非穿透性小梁手术与小梁切除术治疗青光眼的远期疗效对照研究

Objective To evaluate clinical outcomes of non-penetrating trabecular surgery (NPTS)and trabeculectomy surgery (TS) in the treatment of primary open angle glaucoma (POAG). Methods It was a case-control study.A total of 63 patients (63 eyes) with POAG were observed retrospectively.Thirty one eyes and 32 eyes underwent NPTS and TS,respectively.Intraocular pressure(IOP),filtration bleb,visual field and post-operative complications were observed for 6-60 months.The CMH X2 test was used to analyse the difference of them.Results After operation.the IOP in the NPTS group were from(13.87±4.88)mm Hg(1 mm Hg=0.133 kPa) to (24.01±6.55)mm Hg,the IOP in the TS group were from(11.90±4.92)mm Hg to(19.10±7.43)mm Hg.The IOP in the NPTS group was significantly higher than that in the TS group (F=5.137,P<0.05).The ratio of sustained filtration bleb of NPTS group after surgery was 25/31(80.6%),while 6/31 were flat filtration bleb.There were statistically significant difference in the rate of disappearance of filtration bleb between these two groups(X2=8.129,P<0.05).The difference of visual field loss postoperatively between these two groups was not statistically significant.The incidence rate of newly developed cataract after NPTS and TS was 6/31 and 12/32.respectively.The difierence of rate of complication between these two groups was statistically non-significant(X2=3.797,P<0.05).The successful rate after NPTS and TS was 61.54%(16/26)and 14.29%(4/28),respectively.The difference of successful rate between these two groups was statistically significant(X2=14.463,P<0.05).Conclusions Both NPTS and TS are effective methods for the treatment of POAG.Postoperative complications after NPTS are less than those of TS.But patients with TS could maintain a lower IOP than those with NPTS.Long-term efficacy of NPTS is uncertain.it's important to choose the suitable surgery to gain a high success rate.     

非穿透性小梁手术与小梁切除术治疗青光眼的远期疗效对照研究

Objective To evaluate clinical outcomes of non-penetrating trabecular surgery (NPTS)and trabeculectomy surgery (TS) in the treatment of primary open angle glaucoma (POAG). Methods It was a case-control study.A total of 63 patients (63 eyes) with POAG were observed retrospectively.Thirty one eyes and 32 eyes underwent NPTS and TS,respectively.Intraocular pressure(IOP),filtration bleb,visual field and post-operative complications were observed for 6-60 months.The CMH X2 test was used to analyse the difference of them.Results After operation.the IOP in the NPTS group were from(13.87±4.88)mm Hg(1 mm Hg=0.133 kPa) to (24.01±6.55)mm Hg,the IOP in the TS group were from(11.90±4.92)mm Hg to(19.10±7.43)mm Hg.The IOP in the NPTS group was significantly higher than that in the TS group (F=5.137,P<0.05).The ratio of sustained filtration bleb of NPTS group after surgery was 25/31(80.6%),while 6/31 were flat filtration bleb.There were statistically significant difference in the rate of disappearance of filtration bleb between these two groups(X2=8.129,P<0.05).The difference of visual field loss postoperatively between these two groups was not statistically significant.The incidence rate of newly developed cataract after NPTS and TS was 6/31 and 12/32.respectively.The difierence of rate of complication between these two groups was statistically non-significant(X2=3.797,P<0.05).The successful rate after NPTS and TS was 61.54%(16/26)and 14.29%(4/28),respectively.The difference of successful rate between these two groups was statistically significant(X2=14.463,P<0.05).Conclusions Both NPTS and TS are effective methods for the treatment of POAG.Postoperative complications after NPTS are less than those of TS.But patients with TS could maintain a lower IOP than those with NPTS.Long-term efficacy of NPTS is uncertain.it's important to choose the suitable surgery to gain a high success rate.     

Effect of erythropoietin on the expression of HIF-1 and iNOS in retina in chronic ocular hypertension rats

AIM: To research the effect of erythropoietin (EPO) to the HIF-1\iNOS signal transduction path in retina in chronic ocular hypertension rat. METHODS: One hundred and twenty Wistar rats were divided into 12 groups randomly. Two episcleral veins were coagulated unilaterally in rats with electric coagulator to establish the glaucoma model. PT-PCR and Western Blot analysis were used to examine the expression of Caspase-9 genes in retina. And the changes of ERG-b wave before and after were detected using EPO. RESULTS: In EPO drug treatment group, the amplitude of ERG-b wave of retina restored remarkably. There was significant difference between two groups (P＜0.05). The expressions of HIF-1\iNOS mRNA and protein in EPO drug treatment group were weakened remarkably. It was statistically different compared with the non-drug treatment group. CONCLUSION: One of protect mechanisms of EPO to injured retina caused by chronic intraocular hypertension is through HIF-1\iNOS signal conduct path.     

Clinical research of EX-PRESS drainage device and modified trabeculectomy combined with intravitreal conbercept treatment for neovascular glaucoma

AIM:To evaluate the efficacy and safety of modified trabeculectomy(experimental group) and implantation of EX-PRESS drainage device(control group),combined with intravitreal conbercept injection for neovascular glaucoma(NVG).METHODS:Totally 30 patients with NVG were selected from June 2014 to June 2017,and randomly divided into experimental group and control group.All patients were underwent intravitreal conbercept(0.5 mg/0.05 mL) treatment before surgery.Modified trabeculectomy was performed in MT group,while EX-PRESS drainage device implantation was performed in EX group.The success rates,best corrected visual acuity(BCVA),intraocular pressure(IOP),filtering bleb and complications were observed and compared.RESULTS:The differences of success rate,BCVA and filtering bleb were not statistically significant 12mo after the surgery(P>0.05),however,the difference of IOP at 1d,1wk,1,3,and 6mo after surgery was statistically significant(F_time=390.64,P_time<0.0001) between two groups.The interactions between two groups in the given time showed no significant difference(F_{intergroup×time}=0.181,P_{intergroup×time}=0.57),and also there was no significant difference in IOP between the two groups(F=3.16,P=0.09).The results of pairwise comparison at each time point showed no significant difference in IOP between 1d and 1wk,3 and 6,3mo and 12mo after surgery(P>0.05),while the results at other time point indicate statistical differences(P<0.05).CONCLUSION:The modified trabeculectomy and the implantation of EX-PRESS drainage device have clinical application value in reducing IOP and postoperative complications of refractory NVG.     

蓝光滤过型非球面人工晶状体植入术后高阶像差及MTF值临床对比观察

Objective To observe the value of RMSh and MTF 3 months after implantation of bluelight-blocking aspherical intraocular lens. Methods Patients were divided into three groups according to their selection among three kinds of implant IOL: GroupⅠ(PY-60AD), Group Ⅱ (Acrysof IQ),and Group Ⅲ (YA-60BB), Wavefront aberrations were measured across different pupil diameters (PD)(3mm,4mm,5mm,6mm) to record the values of the Z40, coma,total higher order aberration and modulation transfer function (MTF) under pupil diameters of 3mm,5mm three months after cataract phacoemusification and implantation of IOL. Results The values of Z40 in the two aspherical IOL groups were significantly lower than the spherical IOL group at all different pupil diameters (P＜0.05).There was no significant difference between two aspherical IOL groups about the value of Z40.There were no statistically significant differences about the values of coma among three groups (P ＞0.05). The values of RMSh in the two aspherical IOL groups were significantly lower than the spherical IOL group (P＜0.05) when the PD≥5mm, but had no significant difference when the PD＜5mm(P＞0.05).There was no significant difference between two aspherical IOL groups about the RMSh at all different pupil diameters (P＞0.1). At a 3mm pupil diameter,there were no statistically significant differences about the values of MTF at all spatial frequency (5,10,15,20,25,30cpd) among three groups (P＞0.05).At a 5mm pupil diameter,the values of MTF in the two aspherical IOL groups were significantly lower than the spherical IOL group at spatial of 5,10,15,20,25cpd (P＜0.05). There was no significant difference between two aspherical IOL groups about the values of MTF, but in the following order group Acrysof IQ＞group PY-60AD (P＞0.05). Conclusions PY-60AD and Acrysof IQ IOL can decrease the spherical aberration even when the pupil diameter at only 3mm and decrease the higher order aberration when the pupil diameter at or greater than 5mm. Thereby the patients who implanted with aspherical IOLs can acquire better visual quality.There is no significant difference when PY-60AD comparing to Acrysof IQ about the values of wavefront aberrations and MTF. And HOYA PY-60AD is a preloaded IOL that have many advantages fit for widely applied in clinical field.     

Effects of diode laser photocoagulation treatment on ocular biometric parameters in premature infants with retinopathy of prematurity

AIM:To investigate the effects of diode laser treatment on ocular biometric parameters in premature infants with retinopathy of prematurity(ROP).METHODS:Premature infants who received diode laser treatment for ROP(n=68)and premature infants with spontaneous regressed ROP without treatment(n=50)were performed longitudinal ocular biometric measurements including anterior chamber depth,lens thickness and axial length as follows:1 d prior to laser treatment,and 3,6,9,and 12 mo after the laser treatment.RESULTS:The mean birth weight,gestational age and initial examination time values were 936.53±302.07 g,26.66±2.42 wk,36.26±2.73 wk in the treatment group and 959.78±260.08 g,27.28±2.10 wk,36.56±2.54 wk in the control group.There was no statistically significant difference in these demographic characteristics of the groups.Anterior chamber depth,lens thickness and axial length demonstrated statistically significant linear increases during the study period in the two groups(P<0.001 for each).There were no statistically significant differences between the two groups in terms of anterior chamber depth after laser treatment.Measurements of the lens thickness at 9 th and 12 th months(9 th month 3.70±0.22 vs 3.60±0.21 mm,P=0.017;12 th month 3.81±0.21 vs 3.69±0.22 mm,P=0.002)and the axial length at 12 th month(19.35±0.79 vs 19.13±0.54 mm,P=0.031)after laser treatment were statistically higher in the treatment group.CONCLUSION:Diode laser retinal photocoagulation treatment in premature infants seems to increase the lens thickness and axial length.     

两种常用的下斜肌减弱术对睑裂的影响

Objective To observe the effect and the change of the palpebral fissure after recession and anterior transposition of the inferior oblique muscle.Methods To record the preoperative and postoperative situation of the palpebral fissure in the 18 eyes recession and 16 eyes anterior transposition of the inferior oblique muscle,then the data was statistics analyzed.Results The narrowing of the palpebral fissure after surgery (mean+ SD)was 0.77±0.43 mm in the 18 eyes in the recession group,?1.3±0.26 mm in the 16 eyes in the anterior transposition group.The differences were statistically significant between the preoperation and the postoperation of the recession group(P＜0.01,t=6.19)and the anterior transposition group(P＜0.01,t=43),then this difference was statistically significant between the two groups(P＜0.01,t=32).The bulging of the lower eyelid was found in all ease after surgery.However,it was not change on the palpebral fissure of all non-surgical eye after surgery,the difference was not statistically significant.The 28 cases of patients were 78.57 percent effective two weeks after surgery.Conclusions Recession and anterior transposition of the inferior oblique muscle cause significant narrowing of the palpebral fissure as a sole procedure.It was more obviously in anterior transposition group than that of recession group.     

Clinical Evaluation of Pranoprofen Combined with Fluorometholone Eye Drops on Postoperative Reaction of Corneal Cross-linking

 Purpose: To evaluate the efficacy and safety of pranoprofen eye drops for reducing postoperative ocular pain and inflammation after corneal cross-linking (CXL). Methods: Twenty-seven patients (38 eyes) with keratoconus undergoing CXL were examined and randomly divided into control (12 cases; 18 eyes) and experimental groups (15 cases; 20 eyes). The patients in the control group were given fluorometholone eye drops, and those in the experimental group were administered with fluorometholone combined with pranoprofen eye drops．Corneal irritation and haze were compared between the two groups at 1 month postoperatively． Results: At 1 to 3 days after surgery,the corneal irritation in the experimental group was significantly reduced compared with that in the control group (P＜0.05), but there was no significant difference on 5 to 7 days postoperatively (P＞0.05)．The average degree of haze in the experimental group was significantly lower than that in the control group 1 month after surgery (P＜0.05), but there was no significant difference in the best-corrected vision acuity and intraocular pressure between the two groups. There were 2 cases with >20 mmHg intraocular pressure in the control group. Conclusion: The combined use of fluorometholone and pranoprofen can significantly reduce inflammatory response,alleviate corneal irritation at early stage after CXL,effectively prevent and control the average of haze,and reduce the incidence of steroid-induced ocular hypertension after surgery．     

早产儿视网膜病变激光光凝治疗后视网膜功能发育状况观察

Objective To observe the development of cone/rod functions in children with retinopathy of prematurity(ROP)after laser photocoagulation.Methods 30 ROP patients(60 eyes)treated with laser photocoagulation(case group)and 30 preterm infants(60 eyes)without ROP(control group)were enrolled in this study.Flash Electroretinogram(F-ERG)was performed on all the children, and the response of rod cells and cone cells,maximal mixed responses and oscillatory potentials were recorded.Results Compared with the control group,the amplitude of response of rod cells was obviously decreased(t=-2.385,P＜0.05),while the latency phase of rod cells was obviously prolonged(t=-2.799,P＜0.05);the amplitudes of a-and b-wave of maximal response were significantly decreased in the case group(t=-2.967.-4.037;P＜0.05).But there was no significant difference of amplitudes(t=-1.402)and latency phase (t=-1.637,0.465)0f b-/a-wave of the maximal mixed response between two groups(P>0.05).In the response of cone cells,there was no significant difference of the latency phase(t=1.222)and amplitude (t=-0.636)of a-wave as well as amplitude(t=-1.927)of b-wave between two groups(P>0.05).The latency phase of b-wave of cone cells in the case group was longer than that in the control group(t=-2.466,P＜0.05).Conclusions Compared to no-ROP preterm infant retina,laser-treated ROP retina has normal cone function development and delayed rod function development.     

The effect on wound healing of pazopanib and bevacizumab compared with corticosteroid in experimental glaucoma filtration surgery

AIM: To compare the effects of bevacizumab and pazopanib with corticosteroids on wound healing after trabeculectomy. METHODS: In the study, 35 New Zealand white rabbits were randomly divided into five groups. Apart from the first group, limbus-based trabeculectomy was performed for the eyes of rabbits. No postoperative treatment was administered for group I. Topically administered saline, prednisolone acetate (1%), bevacizumab 5 mg/mL, pazopanib 5 mg/mL for group II, III, IV and V respectively were applied for groups 6h daily for 28d. On day 28 of the experiment, eyes were enucleated and histologically and immunohistochemically analyzed. RESULTS: The fibroblast counts of groups IV and V were determined to be lower than those of groups II and III (P<0.05). In the mononuclear cell (MNC) count evaluation, no statistically significant difference was determined between the treatment groups (P>0.05). The immunohistochemical staining intensity of fibroblast growth factor β (FGF-β) and vascular endothelial growth factor (VEGF) was determined to be lower in groups IV and V than in groups II and III (P<0.05). No statistically significant difference was determined between groups IV and V in respect of fibroblast count, MNC count, FGF-β and VEGF staining intensity (P>0.05). The platelet derived growth factor β (PDGF-β) intensity was lower in group V than in groups II, III and IV (P<0.05). While the PDGF-β staining intensity was significantly lower in group IV than in group II, the difference compared with group III was not statistically significant (P>0.05). CONCLUSION: Bevacizumab and pazopanib might be good alternatives of corticosteroid treatment on delaying wound healing in glaucoma surgery.     

Safety and efficacy of combined trabeculectomy for primary angle closure glaucoma with persistent ocular hypertension

Purpose:To investigate the safety and efficacy of combined trabeculectomy for primary acute angle closure glaucoma with persistent ocular hypertension.Methods:A total of 36 patients (40 eyes) with primary acute angle closure glaucoma,who were treated with combined trabeculectomy in the Ophthalmology Unit of our hospital,were selected.Before the procedure,patients were assigned to ocular hypertension group( ≥ 40 mm Hg) or control group(＜ 40 mm Hg) based on intraocular pressure.These two groups were followed up for one year,and compared for post-operative visual acuity,intraocular pressure, filtering bleb,anterior chamber depth, and the occurrence of complications.Results:At 1 week,6 months,and 12 months after the procedure,intraocular pressure was controlled in both the ocular hypertension group and the control group,without significant differences between the two groups (P＞0.05).At 1 week,6 months,and 12 months after the procedure,all of the patients,in both groups,had improved in terms of visual acuity,with a significant difference before and after the procedure for the ocular hypertension group (P＜0.05).After follow-up at 12 months,the two groups presented no statistically significant differences in anterior chamber depth,filtering bleb survival,or the incidence of post-operative complications (P＞0.05 for all).Conclusion:It is feasible,safe,and effective to perform combined trabeculectomy on patients with primary acute angle closure glaucoma complicated by persistent ocular hypertension.     

羟苯磺酸钙对青光眼患者视神经的保护作用

目的:观察羟苯磺酸钙对眼压已经手术控制的青光眼患者的视神经保护作用。方法:选取本院2011-01/2012-02住院的原发性青光眼患者共78例89眼,按照数字表随机分为对照组和观察组,疗程6mo。观察治疗前后两组患者视力、视网膜平均感光度、眼压、视盘形态学的变化,以及评价疗效。结果:两组患者治疗前后视力、眼压、视盘形态学均无明显变化,差异无统计学意义。对照组患者治疗前后视网膜平均感光度无明显变化(14.75±5.17 vs 13.48±4.69),而治疗组患者经羟苯磺酸钙治疗,视网膜平均感光度明显改善(14.56±5.03 vs 18.9±5.77),差异有统计学意义(P<0.05),与对照组治疗后相比,差异亦有统计学意义(P<0.05)。对照组视网膜平均感光度改善率、稳定率、恶化率分别为10.3%,48.7%,41.0%;而观察组分别为64.1%,28.2%,7.7%,两组相比差异有统计学意义(P<0.05)。结论:羟苯磺酸钙能提高青光眼患者视网膜平均光敏感度,对眼压已控制的青光眼患者有视神经保护作用。     

巩膜瓣可调整缝线的小梁切除术对角膜散光的影响

目的 探讨巩膜瓣可调整缝线的小梁切除术对角膜散光的影响及术后屈光度稳定的时间.方法 收集2014年6月至2016年7月于我院眼科收治的70例原发性青光眼患者,将所有患者分为两组:试验组为联合可调整缝线的小梁切除术患者40例40眼,对照组为单纯小梁切除术者30例30眼.检查记录两组术前及术后1周(可调整缝线拆除前)、1个月、3个月的角膜地形图、角膜曲率、屈光度及眼压情况.结果 术后2组各时间点屈光度及眼压比较,差异均有统计学意义(均为P＜0.01).术后1周角膜散光:试验组(3.80±1.31)D和对照组(1.42±0.32)D与术前(1.48±0.79)D、(1.12 ±0.36)D相比,差异均有显著统计学意义(均为P＜0.01);试验组和对照组角膜散光术后1个月(1.50±0.71)D、(1.24 ±0.31)D及3个月(1.36±0.61)D、(1.09±0.34)D与术前相比,差异均无统计学意义(均为P＞0.05),术后1周试验组与对照组角膜散光相比差异有显著统计学意义(P＜0.01),术后1个月及3个月试验组与对照组角膜散光相比差异均无统计学意义(均为P＞0.05).两组术后1个月角膜散光虽较术后3个月时偏高,但差异均无统计学意义(均为P＞0.05).术后3个月试验组、对照组顺规性散光眼数分别是33眼、22眼(P=0.36).结论 可调整缝线的小梁切除术术后1周(可调整缝线拆除前)角膜散光度数明显增加,术后1个月散光度数明显减少,至3个月趋于稳定,术后3个月时角膜散光以顺规性散光为主.     

联合抗VEGF药物的综合疗法治疗新生血管性青光眼的临床疗效

目的　探讨联合抗血管内皮生长因子（vascular endothelial growth factor,VEGF）药物的综合疗法治疗新生血管性青光眼（neovascular glaucoma,NVG）的临床疗效。方法　选取2015年1月至2017年10月在我院住院治疗的NVG患者60例（60眼）,将所有患者按手术方案不同分为试验组和对照组,每组30例（30眼）,试验组采用抗VEGF综合疗法,即抗VEGF药物玻璃体内注射、全视网膜光凝（panretinal photocoagulation,PRP）及复合小梁切除术联合治疗方案。对照组行传统的睫状体冷凝术。比较两组患者治疗前及治疗后1周、2周、1个月、2个月、3个月的眼压、视力变化及临床疗效,随访时间为3个月。结果　两组患者基线特征比较差异无统计学意义（P＞0.05）。两组患者治疗后眼压变化差异有统计学意义（P＜0.05）;两组患者治疗后视力比较差异有统计学意义（χ²=7.680,P＜0.05）;两组患者临床疗效（试验组86.67%、对照组83.33%）比较差异无统计学意义（P＞0.05）;两组患者眼轴长度变化差异有统计学意义（t=5.835,P＜0.05）。结论　NVG患者接受抗VEGF药物综合疗法能获得正常稳定的眼压,稳定术前视力,减少术后并发症,避免眼球萎缩。     

复合式小梁切除联合HEMA青光眼引流器植入术治疗原发性慢性闭角型青光眼

目的应用超声生物显微镜（UBM）观察原发性慢性闭角型青光眼（PCACG）患者复合式小梁切除联合HEMA青光眼引流器植入术后滤过泡的形态,评价其手术效果。方法前瞻性队列研究。采用随机数字表法,将60例（60眼）PCACG患者,随机分为研究组和对照组各30例（30眼）,研究组行复合式小梁切除联合HEMA青光眼引流器植入术,对照组行复合式小梁切除术。术前1 d、术后3个月、术后6个月均进行最佳矫正视力（BCVA,结果转化为logMAR视力用于统计）和Goldman压平眼压（IOP）检查。术后3个月、6个月均进行了UBM检查。数据采用独立样本t检验、重复测量方差分析、Fisher确切概率法进行分析。结果对照组术前1 d、术后3个月、术后6个月的BCVA分别为0.63±0.48、0.54±0.35和0.55±0.34,研究组分别为0.66±0.56、0.49±0.25和0.50±0.27,2组间3个时间点BCVA差异均无统计学意义（P>0.05）。2组各时间点间BCVA的差异也无统计学意义（P>0.05）。对照组3个时间点IOP分别为（19.2±12.2）mmHg、（16.3±4.5）mmHg和（16.8±4.6）mmHg（1 mmHg=0.133 kPa）,研究组分别为（18.7±10.2）mmHg、（12.4±4.1）mmHg和（12.9±3.7）mmHg,2组间术前1 d的IOP差异无统计学意义（P>0.05）,术后3、6个月2组间差异有统计学意义（t=-3.480、-3.628,P<0.01）。对照组各时间点间IOP的差异无统计学意义（P>0.05）,研究组各时间点间差异有统计学意义（F=10.435,P<0.05）,术后3个月和6个月均明显低于术前。术后3个月时对照组L型滤过泡形成率为97%,研究组为100%,2组间L型滤过泡形成率的差异无统计学意义;术后6个月时,对照组L型滤过泡形成率为77%,研究组为97%,组间差异有统计学意义（χ2=5.192,P<0.05）。结论复合式小梁切除联合国产HEMA青光眼引流器植入术较复合式小梁切除术降眼压效果好,术后功能性滤过泡形成率高,手术成功率更高。     

三维OCT在开角型青光眼鉴别诊断价值

目的 探讨高分辨率三维OCT在开角型青光眼中的诊断价值.方法 采用CirrusHD-OCT对正常组94人188只眼和试验组46例92只眼进行视网膜神经纤维层厚度的检测,对比分析视盘形态和视网膜神经纤维层厚度改变.结果 正常组各部位神经纤维层厚度与性别、眼别无相关(P＞0.05).正常对照组各部位神经纤维纤维层厚度明显高于实验组,经过独立样本t检验得出差异有统计学意义(P＜0.05).根据OCT结果,并根据视野、眼压等将试验组46例92只眼诊断为青光眼的24例48只眼,大视杯22例44只眼,两个亚组各部位RNFL厚度和正常对照组相比较,视网膜神经纤维层厚度均变薄,差异有统计学意义(P＜0.05);但大视杯亚组各部RNFL厚度均高于青光眼亚组,差别有统计学意义(P＜0.05).结论 OCT可以清晰显示视网膜神经纤维层变薄的范围和区域,再配合其他检查,即可较准确、快捷鉴别原发性开角型青光眼患者,大大提高开角型青光眼的早期诊断水平,是诊断早期青光眼的不可缺少的重要检查方法之一.

Abstract：

Objective To evaluate the diagnostic value of of high-resolution three-dimensional OCT in early primary open-angle glaucoma.Methods The retinal nerve fiber layer thickness in the normal group of 94 cases (188 eyes) and experimental group (glaucoma suspect group) of 46 cases (92 eyes) were detected using the Cirrus HD-OCT,and the comparative analysis of optic disc and retinal nerve fiber layer thickness were taken.The OCT performance of normal and suspected glaucoma image features was compared.Results There was no relationship in different parts of nerve fiber layer thickness (RNFL) with gender and eyes (P ＜0.05).The thickness of nerve fiber layer of normal control group was higher than experimental group,there was statistically significant difference (P ＜0.05) by independent sample t test.Based on the measured thickness of retinal nerve fiber layer,the image features and characteristics of OCT images,vision and intraocular pressure,48 eyes of 24 patients were diagnosed with glaucoma,and 44 eyes of 22 cases were diagnosed with large cup in experimental group.RNFL thickness of different parts of the two sub-group were thinning compared with the control group,the difference was statistically significant (P ＜0.05);but large cup group showed thicker RNFL than glaucoma group,and there was the statistically significant difference (P ＜0.05).Conclusions Cirrus HD-OCT has important diagnostic value in early primary open-angle glaucoma;also can greatly increase early diagnosis in primary open-angle glaucoma.It is an important and indispensable check method.     

玻璃体腔注射抗血管内皮生长因子单克隆抗体ranibizumab辅助微创玻璃体视网膜手术治疗严重增生型糖尿病视网膜病变的临床观察

目的 观察玻璃体腔注射抗血管内皮生长因子单克隆抗体ranibizumab（IVR）辅助微创玻璃体视网膜手术（VRS）治疗严重增生型糖尿病视网膜病变（PDR）的临床效果。方法 回顾性非随机临床对照研究。临床确诊为严重PDR的60例患者70只眼纳入研究。依据手术前是否行IVR治疗将患者分为IVR组和对照组。IVR组31例35只眼,对照组29例35只眼。IVR组于手术前3～4 d玻璃体腔注射10 mg/ml的ranibizumab 0.05 ml（含ranibizumab 0.5 mg）,然后行23G微创VRS。对照组直接行23G微创VRS。手术后随访3~12个月,平均随访时间（4.5±1.8）个月。对比分析两组患者最小分辨角对数（logMAR）最佳矫正视力（BCVA）、眼压、黄斑中心凹视网膜厚度（CRT）和视网膜复位及手术后并发症的发生情况。结果 IVR组患者均未发生与注射及药物相关的局部及全身不良反应。手术后1周,1、3个月,IVR组玻璃体积血（VH）发生率分别为8.6%、0.0%、0.0%,对照组VH发生率分别为28.6%、17.1%、8.6%。两组手术后各时间点VH发生率比较,手术后1周及1个月之间差异有统计学意义（χ²=4.63、4.56,P＜0.05）,手术后3个月之间差异无统计学意义（χ²=0.24,P＞0.05）。IVR组、对照组手术后平均logMAR BCVA分别为0.81±0.40、1.05±0.42,均较手术前提高。IVR组、对照组手术前后平均logMAR BCVA比较,差异有统计学意义（t=12.78、4.39,P＜0.05）。IVR组手术后平均logMAR BCVA较对照组提高,两组手术后平均logMAR BCVA比较,差异有统计学意义（t=-2.36,P＜0.05）。IVR组、对照组手术后平均CRT分别为（297.6±79.8）、（347.6±85.0） μm,两组平均CRT比较,差异有统计学意义（t=-2.53,P＜0.05）。IVR组、对照组手术后视网膜复位率分别为97.1%、94.3%,两组视网膜复位率比较,差异无统计学意义（χ²=0.35,P＞0.05）。IVR组、对照组一过性高眼压发生率分别为14.3%、34.3%,两组间一过性高眼压发生率比较,差异有统计学意义（χ²=4.79,P＜0.05）。IVR组、对照组视网膜前膜、新生血管性青光眼等并发症发生情况比较,差异也无统计学意义（χ²=0.97、0.51,P＞0.05）。结论 IVR辅助23G微创VRS治疗严重PDR能提高患者视力,降低手术后VH发生率,减小CRT。     

原发性闭角型青光眼高眼压下的复合式小梁切除术

目的 探讨高眼压下原发性闭角型青光眼复合式小梁切除术的临床疗效.方法 从60例(60只眼)联合应用药物24～48h眼压控制不佳的原发性闭角型青光眼患者中,随机选择38例(38只眼)施行复合式小梁切除术(观察组);22例(22只眼)行单纯小梁切除术(对照组),比较两组术后前房形成、眼压、滤过泡及并发症等情况.结果 60只眼手术顺利,未引发爆发性脉络膜出血等严重并发症,术后追踪8～15个月,术后第1天浅前房发生率观察组为5.3%,明显低于对照组22.7%(P＜0.05).术后随访8个月时,观察组34只眼眼压控制在6-21mmHg(89.5%),对照组15只眼压控制在6-21mmHg(68.2%),两组间比较差异有统计学意义(x2=4.22 P＜0.05),观察组功能性滤过泡占86.9%,较对照组功能性滤过泡63.6%为多(x2=4.42 P＜0.05).结论 原发性闭角型青光眼持续高眼压状态下的复合式小粱切除术是安全有效的,对青光眼眼压持续24～48h不降者,应及时复合式小粱切除术,以防止视功能进一步损害,但必须掌握急症高眼压下的手术技巧才能提高成功率.     

内窥镜下睫状体冷凝术与睫状体光凝术对难治性青光眼患者的治疗效果对比

目的　比较内窥镜下睫状体冷凝术（endoscopic cyclocryotherapy, ECC）及内窥镜下睫状体光凝术（endoscopic cyclophotocoagulation, ECP)治疗难治性青光眼的效果及安全性。方法　收集2014年6月至2019年8月我院就诊的难治性青光眼患者36例（36眼）,按手术方式分成2组,其中ECP组22例,ECC组14例。记录术前及术后1周、6个月两组患者的最佳矫正视力、Goldmann眼压、并发症等情况,对两种治疗方法有效性及安全性进行比较。结果　末次随访时,两组患眼视力改善率间差异无统计学意义（P>0.05）。ECC组患眼术后1周和6个月眼压从术前（48.37±9.42）mmHg（1 kPa=7.5 mmHg）分别下降至（21.35±8.18）mmHg和（17.79±4.68）mmHg, ECP组患眼术后眼压从术前（45.71±6.16）mmHg分别降至（19.49±5.83）mmHg及（18.63±5.01）mmHg,两组患眼术后1周、6个月眼压均明显低于术前,差异均有统计学意义（均为P＜0.01）,但术后1周、6个月两组间眼压比较差异均无统计学意义（均为P>0.05）。术后1周手术成功率ECC组（57.1%）低于ECP组（72.7%）(P<0.05),术后6个月两组手术成功率（ECC组为78.6%,ECP组为77.3%）差异无统计学意义(P>0.05)。两组均未出现晶状体脱位及持续性低眼压等严重并发症。结论　ECC和ECP在治疗难治性青光眼方面均有较好的效果及安全性。     

无结膜瓣小梁切除术的临床评价

目的评价无结膜瓣小梁切除术治疗原发性青光眼的临床疗效。方法68例（68眼）原发性青光眼随机分为两组,A组行无结膜瓣小梁切除术;B组行复合式小梁切除术。观察比较术后眼压变化、并发症和滤过泡情况。结果术后随访12个月,A组平均眼压为（15．3±3．5）mmHg,B组平均眼压为（15．9±3．6）mmHg,（P〉0．05）。术后1周内低眼压浅前房,A组5．6％、B组9．4％;脉络膜脱离A组2．8％、B组6．3％;滤过泡渗漏A组5．6％、B组6．3％。结论无结膜瓣小梁切除术对原发性青光眼疗效良好。