青光眼房水引流装置的研究现状

青光眼房水引流装置(GDD)植入术是治疗难治性青光眼的有效方法之一.但滤过泡的纤维化一直是导致GDD植入术失败的主要原因,近年来有多数学者致力于从病理组织学角度解释纤维化形成的原因及纤维化对GDD植入术临床疗效的影响.抗代谢药物曾被认为可以抑制滤过泡的纤维化,但近年来的临床试验却对此观点提出了挑战.尽管GDD植入术能够有效地降低难治性青光眼的高眼压,但这种手术也存在较多严重的并发症,如眼内炎、角膜内皮失代偿、低眼压等.针对现有房水引流装置存在的问题,近年来出现了许多新型的引流物和手术方式.眼前节相干光断层扫描技术可以显示GDD植入术后引流管的形态和位置,对术后的治疗有指导意义.另外,新型材料和纳米技术在GDD植入术中的应用,将可能开创引流物植入手术的新时代.     

103例糖皮质激素性青光眼的临床研究

[目的]研究糖皮质激素性青光眼(GIG)的病因、临床特点、治疗及预防。[方法]对103例(有197只眼患病)GIG患者的发病原因、患者特点及治疗转归等进行综合性、回顾性分析。[结果]103例中,男性55例,女性48例,年龄4～74岁,均因免疫性结膜炎或其他眼部炎症而局部应用糖皮质激素(GC)眼液,同时全身应用者25例,平均用药时间:成人(8±1.67)d,小于18岁的青少年(16±11.22)个月。所有患者均为开角型青光眼。经治疗,眼压均控制于正常。[结论]不规范使用GC是发生GIG的主要原因,早诊断早治疗是防控该病的有效手段。     

Effect of 0. 2 % Brimonidine on Retinal Blood Flow

Purpose: To analyze the effect of 0. 2 % brimonidine eye drops on retinal blood flow ofpatients with glaucoma.Methods: Using self-control method and Heidelberg Retina Flowmeter (HRF), weexamined the volume, flow and velocity of the superior nasal and temporal, the inferiornasal and temporal artery of retina at baseline and 2 hours after single instillation of 0. 2% brimonidine.Results: There were no significant changes in volume, flow and velocity of four vesselsbefore and after the administration of 0. 2 % brimonidine.Conclusions: There are no significant ocular haemodynamic benefits associated withBrimonidine therapy to the glaucoma patients.     

Personalising surgical treatments for glaucoma patients

Surgical treatments for glaucoma have relied for decades on traditional filtering surgery such as trabeculectomy and, in more challenging cases, tubes. Antifibrotics were introduced to improve surgical success in patients at increased risk of failure but have been shown to be linked to a greater incidence of complications, some being potentially vision-threatening. As our understanding of glaucoma and its early diagnosis have improved, a more individualised management has been suggested. Recently the term “precision medicine” has emerged as a new concept of an individualised approach to disease management incorporating a wide range of individual data in the choice of therapeutic modalities. For glaucoma surgery, this involves evaluation of the right timing, individual risk factors, targeting the correct anatomical and functional outflow pathways and appropriate prevention of scarring. As a consequence, there is an obvious need for better knowledge of anatomical and functional pathways and for more individualised surgical approaches with new, less invasive and safer techniques allowing for earlier intervention. With the recent advent of minimally invasive glaucoma surgery (MIGS) a large number of novel devices have been introduced targeting potential new sites of the outflow pathway for lowering intraocular pressure (IOP). Their popularity is growing in view of the relative surgical simplicity and apparent lack of serious side effects. However, these new surgical techniques are still in an era of early experiences, short follow-up and lack of evidence of their superiority in safety and cost-effectiveness over the traditional methods. Each year several new devices are introduced while others are withdrawn from the market.Glaucoma continues to be the primary cause of irreversible blindness worldwide and access to safe and efficacious treatment is a serious problem, particularly in the emerging world where the burden of glaucoma-related blindness is important and concerning. Early diagnosis, individualised treatment and, very importantly, safe surgical management should be the hallmarks of glaucoma treatment. However, there is still need for a better understanding of the disease, its onset and progression, the functional and structural elements of the outflow pathways in relation to the new devices as well as their long-term IOP-lowering efficacy and safety. This review discusses current knowledge and the future need for personalised glaucoma surgery.     

Prevalencia y factores de riesgo para desarrollar hipertensión ocular y glaucoma posterior a queratoplastia penetrante

ObjectiveTo determine the prevalence and factors associated with the development of ocular hypertension and glaucoma, in patients undergoing penetrating keratoplasty, in the Eye Clinic of the city of Bogotá.MethodA retrospective cross-sectional study was conducted, and 130 eyes of patients undergoing penetrating keratoplasty were analyzed at the Eye Clinic in Bogotá, between January 2015 and August 2018. Demographic and clinical data were obtained, and it was determined by bivariate analysis, the association factors and the prevalence of the pathology under study.ResultsPrevalence of ocular hypertension was 27.69% and glaucoma 10%. Average age 48.93 ± 18.63 years; higher frequency of presentation in men (61.5%). Statistically significant association factors were male sex (PR 2.59), presence of peripheral anterior synechiae (PR 1.83), history of trauma (PR 2.16), prior PK (PR 2.10) and graft failure (PR 2.04). Post-KP glaucoma only had statistically significant association with bullous keratopathy (PR 2.76).ConclusionsOcular hypertension and glaucoma had a high prevalence after penetrating keratoplasty, and the association factors were similar to those reported in other international studies. Knowing these factors, allows focusing surveillance and treatment in these patients to avoid blindness due to damage of the optic nerve or corneal graft.     

Hematoma endocapsular: complicación inusual tras facoemulsificación y esclerectomía profunda no perforante

Case reportA 68-year-old male with a cataract and uncontrolled primary open angle glaucoma with maximal tolerated medication underwent non-penetrating deep sclerectomy combined with phacoemulsification surgery in right eye. There were no complications during the procedure, but shortly after the surgery, he lost visual acuity after a Valsalva manoeuvre due to an endocapsular haematoma. Neodymium:YAG laser posterior capsulotomy was performed for the treatment of an unresolving endocapsular haemorrhage at the third month of the follow-up, with immediate visual improvement and optimal control of intraocular pressure.DiscussionTo the best of our knowledge, this is the first reported case of endocapsular haematoma as a complication of non-penetrating glaucoma surgery that has been successfully solved by a YAG capsulotomy.