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诊断青光眼视神经损害的三要素为盘沿丢失、视网膜神经纤维层缺损(RNFLD)及视盘线状出血。三要素中如有两要素改变应诊断为视神经损害。对于盘沿丢失已往的教科书中均无明确描述,笔者认为识别盘沿丢失必须首先认识正常盘沿形态及其影响因素。大多数的正常盘沿形态符合ISNT法则,生理性大视杯也符合该法则。不符合ISNT法则者为盘沿丢失,或者为正常盘沿形态变异。后者如部分小视盘下方盘沿可比上方盘沿窄,判断是否上、下方盘沿丢失时应将其与鼻侧盘沿进行比较;横椭圆视盘鼻侧盘沿较宽,应上、下盘沿比较;视盘主干血管发出位置偏位、视盘倾斜也会影响盘沿形态。如果参照ISNT法则认识正常盘沿变异因素,就不难发现盘沿丢失。然而不是所有的盘沿丢失均为青光眼所致,应鉴别非青光眼性视神经损害。(中华眼科杂志,2006,42:196-198)
The three components of glaucomatous optic nerve damage are loss of rim, loss of retinal nerve fiber layer (RNFLD) and optic disc haemorrhage. If there are two elements of the three elements change should be diagnosed with optic nerve damage. For the disc along the lost textbooks have not been described in the past, I believe that disc loss recognition must first recognize the normal disc along the morphology and its influencing factors. Most of the normal disk along the form consistent with the ISNT rule, physiological big cup also in line with the law. Those who do not conform to the ISNT law are disc edge missing or morphological variations along the normal disc. The latter part of the lower part of the small disc along the lower edge of the disc along the top than the narrow to determine whether the upper and lower disc along the loss should be compared with the nasal disc edge; horizontal elliptical disc nasal disc along the broader, should be on the lower disc Along the comparison; the position of the optic disc trunk vascular position deviation, disc tilt will also affect the disc along the shape. If you refer to the ISNT law to understand the normal variation along the edge of the disk, it is not difficult to find the disk edge is lost. However, not all of the rim is lost due to glaucoma, non-glaucomatous optic nerve damage should be identified. (Chinese Journal of Ophthalmology, 2006,42: 196-198)