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Background: The Chinese people have more than 20 million people with glaucoma, primary angle-closure glaucoma (Primary angle-closure Glaucoma, PACG), including primary chronic angle-closure glaucoma (Primary chronic angle-closure glaucoma, PCACG, ) and they account for more than 60% of the total number of PACG objective morphological examination of the optic disc (optical nerve head, ONH) and the (retina nerve fiber layer RNFL) thickness variation of assessment is particularly important for the diagnosis and treatment of glaucoma, currently still in the international no unified diagnostic criteria for glaucomatous ONH damage. Disc ratio of the optic cup (cup disc ratio, C / D) is the most widely used optic disc damage assessment indicators, but due to its measured value itself far from uniform, and the optic cup, optic disc size difference in the crowd, not as a reliable indicator of qualitative and quantitative glaucoma, simply using the C / D to judge the glaucomatous ONH damages easily misdiagnosed. Computer-aided objective instrument can be more accurate detection of RNFL thickness and rim area, but they can not the intuitive observations disc tray along morphology, optic disc size and optic color change, it is difficult to determine the normal variation between individuals, in addition, it is difficult the identification of non-glaucomatous optic nerve damage result in the RNFL lost. Check for the above insufficient Spaeth glaucoma ONH morphologic damage requires a combination of optic disc diameter and disc along the morphological analysis and presented ONH damage classification (disc damage likelihood scale, DDLS) description of glaucomatous optic nerve morphology. DDLS grading assessment of open-angle glaucoma (primary open angle glaucoma, POAG) optic nerve damage, with similar clinical, PCACG the POAG optic nerve damage so far is not clear whether this method can be applied to PCACG optic nerve damage assessment . Study of the subject from the following aspects to expect to expand the DDLS classification method clinical use range and guide PCACG the clinical use of the classification method, based on late-stage clinical use. A reasonable standard of clinical topics designed to collect PCACG patients; Second, the use of the DDLS grading of optic disc morphology grading OCT optic disc check parameters, vision changes value related research;, DDLS graded on PCACG clinical treatment guidance. Objective: to explore the the DDLS hierarchical values ??and OCT detection of optic disc parameters and visual field (visual field, VF) changes, assessment the DDLS methods PCACG optic nerve damage feasibility. 2. Use DDLS grading controlled chamber angle grading the guidance PCACG clinical, observed laser iris week resection (the lase periperal of combined frequency - doubled LPI) and LPI combined with drug treatment and the trabeculectomy three treatment on intraocular pressure control situation PCACG , to assess the validity of the DDLS guiding clinical treatment. Subjects and methods: 1, collected in our hospital in December 2008 -2011 in March PCACG patient case using the the Volk 90D front mirror slit lamp at the narrowest width measurements along the disc diameter disk DDLS grading score optic disc; Stratus the OCT3000 imaging instrument RNFL 3.4 scan program for each quadrant RNFL thickness of the part-time position and optional parameters, optic disc area parameter; Humphrey perimetry (humprey field analyzer, HFA) 242 program (Swedish Interactive Threshold Algorithm standard, SITA 24-2) Check the visual field mean defect (mean deviation, MD), mode, standard deviation (pattern standared deviation, PSD) value. Use SPSS15.0 analysis DDLS score OCT optic disc parameters, the relationship of the value of the field of vision. 2, PCACG patients were randomly divided into two groups, DDLS grading guide clinical treatment group (experimental group) angle grading guide clinical treatment group (control group), DDLS grading in three phases, the first phase of the control angle lt ; 1800 range and IOP ≥ 21mmHg, MD lt; -6 accept the LPI the treatment; second stage control angle lt; 1800 range and IOP ≥ 21mmH-6 ≤ MD lt; -12 group received the LPI joint drug treatment; three-phase control angle ≥ 1800 range, IOP ≥ 21mmHg, associated with vision the MD ≥ -12 accept trabeculectomy surgery, intraocular pressure changes observed before and after treatment, using logistic regression analysis to test the relationship between the two groups, and assess the experimental group guiding clinical validity. Results: 1 second part of the cases of 20 cases (38) the results of analysis, large-diameter disc 3 (7.9%), the medium diameter disc 11 (28.9%), small diameter disc 24 (63.2% ); above, below, and the temporal side quadrant RNFL thickness mean DDLS grading The The ratings related (r = -0.673, P = 0.0001; r = -0.605, P = 0.0001, r = -0.499, P = 0.0014), the nasal side quadrant RNFL thickness mean DDLS grading irrelevant to (r = -0.352, P = 0.0602); 11,7,6,10,12 hour RNFL thickness DDLS grading correlation (r = -0.673, P = 0.0001; r = -0.605, P = 0.0001; r = -0.531, P = 0.0006; r = -0.525, P = 0.0007; r = -0.520, P = 0.0008), and 3,2,8 point bit free statistics significance (r = -0.320, P = 0.0501; r = -0.320, P = 0.0510; r = -0.297, P = 0.0702,); DDLS grading score and OCT examination optional parameters Avg, Smax, Imax RNFL thickness was a moderate correlation (r = -0.582, P = 0.0001; r = -0.504, P = 0.0012; r = -0.478, P = 0.0024). DDLS grading score OCT detection results show disc area related to the correlation coefficient of the area below the highest (r = -0.878, P lt; 0.0001; r = -0.730, P lt; 0.0001). DDLS grading score and visual field test results: the DDLS score horizons MD related (r = -0.593, P lt; 0.0001), and PSD values ??(r = -0.60, P lt; 0.0001), the OCT detection parameters perimetry The results showed that, overall along the area was a moderate correlation (r = -0.53, p lt; 0.0001), disk along with disc ratio was low correlation with visual field MD values, the level of the steering wheel rim area and visual field MD values ??without statistical significance (r = -0.02, P = 0.058). 2. Third part DDLS group of 29 patients (54), the average age of patients (50.7 ± 9.8) years, angle group, 28 patients (53), the average age of the patients (52.2 ± 10.1) years old; logistic regression analysis prompts DDLS group statistics between the three clinical treatment group were treated with angle group no significant difference (OR = 0.81, p = 0.624), trabeculectomy better than LPI (OR = 4.88, P = 0.0075), LPI combination of drugs and LPI between no see significant difference (OR = 2.39, P = 0.0946), trabeculectomy group than in the other two treatments more effective control of intraocular pressure (OR = 4.88, P = 0.0075). That the two methods of treatment of clinical guidance no significant difference between the different treatment modalities of IOP control efficacy statistically significant. Conclusion: assessment and OCT optic disc check parameters DDLS grading the method PCACG optic nerve damage and visual field examination with correlation the the DDLS classification method for evaluation of the optic nerve damage in the PCACG. DDLS group with angle group IOP control efficiency was no significant difference, DDLS the classification guidance PCACG clinical angle grading a useful supplement to guide clinical treatment.
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