甲状腺相关眼病合并眼压升高106例临床分析

目的 观察甲状腺相关眼病(Thymid—associated Ophthalmopathy，TAO)合并眼压升高的临床特征和影响因素。方法 对1994年～2001年间收治的339例(597眼)TAO患者中106例(188眼)眼压升高患者的临床资料进行分析。结果 本组TAO患者眼压升高的发生率为31．3％，男性略高于女性。眼压升高的发生与TAO患者眼肌肥大对眼球壁的压迫、眶内结缔组织增生及眼肌肥大和水肿致眶压增高、以及TAO病变的严重程度有关，与TAO病程无明显关系。甲强龙冲击和开眶减压手术控制TAO病情和眶压后，绝大部分患者眼压可以控制。结论 TAO眼压升高有其独自的临床特点，应与原发性青光眼鉴别。积极有效的TAO治疗措施可使绝大部分患者的眼压得到控制。     

眶压监测在甲状腺相关眼病的诊断及围手术期的应用

探讨眶压监测对甲状腺相关眼病（TAO）的诊断价值以及眶减压围手术期眶压、眼压的改变。方法自行设计眶压测量仪。测量并比较26例（30只眼）TAO患者眶减压术前后的直接眶压（DOT）、间接眶压（IOT）、眼压（IOP）、眼球突出度（OP）和视力;20例（20只眼）健康成年人设为对照。结果TAO患者DOT、IOT、IOP及OP均高于对照组,△DOT与△IOP呈正相关（r＝0．49,P＜0．01）,△IOT与△OP呈正相关（r＝0．64,P＜0．01）。眶减压术后DOT、IOT、IOP均显著降低,三者的差值呈正相关。结论TAO患者的眼压、眶压升高;眶压监测可以作为眶减压术的重要手术指标并用于术后的疗效判断及观察。     

甲状腺相关眼病手术治疗前后的眼压变化

目的 评估甲状腺相关眼病(Thyroid-associated ophthalmopathy,TAO)患者行眶减压术或斜视矫正术治疗前后眼压的变化.方法 对象为在2008年12月至2009年12月确诊为TAO,并行眶减压或斜视矫正术患者25例(35只眼),比较患者术前、术后的第一眼位眼压(平视)和第二眼位眼压(上视).结果 行眶减压术16只眼,术前平均眼压为:第一眼位,(17.86±4.32)mmHg,第二眼位(23.55±7.16)mmHg.术后平均眼压为:第一眼位(14.57±3.86)mmHg,下降18.42%,P＜0.05,第二跟位(18.77±4.83)mmHg,下降20.3%,P＜0.04;行斜视矫正术19只眼,术前平均眼压为:第一眼位,(17.89±3.85)mmHg,第二眼位(23.12±6.98)mmHg,术后平均眼压为:第一眼位(15.85±3.60)mmHg,下降11.4,P＜0.05,第二眼位:(17.88±3.59)mmHg,下降19.17%,P＜0.03,其中术前眼压＞21mmHg诊断为高眼压症和诊断为青光眼的患者术后眼压下降的更加明显.结论 TAO患者行眶减压术或斜视矫正术后眼压均有明显下降.     

眶肿瘤和单侧性青光眼

缓慢生长的眶肿瘤可致严重的眼球突出,而不引起眼压升高。眶肿瘤伴同侧眼压升高,常与其它机理有关,并非眶肿瘤体积增大之故。作者报告1例生长缓慢的眶肿瘤,其同侧高眼压经肿瘤切除后仍未消失。患者73岁,女性。常规检查时发现,右眼眼压23mmHg,左眼36mmHg(压平眼压计),两眼杯盘比均为0.2。视野和前房角镜检查正     

甲状腺相关眼病性视神经病变的临床分析

目的 观察甲状腺相关眼病(TAO)性视神经病变的临床特征及影响因素。 方法 回顾分析1994年～2001年间收治的62例TAO性视神经病变患 者120只眼的临床资料。 结果 TAO性视神经病变占同期TAO住院患者的18.3%，男性多于女性。TAO性视神经病变的发生与眶压增高、眼肌病变及高血压病、高血脂症、糖尿病、心脏病等全身性疾病有关(P均<0.0000),而与眼球突出度、眼压和TAO病程无关(P均>0.05)。62例患者甲泼尼龙冲击治疗后视力提高者占29.0%；冲击治疗时视力有提高，但停药后又下降者占24.2%；冲击治疗后视力无改善者占46.8%。63只眼在甲泼尼龙冲击治疗基础上进行开眶减压手术，93.7%的患眼视力明显提高。结论 TA O性视神经病变的发生与眶压增高、眼肌病变及高血压病、高血脂症、糖尿病、心脏病等全 身性疾病有关；甲泼尼龙冲击治疗和开眶减压手术是治疗TAO性视神经病变的有效方法。 （中华眼底病杂志，2004，20：142-144）     

直接眶压检测方法及眶压正常值的研究

目的研究直接眶压的测量方法、正常值及影响因素。方法使用自行设计组装的直接眶压计对40例40只正常眼眶进行测量,同时测量眼压、眼球突出度与间接眶压。结果我国正常人的直接眶压值为(49±12)mmHg。直接眶压与眼压有正相关关系(r=056),与年龄有负相关关系(r=-040)。结论该直接眶压测量仪操作简便、创伤性小,结果准确稳定、能客观反映眼眶内的真实压力。     

甲状腺相关性免疫眼眶病与高眼压

甲状腺相关性免疫眼眶病（TAO）是临床上一大类疾病。1887年首次报道了TAO可引起高眼压。以后众多作者发现TAO患者眼球在原位及向上转时，均发生眼压升高。据报道约24％TAO患者有高眼压，重者（1．8％）有视神经受压症状，引起继发性青光眼，甚至失明。综述了TAO引起高眼压的病因、临床表现、辅助检查、诊断、治疗及预后。     

湿性年龄相关性黄斑变性患者注射雷珠单抗后早期眼压的变化

目的 观察湿性年龄相关性黄斑变性(wet age-related macular degenaration,wAMD）患者玻璃体腔注射雷珠单抗后早期眼压的变化。设计 前瞻性病例系列。研究对象 在北京医院接受玻璃体腔雷珠单抗（0.5mg/0.05ml）注射的wAMD患者135例（135眼）。方法 患者接受玻璃体腔注射雷珠单抗术前、术后10、30 min、2 h及术后1天,使用Topcon非接触眼压计分别测量眼压。观察患者注射后早期的眼压变化情况。主要指标 眼压。结果 患者术前眼压平均为（15.41±2.69） mmHg,术后10、30 min、2 h及术后1天的眼压平均值分别为（21.07±5.83） mmHg、（18.24±4.17） mmHg、（17.57±4.60） mmHg、（15.20±3.05） mmHg。术后2小时内的眼压与术前比有显著性差异（P均<0.05）,而术后1天眼压与术前比无显著性差异（P=0.239）。术后各时间段眼压升高比率呈逐渐下降趋势,其中术后10 min,眼压升高比率（眼压升高比率≥10 mmHg占17.78%;≥15 mmHg占5.19%）及升高绝对值（眼压≥21 mmHg占45.93%;≥25 mmHg占21.48 %;≥30 mmHg占8.15%）均明显高于其他时间段。术前眼压越高,术后10 min眼压≥21 mmHg的比例越高（P=0.000, OR=0.117, 95%CI=0.051-0.268）。结论 大部分湿性年龄相关性黄斑变性患者玻璃体腔注射雷珠单抗后早期眼压显著升高,2小时内眼压变化明显;术前眼压偏高可能是玻璃体腔注射雷珠单抗早期眼压升高的危险因素。     

后Tenon囊下注射曲安奈德治疗黄斑水肿对眼压的影响

目的：研究后Tenon囊下注射20mg曲安奈德（TA）治疗黄斑水肿后的眼压变化及眼压升高的影响因素。方法：黄斑水肿患者46例46眼,病因为糖尿病性视网膜病变16例,年龄相关性黄斑变性13例,视网膜静脉栓塞11例,后葡萄膜炎6例,均行后Tenon囊下注射20mgTA。注射前测量眼压,并于注射后2wk;1,2,3,4,5,6mo随访观察眼压变化。结果：患者46例术后2wk;1,2,3,4,5,6mo平均眼压较术前均有升高。术后3mo时,平均眼压达最高值（19.22±6.86）mmHg,有17例（37%）患者IOP〉21mmHg。术后2wk;1,2,3,4,5mo眼压与术前比较,差别有统计学意义（值分别为3.747,5.836,5.982,5.866,4.202,3.246,均P〈0.05）,术后6mo眼压与术前比较,差别无统计学意义（t=1.446,P〉0.05）。年轻、基础眼压高是后Tenon囊下注射曲安奈德后继发性眼压升高的危险因素（χ2值分别为5.599,10.323,均P〈0.05）,而性别、病因与后Tenon囊下注射曲安奈德后继发性眼压升高没有相关性（χ2值分别为0.022,0.050,均P〉0.05）。结论：后Tenon囊下注射20mg曲安奈德,引起眼压升高较为常见,在注射后3mo时眼压升高最为明显,注射后6mo时回落至基础眼压水平。年轻、基础眼压高是继发性眼压升高的危险因素。注射后进行最短为期6mo的眼压随访是非常必要的,尤其是对于年轻患者及基础眼压高的患者。     

两种粘弹剂对小切口白内障术后眼压的影响

目的 评价分散粘弹剂羟丙甲基纤维素(20g·L~(-1))及硫酸软骨素钠-透明质酸钠(30g·L~(-1))对小切口双侧白内障摘出术后眼压的影响。方法 老年性白内障患者20例40眼,全部进行小切口双侧白内障手术。于一眼白内障手术时随机选择1种粘弹剂,另眼时给予另1种粘弹剂。手术采用角膜缘反眉弓切口,长5mm,切开后环形撕囊,水分离,碎核刀碎核,晶状体圈娩出晶状体核,冲洗皮质。然后植入后房型聚甲基丙烯酸甲酯人工晶状体,不缝合。术前测眼压,术后6、24h及1周各测眼压1次。结果 术后6h羟丙甲基纤维素组眼压升高(3.8±5.0)mmHg(1kPa=7.5mmHg,P<0.001),硫酸软骨素钠-透明质酸钠组升高(7.7±7.6)mmHg(P<0.001),硫酸软骨素钠-透明质酸钠组眼压升高比羟丙甲基纤维素组明显(P=0.008)。眼压>30mmHg羟丙甲基纤维素组1眼、硫酸软骨素钠-透明质酸钠组5眼(P<0.05)。术后24h及术后1周平均眼内压无明显差异。结论 研究结果表明,硫酸软骨素钠-透明质酸钠在小切口白内障早期引起的眼压升高比羟丙甲基纤维素更明显。     

血液透析后眼压与颅内压的变化

血液透析是救治急、慢性肾衰竭及其他一些严重疾病的重要方法。研究显示,血液透析会引起眼压、颅内压的变化。对透析过程中眼压和颅内压变化的研究,可能为建立青光眼发病模型提供新的思路,有助于青光眼视神经损害的研究。本文就血液透析后眼压及颅内压的变化作一综述。     

Relationships among systemic blood pressure, intraocular pressure, and open-angle glaucoma

Several vascular factors, including systemic hypertension (or high blood pressure [HBP]), ocular perfusion pressure, and nocturnal hypotension, have been identified as risk factors for the development and progression of glaucoma. The results of epidemiologic studies of these factors and their relationships to intraocular pressure (IOP) and open-angle glaucoma (OAG) have been contradictory. Inconsistent definitions of HBP and OAG, inconsistent design, and differing population characteristics within these studies have obfuscated definitive conclusions. Here, we review the relationships among blood pressure, IOP, and OAG.     

同步监测青光眼患者24h眼压与血压的意义

青光眼是世界范围内致盲和引起视力损害的主要眼病,也是不可逆性致盲性眼病之一.眼压是青光眼发生发展的重要危险因素,但除眼压外,血压在青光眼进展引起的影响也不可忽视.眼灌注压是血压和眼压的差值,可调节视神经的血液供应.眼压、血压、灌注压在青光眼发生发展中有一定相关性.本文通过对眼压和血压在青光眼中的影响以及24 h眼压和血...     

Focal ischaemic normal pressure glaucoma versus high pressure glaucoma

In a total group of 130 patients with Normal Pressure Glaucoma (NPG) twenty-six were classified as Focal Ischaemic NPG (FINPG). This subgroup has a typical defect at the disc with a comparable visual field defect in the corresponding half of the visual field. Visual field defects are more often seen in the upper than the lower half of the visual field. The defects in the upper half are on the average larger (stage 1.6) than those in the lower half (stage 0.9). Abnormalities of the chamber angle were observed in 12% of these patients, the same percentage as in the normal population. Hypertension and/or cardiovascular disorders were found significantly more frequently in FINPG patients (65.4%) than in a control group of High Pressure Glaucoma (HPG) patients (22.2%). Of the local vascular risk factors, papillary haemorrhages (46%) and choroidal sclerosis (30%) were seen significantly more frequently in FINPG than in HPG (11% and 0% respectively). The total amount of peripapillary atrophy (PPA) in FINPG and HPG is the same, but the distribution is clearly different: in FINPG there is more PPA on the side of the papillary defect. Wide veins were observed in a high percentage of cases in both groups. FINPGs were found to be more frequently progressive (38.5%) than had been thought at first. Recognition of subgroups in NPG, and of risk factors, has already made it possible to make a better prognosis in some types of NPG.     

正常眼压性青光眼中眼压与视野间的关系

目的 :探讨正常眼压性青光眼 (normalpressureglaucoma ,NPG)的眼压、视野和相互关系。方法 :分析 98例新诊断NPG患者的眼压曲线和视野状态。结果 :眼压曲线呈单峰式波动 ,双眼对称 ,总体平均水平位于 16mmHg上下 ,波动幅度 <2mmHg。患者男性眼压均值右眼为15 70± 2 5 7mmHg、左眼为 15 46± 2 %41mmHg ,女性右眼为 16 5 2± 1 97mmHg、左眼为 16 45± 2 0 1mmHg ,眼压与年龄相关不显著 (P >0 0 5 )。患者各相应年龄组的眼压均高于正常老年人 (分别P <0 0 2 ,P <0 0 1,P <0 0 0 1)。在 98例患者 196眼的视野中 ,5 2例患者为单眼损害 ,14 4眼的视野损害在损害形态和部位上与眼压升高的原发性开角型青光眼 (hp -POAG)相符合 ,但旁中心损害侵入中心固视区者约占 2 2 2 2 %。在两眼视野损害相对轻重的划分中 ,视野损害不同分级状态下眼压的平均值、最高值和波动差二者间差异不显著 (P >0 0 2 ) ,单侧视野损害患者患眼与对侧眼眼压差异不显著 (P >0 0 5 ) ,但同侧视野损害较重且眼压较高眼数的构成比最大 ,约占 5 5 1%(P <0 0 1)。结论 :NPG患者的眼压状态在单值水平、波动幅度和双眼对称性上均与一般群体生理眼压相一致 ,但平均眼压高于年龄可比的正常老年人。视野损害特征与hp -POAG相符合 ,     

Effect of plasma colloid osmotic pressure on intraocular pressure during haemodialysis

BACKGROUND—In a previous case report, it was shown that an increase in plasma colloid osmotic pressure induced by the removal of fluid during haemodialysis was instrumental in decreasing intraocular pressure. The relation between changes in intraocular pressure, plasma osmolarity, plasma colloid osmotic pressure, and body weight before and after haemodialysis is evaluated.
METHODS—Intraocular pressure, plasma osmolarity, plasma colloid osmotic pressure, and body weight were evaluated before and after haemodialysis in 36 patients.
RESULTS—Intraocular pressure and plasma osmolarity both decreased significantly after haemodialysis (p<0.0001). Plasma colloid osmotic pressure increased significantly after haemodialysis (p<0.0001). Body weight decreased significantly because of the removal of fluid during haemodialysis (p<0.0001). No significant correlation was found between the change in intraocular pressure and that in plasma osmolarity (r=−0.206, p=0.2297), whereas the change in intraocular pressure was correlated with the change in plasma colloid osmotic pressure (r=−0.510, p=0.0012) and the change in body weight (r=0.534, p=0.0006). A significant correlation was found between the change in plasma colloid osmotic pressure and that in body weight (r=−0.756, p<0.0001).
CONCLUSION—The change in intraocular pressure was inversely correlated with the increase in plasma colloid osmotic pressure caused by the removal of fluid during haemodialysis.

Keywords: intraocular pressure; plasma colloid osmotic pressure; plasma osmolarity; haemodialysis     

莫索尼定滴眼液点眼对家兔眼压及血压的影响

目的探讨不同剂量莫索尼定（MOX）滴眼液点眼对眼压、瞳孔、血压和心率的影响。方法 32只家兔全身麻醉后行双眼前房穿刺并连接于生理记录仪描记眼压,行单侧颈动脉插管并连接于生理记录仪描记血压、心率波动。分别将质量分数0.05%、0.1%和0.2%的MOX单侧点眼,同步观察点眼后8h内双侧眼压、瞳孔、血压和心率的变化。结果 0.05%、0.1%、0.2%MOX组点眼后实验眼最大眼压下降幅度分别为3.01mmHg（18.31%）、3.70mmHg（22.13%）和4.46mmHg（25.60%）,降眼压持续时间分别为6h、8h和8h以上。对侧眼眼压下降持续时间较短,最大眼压下降幅度分别为2.64mmHg（15.46%）、3.10mmHg（18.82%）和2.62mmHg（16.48%）。3组MOX滴眼液点眼均可使实验眼瞳孔散大,最大散瞳幅度分别为2.6、3.2、3.9mm。MOX滴眼液点眼对心率影响轻微,0.05%MOX组和0.1%MOX组点眼不影响实验动物的血压,0.2%MOX组可使实验动物舒张压下降,最大下降值为8.85mmHg（9.93%）。结论 MOX滴眼液点眼对家兔有降眼压作用,中低剂量的MOX对实验动物的血压、心率等无明显影响。     

Effect of sildenafil citrate on intraocular pressure and blood pressure in human volunteers

Anecdotal reports have suggested that the vasodilator, sildenafil citrate, which evokes its effect via a select inhibition of PDE5, has the potential to increase intraocular pressure (IOP) in some individuals. An ocular hypertensive effect by sildenafil was also recently described in a sheep animal model. In contrast, clinical studies have not found a direct association between sildenafil ingestion (commonly consumed as Viagra) and changes in IOP. However, some such studies also reported no effects of sildenafil on systemic blood pressure (BP) at the time of the IOP determination. Given this surprising result, our purpose was to repeat a study in human volunteers in the city of Corrientes, Argentina to corroborate the effects of sildenafil on human IOP and systemic BP. For the present study, 9 healthy volunteers (male and female, 18–74 years old) were selected as subjects after ophthalmic and cardiovascular evaluation indicated that they exhibited normal parameters for their age. In a masked, placebo-controlled study, the subjects ingested 100 mg sildenafil citrate (provided as Vorst from Laboratorios Bernabo, Argentina) in one session, and a placebo on a second separate occasion. IOP was measured with a Goldman applanation tonometer by an ophthalmologist, and BP by a second physician, neither of whom witnessed the tablet ingestion by the volunteers, nor provided with information on the nature of the test compounds. A third individual administered the tablets. The average baseline IOP of this group of 9 was 13.1 ± 0.6 mm Hg. Subsequent to sildenafil ingestion, IOP increased by 26% to 16.5 ± 0.8 mm Hg 60 min later (P < 0.005, as paired data), and returned to control values within 2 h. Both systolic and diastolic BP were significantly reduced by sildenafil ingestion. At the point of maximal systemic hypotension (90 min), the systolic and diastolic pressures declined by 15% and 13%, respectively. No significant changes in IOP or BP were recorded after ingestion of the placebo. Our results suggest that sildenafil can elicit a transient IOP increase that may be of importance to patients chronically treated with PDE5 inhibitors for various vascular diseases (e.g., pulmonary hypertension). We discuss possible mechanisms by which PDE5 inhibition might lead to a rise in IOP.