高眼压状态下外伤性前房积血的手术治疗

在持续高眼压状态下行青光眼手术可引起严重的术中、术后并发症,应在术前用药物将眼压降至正常水平。但临床上常见外伤性前房积血继发青光眼的患者应用药物不能有效控制眼压,如不采用手术治疗,将导致严重的视神经损伤,造成不可逆的视功能下降。抗青光眼手术是否能在高眼压下状态下实施目前颇有争议。本研究回顾性分析外伤性前房积血继发急性青光眼患者的临床资料,探讨持续性高眼压青光眼患者的抗青光眼手术疗效。     

青光眼滤过手术中抗瘢痕形成药物的研究进展

青光眼滤过手术目前仍是治疗青光眼药物和激光不能控制眼压时的主要手段,尽管药物和抗青光眼手术已有很大发展,青光眼手术失败率仍较高。其失败的主要原因是手术区滤过口处纤维细胞增生,瘢痕形成而使伤口愈合[1]。一些抗瘢痕形成药物已用于青光眼滤过术的实验及临床研究,对改善     

"最基本的"才是"最重要的"

青光眼诊治的一些基本问题如眼压测量、药物及手术治疗的规范与完美等仍是目前最重要的、需要重新认识与推广的问题.提高青光眼的诊治水平不但需要眼科同行努力,更需要加强青光眼知识的宣教与普及,加强与患者、公众和政府的沟通,实行"全民防治"才是坦途.(眼科,2008,17:4-5)     

丝裂霉素C铺助青光眼滤过手术的研究与应用

丝裂霉素Ｃ铺助青光眼滤过手术的研究与应用西安医科大学第一教学医院眼科刘兵综述崔守信审青光眼滤过手术仍是当前治疗青光眼药物和激光治疗不能控制眼压的重要手段，但其在治疗难治性青光眼如青年患者、无晶体眼，新生血管性和以往手术失败的青光眼等时，滤泡难以形成，...     

葡萄膜巩膜途径降眼压机制治疗青光眼的研究进展

房水排出障碍导致的眼压升高是引起青光眼发病的主要原因,而降眼压仍是目前青光眼治疗的主要方法。房水外流主要通过传统的小梁网途径和非传统的葡萄膜巩膜途径,通过非压力依赖性的葡萄膜巩膜途径降低眼压以治疗青光眼越来越受到重视。本文综述了应用药物和手术从葡萄膜巩膜途径降眼压机制治疗青光眼的研究进展。     

Ahmed青光眼阀植入术后盘周包裹囊状泡的手术疗效

目的 评价Ahmed青光眼阀植入术后盘周包裹囊状泡的手术疗效.方法 回顾性系列病例研究.收集13例经Ahmed青光眼阀植入术后盘周纤维增殖形成并包裹囊壁致眼压升高患者的临床资料,进行回顾性分析.患者眼压升高时间为青光眼阀植入术后3周至5个月,平均2个月,经检查Ahmed青光眼阀的引流盘和管位置均正常,管口无堵塞物,于眼球赤道部引流盘所在位置发现局限隆起包裹的囊状泡.所有患者均行包裹囊壁切除术,术中结膜瓣下使用丝裂霉素C治疗,并将剪除的纤维组织送病理检查,观察术后早期和中晚期患者的眼压和病程转归情况.结果 引流盘周包裹囊壁切除术后1个月,所有患者眼压均在正常范围内,手术成功率100%.术后随访3～20个月,3例患者在未加用任何降眼压药物的情况下,眼压控制在正常范围内;6例患者在使用2或3种降眼压药物的情况下,眼压控制在正常范围内;3例患者用药物仍无法控制眼压,需要进一步手术治疗.其中,57岁及以上患者的手术完全成功率为75%(3/4),37岁及以下患者的手术完全成功率为0(0/8).结论 手术切除包裹囊壁是治疗Ahmed青光眼阀植入术后引流盘周包裹囊状泡的一种有效方法,老年患者的中、长期手术疗效相对好于年轻患者.     

高眼压下原发性闭角型青光眼的手术治疗

高眼压下原发性闭角型青光眼的手术治疗喀左县医院眼科魏艳珍，贾树辉原发性闭角型青光眼（ＰＡＣＧ）患者急性发作期，眼压急剧升高，尽管用各种抗青光眼药物治疗，眼压仍有不降者。此种情况下如不采取手术治疗措施，将严重损害视神经，造成不可逆转的视功能低下，直至失...     

高眼压状态下青光眼小梁切除术的临床分析

目的：探讨青光眼高眼压状态下小梁切除术的安全性和有效性。

方法：对25例26眼充分降眼压后眼压仍不正常的青光眼患者, 前房穿刺放出房水后行复合小梁切除术,观察疗效及术后并发症。

结果：所有手术均顺利完成, 未出现暴发性脉络膜出血、玻璃体脱出等严重并发症,术后眼压控制≤21mmHg,术后视力提高25眼,总有效率96.2%。

结论：小梁切除术治疗青光眼安全、简便、可靠。对药物不能控制的持续性高眼压状态下的青光眼,放出房水后再行复合小梁切除术仍是最有效的理想术式。     

青光眼治疗对眼表组织结构的影响

青光眼是一组以视神经凹陷性萎缩和视野缺损为共同特征的疾病,病理性眼压增高是其主要危险因素.目前青光眼的治疗方法主要包括抗青光眼药物治疗、激光治疗、手术治疗以及视神经保护治疗等.研究证明,青光眼各种临床治疗对患者的眼表组织结构(泪膜、结膜、角膜上皮)均会产生明显影响,引起泪膜功能破坏、球结膜亚临床炎症、球结膜和角膜上皮细胞的损伤,导致患者眼部不适、长期用药依从性降低、干眼的发生甚至降低手术成功率等.本文主要针对抗青光眼治疗对眼表组织结构的影响作一简要综述.     

青光眼手术时机的选择

抗青光眼滤过性手术是一种最有效的降眼压治疗方法，但它又有一定的风险和并发症。为了最大程度发挥手术优越性，避免风险和并发症，在临床上需要正确判断青光眼的类型，准确把握病情。本文对各型原发性青光眼手术时机选择的参考因素进行了讨论。（眼科，2007,16：14-16）     

Medical treatment of glaucoma and the promising perspectives

Although great progress has been made in defining the spectrum of diseases known as glaucoma, its pathogenesis is still poorly understood. One common element seems to be the rise of intraocular pressure (IOP) beyond physiologic limits. The lowering of the existing IOP is accomplished either pharmacologically or surgically by decreasing the production of aqueous humor or by increasing aqueous humor outflow facility. Quite a number of pharmacologic agents are available to decrease IOP through distinctly different mechanisms. Since these drugs have their own mechanisms of action, some are used in combination in attempts to reduce the IOP to acceptable levels that will stabilize the optic nerve head excavation or the visual fields. In most patients with glaucoma beta-blockers are the treatment of initial choice. However, in almost 50% of these individuals therapy with beta-blockers alone does not reduce IOP adequately. Therefore, there is a need for new classes of topical IOP-lowering agents that can be used alone or in a combination with beta-blockers. This review summarizes the possible perspectives of some of the antiglaucomatous drugs that have been introduced in 1995 as well as those still under clinical investigation.     

青光眼顽固性高眼压的分期手术治疗

目的：分析青光眼顽固性高眼压状态下,先行睫状体光凝术降低部分眼压,Ⅱ期行进一步抗青光眼手术治疗的临床疗效观察。方法：回顾性分析北京华德眼科医院2013－01／2014－07收治的青光眼顽固性高眼压患者临床资料,共30例30眼,其中女12例,男18例,平均年龄56岁。这30眼中,急性闭角型青光眼急性发作期2眼,晶状体过熟期4眼,晶状体膨胀期6眼,新生血管性青光眼5眼,抗青光眼术后眼压仍不能控制正常9眼,玻璃体切除术后继发性青光眼4眼。所有患者入院后均首选睫状体光凝术,如果眼压未控制,则根据患者病情再行Ⅱ期抗青光眼手术。结果：在我们随访过程中,30例30眼均获得了满意效果,术前平均眼压62．79±5．59mmHg,一次睫状体光凝术后,眼压均有不同程度的下降,术后1wk,眼压降至32．84±8．16mmHg,其中6例完全控制正常,其余24例Ⅱ期再行进一步抗青光眼手术,术后眼压正常,术中无一例并发症出现。结论：青光眼顽固性高眼压状态下,先行睫状体光凝术控制眼压,可以大大减少二次手术时并发症的出现,后根据患者原发病的个体差异,Ⅱ期行进一步抗青光眼手术是一种安全有效的分期联合手术方式。     

Reducing intraocular pressure: is surgery better than drugs?

Reducing IOP is presently the evidence based, most accepted and most practised therapeutical approach for glaucoma patients. Currently topical ocular hypotensive medications, with its different classes, as well as filtering surgery (trabeculectomy and non-penetrating glaucoma surgery) are in the forefront of therapeutic modalities for IOP reduction. This article looks at the potential advantages and disadvantages of topical medications versus filtering surgery. It does not directly address the question of initial treatment of glaucoma, or what is the better treatment of glaucoma, as other review articles had, but rather looks in a more specific on the pros and the cons of each in relation to IOP reduction. In other words this article deals with the situation once the decision has been made to reduce IOP.     

Glaucoma in endocrine exophthalmus

Elevated intraocular pressure may be found in patients with Graves' disease if it is measured with gaze in the usual straight-ahead direction. In such cases the patient must be allowed to change his direction of gaze, and in particular to his individual "resting" direction of gaze. In pseudoglaucoma IOP will normalize at once. If Graves' disease develops in addition it may become impossible to control existing primary glaucomas by drug therapy. Outflow from the aqueous veins may be impeded by congestion of the orbital veins and lymphatic pathways. It is thus recommended that effective treatment of Graves' disease be carried out first (surgical decompression of the orbit according to Buschmann and Richter if drug therapy fails to reduce the protrusion significantly). After removal of the protrusion and the orbital congestion, it may once again be possible to regulate IOP by drug therapy and glaucoma surgery may not be necessary. If, by contrast, glaucoma surgery is performed on an eye with persistent endocrine exophthalmos, this may result in a fatal progression of the compression in neuropathy of the optic nerve. This should be avoided. Exemplary case histories are discussed.     

Management of cataracts in patients with glaucoma

The management of the glaucoma patient who has visually significant cataracts is a practical but complex topic. As glaucoma is a chronic, potentially progressive disease that can lead to irreversible blindness, ophthalmologists should develop a treatment approach with emphasis based on the severity of glaucoma rather than on cataract alone. Trabeculectomy remains an effective surgical choice, especially in glaucoma patients with advanced disease who require a low and steady IOP. In planning for cataract surgery, surgeons should be mindful of the alterations of astigmatism in terms of power and axis, axial length fluctuation as a result of trabeculectomy, and the relative position of the IOL after surgery. As glaucoma is a potentially progressive disease, surgeons who treat patients with coexistent glaucoma and cataracts must consider that future glaucoma surgery may be necessary when planning for the cataract surgery. A complete discussion of alternatives would go beyond the limited scope of this study. Regardless of the procedures used, the surgeon should consider the secondary effects of both glaucoma surgery and cataract surgery and their impact on each other when developing an individualized treatment plan.     

小梁切除术可以回归其内引流本质吗?

1968年Cairns设计小梁切除术的最初理念是希望房水经小梁切除断端流入Schlemm管而达到内引流降低眼压,但随后的研究发现该手术大部分成功的患者都存在明显的滤过泡,目前普遍认为其属于外引流滤过性手术。历经50年的发展及改良,联合抗代谢药物使用和可拆除缝线技术的复合式小梁切除术已较为完美,一直是青光眼手术治疗的主流术式,但术后远期滤过泡瘢痕化仍是小梁切除术远期疗效的最大挑战。为减少此术式其它一些并发症的发生,一些学者聚焦于“非穿透性”抗青光眼手术,但疗效并不理想。近年来诸多微创青光眼手术（minimally invasive glaucoma surgery,MIGS）逐渐兴起,虽然术后并发症较少,但降眼压幅度有限,且适应证窄。将黏小管成形术整合进小梁切除术中,可望让小梁切除术回归内引流本质,从而回避瘢痕化这一个难以战胜的自然愈合反应。     

Treating patients presenting with advanced glaucoma--should we reconsider current practice?

The management of patients presenting with advanced glaucoma presents a challenge to glaucoma clinicians. Presentation with advanced visual field loss is an important risk factor for progression to blindness in the affected eye(s) during the patients' lifetime. Maximising intraocular pressure (IOP) control in such situations is likely to minimise the risk of further visual field deterioration thus either preventing or slowing progression to blindness. Currently most patients presenting with advanced disease in the UK are managed on an escalating regime of medical treatment. Should this fail glaucoma surgery is usually employed to further lower IOP. Although glaucoma surgery is generally a safe and successful intervention it carries a small risk of severe visual loss and is considered by many clinicians as an intervention only to be used following failure of medical treatment. Recently however the National Institute for Clinical Excellence has suggested in its clinical guidelines for management of ocular hypertension and glaucoma that primary surgery should be offered to patients presenting with advanced glaucomatous visual field loss. This is contrary to the practice of most UK ophthalmologists. In this review the current available evidence underlying the management of presentation with advanced disease is examined.     

青光眼滤过手术联合中西药物治疗的研究进展

青光眼是导致人类失明的三大致盲眼病之一。青光眼的治疗以降眼压为重点,对于药物不能控制眼压的青光眼,手术是其主要的治疗手段。青光眼手术方式多样,但滤过性手术一直以来在临床上都占据着重要地位,滤过性手术虽然经过了多次改良,但单纯手术失败率仍很高。我们就如何提高抗青光眼滤过性手术成功率,回顾了近10a的相关文献,总结中西医对于手术失败原因的认识,介绍青光眼滤过性手术可联合运用的中西药物,以期应用中西药物联合有效提高手术成功率。青光眼是导致人类失明的三大致盲眼病之一。青光眼的治疗以降眼压为重点,对于药物不能控制眼压的青光眼,手术是其主要的治疗手段。青光眼手术方式多样,但滤过性手术一直以来在临床上都占据着重要地位,滤过性手术虽然经过了多次改良,但单纯手术失败率仍很高。我们就如何提高抗青光眼滤过性手术成功率,回顾了近10a的相关文献,总结中西医对于手术失败原因的认识,介绍青光眼滤过性手术可联合运用的中西药物,以期应用中西药物联合有效提高手术成功率。     

Glaukom und Keratoplastik

Glaucoma and corneal disorders are often associated and are of diagnostic, therapeutic and prognostic relevance for each other. Glaucoma is already present in approximately 15% of eyes prior to keratoplasty, whereas in addition approximately 15% of cases are diagnosed following corneal transplantation. Corneal opacities, surface irregularities and pachymetric deviations from the norm can have a negative impact on tonometry, perimetry and morphological glaucoma diagnosis. Digital and intracameral tonometry as well as flash VEP to determine the visual potential can be helpful in this setting. Increased intraocular pressure (IOP), long-term application of antiglaucomatous medication or the use of antimetabolites in glaucoma surgery can all induce keratopathy. Therefore, intraocular pressure should be regulated prior to corneal transplantation. Risk factors for the evolution of glaucoma following corneal transplantation are the specific indication and surgical technique (e. g. combined corneal and cataract/vitreoretinal surgery), as well as postoperative steroid application and chamber angle synechiae. Unpreserved glaucoma medication without pro-inflammatory effects should be preferred following keratoplasty. In the long term surgery to control IOP is required in approximately 25% of eyes. The wider use of lamellar techniques for corneal transplantation is likely to reduce the incidence of secondary glaucoma.