VK-2WX视乳头分析系统检测青光眼杯盘形态特征的临床研究

doi:10.3877/cma.j.issn.2095-2007.2025.04.003

目的

探讨青光眼患者杯盘结构的形态特征及其与非青光眼患者杯盘结构形态的差异。

方法

收集2024年11月至2025年9月期间在首都医科大学附属北京同仁医院门诊接受眼底照相检查并同步完成视乳头分析系统检测的患者288例(288只眼)进行研究。其中，男性146例(146只眼)，女性142例(142只眼)。年龄10~71岁，平均年龄(39.1±15.2)岁。所有患者均进行眼压、眼部生物学测量、眼底像检查及视乳头分析系统分析。根据青光眼病史和眼底像中视杯扩大、盘沿丢失、视神经纤维层典型萎缩性改变及视野缺损等临床表现将患者分为青光眼组和非青光眼组。年龄、眼轴长度、盘沿面积及视盘垂直宽度经检验符合正态分布，以±s表示，组间比较采用独立样本t检验；眼压、中央角膜厚度、前方深度、晶状体厚度、平均角膜曲率半径、瞳孔直径、各个区域的盘沿宽度、盘沿视盘面积比、盘沿体积、垂直杯盘比、视杯面积、杯盘面积比、视杯体积、平均视杯深度、最大视杯深度、视盘面积、视盘体积及视盘损伤可能性评分不符合正态分布，以M(Q1，Q3)表示，组间比较采用Mann-Whitney U检验。

结果

全部患者288例(288只眼)中，非青光眼组和青光眼组患者分别为241例(241只眼)和47例(47只眼)，分别占83.7%和16.3%。非青光眼组和青光眼组患者的眼压分别为16.7(14.0，19.0)mmHg(1 mmHg＝0.133 kPa)和21.9(17.2，25.3)mmHg，非青光眼组低于青光眼组，其差异具有统计学意义(Z＝-5.49，P<0.05)。非青光眼组患者各个区域自A~F点盘沿宽度、盘沿面积及盘沿视盘面积比分别为0.18(0.14，0.21)mm、0.20(0.15，0.25)mm、0.22(0.16，0.29)mm、0.24(0.17，0.33)mm、0.25(0.18，0.33)mm、0.22(0.16，0.27)mm、0.15(0.11，0.18)mm、(1.23±0.36)mm²及0.68(0.54，0.81)，青光眼组分别为0.12(0.09，0.16)mm、0.16(0.09，0.20)mm、0.16(0.11，0.24)mm、0.19(0.12，0.24)mm、0.16(0.11，0.24)mm、0.13(0.08，0.20)mm、0.10(0.05，0.14)mm、(0.94±0.34)mm²及0.52(0.38，0.67)，非青光眼组均大于青光眼组，其差异具有统计学意义(Z/t＝-4.70，-4.05，-3.33，-3.59，-4.37，-4.55，-4.18，5.35，-4.32；P<0.05)。非青光眼组患者垂直杯盘比、视杯面积、杯盘面积比、视杯体积、平均视杯深度及最大视杯深度分别为0.55(0.44，0.65)、0.58(0.30，1.11)mm²、0.32(0.19，0.46)、0.08(0.02，0.22)mm³、0.14(0.08，0.22)mm、0.36(0.23，0.52)mm、2.00(2.00，3.00)，青光眼组分别为0.69(0.58，0.81)、1.05(0.52，1.35)mm²、0.48(0.33，0.62)、0.16(0.07，0.33)mm³、0.18(0.11，0.26)mm、0.43(0.33，0.60)mm、3.00(3.00，3.00)，非青光眼组均低于青光眼组，其差异具有统计学意义(Z＝-4.47, -2.91，-4.32，-2.88，-2.17，-2.41，-6.36；P<0.05)。非青光眼组患者分布于颞侧0°或360°附近者159例(159只眼)，占65.98%；分布于颞下方300°和颞上方60°附近者53例(53只眼)，占21.99%；分布于其他部位者29例(29只眼)，占12.03%。青光眼组患者分布于颞下方300°和颞上方40°附近者22例(22只眼)，占46.81%；分布于其他部位者25例(25只眼)，占53.19%。

结论

生理性大视杯患眼盘沿最窄部位主要分布于颞侧0°或360°附近，而青光眼组患眼近半数集中分布于颞下方300°和颞上方40°附近，其他部位散发；青光眼患眼的盘沿更窄，盘沿面积和盘沿视盘面积比更小，垂直杯盘比、视杯面积、杯盘面积比、视杯体积和视杯深度更大。

关键词: 青光眼, 视乳头分析系统, 眼底照相机, 杯盘形态

Objective

To explore the morphological characteristics of cup and plate structures in glaucoma patients and their differences from those in non glaucoma patients.

Methods

The 288 patients (288 eyes) who underwent fundus photography examination at the outpatient department of Beijing Tongren Hospital affiliated to Capital Medical University from November 2024 to September 2025 were collected and completed the nipple analysis system detection. Among them, there were 146 males (146 eyes) and 142 females (142 eyes) with an average age of (39.1±15.2) years (ranging from 10 to 71 years old). All patients underwent intraocular pressure, ocular biological measurements, fundus imaging examination, and analysis of the optic disc analysis system. Patients were divided into glaucoma group and non glaucoma group based on their history of glaucoma and clinical manifestations such as enlargement of the optic cup, loss of disc edge, typical atrophic changes in the optic nerve fiber layer, and visual field defects in fundus images. Age, axial length, disc edge area, and vertical width of the optic disc were tested to follow a normal distribution, represented by ±s. Independent sample t-test was used for inter group comparison. The intraocular pressure, central corneal thickness, anterior depth, lens thickness, average corneal curvature radius, pupil diameter, disc edge width in each region, disc edge to disc area ratio, disc edge volume, vertical cup to disc ratio, cup area, cup to disc area ratio, cup volume, average cup depth, maximum cup depth, disc area, disc volume, and likelihood of disc damage scores do not followed a normal distribution and were represented by M (Q1, Q3). Mann Whitney U test was used for inter group comparison.

Results

Among the total 288 patients (288 eyes), there were 241 patients (241 eyes) in the non glaucoma group and 47 patients (47 eyes) in the glaucoma group, accounting for 83.7% and 16.3%, respectively. The intraocular pressure of patients in the non glaucoma group and glaucoma group was 16.7 (14.0, 19.0)mmHg (1 mmHg=0.133 kPa) and 21.9 (17.2, 25.3)mmHg, respectively. The non glaucoma group was lower than the glaucoma group, and the difference was statistically significant (Z=-5.49, P<0.05). The width, area, and ratio of optic disc area from point A to point F in the non glaucoma group were 0.18 (0.14, 0.21)mm, 0.20 (0.15, 0.25)mm, 0.22 (0.16, 0.29)mm, 0.24 (0.17, 0.33)mm, 0.25 (0.18, 0.33)mm, 0.22 (0.16, 0.27)mm, 0.15 (0.11, 0.18)mm, (1.23±0.36)mm^2, and 0.68 (0.54, 0.81)mm, respectively. The glaucoma group had 0.12 (0.09, 0.16)mm, 0.16 (0.09, 0.20)mm, and 0.16 (0.11, 0.24)mm, 0.19 (0.12, 0.24)mm, 0.16 (0.11, 0.24)mm, 0.13 (0.08, 0.20)mm, 0.10 (0.05, 0.14)mm, (0.94±0.34)mm^2, and 0.52 (0.38, 0.67)mm, respectively. Those were all larger in the non glaucoma group than in the glaucoma group, and the differences were statistically significant (Z/t=-4.70, -4.05, -3.33, -3.59, -4.37, -4.55, -4.18, 5.35, -4.32; P<0.05). The vertical cup to disc ratio, cup area, cup to disc area ratio, cup volume, average cup depth, and maximum cup depth in non glaucoma patients were 0.55 (0.44, 0.65), 0.58 (0.30, 1.11)mm^2, 0.32 (0.19, 0.46), 0.08 (0.02, 0.22)mm^3, 0.14 (0.08, 0.22)mm, 0.36 (0.23, 0.52)mm, 2.00 (2.00, 3.00), while the glaucoma patients were 0.69 (0.58, 0.81), 1.05 (0.52, 1.35)mm^2, 0.48 (0.33, 0.62), 0.16 (0.07, 0.33)mm^3, 0.18 (0.11, 0.26)mm, 0.43 (0.33, 0.60)mm, and 3.00 (3.00, 3.00)mm were all lower in the non glaucoma group than those in the glaucoma group, and the differences were statistically significant (Z=-4.47, -2.91, -4.32, -2.88, -2.17, -2.41, -6.36; P<0.05). 159 cases (159 eyes) of non glaucoma patients were distributed near temporal 0° or 360°, accounting for 65.98%; there were 53 cases (53 eyes) distributed near 300° below the temporal lobe and 60° above the temporal lobe, accounting for 21.99%; 29 cases (29 eyes) were distributed in other parts, accounting for 12.03%. 22 cases (22 eyes) of glaucoma patients were distributed near 300° below the temporal lobe and 40° above the temporal lobe, accounting for 46.81%; 25 cases (25 eyes) were distributed in other parts, accounting for 53.19%.

Conclusions

The narrowest part of the optic disc in patients with physiological large optic cups is mainly distributed near the temporal side at 0° or 360°, while in the glaucoma group, nearly half of the affected eyes are concentrated near 300° below and 40° above the temporal side, with scattered distribution in other areas. The rim of glaucoma affected eyes is narrower, with a smaller ratio of rim area to optic disc area. The vertical cup to disc ratio, cup to disc area ratio, cup to disc volume, and cup depth are larger.

Key words: Glaucoma, Optic Nerve head analysis system, Fundus camera, Cup-disc morphology

图3 盘沿最窄处分布散点图　图3A示非青光眼组患者视盘盘沿最窄处分布散点图；图3B示青光眼组患者视盘盘沿最窄处分布散点图

表1 非青光眼组与青光眼组患者视盘盘沿相关参数的比较

组别	眼数(只眼)	盘沿FA[M(Q1，Q3)，mm]	盘沿AB[M(Q1，Q3)，mm]	盘沿BC[M(Q1，Q3)，mm]	盘沿CD[M(Q1，Q3)，mm]	盘沿DE[M(Q1，Q3)，mm]
非青光眼组	241	0.18 (0.14，0.21)	0.20 (0.15，0.25)	0.22 (0.16，0.29)	0.24 (0.17，0.33)	0.25 (0.18，0.33)
青光眼组	47	0.12 (0.09，0.16)	0.16 (0.09，0.20)	0.16 (0.11，0.24)	0.19 (0.12，0.24)	0.16 (0.11，0.24)
Z/t值		-4.70※	-4.05※	-3.33※	-3.59※	-4.37※
P值		<0.05	<0.05	<0.05	<0.05	<0.05
组别	眼数(只眼)	盘沿EF[M(Q1，Q3)，mm]	盘沿最窄值[M(Q1，Q3)，mm]	盘沿面积(mm²)	盘沿视盘面积比[M(Q1，Q3)]	盘沿体积[M(Q1，Q3)，mm³]
非青光眼组	241	0.22 (0.16，0.27)	0.15 (0.11，0.18)	1.23 ±0.36	0.68 (0.54，0.81)	0.17 (0.11，0.23)
青光眼组	47	0.13 (0.08，0.20)	0.10 (0.05，0.14)	0.94 ±0.34	0.52 (0.38，0.67)	0.16 (0.08，0.19)
Z/t值		-4.55※	-4.18※	5.35△	-4.32※	-1.71※
P值		<0.05	<0.05	<0.05	<0.05	>0.05

表1 非青光眼组与青光眼组患者视盘盘沿相关参数的比较

组别	眼数(只眼)	盘沿FA[M(Q1，Q3)，mm]	盘沿AB[M(Q1，Q3)，mm]	盘沿BC[M(Q1，Q3)，mm]	盘沿CD[M(Q1，Q3)，mm]	盘沿DE[M(Q1，Q3)，mm]
非青光眼组	241	0.18 (0.14，0.21)	0.20 (0.15，0.25)	0.22 (0.16，0.29)	0.24 (0.17，0.33)	0.25 (0.18，0.33)
青光眼组	47	0.12 (0.09，0.16)	0.16 (0.09，0.20)	0.16 (0.11，0.24)	0.19 (0.12，0.24)	0.16 (0.11，0.24)
Z/t值		-4.70※	-4.05※	-3.33※	-3.59※	-4.37※
P值		<0.05	<0.05	<0.05	<0.05	<0.05
组别	眼数(只眼)	盘沿EF[M(Q1，Q3)，mm]	盘沿最窄值[M(Q1，Q3)，mm]	盘沿面积(mm²)	盘沿视盘面积比[M(Q1，Q3)]	盘沿体积[M(Q1，Q3)，mm³]
非青光眼组	241	0.22 (0.16，0.27)	0.15 (0.11，0.18)	1.23 ±0.36	0.68 (0.54，0.81)	0.17 (0.11，0.23)
青光眼组	47	0.13 (0.08，0.20)	0.10 (0.05，0.14)	0.94 ±0.34	0.52 (0.38，0.67)	0.16 (0.08，0.19)
Z/t值		-4.55※	-4.18※	5.35△	-4.32※	-1.71※
P值		<0.05	<0.05	<0.05	<0.05	>0.05

表2 非青光眼组与青光眼组患者视盘杯盘相关参数的比较

组别	眼数(只眼)	垂直杯盘比[M(Q1，Q3)]	视盘垂直宽度(±s，mm)	视杯面积[M(Q1，Q3)，mm²]	视盘面积[M(Q1，Q3)，mm²]	杯盘面积比[M(Q1，Q3)]
非青光眼组	241	0.55 (0.44，0.65)	1.67±0.25	0.58 (0.30，1.11)	1.88 (1.51，2.38)	0.32 (0.19，0.46)
青光眼组	47	0.69 (0.58，0.81)	1.67±0.24	1.05 (0.52，1.35)	1.91 (1.49，2.40)	0.48 (0.33，0.62)
Z/t值		-4.47※	0.06	-2.91※	-0.16※	-4.32※
P值		<0.05	>0.05	<0.05	>0.05	<0.05
组别	眼数(只眼)	视杯体积[M(Q1，Q3)，mm³]	视盘体积[M(Q1，Q3)，mm³]	平均视杯深度[M(Q1，Q3)，mm]	最大视杯深度[M(Q1，Q3)，mm]	视盘损伤可能性评分[M(Q1，Q3)，分]
非青光眼组	241	0.08 (0.02，0.22)	0.48 (0.26，0.83)	0.14 (0.08，0.22)	0.36 (0.23，0.52)	2.00 (2.00，3.00)
青光眼组	47	0.16 (0.07，0.33)	0.53 (0.29，0.93)	0.18 (0.11，0.26)	0.43 (0.33，0.60)	3.00 (3.00，3.00)
Z/t值		-2.88※	-1.13※	-2.17※	-2.41※	-6.36※
P值		<0.05	>0.05	<0.05	<0.05	<0.05

表2 非青光眼组与青光眼组患者视盘杯盘相关参数的比较

组别	眼数(只眼)	垂直杯盘比[M(Q1，Q3)]	视盘垂直宽度(±s，mm)	视杯面积[M(Q1，Q3)，mm²]	视盘面积[M(Q1，Q3)，mm²]	杯盘面积比[M(Q1，Q3)]
非青光眼组	241	0.55 (0.44，0.65)	1.67±0.25	0.58 (0.30，1.11)	1.88 (1.51，2.38)	0.32 (0.19，0.46)
青光眼组	47	0.69 (0.58，0.81)	1.67±0.24	1.05 (0.52，1.35)	1.91 (1.49，2.40)	0.48 (0.33，0.62)
Z/t值		-4.47※	0.06	-2.91※	-0.16※	-4.32※
P值		<0.05	>0.05	<0.05	>0.05	<0.05
组别	眼数(只眼)	视杯体积[M(Q1，Q3)，mm³]	视盘体积[M(Q1，Q3)，mm³]	平均视杯深度[M(Q1，Q3)，mm]	最大视杯深度[M(Q1，Q3)，mm]	视盘损伤可能性评分[M(Q1，Q3)，分]
非青光眼组	241	0.08 (0.02，0.22)	0.48 (0.26，0.83)	0.14 (0.08，0.22)	0.36 (0.23，0.52)	2.00 (2.00，3.00)
青光眼组	47	0.16 (0.07，0.33)	0.53 (0.29，0.93)	0.18 (0.11，0.26)	0.43 (0.33，0.60)	3.00 (3.00，3.00)
Z/t值		-2.88※	-1.13※	-2.17※	-2.41※	-6.36※
P值		<0.05	>0.05	<0.05	<0.05	<0.05

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The morphological characteristics of glaucoma cups and discs using VK-2WX nipple analysis system

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The morphological characteristics of glaucoma cups and discs using VK-2WX nipple analysis system