Clinical evaluation of the optic nerve in glaucoma.
Clinical evaluation of the optic nerve in glaucoma.
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发表时间：
1994
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通讯作者：
J. Caprioli
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作者：
J. Caprioli
结构、结构损伤的临床检测视神经：视神经头对慢性青光眼的诊断至关重要。特征性视神经拔火罐、视野丧失和眼压升高构成典型的三合一表现，尽管青光眼通常在没有眼压升高的情况下被诊断。仔细评估视盘通常可以在可检测的视力丧失发生之前识别早期青光眼损害。视盘外观可作为损伤的敏感监测，特别是在疾病的早期阶段。视神经拔火罐是视神经视网膜神经节细胞死亡和神经节细胞轴突丧失的表现。这种损伤也可以通过仔细检查视网膜神经纤维层来识别。后一种技术在这里没有详细描述；这个问题已经被彻底审查过了。”本文回顾了视神经评估在青光眼中的重要性，提供了一个历史的视角，详细的检查和测量方法，并回顾了迄今为止进行的横断面和纵向研究。本文报道的原始研究比较了临床方法早期发现损伤的能力，分析了早期和晚期青光眼中视野和视神经损伤的相对发生率，解决了临床试验和结局研究中标准化椎间盘评价的问题，并确定视神经的正常衰老变化是否会混淆纵向临床试验中椎间盘评价的结果。
TIlE CLINICAL I)ETECTION OF STRUC,TURAL DAMAG;E TO THE OPTIC NERV'E head is central to the diagnosis of chronic glaucoma. Characteristic optic nerve cupping, visual field loss, and increased intraocular pressure constitute a classic triad of findings, though glaucoma is often diagnosed in the absence of increased pressure. Careful evaluation of the optic disc can usually identify early glaucomatous damage before detectable visual loss occurs. Optic disc appearance can be used as a sensitive monitor of damage, particularly in the early stages of disease. Optic nerve cupping is a manifestation of retinal ganglion cell death and loss of ganglion cell axons from the optic nerve. This damage can also be recognized by careful examination of the retinal nerve fiber layer. The latter technique is not described in detail here; the subject has been thoroughly reviewed.' This thesis reviews why optic nerve evaluation is important in glaucoma, provides a historical perspective, details methods for examination and measurement, and reviews the cross-sectional and longitudinal studies performed to date. The original studies reported here compare the abilities of clinical methods to detect early damage, analyze the relative rates of visual field and optic nerve damage in early and more advanced glaucoma, address the problem of standardized disc evaluation for clinical trials and outcomes research, and determine if normal aging changes of the optic nerve could confound the results of disc evaluation in longitudinal clinical trials.