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本態性高血壓症患者의 網膜動脈血壓 및 視野의 變化에 對한 觀察

RETINAL ARTERIAL BLOOD PRESSURE AND VISUAL FIELDS IN ESSENTAL HYPERTENSION

항공의학 1957년 5권 1호 p.17 ~ 49
윤원식,
소속 상세정보
윤원식 (  ) - 경전병원안과 서울대학교의과대학안과교실

Abstract


The diastolic blood pressure in the retinal artery and the visual fields were studied in 154 eyes of 81 patients of essential hypertension. Age ranged from 28 to 55 years. No attempt was made to distinguish as to sex and age 150 mmHg systolic and 90 mmHg diastolic blood pressure were considered as the upper limits of the normal brachial blood pressure. The patients were classified according to the criteria of Keith-Wagener, and their distribution by age, sex and Keith Wagener grouping are shown in Table 1.
PART I : RETINAL ARTERIAL BLOOD PRESSURE
The diastolic retinal arterial blood pressure was measured by Bailliart´s ophthal
modynamomter, and the systolic and diastolic brachial blood pressure were measured by the mercury sphygmomanometer in sitting position.
1. The average results of the brachial and retinal blood pressure measurements,
and the ;mean percent ratio of retinal to brachial diastolic pressure in each group were summarized in Table 2. When all cases are. considered as a whole, the mean systolic brachial pressure is 219.5 mmHg, the mean diastolic brachial pressure 140.4 mmHg, the mean diastolic retinal pressure 63.2 mmHg, and the mean percent ratio of retinal to brachial pressure 58. 6%.
2. There is a definite rise in the values for the systolic and diastolic brachial pressure, the diastolic retinal pressure and the percent ratio of retinal to brachial pressure as the K-W group advances, i.e. as the hypertensive state become progressively worse.
3. The variance of the retinal and brachial diastolic blood pressure diminished markedly in group IR and IST.
4. The diastolic retinal blood pressure showed marked increase in group IV.
5. These data were illustrated in Fig. 1, and the author´s results were compared with other workers´ results in Fig. 2.
6. There is a positive correlation of the retinal and brachial diastolic blood pressure, and its coefficient of correlation was found to be 0.63. The correlation diagram and regression line were shown in Fig. 3.
7. The number of cases who have the normal value of diastolic retinal blood pressure was, in the order from group I to IV 9(21?), 4(5?), none, none.
8. The number of cases who have normal percentage ratio of retinal to brachial diastolic pressure was, in the order from group I to IV, 29(69?), 36(48?), 4(19%), none.
9. From the above facts, it might be reasonable to conclude that the retinal diastolic blood pressure has increased definitely and the percentage ratio of retinal to brachial diastolic pressure has exceeded the normal limit, when the hypertensive state had become so worse as to produce retinopathy.
PART TI : VISUAL FIELDS
The visual fields were measured by Brombach perimeter and tangent screen for white (3/330, 11330 and 1/1, 000), red and blue (5/330, 3/330 and 3/1,000 respectively) stimuli in 4 principal meridians. Central scotoma was examined with 0.5/1,000 white and 2/1,000 red and blue test objects.
1. The average fields in patients were listed in Table 3, and field charts were shown in Fig. 4. The fields regarded from the point of view of the visual acuity were illustrated in Fig. 5.
The hypertensive patients showed contraction of the fields for colored test objects (especially for blue) from the early phase. The colored test objects of small visual angles were most effective for the detection of narrowing.
2. The percentage of eyes in each group which showed the significant contraction of fields are graphically represented in Fig. 6. This clearly shows that the greatest number of cases were detected by 311,000 blue test object. And as the hypertensive state advances, the number of pathologic cases increases, and the fields for red and white show definite contraction.
3. The percent contraction is represented in Fig. 7. The contraction occurred
most markedly in the fields , for blue, especially for 3/1, 000 blue. The percentage increases, as the hypertension progressively become severe, and the contraction for red then for white test objects gradually increases.
4. The changes in the central portion of the fields are shown in Table 4. Central scotoma for 3/1,000 blue and 211,000 blue were frequently found in K-W group without any ophthalmoscopic sign.
5. There is no correlation of the contraction of fields with the level of the systolic and. diastolic brachial blood pressure, diastolic retinal blood pressure and percent ratio of retinal to. brachial diastolic blood ressure respectively.
6. The lowering of perception for blue stimuli from the early phase of hypertensive state suggests that the primary impairments of function occur at the. neuroepithelium of the retina, and as the hypertensive state progressively advances the general impairments of retinal function are demonstrated by the added lowering of perception for red and white stimuli.

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