原发性开角型青光眼的遗传学进展

青光眼是全世界继白内障之后的第二大致盲因素 ,影响了大约 70 0 0万人 ,其中一半是开角型青光眼〔1〕。一般认为 ,家族史是原发性开角型青光眼(ｐｒｉｍａｒｙｏｐｅｎ -ａｎｇｌｅｇｌａｕｃｏｍａＰＯＡＧ)中的一个重要危险因素 ,在原发性开角型青光眼的一级亲属中发病率为     

正常眼压性青光眼的临床及其相关研究

对于正常眼压性青光眼的研究 ,国内、外文献报道均较少。 2 0 0 1年在西班牙召开了以“迎接临床挑战”为主题的“2 1世纪的青光眼”国际会议 ,议题之一是“正常眼压性青光眼和闭角型青光眼”。在东南亚老年人群中 ,原发性开角型青光眼 (ｐｒｉｍａｒｙｏｐｅｎ ａｎｇｌｅｇｌａｕｃｏｍａ,ＰＯＡＧ)患者多数表现为正常眼压性青光眼 ,比例高达 6 0 % ;在日本年龄≥ 4 0岁的一般人群中 ,正常眼压性青光眼的患病率为伴有眼压升高ＰＯＡＧ(ＰＯＡＧｗｉｔｈｈｉｇｈｐｒｅｓｓｕｒｅ,ＨＰＧ)患者的 4倍。以往认为ＰＯＡＧ明显少于原发性闭角型…     

青光眼血流动力学变化及其相关因素研究

用彩色多普勒血流成像（ｃｏｌｏｒｄｏｐｐｌｅｒｆｏｌｗｉｍａｇｉｎｇ,ＣＤＦＩ）技术研究青光眼病人眼血流动力学变化及检测指标的可靠性。方法：采用美国Ａｃｕｓｏｎ－１２８ＸＰ型彩多普勒超声仪测量发性开角型青光眼（ｐｒｉｍａｒｙｏｐｅｎ－ａｎｇｌｅｇｌａｕｃｏｍａ,ＰＯＡＧ）２５例,原发性闭角型青光眼（ｐｒｉｍａｒｙａｎｇｌｅ－ｃｌｏｓｅｇｌａｕｃｏｍａ,ＰＡＣＧ）３０例和正常人３０例的眼动脉（ｏｐｈ     

日本低眼压性青光眼的研究动态

日本低眼压性青光眼的研究动态南京医科大学第一附属医院眼科卞春及日本低眼压性青光眼流行病学调查的结果表明，低眼压性青光眼（ＬｏｗＴｅｎｓｉｏｎｇｌａｕｃｏｍａ，ＬＴＧ）的发病率是原发性开角型青光眼（Ｐｒｉｍａｒｙｏｐｅｎ－ａｎｇｌｅｇｌａｕｃｏｍａ；Ｐ...     

未治疗的剥脱性青光眼和原发性开角型青光眼的昼夜眼压变化

目的：旨在叙述和比较剥脱性青光眼（ｅｘｆｏｌｉａｔｉｏｎｇｌａｕｃｏｍａ，ＥＸＧ）和原发性开角型青光眼（ｐｒｉｍａｒｙｏｐｅｎ－ａｎｇｌｅｇｌａｕｃｏｍａ，ＰＯＡＧ）的昼夜眼压变化。患者和设计：我们前瞻性地连续调查了新诊断且未经治疗的ＥＸＧ和ＰＯＡＧ的希腊患者，全部患者收入眼科病房后标准方案进行了２４小时眼压测量。使年龄配对后，比较了这两组青光眼的４０对患者。结果：ＥＸＧ患者眼压的平均波动范围明显     

原发性开角型和低压性青光眼早期视野及视网膜神经纤维层损害的比较

目的探讨原发性开角型青光眼（ｐｒｉｍａｒｙｏｐｅｎ－ａｎｇｌｅｇｌａｕｃｏｍａ，ＰＯＡＧ）和低压性青光眼（ｌｏｗｔｅｎｓｉｏｎｇｌａｕｃｏｍａ，ＬＴＧ）早期视野损害及视网膜神经纤维层缺损的特点。方法应用ＱＺＳ－２型自动视野计全阈值程序对２６例（４１只眼）早期ＰＯＡＧ和１３例（１５只眼）早期ＬＴＧ进行定量视野测定，所有患者散瞳做视盘和视网膜神经纤维层照像，分析视网膜神经纤维层缺损的类型和程度。结果早期ＰＯＡＧ和ＬＴＧ视野损害多表现为局限性视网膜光敏感度下降，少数表现为弥漫性光敏感度下降，视野损害主要位于中心视野，少数可合并周边视野损害。中心视野平均光敏感度和短期波动与正常对照组之间差异有显著性，两型青光眼早期视野损害和视网膜神经纤维层缺损的类型及损害部位分布差异无显著性。结论早期ＰＯＡＧ和ＬＴＧ视野损害特征及视网膜神经纤维层缺损形态一致     

我国原发性闭角型青光眼的研究进展

近年来 ,随着超声生物显微镜 (ｕｌｔｒａｓｏｕｎｄｂｉｏｍｉｃｒｏｓｃｏｐｙ,ＵＢＭ)用于原发性闭角型青光眼 (ｐｒｉｍａｒｙａｎｇｌｅｃｌｏｓｕｒｅｇｌａｕｃｏｍａ,ＰＡＣＧ)的诊断和研究后 ,对ＰＡＣＧ特别是慢性ＰＡＣＧ发生的解剖学基础和病理生理学机制的研究更加深入。笔者复习了国内外有关ＰＡＣＧ研究方面的文献 ,提出了一个以房角关闭机制为基础的ＰＡＣＧ分型系统 ,并提出对多种机制共存型ＰＡＣＧ的诊断和处理原则。一、人种和ＰＡＣＧ的关系1 不同人种ＰＡＣＧ患病率的差异 :原发性闭角型青光眼是亚洲人群最常见的青光…     

由OPTN突变引起的成人型原发性开角型青光眼

原发性开角型青光眼 (ＰＯＡＧ)是主要的致盲眼病 ,全世界约有 3千多万患者。目前已知有 8个基因位点与青光眼有关 ,其中 2个基因已被确定 :ＣＹＰ1Ｂ1基因编码细胞色素Ｐ450 1Ｂ1酶 ,与原发性先天性青光眼有关 ;ＭＹＯＣ/ＴＩＧＲ基因编码ｍｙｏｃｉｌｉｎ ,与青少年型ＰＯＡＧ有关。作者报道一个与成人型ＰＯＡＧ有关的基因 ,已被人类基因组织命名委员会确定 ,称为ＯＰＴＮ ,其编码的蛋白产物为ｏｐｔｉｎｅｕｒｉｎ ,含义是引起视神经病变的蛋白。作者所在的实验组于 1 998年通过对一正常眼压性青光眼家系的基因连锁分析 ,发现了定位于 1…     

光学相干断层成像术对原发性开角型青光眼视网膜神经纤维层的定 …

目的 探讨原发性开角型青光眼（ｐｒｉｍａｒｙ ｏｐｅｎ ａｎｇｌｅ ｇｌａｕｃｏｍａ,ＰＯＡＧ）的光学相干断层成像术（ｏｐｔｉｃａｌ ｃｏｈｅｒｅｎｃｅ ｔｏｍｏｇｒａｐｈｙ,ＯＣＴ）的图像特征,ＰＯＡＧ患者视网膜神经纤维层（ｒｅｔｉｎａｌ ｎｅｒｖｅ ｆｉｂｅｒ ｌａｙｅｒ,ＲＮＦＬ）厚度与正常人之间的差异,ＲＮＦＬ与视野指数之间的关系。方法 采用ＯＣＴ对８３例（１４９只眼）ＰＯＡＧ患者和８３例     

视觉运动觉在原发性开角型青光眼中的应用研究

目的研究原发性开角型青光眼（ｐｒｉｍａｒｙｏｐｅｎ－ａｎｇｌｅｇｌａｕｃｏｍａ，ＰＯＡＧ）的视觉运动觉特性。方法在ＰＣ兼容机上，应用运动觉检测软件，对４１例（６７只眼）ＰＯＡＧ患者和５６例（１１２只眼）正常人进行运动觉测试。结果ＰＯＡＧ患者的运动觉总异常率为８９．５％，其中早期异常率为８１．６％；在等级相关分析中，ＰＯＡＧ患者运动觉的异常程度与杯盘比、眼压及视野的校正缺损方差呈正相关，与视力及视野的视网膜平均光敏感度呈负相关，而与患者的年龄及视野短期波动无相关。结论视觉运动觉测定为ＰＯＡＧ的早期诊断提供了一种新的有效和简便的检测手段。     

Paraneoplastic and non-paraneoplastic retinopathy and optic neuropathy: Evaluation and management

Paraneoplastic syndromes involving the visual system are a heterogeneous group of disorders occurring in the setting of systemic malignancy. Timely recognition of one of these entities can facilitate early detection and treatment of an unsuspected, underlying malignancy, sometimes months before it would have otherwise presented, and gives the patient an increased chance at survival. We outline the clinical features, pathogenesis, and treatment strategies for the retinal- and optic nerve–based paraneoplastic syndromes: cancer-associated retinopathy; melanoma-associated retinopathy; paraneoplastic vitelliform maculopathy; bilateral diffuse uveal melanocytic proliferation; paraneoplastic optic neuropathy; and polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes syndrome. Distinguishing these disorders from their non-paraneoplastic counterparts (e.g., autoimmune-related retinopathy and optic neuropathy, and acute zonal occult outer retinopathy) and determining appropriate systemic evaluation for the responsible tumor can be challenging. In addition, we discuss the utility and interpretation of autoantibody testing.     

Anesthesia and preoperative and postoperative medications

Retrobulbar blocks, although widely used, still have potentially serious complications. Topical anesthesia presents less risk of injury to the globe and less pain but requires careful usage and an experienced surgeon. New techniques, however, allow for an increase in the percentage of patients able to have topical anesthesia. Preoperatively, 2.5% phenylephrine is found to be just as effective as 10% phenylephrine, and, when compared with wound closure and surgeon's experience, the effect of prophylactic medications was found to be negated. Postoperatively, diclofenac is found to be as effective an anti-inflammatory agent as prednisolone. Also, the addition of 10% phenylephrine to 4% pilocarpine drops enhances the effectiveness of pharmacologic treatment of postoperative iridocorneal adhesions. In addition, ophthalmologists should be aware of emerging antibiotic resistance.     

Proximal and accommodative convergence and age

The authors have estimated the phoria for distant and near fixation in two groups of subjects (mean age 27.5 ± 4.4 and 59.2 ± 8.2 years). Different accommodative stimuli were induced by adding minus lenses for distant fixation and plus lenses for near fixation. Statistical analysis of the experimental data indicates that, for distant fixation, the value of phoria per unit of accommodative stimulus is significantly lower in presbyopic than in nonpresbyopic subjects. Also, during near fixation, the accommodative convergence (AC/A ratio) is more reliable in the presbyopic subjects when the accommodative stimulus is progressively reduced. This varying behavior indicates in presbyopic subjects that proximal convergence is of greater relative importance in the determination of the fusion-free position. In nonpresbyopic subjects, accommodative convergence is the more important component.     

Anesthesia and preoperative and postoperative medications

Although certain methods such as retrobulbar blocks are used extensively, improvements in procedure can always be implemented. The use of ultrasound, low concentrations of anesthesia, careful monitoring, and, in the case of risk patients, anesthesia standby are all important considerations to ensure uneventful treatments. Topical anesthesia eliminates needle risk as well as risk of ptosis and bruising. Because it has been demonstrated that bacteria routinely enter the anterior chamber during uncomplicated cataract surgery, certain irrigation solutions are helpful, but still debatable. Postoperatively, diclofenac, flurbiprofen, and timolol have all been proven to be effective in reducing ocular inflammation, reducing incidence of CME, and controlling pressure increase, respectively.     

Segmentation and accuracy in copying and drawing: Experts and beginners

As part of an ongoing investigation into real-world copying and drawing, I recorded the eye-hand drawing strategies of 16 subjects with drawing experiences ranging from expert to novice while they copied a line drawing of a standing nude. The experts produced accurate copies whereas all the beginners produced marked inaccuracies of overall scaling, proportion and shape. Analysis of eye and hand movements showed that the experts alone segmented the original drawing into simple line sections that were copied one at a time using a direct eye-hand strategy not requiring intermediary encoding to visual memory. The results suggest that segmentation into simple lines defines the task-specific process of accurate copying, and that this process is restricted to experts, i.e. acquired through training and practice. Additional preliminary tests also suggest that a similar process may apply to drawing a model from life.     

Sensitivity to first- and second-order motion and form in children and adults

We compared the sensitivity of adults and children aged 3-10 years to first- and second-order motion and form. For first-order stimuli, at all ages sensitivity was better for motion than form, and motion thresholds were better at 6 Hz than at 1.5 Hz. For second-order stimuli, at all ages sensitivity was better for form than motion, and motion thresholds were better at 0.25 cyc/deg than at 1 cyc/deg. Thresholds became adult-like later for motion than for form and later for first-order than second-order stimuli. For first-order stimuli, the changes with age were larger and more protracted.     

Ethics and optometry: concepts and applications

Ethics refers both to the study of behaviour, and moral principals. The related concepts of justice and law are also relevant to optometry. A profession typically claims specialist knowledge and ethical behaviour – putting the interests of clients above its own. However, professional codes fail as ethical directives, and their goals are questioned. Beginning with broad principles, institutional ethics and issues of general health care provision are considered, and applications to optometry are made. Ethical theory can guide us in interacting with our patients, utilising resources and ordering priorities. The conservative approach to consumerism and advertising is defended on the basis of protecting public and professional interests. Ethical behaviour can be fostered, and this process should begin in undergraduate education.     

Nodes and nodal points and lines in eyes and other optical systems

The typical stigmatic optical system has two nodal points: an incident nodal point and an emergent nodal point. A ray through the incident nodal point emerges from the system through the emergent nodal point with its direction unchanged. In the presence of astigmatism nodal points are not possible in most cases. Instead there are structures, called nodes in this paper, of which nodal points are special cases. Because of astigmatism most eyes do not have nodal points a fact with obvious implications for concepts, such as the visual axis, which are based on nodal points. In order to gain insight into the issues this paper develops a general theory of nodes which holds for optical systems in general, including eyes, and makes particular allowance for astigmatism and relative decentration of refracting elements in the system. Key concepts are the incident and emergent nodal characteristics of the optical system. They are represented by 2 × 2 matrices whose eigenstructures define the nature and longitudinal position of the nodes. If a system's nodal characteristic is a scalar matrix then the node is a nodal point. Otherwise there are several possibilities: Firstly, a node may take the form of a single nodal line. Second, a node may consist of two separated nodal lines reminiscent of the familiar interval of Sturm although the nodal lines are not necessarily orthogonal. Third, a node may have no obvious nodal line or point. In the second and third of these classes one can define mid-nodal ellipses. Astigmatic systems exist with nodal points and stigmatic systems exist with no nodal points. The nodal centre may serve as an approximation for a nodal point if the node is not a point. Examples in the Appendix , including a model eye, illustrate the several possibilities.