陕西省农村人群青光眼的流行病学调查

目的:调查陕西省农村≥50岁人群中青光眼的患病情况。方法:2003-07/12,采用按比例随机整群抽样的方法在陕南、陕北及关中3个地区农村调查8500人,其中≥50岁人群有2125人。所有受检人员均进行标准问卷调查,包括询问青光眼确诊史、家族史、发作史及手术史,并进行了相关的眼科检查,包括视力、外眼、前房深度及眼底检查。≥50岁人群应用压平式眼压计测量眼压,对可疑青光眼者进行进一步检查,包括复查眼压、前房角镜检查、激发试验、视野检查。结果:≥50岁人群中有1775人完成了青光眼的相关检查,受检率为83.53%。青光眼的患病率为2.14%,其中原发性闭角型青光眼、原发性开角型青光眼、继发性青光眼患病率分别为1.63%、0.39%、0.11%。55.26%青光眼患者存在不同程度的视力损伤,其中单眼低视力、双眼低视力、单眼盲及双眼盲所占比例依次为18.42%、5.26%、18.42%和13.16%。事前未被诊断为青光眼的患者占71.05%(27例),在另外28.95%(11例)有确诊史的青光眼患者中只有6例(54.55%)曾接受过治疗。正常眼的眼压平均值为13.9±2.2mmHg(1mmHg=0.133kPa),随着年龄的增加眼压有增加的趋势(P<0.05)。结论:陕西省农村人群青光眼的患病率为2.14%,但原发性闭角型青光眼和原发性开角型青光眼在原发性青光眼中的比例为4.18:1。无确诊史的青光眼患者占大多数。     

北京市西长安街社区50岁以上人群青光眼调查

目的调查北京市城市社区50岁以上人群中青光眼患病状况及其视功能损害情况。设计横断面调查。研究对象北京市西城区西长安街社区≥50岁居民。方法共检查2410人,应答率88．06％。检查包括视力、裂隙灯显微镜、检眼镜检查,询问青光眼家族史。采用非接触眼压计测量眼压,裂隙灯显微镜测量周边前房深度,观察视盘有无青光眼性视神经改变。对已确诊为青光眼者,记录其青光眼发作史、手术史等。对高危人群及可疑青光眼患者Goldman眼压计测量眼压、前房角镜检查、激发试验、视野检查等。主要指标青光眼患病率,盲与低视力比例。结果西城区西长安街社区50岁及50岁以上人群青光眼患病率为2．49％,其中原发性闭角型青光眼、原发性开角型青光眼、继发性青光眼患病率分别为1．66％、0．62％、0．08％。57．89％的青光眼患者视功能有损伤,青光眼患者中双眼盲比例为7．02％,均为≥66岁的患者。单眼盲、双眼低视力和单眼低视力的比例分别为24．56％、5．26％和21．05％。结论社区居民青光眼患者中以原发性青光眼为主。原发性开角型青光眼的构成比较既往有增加的趋势。防治青光眼是今后社区防盲工作的重点之一。     

天津市蓟县桑梓村40岁及以上人群中青光眼患病率调查

目的 调查天津蓟县桑梓村40岁及以上人群中青光眼的患病率。方法 2003年1～3月，对天津蓟县桑梓村1987人进行青光眼的普查，每一位受检者接受了问卷调查、视力、色觉、眼前节检查、前房深度、眼压测量及眼底检查，部分接受了倍频视野仪、Goldmann前房角镜及中心视野检查。结果 1701人完成了检查，受检率为85.61％。青光眼患病率为1．59％，原发性闭角型青光眼为1．12％，原发性开角型青光眼为0．35％，继发性青光眼为0.12％；高龄、有青光眼家族史者原发性青光眼患病率较高。所检出的27例青光眼患者中，有19例视功能有一定程度的损伤，其中6例双眼盲，5例单眼盲，4例双眼低视力，4例单眼低视力；19例视力损伤中13例患者年龄≥70岁。结论 青光眼引起的视功能损伤是十分严重的，高龄伴有青光眼家族史的人群应定期随访。     

重庆市永川地区50岁以上人群中青光眼患病率调查

目的 调查重庆市永川地区50岁以上人群中青光眼的患病率.方法 选取2005年4～6月采用分层整群随机抽样法在永川地区行青光眼调查.在该地区城区、近郊、远郊,抽取29个抽样自然村或居委会,每一位≥50岁受检者接受了问卷调查、视力和一般眼部检查外,以VanHerick法测量周边前房深度,用Perkins手持压平眼压计测量眼压,用直接眼底镜检查眼底,主要观察视乳头,包括杯/盘比,杯盘比差,横竖径,盘沿切迹及盘沿出血.结果 5938人完成了检查,受检率85.19%.青光眼的患病率为3.55%.其中原发性闭角性青光眼患病率为2.49%,且随年龄增加而增加,女性明显高于男性,文化程度低的明显高于文化程度高的,三者差异均有统计学意义.原发性开角型青光眼患病率为0.86%,继发性青光眼患病率为0.20%.在青光眼患者中,仅有2例双眼视力≥0.3,有209例有视功能损害.其中单眼低视力8例,双眼低视力4例,单眼肓168例,双眼盲29例.结论 重庆永川地区城乡人口中青光眼总患病率较1996年北京顺义地区高,原发性闭角型青光眼仍是该地区主要青光眼类型.青光眼患者的眼球摘除率和盲目率高,与永川地区经济和文化和教育程度等社会因素有关.通过筛查对前房≤1/4角膜厚度的人群密切随访或干预治疗可以降低青光眼的致盲率.     

广州市萝岗区盲与低视力流行病学调查

目的 调查广州市萝岗区年龄≥50岁人群盲与低视力的患病率及主要致病原因.方法 采用整群抽样方法 ,按世界卫生组织盲与低视力分类标准,对广州市萝岗区50岁及以上人群进行问卷调查,视力检测初筛后对针孔镜下视力低于0.3者,由眼科医师做视功能、眼前后节形态检查及主要致盲原闪诊断.结果 共录入人数4532人,实际受检4126人,受检率91.04%.其中双眼肓患病率为1.91%,单眼盲患病率5.96%,双眼低视力患病率8.41%.随着年龄增加,盲与低视力患病率明显升高.70岁年龄组双眼肓是50岁年龄组的25.5倍,差异具有统计学意义(P<0.01).在盲与低视力人群中致病原因的前几位依次是白内障(47.9%),眼底病(20.4%),屈光不正(9.52%),角膜病(7.59%).另外,脑垂体瘤致盲占0.74%.结论 广州市萝岗区≥50岁老年人群盲与低视力的首要原因为白内障,故降低自内障的患病率是该地区防旨治盲的关键,另外眼底病在该地区也是重点防治的疾病.     

广东省梅县盲和低视力流行病学调查

目的 调查梅县盲及低视力的流行病学情况。方法 采用分层随机抽样原因,以世界卫生组织盲目分级为标准,对全县按2.01%抽样比例抽取11327例进行盲和低视力的流行病学调查。结果 双眼盲及低视力患病率分别为0.47%（男性0.30%,女性0.63%）和0.89%（男性0.66%,女性1.12%）;双眼盲率：县城0.29%、附城郊区0.34%、山区0.56%。单眼盲、双眼低视力和单眼低视力的患病率分别为0.72%、0.89%和0.59%。≥50岁盲及低视力患者的患病率明显增高。结论 致盲和致低视力的眼病均以白内障居首位,其次为青光眼、屈光不正、弱视及翼状胬肉等。     

海南省盲和低视力流行病学调查

对海南省３３６００人，进行了盲和低视力流行病学调查，海南省双眼盲患病率为０．７６％，单眼盲患病率为０．７１％，双眼低视力患病率为０．７３％，单眼低视力患病率为０．５０％，盲和低视力的患病率都随年龄增长而递增，双，单眼盲和低视力都是女性明显高于男性，致盲病因中，双单眼盲部都以白内障最多。其次双眼盲以青光眼，单眼盲以角膜病，眼外伤最多，双眼盲２５４人中有１８３人可以治疗，占７２％，单眼盲２４０人中有１     

云南省高海拔农村多民族聚居区盲和低视力患病率调查

目的 探讨云南省高海拔农村多民族聚居区贡山县盲和低视力患病率及分布特点。方法 采用整群随机抽样的方法。2008年2至4月选取云南省贡山县全年龄组常住居民作为调查对象。调查地点为人选居民所在的村庄。调查程序包括问卷调查、预调查、视力检查、眼压、裂隙灯显微镜检查及眼底检查。盲定义为较好眼最佳矫正视力＜0.05,低视力定义为较好眼最佳矫正视力≥0.05且＜0.3。按年龄、性别、职业、教育程度、民族及居住地海拔高度分别计算盲和低视力的患病率,同时确定盲和低视力的原因。患病率的分层比较采用四格表卡方检验、Rx2卡方检验、趋势卡方检验。结果 3070名入选对象中2460名接受检查,受检率为80.1％。其中有159例视力损伤,总体患病率为6.46％,包括19例双眼盲患者,46例单眼盲患者,49例双眼低视力患者,45例单眼低视力患者。视力损伤在不同民族之间差异无统计学意义(x2 =0.75,P=0.388),而视力损伤在不同海拔居住地的居民之间差异有统计学意义(x2 =18.34,P=0.000)。年龄大（≥70岁）、文盲和从事体力劳动者视力损伤患病率高,分别为2.24％、4.19％、5.65％。42.1％(8/19)的双眼盲患者的致盲原因是白内障,角膜混浊占26.32％ (5/19)及眼底异常占21.1％ (4/19)。白内障也是双眼低视力的主要原因,占42.9％ (21/49)。结论 白内障是云南省贡山县的主要致盲原因,需要当地卫生机构采取措施来降低当地盲和低视力患病率,尤其是白内障盲。     

陕西省农村50岁以上人群白内障和盲的患病率调查

目的:调查陕西省农村50岁以上老年人群中白内障的患病率,并评价由白内障造成视力损伤的情况.方法:2003-07/12,采用整体随机分层抽样法在陕西省洋县、靖边县和富平县调查8 500人,其中≥50岁人群2 213人.所有受检人员均进行标准问卷调查及详细的眼科检查.视力检查使用LogMAR视力表分别对每只眼进行测量,晶状体混浊使用国内标准在裂隙灯下进行评价.结果:1 775人接受了检查,应答率为80.2%,50岁以上人群白障患病率为37.2%,男性白内障患病率为28.6%,女性白障患病率为44.3%,男性患病率低于女性(P＜0.01),50岁人群白内障患病率为17.9%,70岁以上人群则上升到82.4%,白内障的患病率随着年龄增长而明显上升(P＜0.01).其中皮质性白内障患病率为34.5%,核性白内障为9.2%,后囊下白内障为6.7%.在1 775名受检者中,20人在检查前实施了白内障手术.该人群中双眼盲和双眼低视力的患病率分别为2.1%和3.2%,由白内障造成的双眼盲、单眼盲、双眼低视力、单眼低视力分别占56.8%,68.8%,38.6%,73.8%.结论:调查结果表明白内障在陕西省农村还是一个比较严重的公众健康问题.白内障手术在农村地区实施的情况还很低.白内障是造成视力损伤的最主要原因.     

上海市北新泾街道老年人高度近视眼的流行病学调查

目的 了解上海市北新泾街道60岁及以上老年人高度近视眼患病率、高度近视眼视网膜脉络膜病变的患病率及其相关影响因素.方法 采用整群随机分层抽样法,对上海市北新泾街道的4153位60岁及以上老年人进行人群普查,受检者3851例,受检率为92.73%.现场调查内容为问卷调查及全面的眼科检查,包括视力、屈光度、裂隙灯显微镜、直接检眼镜检查和眼底照相等.屈光不正用等效球镜度数(SE)表示.若受检者SE>-6.00 D,眼底表现有后巩膜葡萄肿、漆纹样裂纹、Fuchs斑、近视弧形斑等近视性视网膜脉络膜萎缩病灶则诊断为高度近视眼视网膜脉络膜病变.小孔视力按照WHO视力损伤分级:最佳矫正视力≥0.05但<0.3为低视力,<0.05为盲.结果 受检者中,高度近视眼207例,占5.37%.其中,183例表现高度近视性视网膜脉络膜病变,占88.40%.随年龄的增长,高度近视眼视网膜脉络膜病变的患病率显著下降(X2=19.21,P<0.01),但男女之间患病率差异无统计学意义(X2=1.83,P>0.05).Logistic回归分析显示,不同年龄、不同文化程度、有无高度近视眼家族史人群的患病率差异均有统计学意义(X2=19.21,32.08,960.68;P<0.01).受检者中,双眼盲29例,单眼盲96例,双眼低视力104例,单眼低视力562例.183例高度近视眼视网膜脉络膜病变患者中,111例存在明显的视力损伤,占60.65%,其中,双眼盲、单眼盲、双眼低视力、单眼低视力的患者分别为10例,11例、31例和59例,分别占总受检人群中视力损伤者的34.48%、11.46%、29.81%和10.50%.结论上海市北新泾地区老年人高度近视眼的患病率较高.年龄、文化程度,高度近视眼家族史是影响高度近视眼视网膜脉络膜病变的重要因素.     

Relationship between postural change of the intraocular pressure and visual field loss in primary open-angle glaucoma

PURPOSE: To determine the relationship between the postural changes of the intraocular pressure and the visual field loss in patients with primary open-angle glaucoma. METHODS: Eleven normal subjects and 11 patients with primary open-angle glaucoma were studied. Intraocular pressure was measured in both the sitting and the supine positions. Visual fields were measured with automated perimetry. RESULTS: When patients moved from a sitting to supine position, the intraocular pressure increased by an average of 3.1 +/- 0.4 mm Hg (mean +/- SEM) in normal subjects and 4.0 +/- 0.2 mm Hg in patients with primary open-angle glaucoma. There was a significant difference between the normal subjects and patients with primary open-angle glaucoma (P = 0.049). Intraocular pressure increased by 4.4 +/- 0.3 mm Hg (P = 0.02) in the worse eye for mean deviation and 3.6 +/- 0.3 mm Hg (P = 0.38) in the better eye for mean deviation. There was no significant difference in intraocular pressure in the sitting position between both groups. CONCLUSIONS: The greatest difference in intraocular pressure between the sitting and supine positions was observed in the worse eye of patients with primary open-angle glaucoma. This result suggests that damage to the optic nerve in primary open-angle glaucoma might occur when patients are asleep in the supine position.     

Open-angle glaucoma associated with Graves disease

PURPOSE: To estimate the prevalence of open-angle glaucoma, including normal-tension glaucoma, in association with Graves disease. METHODS: In a prospective study, a complete ophthalmic examination including applanation tonometry, exophthalmometry, automated static threshold perimetry, and computed tomography of the orbit was performed in 104 consecutive Japanese patients with Graves disease (age range, 11 to 86 years; mean, 42 years; 80 women, 24 men). Ocular hypertension was defined as an intraocular pressure greater than 21 mm Hg on at least two occasions during the period of follow-up. RESULTS: Of the 104 patients, 14 (13%) exhibited typical glaucomatous visual field defects in automatic static threshold perimetry in the absence of compressive optic neuropathy. The intraocular pressure in seven of the 14 patients was consistently less than 21 mm Hg during the follow-up period. Thus, these patients were diagnosed as having normal-tension glaucoma. Of the 104 patients, 23 (22%) were diagnosed as having ocular hypertension. CONCLUSIONS: The prevalence of normal-tension glaucoma as well as open-angle glaucoma and ocular hypertension was significantly higher among patients with Graves disease than in the general population.     

Combined pars plana vitrectomy and glaucoma drainage implant placement for refractory glaucoma

PURPOSE:To report visual acuity and intraocular pressure outcomes among patients who have undergone combined pars plana vitrectomy and placement of a glaucoma drainage implant.METHODS:The medical records of all patients who underwent combined pars plana vitrectomy and placement of a glaucoma drainage implant at the Bascom Palmer Eye Institute by one of the authors between January 1, 1990, and February 28, 1998, were reviewed. Forty patients (40 eyes) were identified, including 14 patients with neovascular glaucoma secondary to proliferative diabetic retinopathy or central retinal vein occlusion, 15 patients with other posterior segment disease, seven patients with secondary angle-closure glaucoma, and four patients with aphakia with ruptured anterior hyaloid face. Main outcome measures included visual acuity and intraocular pressure at 1 year postoperatively.RESULTS:At 1 year postoperatively, 31 (77.5%) of 40 patients had stable or improved visual acuity; three eyes (7. 5%) had a final visual acuity of no light perception and three additional eyes (7.5%) were enucleated (because of chronic pain in two eyes and endophthalmitis in one eye). Mean preoperative intraocular pressure was 34 mm Hg and the median number of preoperative antiglaucoma medications was two. At 1 year postoperatively, mean intraocular pressure was 13 mm Hg and the median number of antiglaucoma medications was zero. Twenty-two patients (55.0%) achieved an intraocular pressure greater than 5 mm Hg and less than or equal to 21 mm Hg without antiglaucoma medication, and an additional seven patients (17.5%) achieved this level of intraocular pressure control with medication. Only one patient (2.5%) underwent further glaucoma surgery for uncontrolled intraocular pressure.CONCLUSIONS:Although combined pars plana vitrectomy and placement of a glaucoma drainage implant is often a successful management option in selected patients with refractory glaucoma, visual outcome may be poor because of severe underlying ocular disease and postoperative complications.     

Extracapsular cataract extraction and posterior chamber intraocular lens implantation combined with trabeculectomy in patients with glaucoma

We reviewed 75 consecutive cases of extracapsular cataract extraction and posterior chamber intraocular lens implantation combined with trabeculectomy in 69 patients with glaucoma. The mean preoperative intraocular pressure was 19.3 mm Hg on an average of 2.3 glaucoma medications. Visual acuity improved in 58 eyes (77%) at two months, with an average improvement of 3.3 and 3.6 lines at two and 12 months, respectively. Of the 75 eyes, 49 (65%) achieved a visual acuity of 20/40 or better; three patients (4%) had further deterioration in vision at the completion of follow-up because of progressive glaucoma or macular disease. Postoperatively, the average intraocular pressure was 3.8 and 3.0 mm Hg lower than the preoperative level at two and 12 months (P less than .001) on 0.63 and 0.79 glaucoma medications, respectively. However, 27 (36%) of the 75 eyes had a recorded intraocular pressure greater than 30 mm Hg and 30 (40%) had a pressure 7 mm Hg or more above their preoperative level during the first six months after surgery. Despite improved long-term control of intraocular pressure, detectable conjunctival filtering blebs were present in only 31 (41%) of 75 eyes at two months and in seven (12%) of 56 eyes at 12 months. Hyphema occurred in 34 (45%) of the cases.     

Juvenile glaucoma

Juvenile glaucoma is an uncommon form of chronic open angle glaucoma that appears between 3 and 35 years of age. We reports in this study four cases; one of them had unilateral visual acuity reduced. The intraocular pressure is above to 30 mm Hg, and a myopia was associated to two cases. The insidious development of this pathology and the difficulty of its diagnosis among young people, often result in severe clinical manifestations, with high visual field defects, and important optic disc cuppings.     

Intraocular pressure and progression of glaucomatous visual field loss

PURPOSE:To evaluate the relationship between intraocular pressure and visual field progression in patients with primary open-angle glaucoma.METHODS:We prospectively followed 113 patients with early to moderate glaucomatous field damage. Conventional automated static perimetry, high-pass resolution perimetry, and intraocular pressure measurements were carried out at 6-month intervals. The mean and the highest intraocular pressure in the follow-up were compared in stable and progressing patients with each perimetric technique. RESULTS:The mean (+/- SD) follow-up was 4.5 +/- 0.9 years. The mean (+/- SD) intraocular pressure in patients remaining stable with conventional perimetry [18.2 +/- 3.3 mm Hg, n = 81 (71.7%)] was not significantly different (P =.65) from those in whom it progressed (17.9 +/- 3.3 mm Hg, n = 32 [28.3%]). The mean intraocular pressure in patients remaining stable with high-pass resolution perimetry (17. 9 +/- 3.5 mm Hg, n = 63 [55.8%]) was not significantly different (P =.33) from those in whom it progressed (18.5 +/- 3.0 mm Hg, n = 50 [44.2%]). The mean (+/- SD) of the highest (single or three highest) pressure during follow-up for stable and progressing patients with conventional perimetry was not significantly different (22.6 +/- 5.0 and 23.0 +/- 4.6 mm Hg, respectively, P =.76). However, for high-pass resolution perimetry, the difference was highly significant (21.6 +/- 4.5 and 24.1 +/- 4.9 mm Hg, respectively, P <. 01). Furthermore, patients who progressed with high-pass resolution perimetry had more damaged baseline fields compared with those who remained stable (P <.01).CONCLUSIONS:The mean level of intraocular pressure does not differentiate glaucoma patients with progressive visual field loss from ones who remained stable. Baseline visual field status and peak intraocular pressure of patients who progress with high-pass resolution perimetry are significantly different from those who remain stable.     

Efficacy and safety of inferior 180 degrees goniosynechialysis followed by diode laser peripheral iridoplasty in the treatment of chronic angle-closure glaucoma

PURPOSE: To report the efficacy and safety of inferior 180 degrees goniosynechialysis followed by diode laser peripheral iridoplasty in the treatment of chronic angle-closure glaucoma with total synechial angle closure. METHODS: Five patients with chronic angle-closure glaucoma and total synechial angle closure whose intraocular pressures were higher than 21 mm Hg while taking maximally tolerated medications underwent goniosynechialysis followed by diode laser peripheral iridoplasty to the inferior half of the angle. Intraoperative complications, postoperative visual acuity, intraocular pressures, and complications were evaluated. RESULTS: Five eyes of five patients received the operation and the mean follow-up was 7.6 months (range, 6-12 months). The mean preoperative intraocular pressure was 33.8 +/- 5.8 mm Hg. The mean postoperative intraocular pressure at most recent follow-up was 15.8 +/- 2.2 mm Hg. Postoperative complications included transient increase in intraocular pressure, hyphema, and cataract. The success rate (intraocular pressure less than 20 mm Hg with or without medication) was 80.0%. CONCLUSION: It appears that 180 degrees goniosynechialysis followed by diode laser peripheral iridoplasty is an effective and safe surgical procedure for treating chronic angle-closure glaucoma with total synechial angle closure.     

晶状体超声乳化吸除及人工晶状体植入术对闭角型青光眼眼压及前房深度的影响

目的评价品状体超声乳化吸除及后房型折叠式人工晶状体植入术或联合小梁切除术，治疗合并有自内障的闭角型青光眼，观察其术后眼压、前房深度及视力等的变化。方法回顾分析27例（30只眼）闭角型青光眼合并白内障患者。经综合降眼压治疗3～4d，眼压低于25mmHg者21只眼，即行巩膜隧道切口晶状体超声乳化吸除及后房型折叠式人工晶状体植入术，眼压高于25mmHg者9只眼，即行巩膜隧道切口晶状体超声乳化吸除及后房型折叠式人工晶状体植入联合抗代谢药物及小梁切除术。随访3—6个月。结果所有患者术中、术后没有出现严重的并发症，术后视力均有提高，术后眼压都得到控制。平均眼压由术前的20．28mmHg降至11．07mmHg；中央前房深度由术前的2．14mm加深到3．43mm。术后眼压、中央前房深度与术前相比均有显著性差异。术后前房角开放均≥180°。结论晶状体超声乳化吸除及后房型折叠式人工晶状体植入术或联合小梁切除术，是治疗合并有白内障的闭角型青光眼的有效方法。