT EDI) technology was used to measure the average and 0°, 30°, 60°, 90°, 120°, 150° SLC of the affected eyes, and calculate the SLC index (SLCI) and SL curve depth (SLCD). Quantitative data comparison between groups used independent sample t test. Count data comparison used χ2 test. Univariate and multivariate logistic regression analysis were used for correlation analysis.ResultsThe results of OCT EDI examination showed that the SLC of eyes with PXG and CPACG was significantly steep, while the SLC of eyes with POAG was relatively flat. Except for the angle of 150°, the other 6 angles of SLCI and SLCD in the PXG group and CPACG group were higher than those in the POAG group, and the differences were statistically significant (P＜0.05). However, there was no statistically significant difference between PXG group and CPACG group for 7 angles of SLCI and SLCD (P＞0.05). Logistic regression analysis showed that the average SLCI [odds ratio (OR)=1.498, 95% confidence interval (CI) 1.137-2.018, P=0.001], age (OR=1.074, 95%CI 1.019-1.143, P=0.016) was significantly correlated with PXG; mean SLCI (OR=1.625, 95%CI 1.192-1.997, P=0.001), intraocular pressure (OR=1.383, 95%CI 1.106-1.993, P=0.012) was significantly correlated with CPACG. POAG group (β=0.143, 95%CI 0.032-0.208, P=0.016), CPACG group (β=0.132, 95%CI 0.079-0.315, P=0.043) intraocular pressure was correlated with mean SLCI; all factors of PXG group were correlated with SLCI without correlation (P＞0.05).ConclusionCompared with POAG, the SLC of eyes with PXG and CPACG is steeper and related to disease occurrence.
Objective To observe the changes in peripapillary vessel perfusion after uncomplicated phacoemulsification surgery in patients with cataract and primary open-angle glaucoma (POAG). Methods A case-control study. From November 2017 to April 2019, 17 eyes of 17 cases of POAG complicated with cataract (observation group) and 17 eyes of 17 cases of simple senile cataract (control group) were included in the study. All the affected eyes underwent best corrected visual acuity (BCVA), intraocular pressure (IOP), visual field, optical coherence tomography angiography (OCTA) examination, and measurement of axial length (AL) and central corneal thickness (CCT). All eyes underwent conventional phacoemulsification surgery for cataract. After the operation, the same equipment and methods as before the operation were used for related inspections. The VD, the thickness of the retinal nerve fiber layer (RNFL), and the IOP were observed before the operation, at the end of the operation, and 1 d, 1 week, 1 month and 3 months after the operation, mean visual field defect (MD) changes 3 months after surgery. Data comparisons within groups used repeated measures analysis of variance; data comparisons between groups used independent samples t test. Results The average age of patients in the observation group and control group was 68.18±6.13 and 65.82±6.95 years, respectively, and the difference was not statistically significant (t=1.912, P=0.072). There was no significant difference in AL (t=1.436), CCT (t=−1.557) and phacoemulsification (t=1.602) between the two groups (P>0.05). The difference of the mean IOP was statistically significant between the two groups (t=4.139, P<0.05). Before surgery, the VD (t=−6.560) and RNFL thickness (t=−7.320) of the observation group were lower than those of the control group, and the difference was statistically significant (P＜0.05). Compared with before the operation, the VD around the disc of the eye in both groups increased at the end of the operation and at different time points after the operation. Among them, the observation group had a statistically significant difference at 1 month after the operation of the eye (F=3.108, P=0.042); the control group had no significant difference at different time points after the operation (F=1.981, P＞0.05). The results of each quadrant analysis showed that only the observation group had a statistically significant difference in the temporal side of the eye one month after surgery (F=5.414, P=0.017). After surgery, the observation group and the control group had thicker RNFL thickness around the disc of the eye, and the difference was statistically significant (F=22.670, 23.080; P=0.002, 0.001). Before the operation and 3 months after the operation, the average MD of the eyes of the observation group and the control group were 14.90±7.15, 1.12±0.93 dB and 12.10±7.70, 0.88±0.66 dB, respectively. The average MD before and 3 months after the operation was compared, and the difference was statistically significant (t=14.414, 13.225; P=0.000, 0.000). Compared with before surgery, there was no statistically significant difference in the average MD of the two groups of eyes at 3 months after surgery (t=0.938, 0.817; P=0.082, 0.103). At the end of the operation, the intraocular pressure of the observation group and the control group were 10.84±3.39 and 11.46±3.79 mm Hg (1 mm Hg=0.133 kPa), respectively; they were both lower than before the operation, and the difference was statistically significant (t=−2.211, −2.310; P＜0.05). Conclusions The thickness of VD and RNFL in eyes with POAG combined with cataract is lower than that in patients with senile cataract alone. The high perfusion pressure during conventional phacoemulsification surgery can cause a transient increase in VD, but it will not cause further damage to the visual field of POAG patients.
ObjectiveTo observe and analyze the structural characteristics of the optic discs in high myopia (HM) combined with primary open-angle glaucoma (POAG) and the optic disc parameters with diagnostic efficacy. MethodsA cross-sectional study. From August 2020 to March 2021, a total of 114 eyes of 68 patients with POAG, HM and healthy volunteers who were diagnosed by Department of Ophthalmology, The First Affiliated Hospital of Kunming Medical University were included in the study. Among them, 21 POAG patients (39 eyes) were divided into H+P group (9 patients, 18 eyes) and non-H+P group (12 patients, 21 eyes) according to whether or not HM was combined; 26 HM patients (37 eyes) were selected as HM group; 21 healthy volunteers (38 eyes) were selected as normal control group. The subjects included 31 males (51 eyes) and 37 females (63 eyes), whose average age was 36.93±12.60 years old. Diopter, central corneal thickness (CCT) and axial length (AL) were measured. There was no significant difference in age (F=8.333), sex composition ratio (χ2=0.863), and CCT (F=1.425) among the four groups (P＞0.05); while, there were significant differences in AL (F=69.956), diopter (F=37.711), visual field index (VFI) (F=43.254) and mean defect (MD) (F=49.793) among the four groups (P＜0.01). Enhanced depth imaging using optical coherence tomography was used to obtain the tilt parameters, the disc rim parameters, the lamina cribrosa parameters and the retinal nerve fiber layer (RNFL) thickness. The tilt parameters included optic disc horizontal diameter, optic disc vertical diameter, optic disc ellipse index (horizontal diameter/vertical diameter); the disc rim parameters included Bruch’s membrane opening-minimal rim width (BMO), optic cup area, optic disc area, disc rim area, cup-disc area ratio; the lamina cribrosa parameters included anterior laminar insertion depth (ALID), prelaminar neural tissue (PLNT), and lamina cribrosa thickness. The pairwise comparison between groups were performed by ANOVA test. Pearson correlation analysis was used to analyze the correlation between disc tilt parameters, disc rim parameters, lamina cribrosa parameters and visual field parameters, as well as between disc rim parameters and RNFL thickness. According to receiver operating characteristic (ROC) curve and area under the curve (AUC), the predictive value of those above related factors for HM combined with POAG was evaluated. ResultsTilt parameters: compared with the optic disc horizontal diameter of non-H+P group, those of normal control group, HM group and H+P group were significantly decreased (P＜0.05), the ellipse indices of HM group and H+P group were significantly lower than those of normal control group and non-H+P group (P＜0.05). The results of correlation analysis showed that the optic disc horizontal and vertical diameters were negatively correlated with MD (r=－0.302, －0.235; P=0.002, 0.017), and negatively correlated with VFI (r=－0.291, －0.246; P=0.003, 0.013). Disc rim parameters: the disc cup area and cup-disc area ratio of non-H+P group and H+P group were significantly larger than those of normal control group and HM group (P＜0.05). The disc rim area and the average BMO of HM group, non-H+P group and H+P group were significantly smaller than those of normal control group (P＜0.05). The results of correlation analysis showed that the cup-disc area ratio (r=－0.584), the average BMO (r=0.650) had the highest correlation with the average RNFL thickness (P＜0.001). The superior, inferior, nasal and temporal BMO were all positively correlated with the corresponding quadrant RNFL thicknesses (r=0.431, 0.656, 0.362, 0.375; P＜0.05); the optic disc rim area, the average BMO were positively correlated with MD (r=0.449, 0.618) and VFI (r=0.449, 0.605) (P＜0.05), among which the correlation of the average BMO was the highest; the optic cup area and cup-disc area ratio were negatively correlated with MD (r=－0.346,－0.559) and VFI (r=－0.312,－0.548) (P＜0.001), among which the correlation of the cup-disc area ratio was the highest. Lamina cribrosa parameters: ALID of non-H+P group and H+P group were significantly deeper than those of normal control group and HM group (P＜0.05). LC of non-H+P group and H+P group were significantly thinner than those of normal control group and HM group (P＜0.05). The results of correlation analysis showed that ALID was negatively correlated with MD and VFI (r=－0.402, P＜0.001), VFI (r=－0.405, P=0.001); LC was positively correlated with MD and VFI (r=0.403, P＜0.001), VFI (r=－0.401, P=0.015). Comparison of diagnostic efficiency between various optic disc parameters: the results of ROC analysis showed that the cup-disc area ratio had the highest diagnostic performance (AUC=0.847, P=0.007), the maximum Youden index was 0.563, the sensitivity and specificity were 0.833 and 0.730, respectively, and the best critical value was 0.340. ConclusionsOptic disc tilt is more pronounced in HM combined with POAG; BMO in each quadrant could objectively reflect the disc rim defect of HM combined with POAG; the thinning and the backward shift of the lamina cribrosa were consistent with the aggravation of the visual field defect. Among them, the cup-disc area ratio had better diagnostic performance．