青光眼網膜神經纖維層的臨床評估(Ⅳ)青光眼之楔狀網膜神經纖維層缺損與視野缺損的關係

Clinical Assessment of Nerve Fiber Layer in Glaucoma (Ⅳ) the Correlation between Wedge-Shaped Nerve Fiber Layer Defect and Visual Field Changes

謝瑞玟(Jui-Wen Hsieh) ； 藍郁文(Yu-Wen Lan)

《中華民國眼科醫學會雜誌》 34卷4期 (1995/12) Pp. 463-473

https://doi.org/10.30048/ACTASOS.199512.0005

摘要

本研究自馬偕醫院青光眼特別門診中，選出35位已確定患有青光眼，且具有楔狀網膜神經纖維層缺損的病患，來探討網膜神經纖維層之楔狀缺損與視野變化間的關係。76個具有楔狀缺損的半邊(Hemifield)網膜神經纖維層，其中18.4%的視野仍是正常的。當楔狀網膜神經纖維層缺損＜0.5 o'clock時，mean defect(MD)值出現不正常，而不正常的corrected loss variance (CLV)值則需楔狀缺損≥1.0 o'clock時才會出現，一旦MD，CLV值約呈明顯異常時，則楔狀缺損已≥1.5 o'clock；當楔狀缺損＜1.0 o'clock時，cup/disc ratio(C/D ratio)仍可能出現＜0.5的情形。楔狀缺損的嚴重程度，與視野變化的種類，嚴重程度及MD，CLV值之間皆有很好的相關性。而楔狀缺損的嚴重程度與C/D ratio間，也有正比的關係。正常的視野及正常的C/D ratio均不能代表其網膜神經纖維層是正常的。網膜神經纖維層的缺損比視野變化早發生，且此檢查與視神經盤檢查有相當的敏感度，因此網膜神經纖維層的檢查應廣為使用，以期早期診斷青光眼。

並列摘要

Thirty five cases of glaucoma with wedge-shaped nerve fiber layer defect were selected from the glaucoma clinic in Mackay Memorial Hospital to discuss the relationship between wedge-shaped nerve fiber layer defect and visual field changes. About 18.4% of the hemifield with wedge-shaped retinal nerve fiber layer defect had normal visual field. When the wedge-shaped nerve fiber layer defect was ＜0.5 o'clock, the value of mean defect (MD) was usually abnormal. The corrected loss variance (CLV) value became abnormal when the wedge-shaped nerve fiber layer defect was ≥1.0 o'clock. If the wedge-shaped nerve fiber layer defect was ≥1.5 o'clock, the value of MD and CLV were obviously abnormal. It was noted that the CID ratio was remained ＜0.5 in cases with the wedge-shaped nerve fiber layer defect ＜1.0 o'clock. There was a close correlation between the severity of wedge-shaped nerve fiber layer defect and the visual field changes in type, severity, MD and CLV value. Besides, the more the severity of wedge- shaped nerve fiber layer defect was noted, the more the CID ratio was increased. The normal visual field and the normal C/D ratio did not mean that the nerve fiber layer was normal. The nerve fiber layer defect always happens earlier than the visual field change and the sensitivity of nerve fiber layer examination is as sensitive as the optic disc examination. Therefore, nerve fiber layer examination is a good method for early diagnosis of glaucoma.

並列關鍵字

Nerve fiber layer ； Wedge-shaped defect ； Cup/Disc ratio ； Visual field