近視的青光眼視神經病變及視野缺損之特徵

Characteristics of Glaucomatous Optic Neuropathy and Visual Field Defect in Myopic Eyes

陳立威(Li-Wei Chen)

指導教授 ： 黃曼菁

共同指導教授 ： 謝瑞玟

臺北醫學大學/醫學院/臨床醫學研究所/碩士(2013年)

摘要

目的：探討近視的青光眼視神經病變及視野缺損的特徵，並分析青光眼視野缺損的危險因子。
方法：橫斷面回朔分析於2009至2011年間在馬偕紀念醫院就診且年齡20至60歲的原發性隅角開放型青光眼 (POAG) 病患。分析年齡、屈光狀態、中心角膜厚度、基準眼壓、面積參數（視神經盤、視神經凹陷、神經網膜緣、視神經盤與凹陷面積比例）、及地圖學變化（視神經盤傾斜、視神經盤旋轉），比較其對於是否出現視野缺損、缺損形態、缺損位置、及視野嚴重程度的相關性。
結果：共377位病患於研究期間完成青光眼的相關檢查而納入統計，其平均屈光度為 -5.20±3.93 D，38.7%患者有視野缺損。視神經盤面積較大、視神經凹陷面積較大、視神經盤與凹陷面積比例較大、視神經盤凹陷比例較大、視神經傾斜或旋轉都與較高度的近視相關。極高度近視患者上下半視野缺損分佈趨於平均，也較容易出現顳側楔形視野缺損。近視增加、年齡增加、視神經盤與凹陷面積比例加大、視神經盤凹陷比例加大、視神經凹陷面積增加、及神經網膜緣面積減少是POAG視野缺損及嚴重度的最重要危險因子。
結論：高度近視的青光眼視神經病變及視野缺損的特徵不同於遠視、正視及較低度的近視。面積極大或極小的視神經盤、視神經盤傾斜或旋轉者其屈光度均趨向高度近視。近視嚴重度是POAG視野缺損重要的危險因子。

關鍵字

原發性隅角開放型青光眼 ； 近視 ； 青光眼視神經病變 ； 青光眼視野缺損 ； 視神經盤傾斜 ； 視神經盤旋轉 ； 視神經盤面積 ； 視神經盤與凹陷面積比例 ； 視神經盤凹陷比例

並列摘要

PURPOSE: To evaluate the characteristics of glaucomatous optic neuropathy and visual field (VF) defect in myopic eyes, and to analyze risk factors for glaucomatous VF defect.
METHODS: A cross-sectional, retrospective study of patients with primary open-angle glaucoma (POAG) aged between 20 and 60 years who visited Mackay Memorial Hospital from year of 2009 to 2011. Data of age, refractive status, central corneal thickness, baseline intraocular pressure (IOP), area parameters (area of optic disc, cup, rim, and cup-to-disc area ratio), and topographic parameters (tilted disc or torted disc) were analyzed and evaluated for their correlation with the presence, severity, pattern, and location of the VF defect.
RESULTS: Data from a total of 377 patients who completed the glaucoma examinations during the study period were analyzed. The mean refractive error was -5.20±3.93 D, and 38.7% of patients were perimetric POAG. Larger optic disc area, larger optic cup area, larger cup-to-disc area ratio, larger cup-to-disc ratio, tilted or torted discs were correlated with higher myopia. Excessive myopia was correlated both with more consistent distribution of VF defect between superior and inferior hemifields, and with the presence of temporal wedge VF defect. Higher myopia, older age, larger cup-to-disc area ratio, larger cup-to-disc ratio, larger optic cup area, and smaller optic rim area were the most prominent risk factors for perimetric POAG, and for more severe VF defect.
CONCLUSIONS: The characteristics of glaucomatous optic neuropathy and VF defect differ between highly myopic eyes and eyes with hyperopia, emmetropia or lower myopia. Eyes with large or small optic discs, or with tilted or torted optic discs tend to be high myopic. Severity of myopia is an important risk factor for glaucomatous VF defect.

並列關鍵字

primary open-angle glaucoma ； myopia ； glaucomatous optic neuropathy ； glaucomatous visual field defect ； tilted optic disc ； torted optic disc ； optic disc area ； optic cup-to-disc area ratio ； optic cup-to-disc ratio

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