中国人群渗出性年龄相关性黄斑变性与线粒体基因A4917G多态性的相关性分析

目的研究线粒体基因A4917G多态性改变与中国人群渗出性年龄相关性黄斑变性（AMD）的相关性,寻找中国人群渗出性AMD发病的易感基因。设计病例对照研究。研究对象来自北京同仁医院的渗出性AMD患者158例和健康对照者117例。方法应用聚合酶链反应（PCR）并结合限制性内切酶酶切分析和DNA序列测定方法对线粒体基因A4917G多态性改变进行检测。主要指标线粒体基因A4917G多态性。结果AMD患者组与对照组比较,两组间年龄（P=10．614）与性N（P=0．427）差异无统计学意义。AMD患者及对照人群线粒体基因4917位点的碱基全部为A,两组中均未见变异型4917G。在本研究人群中线粒体基因A4917G多态性改变与渗出性AMD不存在相关性。结论线粒体基因A4917G多态性在中国人中罕见,与中国人群渗出性AMD发病无明显相关性。     

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。     

同步监测青光眼患者24h眼压与血压的意义

青光眼是世界范围内致盲和引起视力损害的主要眼病,也是不可逆性致盲性眼病之一.眼压是青光眼发生发展的重要危险因素,但除眼压外,血压在青光眼进展引起的影响也不可忽视.眼灌注压是血压和眼压的差值,可调节视神经的血液供应.眼压、血压、灌注压在青光眼发生发展中有一定相关性.本文通过对眼压和血压在青光眼中的影响以及24 h眼压和血...     

中国陕西省农村人群血压、眼压和原发性开角型青光眼流行病学调查

目的：调查中国陕西省农村≥50岁人群原发性开角型青光眼、眼内压与全身血压的联系。 方法：2003-07／12，采用整体随机分层抽样法在陕西省洋县、靖边县及富平县调查8500人，其中≥50岁人群2125人，所有受检人员均进行标准问卷调查及详细的眼科检查，包括视力检查、裂隙灯检查、测量眼压及散瞳后直接检眼镜检查眼底。受检者于坐位测量血压。若有可疑青光眼性视盘损害或眼压高于22mmHg者则应进行视野检查。 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％。通过相关分析，发现此人群中眼压与全身性血压有显著相关性；眼压与收缩压均随年龄的增长而显著升高。通过多因素logistic回归分析，显示原发性开角型青光眼与低舒张期灌注压有显著联系，但未发现原发性开角型青光眼与高血压的显著联系。 结论：中国陕西省农村≥50岁人群中原发性开角型青光眼的患病率与中国其他报道相近。证实较低的舒张期灌注压是原发性开角型青光眼的一个重要危险因素。     

甲状腺相关眼病患者眼压与眶压的关系

目的了解甲状腺相关眼病(thyroidassociatedophthalmopathy,TAO)患者眶压与眼压的关系。方法对96例TAOII型患者进行眼球突出度、眶压及眼压测量,将结果及其他相关因素进行分析。结果96例129眼中34眼眼压≥30mmHg(1kPa=7.5mmHg)。高眼压者均有眶压升高。TAO发病早期眶压及眼压升高的发生率较高。结论TAO早期眶压升高可引起眼压升高,并引起视功能损害,眶内静脉系统回流受阻是眼压升高的重要因素,TAO早期眶压升高合并眼压升高时应以药物治疗为主,眼压不能控制时再行眶减压及抗青光眼手术。     

Change in appearance of the optic disc associated with lowering of intraocular pressure

This report provides additional documentation that the appearance of the optic disc may improve after intraocular pressure is lowered in patients with glaucoma. Photographic records of one of the authors (GLS) were reviewed retrospectively. Seven previously unreported cases showing apparent improvement of the optic disc were found, and the patients' charts were reviewed. In two cases the improvement was transient, and in five it was lasting. Patients with evidence of disc improvement had an age range of 5 to 55 years. In one case, the scleral ring decreased in size following the lowering of intraocular pressure. In the other cases, the disc appeared to "fill in" without change in the size of the scleral ring. When improvement is short-lived, it presumably represents edema. When of longer duration, it may be a response to anterior repositioning of a posteriorly displaced lamina cribrosa, a decrease in diameter of the scleral ring, hypertrophy and/or proliferation of glial cells, or return towards normal of axonal metabolism. Because apparent improvement in the appearance of the optic disc can be subtle, it is usually not sought and is probably often unrecognized. Its true incidence is still unknown but appears to be underestimated.     

青少年近视合并高眼压的静态阈值视野改变

目的：探讨合并高眼压青少年近视的静态视野改变的特点及其临床意义。方法：应用Octopus101型全自动视野计对45例(87只眼)青少年近视合并高眼压和36例(72只眼)正常眼压青少年近视进行定量视野测定，并分析其视野缺损形式及视野指数与眼压、屈光度的关系。结果：合并高眼压青少年近视的视野损害发生率明显高于正常眼压青少年近视。视野损害多表现为生理盲点扩大，特征性青光眼视野缺损。与正常眼压青少年近视有显著性差异。平均敏感皮MS值、平均缺损MD值、缺损变异LV值均与正常眼压青少年近视有显著性差异，且在正常眼压青少年近视组中，随着近视度数增加，MS值逐渐下降，MD及LV值逐渐升高。结论：高眼压是青少年近视人群中发展为青光眼性视野损害的一个重要因素。眼压应列为青少年近视的眼科常规检查项目。采用全自动视野计检测是早期发现青少年近视青光眼性视野损害的最敏感最有特异性的检查方法。     

沐欣滴眼液预防白内障超声乳化术后高眼压的临床观察

目的:评价沐欣滴眼液预防白内障超声乳化术后高眼压的临床效果。方法:对66例(66眼)因老年白内障在我院行白内障超声乳化 人工晶状体植入术的患者随机分成两组。试验组(33例),在术前1d和术前1h给予沐欣滴眼液1滴。对照组(33例)在术前1d和术前1h给予人工泪液1滴。记录术前眼压和术后4,6,12,24h眼压,观察心率、血压等全身和眼部并发症。结果:术后24h对照组平均眼压为(17.11±2.23mmHg),试验组为(13.50±1.65mmHg),术后每个时间点对照组平均眼压均高于试验组,差异有统计学意义。两组术后眼压最高峰均在术后6h左右。同术前眼压比较,术后高峰眼压(术后6h)试验组有19例(57%)眼压比术前更低,对照组有7例(21%)眼压比术前更低。结论:对行白内障超声乳化术 人工晶状体植入的患者,术前给予沐欣滴眼液,能有效预防术后高眼压。     

Additive effect of latanoprost and dorzolamide in patients with elevated intraocular pressure

Purpose : To evaluate the additive ocular hypotensive effect of latanoprost and dorzolamide in combination, on intraocular pressure reduction in patients with elevated intraocular pressure (IOP). Methods : Thirty patients with ocular hypertension or early capsular or primary open-angle glaucoma and elevated IOP were randomly assigned to two parallel treatment groups. The treatment period was twenty days. Fifteen patients (Group 1) received latanoprost once daily during the first ten days and, in addition, dorzolamide three times daily during the second ten days. Fifteen patients (Group 2) received dorzolamide three times daily during the first ten days and, in addition latanoprost, once daily during the second ten days. IOP was measured and conjunctival hyperemia was evaluated. Results : In Group 1, the mean IOP on day 0 was 26.8 mmHg; on day 10, 18.7 mmHg; and on day 20, 15.9 mmHg. In Group 2, the mean IOP on day 0 was 26.3 mmHg; on day 10, 21.2 mmHg; and on day 20, 16.1 mmHg. Both groups had clinically significant IOP- lowering effect on day 10 as compared with baseline day (30.2% and 19.4% respectively) (p < 0.01). When dorzolamide was added to latanoprost, the additional IOP reduction was 2.8 mmHg (15%) (p<0.01) compared with 5.1 mmHg (24.1%) (p<0.01when latanoprost was added to dorzolamide. No local serious adverse reactions were observed. A mild but statistically significant increase in conjunctival hyperemia was seen in latanoprost applied patients. Conclusions : The results showed that latanoprost and dorzolamide can be combined successfully to reduce IOP with their additive effects.     

Effect of mitomycin C on ciliary body and intraocular pressure with various application depths: an experimental study

BACKGROUND: To evaluate the effects of mitomycin C (MMC) on intraocular pressure (IOP) and ciliary body via transmission electron microscopy when applied under conjunctiva or different depths of sclera, without performing any filtering surgery. METHODS: Thirty-six eyes of 36 New Zealand albino rabbits were used in this study. MMC was prepared in a concentration of 0.4 mg/mL and 0.05 cc (20 microg) was soaked in preprepared sterile surgical sponges. Six groups each consisting of six eyes were formed and IOP was measured preoperatively. Group 1 was the control group: the superior conjunctiva was opened and only irrigated with balanced salt solution (BSS). In group 2, MMC soaked sponges were applied under the conjunctiva. In groups 3 and 4, a scleral flap of approximately 1/3 scleral thickness was prepared and in groups 5 and 6, and a scleral flap of approximately 2/3 scleral thickness was prepared, all with a standard size of 4 x 4 mm. MMC soaked sponges were applied under these areas for 5 min in eyes in groups 3 and 5 followed by an irrigation of the relevant areas with 10 cc BSS, whereas only irrigation with BSS was done in groups 4 and 6 as control groups. No filtering procedure was performed in any of the eyes. Eyes were enucleated on the 30th day following measurement of IOP and the ciliary body regions were evaluated using transmission electron microscopy. Kruskal-Wallis test was used for the statistical assessment of IOP between groups. RESULTS: The deep scleral flap group (group 5) showed statistically significantly more IOP reduction than both the superficial scleral flap group (group 3; P = 0.004) and the subconjunctival group (group 2; P = 0.002) on postoperative day 30. Electron microscopic evaluation of the surgical groups revealed a wide range of different histopathological effects due to different MMC application methods. The histopathological changes were more evident in the group 5, where MMC was applied under deep scleral flap. CONCLUSIONS: Subscleral application of MMC seems to provide greater IOP decrease than subconjunctival application, possibly caused by a more significant ciliary body toxicity. This may be the beginning of a non-penetrating, easy to perform and safe method to decrease IOP in glaucoma patients, which the authors call 'toxic ciliary ablation surgery'. However, the long-term results and complications must be assessed with further studies.     

Factors associated with topographic changes of the optic nerve head induced by acute intraocular pressure reduction in glaucoma patients

Purpose

To investigate factors associated with changes in optic nerve head (ONH) topography after acute intraocular pressure (IOP) reduction in patients with primary open-angle glaucoma (POAG).

Methods

Untreated POAG patients (IOP >21 mm Hg) were prospectively enrolled. Systemic and ocular information were collected, including central corneal thickness (CCT) and corneal hysteresis (CH). All patients underwent confocal scanning laser ophthalmoscopy and tonometry (Goldmann) before and 1 h after pharmacological IOP reduction. The mean of three measurements was considered for analysis. Changes in each ONH topographic parameter were assessed (one eye was randomly selected), and those that changed significantly were correlated with patient''s systemic and ocular characteristics.

Results

A total of 42 patients were included (mean age, 66.7±11.8 years). After a mean IOP reduction of 47.3±11.9%, significant changes were observed in cup area and volume, and in rim area and volume (P<0.01), but not in mean cup depth (P=0.80). Multiple regression analysis (controlling for baseline IOP and magnitude of IOP reduction) showed that CH (r²=0.17, P<0.01) and diabetes diagnosis (r²⩾0.21, P<0.01) were negatively correlated with the magnitude of changes in ONH parameters, whereas the cup-to-disc ratio was positively correlated (r²=0.30, P<0.01). Age, race, disc area, and CCT were not significant (P⩾0.12). Including all significant factors in a multivariable model, only the presence of diabetes remained significantly associated with all ONH parameters evaluated (P<0.01).

Conclusions

Different systemic and ocular factors, such as diabetes, CH, and the relative size of the cup, seem to be associated with the magnitude of changes in ONH topography after acute IOP reduction in POAG patients. These associations partially explain the ONH changes observed in these patients and suggest that other factors are possibly implicated in an individual susceptibility to IOP.     

青少年近视患者视力与眼压及C/D比值的相关性研究

目的:探讨青少年单纯性近视眼视力与眼压及眼底杯盘比值(C/D)的关系。方法:对单纯性近视80例160眼,分别测量其裸眼视力,眼压及眼底C/D比值,对所得数据利用SPSS进行相关性分析,了解其相关性。取近视患者中18例36眼与正常视力者14例28眼,比较其裸眼视力,眼内压及眼底C/D比值之间的差异。结果:眼压与年龄呈正相关,相关系数r=0.286,与视力呈负相关,相关系数r=-3.485;与眼底C/D值之间没有相关性。近视眼组和正常视力组的组间视力和眼压均数的差异具有统计学意义(P<0.001;P<0.05)。两组间眼底C/D值之间均数差异无统计学意义(P>0.05)。结论:青少年单纯性近视的视力与眼压密切相关,提示眼压的升高在近视眼的发生发展中起到一定作用。     

前房穿刺放液术在青光眼高眼压持续状态中的应用

目的:探讨前房穿刺放液术治疗高眼压持续状态的疗效。方法:对36例高眼压持续状态的患者,其中急性闭角型青光眼急性发作期16例,慢性闭角型青光眼4例,新生血管性青光眼5例,外伤性前房出血性青光眼5例,年龄相关性白内障膨胀期2例,白内障术后高眼压4例。在应用常规降眼压药物治疗后仍不能有效降低眼压者,采用在裂隙灯显微镜前行前房穿刺术放液术。结果:所有患者经前房穿刺放液后眼压迅速降低,眼痛头痛缓解。并发症有前房出血5例,虹膜与穿刺口粘连2例,晶状体损伤1例。结论:前房穿刺术是治疗高眼压持续状态的简单有效的方法,可以避免长期大量使用全身降眼压药物的副作用,迅速缓解症状,减轻高眼压对视功能的损害。     

外路全周缝线小梁切开术对原发性开角型青光眼患者24 h眼压波动规律的影响

目的：评估外路全周缝线小梁切开术(CST)对原发性开角型青光眼(POAG)24 h眼压波动规律的影响。

方法：回顾性研究。纳入2021-03/2022-05在我院就诊的药物治疗眼压控制不佳的POAG患者18例18眼,均行CST治疗,分别在术前,术后1 a进行24 h眼压检查(选择时间点为9：00 AM、12：00 AM、3：00 PM、6：00 PM、9：00 PM、12：00 PM、3：00 AM、6：00 AM),比较术前,术后1 a 24 h眼压均值、峰值及峰值时间、谷值及谷值时间、波动范围及昼夜平均眼压差变化。

结果：术前,术后1 a 24 h眼压曲线均呈现日间下降、夜间升高的变化趋势,下午降至波谷,夜间升至波峰; 与术前相比,术后1 a 24 h眼压谷值、峰值时间较术前提前,术后1 a 24 h眼压均值、峰值、谷值明显下降,波动范围无明显差异,昼夜平均眼压差明显增加。

结论：CST可降低POAG患者眼压,但不改变 24 h眼压波动范围,反而升高昼夜平均眼压差,提示CST不能改善POAG患者昼夜眼压波动。     

前房穿刺联合黏弹剂在青光眼持续高眼压中的临床应用

目的:探讨前房穿刺联合黏弹剂在青光眼持续高眼压中应用的安全性和可行性。方法:对32例34眼眼压控制不良的青光眼患者进行了术前、术中前房穿刺,术中联合应用黏弹剂,观察术后视力和眼压,以及术中、术后并发症的情况。结果:所有病例手术过程顺利,无1例出现驱逐性脉络膜出血,1例前房出血经治疗后很快吸收,1例发生恶性青光眼转上级医院治疗。术后1mo视力较术前提高者18眼,占53%;视力不变者10眼,占29%;视力下降者6眼,占18%;术后1mo共30眼眼压控制理想,占88%,1眼发生恶性青光眼已转院,3眼眼压>21mmHg,经药物治疗、局部按摩,手术1mo后此3眼中有2眼眼压逐渐降至正常。结论:前房穿刺联合黏弹剂在青光眼持续高眼压中应用,可以减轻手术并发症,提高手术成功率。     

POAG和高眼压症患者24h眼压与饮水试验的临床特点和相关性分析

目的:总结原发性开角型青光眼(POAG)和高眼压症(OHT)患者24h眼压和饮水试验(WDT)的临床特点并分析其相关性。方法:收集2019-12/2022-03于深圳大学总医院眼科行24h眼压(每2h测量1次)和WDT(按1 000mL饮水量,5min内饮完,之后1h内每15min测量1次)的POAG和OHT患者87例174眼,共分为三组：高眼压性开角型青光眼(HTG组)33例66眼,正常眼压性青光眼(NTG组)28例56眼,OHT组26例52眼。总结三组患者24h眼压和WDT临床特点,并对各组眼压峰值、波动值进行Spearman相关分析。结果:三组患者临床特点：(1)24h眼压HTG组、NTG组、OHT组眼压峰值比例：凌晨(2∶00～6∶00):40.9%、23.2%、26.9%;上午(8∶00～12∶00):34.8%、46.4%、55.8%;下午(14∶00～18∶00):18.2%、21.4%、11.5%;夜间(20∶00～24∶00):6.1%、8.9%、5.8%。各组谷值比例：凌晨：21.2%、25.0%、30.8%;上午：22.7%、10.7%、13.5%;下午：19.7...     

Corneal biomechanical changes and intraocular pressure in patients with thyroid orbitopathy

AIM: To determine the relevance of the objective parameters addressing the altered biomechanical properties of cornea for glaucoma monitoring in patients with mild or moderate thyroid associated orbitopathy (TAO), and in healthy individuals. METHODS: Twenty-five patients with TAO (group 1) and 25 healthy adults (group 2) were included to the study. Both groups were of a similar age and the ratio women:man. For each patient, the following parameters of both eyes were measured with ocular response analyzer (ORA): corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann correlated intraocular pressure (IOPg) and corneal compensated intraocular pressure (IOPcc). In both groups participating in our study, all measurements were performed within minutes to reduce the diurnal effects. RESULTS: The mean age in group 1 was 56±11y and 76% were women, 24% were men. The mean age in group 2 was 64±11y and 68% were women, 32% were men. CH correlated negatively with IOPg in group 1 (r2=0.10, P<0.05). IOPg strongly correlated with IOPcc in both groups (group 1: r2=0.79, P<0.0001; group 2: r2=0.85, P<0.0001). There was positive correlation between CRF and IOPg in group 1 (r2=0.12, P<0.05) and in group 2 (r2=0.31, P<0.0001). Statistical analysis revealed no significant correlation between CRF and IOPcc in group 1 (r2=0.009, P>0.05) and also no significant correlation in group 2 (r2=0.04, P>0.05). CRF mean value in group 2 (11.51±1.72 mm Hg) was higher than in group 1 (10.85±1.45 mm Hg) (P<0.05). IOPg strongly correlated with IOPcc in both groups (group 1: r2=0.79, P<0.0001; group 2: r2=0.85, P<0.0001). There was also strong correlation between CRF and CH in both populations: group 1: (r2=0.58, P<0.0001), group 2: (r2=0.41, P<0.0001). CONCLUSION: Biomechanical parameters of cornea, as quantified by CH and CRF, and measured together with IOPcc, precisely reveal glaucoma staging in TAO and thus are reliable for diagnosing and follow-up in clinical practice.     

大杯盘比患者眼压和视野及电生理的分析研究

目的：分析研究大杯盘比( cup/disk, C/D)患者24h眼压、视野及电生理的变化情况。
　　方法：选择大C/D(C/D>0.3)患者120例240眼,并根据C/D大小将其分为两组：A组,0.3　　结果：对于24 h眼压,三组患者眼压均值比较无显著统计学差异(P>0.05),波动幅度比较有显著统计学差异(P<0.05);B组患者眼压波动幅度明显高于正常对照组,差异具有统计学意义(P<0.05)。对于静态阈值视野,三组患者平均偏差( mean deviation, MD)及图样标准差( pattern standard deviation, PSD )比较有显著统计学差异( P<0.05);两两比较,与正常对照组相比, B 组患者 MD 及PSD明显增加,差异具有统计学意义(P<0.05),而A组则无显著统计学差异(P>0.05);A,B 两组相比,B 组患者MD及 PSD 明显高于 A 组,差异具有统计学意义( P<0.05)。对于P-ERG检查,三组患者P50波潜伏期比较无显著统计学差异(P>0.05),波幅比较有显著统计学差异(P<0.05);两两比较,与正常对照组相比,B 组患者P50波振幅明显降低,差异具有统计学意义(P<0.05),而A组则无显著统计学差异(P>0.05);A,B两组相比,B组患者P50波振幅明显低于A组,差异具有统计学意义(P<0.05)。结论：当C/D≥0.6时,患者24h眼压监测、静态阈值视野检查及图形视网膜电流图P50波有明显改变。对于大杯盘比患者,仅行单次眼压检查是远远不够的,应予以详细视功能检查。同时,将C/D 0.6作为可疑青光眼的筛查标准是可行的。     

小檗胺对兔急性高眼压视网膜损伤保护作用的实验研究

目的探讨小檗胺(berbamine,BER)对急性高眼压下视网膜损伤的保护作用及其机制。方法 96只大耳白兔随机分6组:正常对照组,阴性对照组,阳性对照组(VER),BER A、B、C组,后5组建立兔缺血-再灌注损伤模型,术后分时段观察视网膜形态、厚度的变化,并测量视网膜细胞内Ca2+含量的变化。结果阳性对照组,BER A、B、C组视网膜早期水肿较轻,晚期视网膜内层厚度明显厚于阴性对照组,术后168h BER C组视网膜内层厚度为(104.82±0.87)μm、阳性对照组为(105.14±0.92)μm,与正常对照组(105.94±0.66)μm相比,差异均无统计学意义(均为P>0.05)。造模后0h视网膜细胞中Ca2+含量开始升高,随再灌注时间延长呈逐渐增高趋势。BER组随再灌注时间的延长及药物浓度的增加,细胞内Ca2+含量逐渐减少,至术后168h,BER C组Ca2+含量为(45.35±0.48)μg·g-1,与正常对照组(44.61±0.84)μg·g-1相比,差异无统计学意义(P>0.05)。结论视网膜细胞内Ca2+超载,参与了视网膜缺血-再灌注损伤,BER通过抑制Ca2+内流从而保护视网膜细胞,并呈浓度依赖性。