吴仁毅青光眼诊治新进展

glaucoma earlier than SAP
FDT may accurately detect
相对于SAP，SWAP和FDT可能可以更早检测到青光眼性改变
There is little evidence to support the use of a particular selective
H.A. Quigley, et al. ARVO 2008
Iris area decreased 10.2 + 2.5% with
each mm increase in pupil diameter

Dilation = Squeezing a sponge
Iris volume change as a predictor of ACG
SD/FD OCT 黄斑成像
基于SD/FD OCT 的三维成像
SD/FD OCT 的优势及展望

良好的可重复性 图像更为精细 特异性和敏感性更高 连续和动态在体检查 分析软件需跟进
正常人数据库的建立
可应用于角膜，眼前节，视盘，视网膜等部位
海德堡视网膜断层成像仪 （HRT Ⅱ）
诊断
“治愈”
青光眼 治疗
药物 手术 药物缓释系统（纳米颗粒） 激光 滤过道瘢痕化控制
新模式
早期青光眼性视神经病变 晚期青光眼性视神经病变 前房角关闭的检测 闭角型青光眼的预测 青光眼形态（结构）进展 青光眼视功能进展
诊断
神经保护 血流 干细胞 基因诊断（危险因素，药物
Consesus Statement on Functional Assessment in the Managemethod for detecting abnormality and documenting functional
status should be part of routine clinical management of glaucoma
visual function test (SWAP VS FDT) over another in clinical practice because there are few studies with adequate comparisons.
没有证据支持选择性的视功能检查 (SWAP 与 FDT) 何者更胜一筹
Standard automated perimetry, as usually employed in clinical
practice is not optimal for early detection
临床常用的自动视野检查并非早期青光眼检测的最佳方法
Emerging evidence that SWAP and
Glaucoma Surgery Open Angle Glaucoma edited by: R.N. Weinreb & J.G. Crowston
Angle Closure and Angle Closure Glaucoma edited by: R.N. Weinreb & D.S. Friedman Intraocular Pressure edited by: R.N. Weinreb & J.D. Brandt & D. Garway-Heath & F.A. Medeiros
HRT Ⅲ 改进 硬件：直接与笔记本电脑相连 软件
扩大数据库样本量 自动评价盘沿是否遵循ISNT原则 青光眼可能性评分
改进了TCA进展分析
HRT Ⅲ
角膜
青光眼
黄斑水肿
HRT 与OCT在视盘分析上的比较
WGA Consensus Series
Glaucoma Diagnosis Structure and Function edited by: R.N. Weinreb & E.L. Greve
“治愈”
青光眼 治疗
药物 手术 药物缓释系统（纳米颗粒） 激光 滤过道瘢痕化调控
选择，ACG易感性，等）
基因治疗（前房内注入基因
改造小梁网，等）
新模式
OCT 检查的进展
眼前段OCT
(光学相干断层扫描）
眼前段OCT
优点
分辨率高（10－20 mm) vs 操作简单，易于掌握 非接触，安全性高 无机械操作对组织的干扰
b－阻滞剂与死亡率
Topical b blockers and Mortality:Long-Term and Short Term Effect
R. Musken, et al. Presented at ARVO 2008
Purpose: Association between the use of topical timolol and cardiovascular mortality was reported by the Blue Mountains Eye Study (Lee AJ， et al. Ophthalmology 2006). To confirm or falsify this clinically very important finding. Methods: Long-term effects: 3842 participants of the Rotterdam Study were followed from 1997 onwards. Cause of death was registered up to January 1, 2005. Short-term effects: 484 incident beta-blocker users were compared to an agematched group of 4700 controls. Short term effects (death within three months after the first prescription of topical beta-blockers) were examined using a chi-squared test..
每秒400次 A 超扫描 9－10 mm 轴向分辨率
每秒26000次 A 超扫描
5 mm 轴向分辨率
Optovue/RTvue OCT
SD/FD OCT 视盘RNFL分析
SD/FD OCT 视盘RNFL分析
Invest. Ophthalmol. Vis. Sci. Walia and Fishman doi: 10.1167/iovs.08-1842
b－阻滞剂与死亡率
Topical b blockers and Mortality:Long-Term and Short Term Effect
R. Musken, et al. Presented at ARVO 2008
Purpose: Association between the use of topical timolol and cardiovascular mortality was reported by the Blue Mountains Eye Study (Lee et al. Ophthalmology 2006). To confirm or falsify this clinically very important finding. Methods: Long-term effects: 3842 participants of the Rotterdam Study were followed from 1997 onwards. Cause of death was registered up to January 1, 2005. Short-term effects: 484 incident beta-blocker users were compared to an agematched group of 4700 controls. Short term effects (death within three months after the first prescription of topical beta-blockers) were examined using a chi-squared test.. Conclusions: Use of topical beta-blockers appears not to be associated with mortality.
检测（功能）异常并记录视功能状态应作为青光眼诊治的常规
Unlikely that one functional test assesses the whole dynamic range of
function
一种视功能检查并不能反映整体功能的动态范围
Consesus Statement on Functional Assessment in the Management of Glaucoma
青光眼诊治新进展及共识
浙江大学医学院附属第二医院眼科中心 吴仁毅
诊断
“治愈”
青光眼 治疗 新模式
早期青光眼性视神经病变 晚期青光眼性视神经病变 前房角关闭的检测 闭角型青光眼的预测 青光眼形态（结构）进展 青光眼视功能进展
诊断
“治愈”
青光眼 治疗 新模式
早期青光眼性视神经病变 晚期青光眼性视神经病变 前房角关闭的检测 闭角型青光眼的预测 青光眼形态（结构）进展 青光眼视功能进展
应用合适的数据库对结果进行自动分析有助于发现青光眼相关的异常
Different imaging technologies may be complementary, and detect