半导体激光小梁成形术治疗原发性开角型青光眼、无晶体性慢性青光眼临床观察

目的 观察半导体激光小梁成形术对降低原发性开角型青光眼及部分无晶体性慢性青光眼眼压临床疗效。方法 半导体激光小梁成形术治疗原发性开角型青光眼45例，无晶体性慢性青光眼26例，术后随访1～24个月眼压变化情况。结果 原发性开角型青光眼、无晶体性慢性青光眼激光小梁成形术后6个月眼压控制在20．55mmHg以内分别占78．89％、83．25％。24个月眼压略有回升。结论 观察半导体激光小梁成形术治疗药物控制不良原发性开角型青光眼及部分无晶体性慢性青光眼临床疗效满意。     

Comparison of corneal biomechanics among primary open-angle glaucoma with normal tension or hypertension and controls

Background:Normal tension glaucoma (NTG) is a less pressure-dependent type of glaucoma with characteristic optic neuropathy. Recently, the biomechanical mechanism has been thought to account for glaucomatous optic neuropathy to some degree. We intended to compare dynamic corneal response parameters (DCRs) among patients with primary open-angle glaucoma with normal tension or hypertension and controls. The correlations between DCRs and known risk factors for glaucoma were also analyzed.Methods:In this cross-sectional study, 49 NTG subjects, 45 hypertension glaucoma (HTG) subjects, and 50 control subjects were enrolled. We compared the differences in DCRs using corneal visualization Scheimpflug technology among the NTG, HTG, and control groups. We also analyzed the correlations between DCRs and known risk factors for glaucoma (eg, central corneal thickness [CCT], intraocular pressure [IOP], etc).Results:The maximum inverse concave radius (NTG: 0.18 [0.17, 0.20] mm⁻¹; control: 0.17 [0.16, 0.18] mm⁻¹; P = 0.033), deformation amplitude ratio of 2 mm (DAR 2 mm, NTG: 4.87 [4.33, 5.39]; control: 4.37 [4.07, 4.88]; P < 0.001), and DAR 1 mm (NTG: 1.62 [1.58, 1.65]; control: 1.58 [1.54, 1.61]; P < 0.001) were significantly higher in NTG than in the controls. The integrated radius (IR, NTG: 8.40 ± 1.07 mm⁻¹; HTG: 7.64 ± 1.31 mm⁻¹; P = 0.026) and DAR 2 mm (NTG: 4.87 [4.33, 5.39]; HTG: 4.44 [4.12, 5.02]; P < 0.007) were significantly higher, whereas the stiffness parameter at the first applanation (SP-A1, NTG: 91.23 [77.45, 107.45]; HTG: 102.36 [85.77, 125.12]; P = 0.007) was lower in NTG than in HTG. There were no significant differences in the DCRs between HTG and control groups (P > 0.05). In the univariate and multivariate analyses, some of the DCRs, such as IR, were negatively correlated with CCT and IOP, whereas SP-A1 was positively correlated with CCT and IOP.Conclusions:The cornea was more deformable in NTG than in HTG or controls. There were no significant differences in corneal deformability between HTG and controls. The cornea was more deformable with the thinner cornea and lower IOP.     

青少年开角型青光眼临床表型及遗传学特征

青少年开角型青光眼（juvenile—onsetopen—angle glaucoma,JOAG）是常染色体显性遗传性疾病,具有发病年龄早、眼压高和进展快等特点。本文回顾了JOAG的临床表型、相关基因及功能,为建立基因型和表型之间的联系,为探讨青光眼的发病机制提供帮助。     

Prevalence of Open-angle Glaucoma in Southwestern China: the Yongchuan Glaucoma Study简

This study examined the prevalence of primary open-angle glaucoma（POAG） among residents aged ≥50 years living in Yongchuan district of Chongqing. Stratified cluster sampling was employed in random selection to estimate the prevalence of glaucoma from April to June, 2005. Twenty-nine villages or neighborhood communities were randomly selected in urban area（Zhongshan Road）, suburban area（Shanjiao Town） and exurban area（Zhutuo Town） of this district. All the respondents underwent detailed ophthalmic examinations. The examinations included questionnaire investigation, visual acuity test, naked-eye examination, measurement of peripheral anterior chamber depth（Van Herrick＇s technique）, detection of intraocluar pressure（IOP） with a Perkins hand-held applanation tonometer（HA-2） and examination of the optic disc by using a 78 diopters（D） lens（including the cup-disc ratio, cup/disc ratio asymmetries, horizontal and vertical diameter, notching and optic disc hemorrhages）. A total of 5938 residents were actually examined, and the response rate was 85.19%. The crude prevalence of POAG was 0.86%（n=51/5938, 95% CI 0.64%–1.11%）. There were 24 males and 27 females in the glaucoma group. The glaucoma prevalence was not significant different in case number between the male and female subjects（P=0.4900）. Furthermore, no association between age or schooling and POAG was noted（P=0.8030, 0.0734）. Out of 51 subjects with POAG, unilateral glaucoma-related blindness occurred in 38 subjects（74.5%） and bilateral glaucoma-related blindness was found in 7 subjects（13.7%）. This study exhibited that the prevalence of POAG was 0.86% among residents aged ≥50 years living in Yongchuan District of Chongqing. The vision loss caused by POAG in this population was obviously higher than that previously reported in other studies. Glaucoma management, detection of affected persons and handling of the burden of glaucoma should be the priorities of the agenda of local health authorities of Western China.     

噻吗洛尔与卡替洛尔治疗原发性开角型青光眼的效果及安全性分析

目的观察噻吗洛尔与卡替洛尔治疗原发性开角型青光眼的临床效果及安全性。方法选取2010年8月至2011年7月成都市龙泉驿区第一人民医院眼科收治的原发性开角型青光眼患者90例,依据用药方案不同分为三组:每组30例,A组采用噻吗洛尔治疗、B组采用卡替洛尔治疗,C组采用噻吗洛尔联合卡替洛尔治疗,比较三组患者的临床疗效及不良反应。结果三组患者经过6个月治疗后,其眼压较治疗前均有显著下降(P<0.05),但C组患者眼压下降的程度显著高于A、B两组(P<0.05);C组患者眼压达目标值率显著高于A组和B组(P<0.05);C组患者的达标平均时间显著低于A组和B组(P<0.05)。结论噻吗洛尔和卡替洛尔在一定的治疗时间内均能有效控制原发性青光眼患者的眼压,但两者联用在改善患者眼压的效率方面较单用有明显优势,且药物不良反应并未因为联合用药而增加。     

非穿透性青光眼手术治疗开角型青光眼有效性的系统评价

目的 评估非穿透性青光眼手术（NPGS）治疗开角型青光眼患者的降眼压（IOP）效果。方法 全面收集评价NPGS治疗原发性/继发性开角型青光眼的随机对照试验,进行系统评价。主要疗效指标包括IOP下降百分比和IOP达标率。应用多功能meta分析软件2.0版的随机效应模型进行汇总分析,计算合并评价量。结果 术后2年,与小梁切除术（TE）相比,深层巩膜切开术（DS）、黏小管切开术（VCO）的降眼压作用均相对较低,IOP下降百分比分别为35.2%（DS）、30.2%（VCO）、45.6%（TE）。术中加用植入物及丝裂霉素C（MMC）均可提高DS的降眼压作用,术后2年的IOP下降百分比分别为41.1%和41.7%。术后4年,DS、VCO、TE的IOP达标率分别为35.4%、22.7%、47.6%;DS加用植入物和MMC的IOP达标率分别为64.6%、52.1%,高于单纯DS。NPGS并发症的发生率较TE低。结论 常用的NPGS（DS和VCO）能有效降低眼压,并发症也比TE少,但是NPGS的降眼压作用要比TE为低。术中加用植入物、MMC可提高DS的降眼压作用。     

Characteristics of optic disc parameters and its association in normal Chinese population: the Handan Eye Study

Background Assessment of the optic disc and retinal nerve fiber layer （RNFL） is essential for the diagnosis and monitoring of glaucoma.Knowledge of normal optic disc topography provides a benchmark for evaluating glaucomatous pathologic changes,especially in its early stages.The purpose of this study was to evaluate the characteristics and correlation factors of the optic disc parameters using the Heidelberg Retina Tomograph Ⅱ （HRT Ⅱ） in a large sample of normal eyes of adult Chinese subjects.Methods Disc data were obtained from 6 830 subjects aged ＞30 years from the Handan Eye Study.All participants underwent comprehensive eye examinations and physical examinations.The associations of gender,age,body mass index,blood pressure,waist-to-hip ratio; refractive error,intraocular pressure,axial length,and disc area were assessed using simple and multiple regression analysis.The correlation between HRT Ⅱ parameters was evaluated.Results Of the 7 557 eligible subjects,6 830 took part in the study （90.4％ response rate） and 2 633 normal eyes with good-quality HRT Ⅱ images were selected.The mean disc area was 2.28 mm2 （standard deviation （SD） 0.43） and mean neural rim area was 1.80 mm2 （SD 0.29）.In multiple regression analysis,optic disc area significantly correlated with age,gender,and axial length （P ＜0.001）.All optic disc parameters showed a significant correlation with disc area （0.054 ＜r ＜0.736,P ＜0.01）.The association between mean RNFL thickness and rim area is statistically significant but not strong （regression linear equation：rim area =1.42 × mean RNFL thickness ＋ 1.32 mm2,P ＜0.001; R2=0.070）.The global RNFL cross-sectional area was significantly associated with global rim area （regression linear equation：rim area =1.14× RNFL cross-sectional area ＋ 0.44 mm2,P ＜0.001; R2 =0.271）.Conclusions The optic disc area in rural Chinese population is larger than reported in white and Japanese populations,similar to that of Indian population and urban Chinese population.Most optic disc measurements were moderately or weakly affected by disc area.In addition to the RNFL,there may be other factors affecting the rim area.The relationship between optic disc and axial length may suggest a link between larger disc area,thinning of the lamina cribrosa,and increased glaucoma susceptibility in myopic eyes.     

Genetic and environmental risk factors for primary open-angle glaucoma

Glaucomaisacomplexandprogressivedisorderoftheopticnervesandaleadingcauseofvisualfielddefectsandblindnessindevelopedcountries Primaryopen angleglaucoma (POAG)isthemostcommontypeofglaucomainmanypopulations ,accountingformorethan 5 0 %ofglaucomaindevelopedcountries 1　Itisgeneticallyheterogeneous ,andtheunderlyingmolecularmechanismstillunknown 2 ,3　InmanyAsianpopulations,primaryangle closureglaucoma (PACG)isthemajorglaucomaform 4 　AmongChineseadult,glaucomaisamaincauseofblindnessandispredom…     

针刺配合滴眼液治疗原发性开角型青光眼降眼压的疗效观察

目的观察针刺配合滴眼液治疗原发性开角型青光眼对患者眼压的影响与单纯滴眼液治疗的疗效差异。方法将49例（86眼）原发性开角型青光眼患者,随机分为治疗组与对照组,治疗组采用针刺配合滴眼液治疗,对照组采用单纯滴眼液治疗,治疗前后分别检测2组患者眼压指标,并进行对比研究。结果2组患者治疗后眼压与治疗前相比均有显著性差异（P〈0．05）。治疗组半年后患者眼压与治疗前比较仍具有显著性差异（P〈0．05）。结论针刺配合滴眼液治疗原发性开角型青光眼可降低患者眼压。     

幽门螺杆菌感染与原发性开角型青光眼的关系

目的探讨幽门螺杆菌(helicobacter pylori,Hp)感染与原发性开角型青光眼(primary-open angle glaucoma,PO-AG)之间的关系。方法收集在眼科门诊就诊的37例POAG患者(观察组)血清标本,同时收集来自门诊的34例健康志愿者(对照组)血清标本。采用酶联免疫吸附试验检测观察组和对照组血清Hp特异性免疫球蛋白抗体G(Hp CagA-IgG)的表达情况。结果观察组Hp CagA-IgG阳性率高于对照组(P<0.01)。结论 Hp感染可能增加患POAG的几率。     

Octopus 101GKP动静态自动视野计在原发性开角型青光眼诊断中的应用

目的评估Octopus101 GKP动静态自动视野计在原发性开角型青光眼（POAG）诊断中的应用价值。方法 对2006年10月-2007年3月在我院门诊确诊的30例POAG患者及34例正常人分别进行Octopus101GKP动静态自动视野计的GKP及TOP程序的检查。分析比较这两组受试者的视力、眼压、眼底C／D值及联合检查所得的平均缺陷度（MD）、丢失方差（LV）、不同视标参数下等视线的面积和检查时间等参数。结果 POAG组的平均视力、平均眼压和眼底平均C／D值与正常对照组相比差异均有显著性（P均=0．000）;两组的眼压（IOP）与平均缺陷度及等视线面积均无相关性;Ⅲ4e与Ⅰ2e两种不同的视标参数对POAG患者检出的等视线面积差异有显著性（P=0．000）;POAG组的平均检查时间为（307．78±134．50）s,明显高于正常对照组的（228．12±75．33）s（P=0．001）;正常对照组静态视野检查所得的平均缺陷度和丢失方差明显小于POAG组（P均=0．000）;静态视野检查的敏感性为80％,特异性为45％;动态视野检查的敏感性为86％,特异性为63％;两者联合检查敏感性为90％。结论 Octopus101GKP动静态自动视野计可同时完成静态及动态视野检查,通过反应时间减少个体差异,提高检查结果的准确性;同时还可通过改变视标大小、背景光明暗、视标移动速度提高POAG早期缺损检出的可能性,大大提高了POAG检出的敏感性,对于一些早期有小的周边缺损的患者更具优势。     

降低眼内压对阻滞高度近视发展的可行性

高度近视是我国致盲和低视力的主要眼病之一,其治疗手段有限,预后不佳,严重影响患者的生活质量。近视的发病机制复杂,国内外最新的研究发现,近视屈光度与眼压呈正相关,但其具体机制及相应治疗方法尚未见报道。为进一步指导高度近视临床治疗,开拓新的思路和有效策略,现探讨将高度近视以隐匿型青光眼对待、应用降眼压药物阻滞高度近视恶化的可行性。     

原发性青光眼患者屈光状态的研究

目的:探讨原发性青光眼患者的屈光状态对其发病机制的影响.方法:对原发性青光眼患者50例(100眼),分别进行裸眼视力、矫正视力、主觉和他觉验光检查,以及眼轴的测量.结果:原发性青光眼患者50例(100眼)中,屈光不正患病率为71.00%.原发性开角型青光眼患者的近视率为76.09%,平均屈光度为-3.61D;原发性闭角型青光眼患者的远视率为50.00%,平均屈光度为 0.57D(P＜0.01).原发性开角型和闭角型青光眼平均眼轴长度为24.81 mm和22.30 mm(P＜0.01).结论:原发性青光眼的发病与患者的屈光状态存在一定内在联系,原发性开角型青光眼以近视性屈光不正为主,原发性闭角型青光眼以远视性屈光不正为主.     

无晶体性青光眼的病因和治疗

探讨引起无晶体眼眼压升高的各种原因及无晶体性青光眼的治疗方法。分析３１例（３１只眼）无晶体性青光眼的病因，根据不同致病因素分别采用药物降眼压、激光治疗及前房穿刺、小梁切除、状体剥离、玻璃体切割等手术治疗。结果：眼压均控制在下沉范围。瞳孔阻滞、周边虹膜前粘连、前房出血、晶体物质残留、炎症、玻璃体进入前房及有原发性青光眼因素存在均可引起白内障术后眼压升高，根据不同 病因采取不同的治疗方案可取得良好效果     

原发性开角型青光眼患者手术前后焦虑抑郁情绪的影响因素分析

目的:分析原发性开角型青光眼(POAG)患者术前及术后1个月焦虑抑郁情况的影响因素?方法:收集POAG患者83例,分别在抗青光眼手术前采用低视力者生存质量量表(LVQOL)?汉密尔顿焦虑量表(HAMA)及汉密尔顿抑郁量表(HAMD)?家庭支持量表进行测试,术后1个月采用HAMA?HAMD和LVQOL进行测试?正常人83例作为对照组,采用HAMA?HAMD进行测试?评价POAG患者术前及术后1个月焦虑和抑郁的伴发率,并对年龄?性别?家庭支持?文化程度等影响因素进行分析?结果:83例POAG患者,术前焦虑及抑郁的伴发率分别为59.0%和30.1%,术后1个月焦虑及抑郁的伴发率分别为20.5%和15.7%?对照组焦虑及抑郁的伴发率分别为8.4%和4.8%?男性?家庭支持高者,术前HAMA评分低;男性?年龄小?术前生活质量高?家庭支持高者,术前HAMD评分低?Logistic回归分析显示,年龄?生存质量是术后1个月焦虑情绪的影响因素(P = 0.027,P = 0.009);生存质量是术后1个月抑郁情绪的影响因素(P = 0.047)?结论:POAG患者术前?术后1个月发生焦虑?抑郁为多种影响因素共同作用的结果,应引起临床医师重视,尽早给予心理干预?     

慢单平对原发性开角型青光眼视功能影响的临床研究

目的 观察慢单平冲剂对原发性开角型青光眼视功能的影响.方法将56例(94眼)原发性开角型青光眼患者,按病程分为早期组、中期组,治疗前后分别检测2组患者视力、视野及视网膜神经纤维层,并进行2组间及与正常人对照组的对比研究.结果 2组患者治疗后全视网膜平均光敏感度、15°环平均光敏感度及上1/2视野平均光敏感度与治疗前相比均有显著性差异(P＜0.05).治疗半年后随访上述指标仍显著高于治疗前(P＜0.05).结论慢单平冲剂可部分改善原发性开角型青光眼的视功能.     

尼莫地平对原发性开角型青光眼的疗效观察

目的 观察尼莫地平对原发性开角型青光眼的治疗效果.方法 原发性开角型青光眼患者22例(36眼),分为两组,两组患者的眼压均控制在18mmHg以下,其中一组予口服尼莫地平,治疗前后分别检测视力、眼压和视野(用视网膜平均光敏感度代表),采用t检验和x2检验比较两组之间的差异.结果 治疗6、12个月时,尼莫地平组的视网膜平均光敏感度分别为(16.48±3.05)dB和(16.05±2.47)dB,对照组分别为(12.36±2.64)dB和(10.49±2.58)dB,两组比较有显著性差异(t=4.43,6.54,P<0.01).治疗12个月时,尼莫地平组有2眼出现视野进行性损害,对照组有7眼出现视野进行性损害,两组比较有显著性差异(x2=5.40,P<0.05).治疗前后各时间段两组的眼压和视力无显著性差异.应用尼莫地平的患者未出现明显的药物不良反应.结论 尼莫地平可能有利于保护或改善青光眼患者的视野.     

原发性开角型青光眼球结膜微循环改变与视野损害

目的 :探讨原发性开角型青光眼患者的球结膜微循环改变与视野损害的关系。方法 :观察POAG者和正常对照组眼部球结膜微循环变化 ,实行加权记分法进行统计分析 ,同时对出现视野缺损与球结膜微循环病理改变积分进行单因素逐步回归分析。结果 :POAG组和正常对照组比较 ,球结膜微循环改变在血流障碍 (P <0 .0 1)和微动脉变窄 (P <0 .0 1)上有显著性差异。单因素回归分析表明视野损害与球结膜微循环血流障碍和微动脉变窄有明显的相关性。结论 :在POAG的发病中 ,眼压升高仍是最基本的视功能损害因素 ,观察球结膜微循环改变也可为POAG的诊断提供更多的有价值的病理信息     

非穿透性小梁手术联合羊膜植入物治疗原发性开角型青光眼的临床研究

目的　探讨非穿透性小梁手术 (non penetratingtrabecularsurgery ,NPTS)联合羊膜植入物对原发性开角型青光眼的临床疗效。方法　对 2 2例 (2 6只眼 )原发性开角型青光眼患者进行非穿透性小梁手术联合羊膜植入物治疗。术后观察眼压、眼内反应和滤过泡并做前房角镜检查。随访时间平均 9.4个月。结果　术后视力较术前无明显变化。患者术前平均眼压 36 .84mmHg ,术后 16 .4 5mmHg ,差异有显著性 (t=5 .86 ,P <0 .0 1)。术前平均用药 3.6 4种 (2～ 4种 ) ,术后 0 .93种 (0～ 2种 ) ,差异有显著性 (秩和检验T =10 4 ,P <0 .0 1)。随访期间眼压≤ 2 1mmHg者 2 4只眼 (92 .3% ) ,无需药物治疗而眼压正常者 15只眼 (5 7.7% ) ,需用药后眼压保持正常者 9只眼(34.6 % )。结论　NPTS联合羊膜植入术能有效降低眼压 ,减少抗青光眼药物的应用 ,术后并发症少 ,是一种治疗原发性开角型青光眼的有效的新方法。     

原发性开角型青光眼患者血清 miR-29b 差异性表达

目的检测散发原发性开角型青光眼（POAG）患者血清miR-29b表达,探讨miR-29b在分子水平致病机制中的作用。方法通过qRT—PCR技术检测并比较20例散发POAG患者及20例健康对照者血清miR-29b表达的差异性。结果散发POAG组血清miR-29b相对表达量是健康对照组的0．15倍,差异有统计学意义（P=0．03）。结论散发POAG组血清miR-29b表达较健康对照组明显下调,提示miR-29b在POAG致病机制中可能起重要作用。