疑似青光眼患者24h眼压变化规律

目的：分析疑似青光眼患者24h眼压的变化规律。

方法：收集疑似青光眼患者48例96眼,使用Accupen手持眼压计(24-3000)和NCT非接触眼压计(CT-80)测量24h眼压,自7：30开始,每2h测一次眼压,共12次,其中7：30～21：30测量坐位眼压,23：30～5：30测量坐位及卧位眼压。

结果：两种眼压计测量的传统体位下24h眼压峰值均出现在7：30,非接触眼压计测得的结果为22.05±3.608mmHg,手持式眼压计测得的结果为19.79±4.147mmHg。手持眼压计测得习惯性体位下眼内压峰值出现在5：30,平均21.64±4.814mmHg,且两种体位24h眼内压谷值均出现在21：30,谷值眼内压平均值为15.73±3.649mmHg。两种体位均呈夜间眼压逐渐升高,白天眼压逐渐下降的趋势。

结论：疑似青光眼患者眼内压峰值多出现在清晨,夜间卧位眼压值较坐位眼压值高。     

Myocilin mt.1 gene promoter single nucleotide polymorphism (-1000C>G) in Brazilian patients with primary open angle glaucoma

Background: The myocilin (MYOC) gene promoter polymorphism -1000C>G (MYOC mt.1) can be associated with faster progression of primary open angle glaucoma (POAG). The purpose of this study was to investigate the MYOC mt.1 in Brazilian patients with POAG and to evaluate its possible role on the phenotype and the severity of the disease.

Material and methods: One hundred sixty-seven POAG patients and 130 normal controls were enrolled. DNA samples were prepared and the MYOC mt.1 polymorphism was screened by real-time polymerase chain reaction (RT – PCR) in an Single-nucleotide polymorphism (SNP) assay. Frequencies of the MYOC mt.1 promoter polymorphism were determined for both groups and compared by Fisher’s exact test and Chi-square test with Yate’s correction. Intraocular pressure (IOP), cup-to-disc ratio (C/D), number of glaucoma medications, and number of glaucoma surgeries were compared between MYOC mt.1 carriers and non-carriers.

Results: MYOC mt.1 genotype frequencies did not differ between POAG and controls (P = 0.420); 14.6% of controls and 16.4% of POAG patients were MYOC mt.1 carriers (CG or GG). Frequencies of the G allele were similar between glaucomatous patients and controls (7.3% and 9.2%, respectively; P = 0.477). Among POAG patients, there were no differences in mean C/D ratio, IOP, number of glaucoma medications, and surgical procedures for IOP control between carries and non-carriers of the MYOC mt.1 promoter polymorphism (p>0.05).

Conclusion: The G allele of the MYOC mt.1 promoter polymorphism was equally distributed among POAG patients and healthy subjects and it is possibly unrelated to the risk and severity of disease in the Brazilian population.     

Association of life-style with intraocular pressure in middle-aged and older Japanese residents

PURPOSE: To evaluate the associations of several life-style-related factors with intraocular pressure (IOP). METHODS: Of a total of 649 men and women who had been examined in an annual health check-up being conducted by a general hospital in Ibaraki prefecture, Japan, 569 individuals (age range, 29-79 years) who had not undergone any medical treatment for hypertension, ocular hypertension, or glaucoma, were selected as the subjects of this study. The associations of several life-style-related factors with the IOP were evaluated by multiple regression analyses and analyses of covariance. RESULTS: Body mass index (BMI), alcohol consumption score, and cigarette consumption were found to have a significantly positive association with the IOP in men (P for trend =.002, <.001, and <.001, respectively). In women also, the BMI was positively related to the IOP (P for trend =.071). In respect to the effects of coffee consumption, it was shown that in men the mean IOP adjusted for age, the BMI, alcohol intake score, cigarette consumption, and blood pressure were significantly lower in habitual coffee drinkers than in coffee abstainers (P =.016). CONCLUSION: The results of this study suggest that the IOP level may be substantially affected by daily life-style among Japanese.     

Asymmetry of diurnal intraocular pressure fluctuation between right and left eyes

Purpose: To evaluate diurnal curves of intraocular pressure (IOP) in the right and left eyes of non‐glaucomatous patients. Methods: We measured IOP during waking hours and in habitual positions in 102 non‐glaucomatous patients every 2 hr between 09.00 hr and 23.00 hr using a Goldman applanation tonometer. Individual factors and biometries were measured and associated with diurnal IOP variations. Results: There was no significant difference in IOP variation between the right and left eyes over eight time‐points (repeated measure anova , P = 0.995). The mean coefficient of IOP in the right and left eyes at the eight time‐points ranged from 0.806 to 0.887. Forty‐one (40.2%), 15 (14.7%) and five (4.9%) patients showed at least one asymmetrical IOP variation over seven time intervals at the cut‐off value ≥ 2, ≥ 3 and > 3 mmHg, respectively. Mean incidence of asymmetrical IOP variation was 10.9 ± 1.6% at ≥ 2 mmHg, 2.9 ± 0.8% at ≥ 3 mmHg and 0.8 ± 0.4% at > 3 mmHg. Age, differences in anterior chamber depth, lens thickness and axial length showed several significant associations with the incidence of asymmetrical IOP variation. Conclusion: Diurnal variation of IOP showed asymmetry between right and left eyes in patients without glaucoma. Ageing and differences in local ocular factors between bilateral eyes may affect the incidence of asymmetrical IOP variation.     

Relationship between intraocular pressure and systemic health parameters in a Korean population

Purpose: This study aimed to evaluate the relationship between intraocular pressure (IOP) and age and obesity, adjusted for systemic health parameters such as sex and mean blood pressure, in a Korean population. Methods: A total of 13 212 healthy participants underwent automated multiphasic tests, including tonometry, automated perimetry, fundus photography, blood pressure and body mass index (BMI). Six age groups were used, divided by decades ranging from 20?29 years to 70+ years. The association between IOP and systemic health para­meters was examined using cross‐sectional analysis. Results: The median age of participants was 47.6 years (range 20?84 years), and 6684 (50.6%) of participants were men. The mean IOP of participants was 15.5 mmHg. The mean IOP, blood pressure and BMI values were significantly higher in men than in women (P < 0.05). The overall prevalence of ocular hypertension, defined as IOP >21 mmHg without signs of glaucomatous visual field loss or optic disc damage, was 6.1% in men and 2.5% in women. Intraocular pressure was associated with mean blood pressure, sex, age and BMI by multiple regression analysis (P < 0.05). The relationship between IOP and age adjusted for sex, mean blood pressure and BMI had a significantly negative tendency for both sexes (P < 0.05). Body mass index had a significantly positive relation with IOP after controlling for age, sex and mean blood pressure in men (P < 0.05), but not in women. Conclusions: In this Korean population, after multiple adjust­ment, IOP was found to decrease with age and to increase with BMI in men.     

POAG患者习惯性体位眼压及眼灌注压昼夜波动趋势的研究

目的：探讨初诊未行治疗的原发性开角型青光眼( prilary open angle glaucola,POAG)患者习惯性体位眼压及眼灌注压(ocular perfusion pressure,OPP)波动趋势,并验证由日间平均坐位及卧位眼压推导夜间峰值眼压的可行性。
　　方法：选取POAG患者19例19眼及正常对照组18例18眼,分别于10：00,14：00,18：00及22：00时行坐位眼压及血压监测,为验证由日间卧位眼压推导夜间峰值眼压的可行性,另对POAG组于卧位5 lin后再行监测。2：00,5：00及7：00行卧位监测,计算出OPP并行数据分析。由已知公式通过日间眼压计算夜间峰值眼压,并与实际值对比。
　　结果：24h习惯性体位下,POAG患者平均眼压及眼压波动均高于正常对照组(P<0.05),POAG组平均眼压峰值出现于凌晨5：00,对照组则为7：00。两组夜间眼压均值均大于日间,差异有统计学意义(P<0.05)。两组内习惯性体位平均眼灌注压( MOPP )均表现为夜间低于日间( P<0.05),而两组间 MOPP 无明显统计学差异( P>0.05)。POAG患者MOPP波动较对照组大,差异有统计学意义( P<0.05)。由两公式推导所得夜间眼压峰值均与所测值无明显统计学差异(P>0.05)。
　　结论：习惯性体位下POAG组及正常人的眼压峰值多出现在凌晨至上午,POAG患者的习惯性体位平均眼压及眼压波动均高于对照组。两组内夜间灌注压均较日间低,且POAG患者有更大的MOPP波动。由日间眼压推导夜间峰值眼压具有一定的可行性。     

沈阳市眼健康筛查人群眼压分布

目的：分析沈阳地区30岁及以上眼健康筛查人群眼压的分布特征。方法：横断面调查研究。收集 2016年3─9月在沈阳市第四人民医院健康体检中心预约进行体检的30岁及以上的本地城市居民， 按登记的居住地所属辖区分布，进行分层随机抽样。所有被纳入者在全身健康体检时增加生活视 力、眼压和免散瞳眼底照相检查。眼压测量采用非接触眼压计，测量3次取平均值。眼压>21 mmHg （1 mmHg=0.133 kPa）且不伴有眼底异常者定义为可疑高眼压征。眼底照相存在2项及以上青光眼性 视神经改变者定义为可疑青光眼。采用t检验和方差分析比较不同性别和年龄人群眼压分布的差异。 结果：共纳入15 303例，最终12 374例被检者的数据用于结果分析，包括11 296例（91.3%）眼部健康者、 801例（6.5%）可疑高眼压征和277例（2.2%）可疑青光眼。健康组被检者年龄为（50±13）岁，双眼平均眼压为（16.2±2.2）mmHg，左眼眼压（16.3±2.3）mmHg，高于右眼的（16.0±2.3）mmHg（t=-19.813， P<0.001）；女性眼压为（16.1±2.3）mmHg，高于男性的（15.9±2.3）mmHg（t=-3.264，P=0.001）；眼压随年龄增加呈下降趋势（F=29.729，P<0.001）。可疑高眼压征人群年龄为（49±13）岁，右眼眼压 为（21.7±2.3）mmHg，性别及年龄对眼压分布无显著影响。可疑青光眼人群年龄为（56±13）岁，右眼眼压为（18.0±4.0）mmHg，显著高于健康组的眼压，且低于可疑高眼压征（F=2300，P<0.001）。 可疑青光眼人群中单眼或双眼眼压>21 mmHg者仅为16.6%，不同性别和年龄在个体间的眼压水平差异无统计学意义。结论：沈阳地区成年健康人群的眼压随年龄增加而降低，女性眼压高于男性。 单纯眼压测量在青光眼筛查中的诊断价值有限，建议联合眼底照相，以提高特异性和准确性。     

Relationship between age and intraocular pressure: the Blue Mountains Eye Study

This study aimed to assess the influence of age on intraocular pressure(IOP) in a general population. The Blue Mountains Eye Study assessed 3654 residents aged 49+ years during 1992-1994. Intraocular pressure was measured using Goldmann applanation tonometry. Subjects with glaucoma, those currently on glaucoma medications and those with a history of cataract surgery were excluded. The IOP was reliably measured in 3260 subjects. Mean IOP was 16.0 mmHg with no significant difference found between men and women (P < 0.89). In univariate analyses, age was positively associated with IOP (P < 0.05). Systolic blood pressure (SBP) was strongly positively associated with IOP (P < 0.001). After adjusting for SBP, there was a trend for IOP to decrease with increasing age(P < 0.051). After further adjusting for other potential confounders (diabetes, glaucoma family history and myopia), age was no longer significantly associated with intraocular pressure (P < 0.29). In summary,no evidence was found of an independent age affect on IOP.     

国产与进口拉坦前列素滴眼液降眼压作用的短期效果比较

目的 比较国产与进口拉坦前列素滴眼液的短期降眼压效果。设计 随机、开放、平行对照的临床研究。 研究对象  原发性开角型青光眼患者和高眼压症患者42例。方法 对上述患者按所用药物的不同依随机表法分为A、B两组。A组28例（28眼）,滴用国产拉坦前列素滴眼液（特力洁）,B组14例（14眼）,滴用进口拉坦前列素滴眼液（适利达）,均为每日1次,每次1滴,共28天。受试者于入组当日及用药后第28天8:00、11:00、14:00、16:00测眼压,第7、14、21天则于8:00测眼压。眼压测量采用Goldmann压平眼压计,测量3次取平均值。裂隙灯显微镜观察角膜、虹膜、晶状体情况。主要指标  眼压值。结果 A组用药前眼压为（23.99±1.51）mm Hg, 用药后1～4周眼压分别为（18.04±1.27）mm Hg、（17.75±1.43）mm Hg、（17.63±1.50）mm Hg、（17.49±1.47）mm Hg,用药后眼压明显下降,与用药前相比差异有统计学意义（F=105.72,P=0.000）。B组用药前眼压为（24.37±1.55）mm Hg,用药后1～4周眼压分别为（17.91±1.35）mm Hg、（17.71±1.39）mm Hg、（17.55±1.34）mm Hg、（17.44±1.17）mm Hg,与用药前相比,用药后眼压明显下降,差异有统计学意义（F=67.85 P=0.000）。A、B两组用药前眼压比较无显著性差异（P=0.43）,用药后1～4周两组眼压比较无显著性差异（P值分别为0.76、0.93、0.86、0.89）。入组当日8:00、11:00、14:00、16:00  A、B两组眼压之间的比较无显著性差异（P值分别为0.46、0.44、0.50、0.31）,用药后28天8:00、11:00、14:00、16:00  A、B两组眼压之间的比较无显著性差异（P值分别为0.89、0.85、0.94、0.98）。用药28天时两组患者角膜、虹膜、晶状体均无异常改变。结论  本文的小样本、短期研究显示,国产拉坦前列素与进口拉坦前列素均能有效降低原发性开角型青光眼及高眼压症患者的眼压,两者之间的降眼压效果无显著差异。（眼科, 2012, 21: 111-114）     

Genetic polymorphisms in the angiotensin II receptor gene and their association with open-angle glaucoma in a Japanese population

PURPOSE: The local renin-angiotensin system (RAS) is present in the ciliary body and plays a role in regulating aqueous humor dynamics and thus intraocular pressure (IOP). The purpose of this study was to determine whether gene polymorphisms in the RAS increase the risk of development of glaucoma in the Japanese. METHODS: A case-control study was performed in 698 Japanese subjects: 190 patients with primary open-angle glaucoma (POAG), 268 patients with normal-tension glaucoma (NTG), and 240 normal subjects. Ten polymorphisms in seven genes-AGT/Thr174Met and AGT/Met235Thr; REN/I8-83G-->A; ACE/insertion(I)-deletion(D); CMA/-1930A-->G; AGTR1/-731T-->G, AGTR1/-521C-->T, and AGTR1/1166A-->C; AGTR2/3123C-->A; and CYP11B2/-344T-->C were examined. The age, IOP, and visual field defects, all at diagnosis, were examined to determine whether they were associated with the polymorphisms. The effects of oral angiotensin II receptor blocker (ARB) on IOP were examined in association with the AGTR1 and AGTR2 polymorphisms in 20 normal subjects. RESULTS: Of the 10 polymorphisms, the AGTR2/3123C-->A polymorphisms had a significantly different distribution in female patients with NTG; the frequency of the CA+AA genotypes was significantly higher than in female control subjects (P = 0.0095 for CC versus CA+AA). Although no significant difference was seen in the clinical characteristics of female patients with NTG who carried the AGTR2/3123C-->A genotype, patients with CC in the AGTR2 gene had significantly worse visual field scores if they carried ACE/ID+DD (i.e., D carriers; P = 0.012). ARB significantly lowered IOP in normal subjects, but the male subjects with the AGTR2/3123A genotype had significantly less lowering of IOP than those with the C genotype (P = 0.014). CONCLUSIONS: Angiotensin II receptor gene polymorphisms may be associated with the risk of glaucoma in the Japanese population.