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目的 观察单侧视盘出血(DH)的正常眼压性青光眼(NTG)患者出血眼的临床特征.方法 回顾性分析37例单侧DH的NTG患者双眼间差异,观察指标包括眼压,屈光度,中央角膜厚度,视盘的面积、横径、纵径、横径/纵径,视盘的整体参数和DH所在区域的分区参数,视盘旁脉络膜萎缩灶β区(PPA)的发生率、面积、范围、最大宽度等.视盘面积及其他整体和分区参数通过应用海德堡视网膜断层扫描仪Ⅱ型(HRT-Ⅱ)测量获得,视盘的横径、纵径及PPA系列参数则通过使用计算机Image-pro plus 6专业图像分析软件对视盘的HRT-Ⅱ图像进行分析获得.所得结果进行单因素及多因素回归分析.结果 DH组视盘的纵径较对侧组长(P＜0.01),横径/纵径较对侧小(P=0.017),PPA的发生率较对侧高(P=0.031),差异均有统计学意义.DH组视盘整体参数的视网膜神经纤维层平均厚度(G-MRNFLT)、轮廓线高度变异(G-HVC)较对侧小(P值分别为0.028、0.047),视杯形态测量(G-CSM)较对侧组大(P=0.047),盘沿面积(G-RA)、盘沿体积(G-RV)与对侧组无明显差异;分区参数的S-RA、S-RV、S-MRNFLT较对侧组小(P值分别为0.033、0.01、0.008),S-CSM较对侧大(P=0.021),S-HVC与对侧无明显差别.两组在角膜厚度、屈光度、眼压、PPA的面积、范围、最大宽度方面无明显差异.将视盘面积、屈光度、G-RA、G-MRNFLT、G-CSM、横径/纵径、β区弧度范围进行多因素回归分析,横径/纵径为与视盘出血相关的独立因素(P=0.032,OR＜0.001:＜0.001～0.35);将视盘面积、屈光度、S-RA、S-MRNFLT、S-CSM、横径/纵径、β区弧度范围进行回归分析,横径/纵径及S-MRNFLT是与视盘出血相关的因素(S-MRNFLT:P=0.019,OR＜0.001:＜0.001～0.154;横径/纵径:P=0.02,OR＜0.001:＜0.001～0.124).结论 NTG单侧DH眼出血所在区域的视网膜神经纤维层较薄,横径/纵径值较小,前者表明NTG单眼DH患者出血所在区域的视网膜神经纤维层损害较重,后者则提示DH眼的视盘较长,这一形态特点可能与其发生出血之间有一定的内在关系.

Objective To investigate the clinical characteristics of the eyes with unilateral disc hemorrhage (DH) in normal tension glaucoma (NTG) patients. Methods 37 normal-tension glaucoma patients with unilateral DH were studied. Extensive parameters were analyzed to evaluate which parameters differ significantly between the DH eyes and the companion eyes. These parameters are:(1) intraocular pressure (IOP), (2) dioptres of refractive errors, (3) central corneal thickness (CCT), (4) disc area, (5)disc shape including horizontal diameter, vertical diameter and horizontal diameter/vertical diameter, (6)global parameters of optic disc, including rim area(G-RA), rim volume(G-RV) , mean retinal never fiber layer thickness( G-MRNFLT), cup shape measure ( G-CSM) and height variation contour ( G-HVC), (7)sectorial parameters of DH located area, including S-RA, S-RV, S-MRNFLT, S-CSM and S-HVC, (8)parameters of the peripapillary atrophy (PPA) beta zone including the incidence rate, area, extent and maximum width. The global and sectorial parameters of the optic disc were obtained directly from HRT-Ⅱ.The other parameters, such as optic disc horizontal diameter, vertical diameter and PPA, were obtained by processing the raw optic disc images acquired from HRT-Ⅱ using computer software Image-pro plus version 6.Univariate and multivariate regression analyses were performed on the acquired parameters. Results The disc vertical diameter ( P＜0.01) and incidence rate ( P = 0. 031 ) of zone beta appeared to be significantly larger in the DH eyes than the ones in the contra-lateral eyes, while horizontal diameter/vertical diameter was significantly smaller in the DH eyes. As for the optic disc global parameters, the G-MRNFLT (P=0. 028), G-HVC (P = 0.047) were significantly lower in the DH eyes than in the contra-lateral eyes while the G-CSM was significantly higher in DH eyes (P =0. 047). The differences of G-RA, G-RV between two eyes were not significant. As for the regional parameters, S-RA, S-RV, S-MRNFLT were significantly smaller in the DH eyes than in the contra-lateral eyes with P-values 0. 033, 0. 01 and 0. 008 respectively. SCSM was significantly larger in DH eyes (P =0. 021 ). S-HVC did not display significant difference between two groups. There were also no significant differences in CCT, dioptres of refractive errors, IOP, PPA parameters (including area, extent and maximum width) between DH eyes and companion eyes.Multivariate regression analysis demonstrated that contained disc area, dioptres of refractive errors, G-RA,G-MRNFLT, G-CSM, horizontal diameter/vertical diameter and zone beta extent, the horizontal diameter/vertical diameter were the significant factors independently associated with disc hemorrhage ( P = 0.032,OR ＜ 0.001: ＜ 0.001 -0.35). Logistic regression analysis also showed that contained disc area, dioptres of refractive errors, S-RA, S-MRNFLT, S-CSM, horizontal diameter/vertical diameter and zone beta extent,the horizontal diameter/vertical diameter and S-MRNFLT were the significant factors independently associated with disc hemorrhage ( S-MRNFLT: P = 0. 019, OR ＜ 0. 001: ＜ 0. 001 - 0. 154; horizontal diameter/vertical diameter: P = 0.02, OR ＜ 0. 001: ＜ 0. 001 - 0. 124). Conclusion Our study indicates that horizontal diameter/vertical diameter is significantly smaller in NTG patients with unilateral optic disc hemorrhages. The DH located area also appears to have thinner RNFL thickness. Unilateral optic disc hemorrhages tend to have severe RNFL damage in DH located area and their optic disc shape tend to be longer, therefore we hypothesis that the elongation of the optic disc may be associated with the occurrence of DH.