台灣一醫學中心青光眼門診病例型態及相關的眼球結構之分析

Analysis of the Pattern of Cases in a Glaucoma Outpatient Clinic and Corresponding Ocular Components in a Medical Center of Taiwan

李金蓉(Jin-Jung Lee) ； 藍郁文(Yu-Wen Lan) ； 謝瑞玟(Jui-Wen Hsieh)

《中華民國眼科醫學會雜誌》 48卷2期 (2009/06) Pp. 161-170

https://doi.org/10.30048/ACTASOS.200906.0007

摘要

目的：探討主要青光眼型態的轉變及不同青光眼型態和眼球特徵的關係。
方法：回溯性病歷分析。收集2002年到2004年，這三年間在本院青光眼門診初診及規律複診的患者，依照病歷上有關隅角鏡檢查及視神經盤變化，重新確認每一病患所罹患的青光眼型態，並將這群患者病歷上的記錄，包括患者生日、性別、過去病史、眼科初診日期、確定診斷為青光眼的日期及當時的視力、屈光度、眼壓、眼球生物測量尺、視神經盤凹陷比例及後續追蹤所測的中央角膜厚度，加以建檔分析。
結果：總共有3360位患者收錄於檔案中。其中原發性隅角開放型青光眼、正常眼壓性青光眼及隅角閉鎖型組群（包括原發性隅角閉鎖、青光眼急性發作及原發性隅角閉鎖型青光眼）所佔的比例分別為33.8%、15.3%以及35.9%。1989到2004年間的患者，原發性隅角開放型青光眼所佔的比例大約維持在三分之一，但正常眼壓性青光眼從0.6%增加到24.1%，而隅角閉鎖型組群則從61.5%降到22.0%。不論青光眼的類型，女性所佔的比例皆大於一半。隅角開放型組群（包括原發性隅開放型青光眼及正常眼壓性青光眼）的屈光度為－3.5±4.2D，而隅角閉鎖型組群則為＋0.8±2.2D。正常眼壓性青光眼患者有較薄的中央角膜厚度(535.3±32.3μm)，而高眼壓症患者的中央角膜厚度則較厚(582.0±38.6μm)，平均眼壓分別為14.7±2.7mmHg及23.2±2.4 mmHg。有8.0%的隅角開放型組群被診斷為青光眼時已有大於0.9 的視神經盤凹陷比例，此比例在原發性隅角開放型及正常眼壓性青光眼分別為9.4%及5.1%。而隅角閉鎖型組群則有9.9%在診斷時其視神經盤凹陷比例大於0.9，其中以原發性隅角閉鎖型青光眼14.3%為最高。隅角閉鎖型組群有較淺的前房(2.61±0.32mm)、較厚的水晶體(4.85±0.40mm)以及較短的眼軸(22.69±0.99mm)。
結論：隅角開放型與隅角閉鎖型組群的比例為1.4:1。青光眼的型態隨著時代在轉變中，隅角閉鎖型組群的比例逐年下降，而正常眼壓性青光眼則逐年增加。隅角開放型組群多偏向近視眼，而隅角閉鎖型組群則多屬於遠視眼且有較擁擠的眼球構造。不論是隅角開放型或隅角閉鎖型組群，約有10%的患者在確定診斷時己有嚴重的視神經病變。

並列摘要

Purpose: To study the changes in glaucoma pattern over time and the relationship between different types of glaucoma and ocular components.
Methods: We reviewed the charts and reconfirmed the correct diagnosis of patients who were regularly followed up at a glaucoma outpatient clinic from 2002 to 2004. The following data of age, sex, the date of diagnosis, types of glaucoma, refraction error, intraocular pressure (IOP), C/D ratio (CDR), ocular biometry including anterior chamber depth, lens thickness and axial length at the time of diagnosis, and central corneal thickness (CCT) in the follow up period were extracted from the chart.
Results: Totally, 3360 patients were enrolled. The distributions of primary open-angle glaucoma (POAG), normal tension glaucoma (NTG) and angle-closure group (ACGr) including primary angle closure (PAC), acute attack and primary angle-closure glaucoma (PACG), were 33.8%, 15.3% and 35.9%, respectively. From 1989 to 2004, the percentage of POAG was unchanged and was around one-third. However, the percentage of NTG increased from 0.6% to 24.1% and ACGr decreased from 61.5% to 22.0%. Regardless of the type of glaucoma, more than half of the patients were female. The spherical equivalent was -3.5±4.2D in the open-angle group (OAGr), including POAG and NTG, and +0.8±2.2D in ACGr. Patients with normal tension glaucoma have thinner CCT (535.3±32.3μm), however, the CCT in patients with ocular hypertension was thicker (582.0±38.6μm). The mean IOP in the NTG and ocular hypertension was 14.7±2.7mmHg and 23.2±2.4mmHg, respectively. At the time of diagnosis, 8% of OAGr (9.4% of POAG and 5.1% of NTG) and 9.9% of ACGr (mostly in PACG, 14.3%) patients had CDR more than 0.9. Patients in the ACGr had a shallower anterior chamber depth (2.61±0.32mm), thicker lens (4.85±0.40mm) and shorter axial length (22.69±0.99mm).
Conclusion: About half the glaucoma patients belonged to the open-angle group and one-third of patients belonged to the angle-closure group. The patients with NTG increased, but the ACGr decreased year by year. Patients in the ACGr had smaller eyes and crowded anterior segment. About 10% of patients, either the OAGr or ACGr, were diagnosed at the late stage with advanced optic neuropathy.

並列關鍵字

open angle glaucoma ； normal tension glaucoma ； ocular hypertension ； angle closure