背景 视神经纤维层厚度测量和影像学研究证实,青光眼患者早期即存在黄斑区神经纤维层结构的改变,但目前青光眼的功能检测主要依靠心理、物理学检查的自动静态视野计,不能反映病变早期相对应的损害.MP-1微视野计是一种定量评估黄斑区视网膜平均光敏感度(MS)的方法,较普通视野计更为敏感. 目的采用MP-1微视野计对原发性开角型青光眼(POAG)、慢性闭角型青光眼(CACG)及正常眼的黄斑区视网膜MS进行对比研究,观察POAG患者和CACG患者早中期黄斑区视网膜的功能变化. 方法 采用横断面病例对照研究设计.收集患者126例126眼,其中POAG患者50眼,CACG患者23眼,正常对照眼53眼.使用MP-1微视野计进行眼底成像和微视野检查,选用Macular 10°程序,检测并比较POAG、CACG和正常对照组患者黄斑中心2°、6°和10°环(内、中、外环)的视网膜MS,同时对各组受试者黄斑中心6°范围内4个象限的视网膜MS进行分析.结果 POAG组患者黄斑中心2°、6°、10°范围内及全黄斑区的MS分别为(15.09±3.03)、(15.72±3.22)、(13.99±3.63)和(14.91±3.07) dB,均明显低于正常对照组的(17.29±1.59)、(18.05±1.24)、(16.76±1.89)和(17.37±1.46)dB,差异均有统计学意义(均P=0.000).CACG组黄斑中心2°、6°、10°环及全黄斑区的MS分别为(16.00±2.39)、(15.83±2.63)、(14.45±3.15)和(15.42±2.54)dB,其中6°、10°环及全黄斑区的MS明显低于正常对照组,差异均有统计学意义(P=0.004、0.013、0.011).各组黄斑中心6°环4个象限的MS分析表明,POAG、CACG组颞下象限的MS明显低于正常对照组,差异均有统计学意义(P=0.000、0.022),但POAG组和CACG组间差异无统计学意义(P=0.311).POAG组鼻下象限的MS明显低于正常对照组,差异有统计学意义(P=0.005),但CACG组鼻下象限MS与正常对照组间差异无统计学意义(P=0.119).POAG组颞下象限MS明显低于鼻上象限和颞上象限,差异均有统计学意义(P=0.043、0.016),CACG组4个象限MS差异均无统计学意义(P＞0.05). 结论 POAG患者和CACG患者在患病早中期黄斑区视网膜功能已发生轻度损害,患者的视功能损害主要在颞下象限和鼻下象限,POAG患者的视功能损害较CACG患者更为严重.%Background The biomeasurement and imageology of retinal nerve fiber layer(RNFL) thickness showed the damage of retinal structure in the early and middle stage of glaucomatous eye,however,the subtle functional damage of glaucoma can not be timely reflected only with automatic static perimeter.Microperimetry is a method of quantitatively assessing mean sensitivity (MS) of macular zone.Objective This study was to evaluate and compare the macular functional change in early and middle stage of primary open angle glaucoma (POAG) and chronic angle-closure glaucoma (CACG) with MP-1 microperimeter.Metbods This trail protocol was approved by Ethic Committee of Peiking University Third Hospital,and written informed consent was obtained from each subject prior to entering the study group.A cross-sectional and case-controlled study was designed.A total of 126 eyes from 126 subjects were enrolled in the trail,including 53 eyes of 53 normal subjects,50 eyes of POAG patients and 23 eyes of CACG patients.A macular 10° program was set with MP-1 microperimetry to record the MS of various subareas.The macula was zoned into central 2°,6°,and 10° visual fields and 4 quadrants in each ring.The MS of different rings and subareas was detected and compared among POAG patients,CACG patients and normal controls.Results The MS values of central 2°,6°,10° and whole macular area were (15.09 ± 3.03),(15.72 ± 3.22),(13.99 ± 3.63) and (14.91±3.07)dB in the POAG group,which were significantly lower than those of (17.29±1.59),(18.05±1.24),(16.76±1.89) and (17.37±1.46)dB in the normal control group (all at P=0.000).The MS values of central 2°,6°,10° and whole macular area was (16.00±2.39),(15.83±2.63),(14.45±3.15) and (15.42±2.54) dB in the CACG group,and the reduced MSs were seen at the 6°,10° rings and whole macular area in the CACG group compared with the normal control group (P =0.004,0.013,0.011).Within the 6° ring,the MS values in the inferotemporal quadrant were declined in the POAG group and CACG group compared with the normal control group (P =0.000,0.022),but the difference was not statistically significant between the POAG group and the CACG group (P =0.311).In addition,the MS value in the inferonasal quadrant was significantly lower than that of the normal control group (P =0.005); while that in the CACG group was not significantly different in comparison with the normal control group (P=0.119).In the POAG group,the MS value of the inferotemporal quadrant was significantly lower than that of the superonasal or superotemopral quadrant (P =0.043,0.016),but no significant differences were found among the 4 quadrants in the CACG group (all at P＞0.05).Conclusions The mild damage of retinal function appears in the early and middle stage of POAG and CACG.More serious MS reducing occurs in the inferotemporal and inferonasal quadrants of POAG.
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