青光眼英语ppt课件.ppt

视盘和RNFL检查 重要性：视盘改变、RNFL改变和视盘周围的脉络膜萎缩早于视野缺损。视盘出血是重要的体征。 裂隙灯：散瞳下放大的立体像观察 直接检眼镜：作为补充，由于放大倍率更大，可以提供更多的细节。 无赤光照明用于RNFL 眼底检查 散瞳下的眼底检查寻找可引起类似视盘和视野改变的眼底病变 视神经苍白 视盘玻璃疣 视盘小凹 optic nerve pits 中枢神经系统疾病造成的视盘水肿 黄斑变性 视网膜血管阻塞 Supplemental Ophthalmic Testing 中央角膜厚度 视野 视盘和视网膜神经纤维层分析 中央角膜厚度 CCT和IOP之间相关性：没有公认的校正公式 CCT是一个独立于IOP的危险因素（OHTS level II ） 视野检查 自动静态视野检查 The frequency doubling technology (FDT) method with the central 20-degree test program (C-20) short-wavelength automated perimetry (SWAP) with the central 24-degree test program (24-2) are two of several alternative testing methods to screen for a defect before conducting more definitive threshold testing 比传统的白-白视野检查 Careful manual combined kinetic and static threshold testing (e.g., Goldmann visual fields) is an acceptable alternative when patients cannot perform automated perimetry reliably or if it is not available.[A:III] Repeat, confirmatory visual field examinations may be required for test results that are unreliable or show a new glaucomatous defect before changing management.110,111 [A:III] In the OHTS, 86% of visual field defects were not confirmed upon subsequent testing.110 It is best to use a consistent examination strategy for visual field testing. 视盘和视神经纤维层分析 Color stereophotography computer-based imaging confocal scanning laser ophthalmoscopy optical coherence tomography scanning laser polarimetry MANAGEMENT 对于青光眼或疑似患者，眼压是唯一可调控因素 决定开始降眼压治疗是一个复杂的过程： 眼科医生对检查结果的判断 风险评估 患者的评估 患者的选择 与患者（家属）探讨：危险因素的数量和严重程度，预后、诊疗计划、治疗一旦开始就要长期坚持 恰当的治疗方案：降眼压效果、副作用、依从性 何时开始治疗？ Any patient who shows evidence of optic nerve deterioration based on optic nerve head appearance, retinal nerve fiber layer loss, or visual field changes consistent with glaucomatous damage has developed POAG and should be treated as described in the Primary Open-Angle Glaucoma PPP.119 [A:III] Development of subtle abnormalities in the optic disc and retinal nerve fiber layer are best detected by comparing periodic fundus imaging with disc and retinal nerve fibe