干预护理在老年白内障合并青光眼患者手术中的应用效果

目的：探讨干预护理在老年白内障合并青光眼患者手术中的应用效果。方法选取2013年1月~2014年1月本院眼科收治的100例白内障合并青光眼患者作为研究对象,随机分为对照组和观察组。对照组采用常规护理,观察组采用干预护理方法进行护理,比较两组的术后焦虑、抑郁、疼痛评分,并发症发生率及护理满意度。结果观察组的焦虑、抑郁、疼痛评分及术后并发症发生率显著低于对照组,差异有统计学意义(P<0.05)。观察组的护理满意度显著高于对照组,差异有统计学意义(P<0.05)。结论干预护理在老年白内障合并青光眼患者手术中的应用效果显著,可减少患者的不良情绪,降低术后并发症发生率,提高护理满意度,值得临床推广应用。     

激光治疗闭角型青光眼日间病房管理模式的探讨

日间病房是一种以病人为中心,介于门诊与住院之间的诊疗模式,是对传统医疗模式的补充,具有提高床位周转率、缩短住院天数、降低费用、缓解医患矛盾等优点,其发展具有广阔前景。首都医科大学宣武医院眼科为适应医疗服务发展需要,开设了激光治疗青光眼日间病房,为医院取得了良好的社会效益和经济效益。     

Biomechanics of Schlemm's canal endothelium and intraocular pressure reduction

Ocular hypertension in glaucoma develops due to age-related cellular dysfunction in the conventional outflow tract, resulting in increased resistance to aqueous humor outflow. Two cell types, trabecular meshwork (TM) and Schlemm's canal (SC) endothelia, interact in the juxtacanalicular tissue (JCT) region of the conventional outflow tract to regulate outflow resistance. Unlike endothelial cells lining the systemic vasculature, endothelial cells lining the inner wall of SC support a transcellular pressure gradient in the basal to apical direction, thus acting to push the cells off their basal lamina. The resulting biomechanical strain in SC cells is quite large and is likely to be an important determinant of endothelial barrier function, outflow resistance and intraocular pressure. This review summarizes recent work demonstrating how biomechanical properties of SC cells impact glaucoma. SC cells are highly contractile, and such contraction greatly increases cell stiffness. Elevated cell stiffness in glaucoma may reduce the strain experienced by SC cells, decrease the propensity of SC cells to form pores, and thus impair the egress of aqueous humor from the eye. Furthermore, SC cells are sensitive to the stiffness of their local mechanical microenvironment, altering their own cell stiffness and modulating gene expression in response. Significantly, glaucomatous SC cells appear to be hyper-responsive to substrate stiffness. Thus, evidence suggests that targeting the material properties of SC cells will have therapeutic benefits for lowering intraocular pressure in glaucoma.     

Retinal microglia: Just bystander or target for therapy?

Resident microglial cells can be regarded as the immunological watchdogs of the brain and the retina. They are active sensors of their neuronal microenvironment and rapidly respond to various insults with a morphological and functional transformation into reactive phagocytes. There is strong evidence from animal models and in situ analyses of human tissue that microglial reactivity is a common hallmark of various retinal degenerative and inflammatory diseases. These include rare hereditary retinopathies such as retinitis pigmentosa and X-linked juvenile retinoschisis but also comprise more common multifactorial retinal diseases such as age-related macular degeneration, diabetic retinopathy, glaucoma, and uveitis as well as neurological disorders with ocular manifestation. In this review, we describe how microglial function is kept in balance under normal conditions by cross-talk with other retinal cells and summarize how microglia respond to different forms of retinal injury. In addition, we present the concept that microglia play a key role in local regulation of complement in the retina and specify aspects of microglial aging relevant for chronic inflammatory processes in the retina. We conclude that this resident immune cell of the retina cannot be simply regarded as bystander of disease but may instead be a potential therapeutic target to be modulated in the treatment of degenerative and inflammatory diseases of the retina.     

Ahmed青光眼阀植入术后并发症分析及处理

目的探讨不同类型的青光眼采用Ahmed青光眼阀植入术后出现并发症的处理。方法分析23例(26只眼)Ahmed青光眼阀植入术失败的原因,并对其处理措施及疗效进行回顾性分析,术后随访36个月。结果23例(26只眼)Ahmed青光眼阀植入眼压由术前平均(31.84±7.10)mm Hg(8.01~47.03 mm Hg)。术后降至(19.86±7.10)mm Hg(8.01~31.03 mm Hg)。其早期并发症有浅前房、低眼压的9只眼,占34.62%;早期高眼压的7只眼,占26.92%;迟发性脉络膜上腔出血3只眼,占11.54%;因引流盘纤维包裹引起术后中远期高眼压19只眼,占73.08%;引流物蚀出或引流管暴露的4只眼,占15.38%;眶上神经痛1只眼,占3.85%;排异反应1只眼,占3.85%。结论青光眼房水引流管植入术后并发症是不容忽视的,应据情况及时处理。     

Incidence,efficacy and safety of YAG laser goniopuncture following nonpenetrating deep sclerectomy at a university hospital in Riyadh,Saudi Arabia

Purpose

Assessing the frequency and evaluating the efficacy and safety of Neodymium:Yttrium Aluminum Garnet (Nd:YAG) Laser goniopuncture (LGP) following nonpenetrating deep sclerectomy (NPDS).

Design

Retrospective cohort study.

Patients and methods

We retrospectively reviewed the outcome of 197 eyes of 153 patients with open angle glaucoma who underwent either NPDS or NPDS combined with cataract extraction between January 2005 and September 2010 at King Abdulaziz University Hospital (KAUH). Both demographic and clinical data were retrieved and analysed.

Results

Goniopuncture (GP) was needed in 48 (24.4%) of the eyes which had NPDS or NPDS with cataract extraction after a mean post operative interval of 9.78 (±11.16) months. The mean IOP had significantly decreased from 23.3 (±5.9) mmHg prior to Nd:YAG LGP procedure to 14.6 (±4.4) mmHg at the last post-procedure assessment. At the last follow-up; Nd:YAG LGP was successful in controlling IOP in 27 eyes (56.3%). Mean Nd:YAG LGP failure time was 6.04 (±5.80) months. Young age (<50 years) (p = 0.001); type of glaucoma (secondary versus primary open angle, p = 0.0258) and the use of drainage implant (p = 0.038) were the identified predicting factors for the need of Nd:YAG LGP. Complications following Nd:YAG LGP occurred in 5 eyes (iris touch to TDM (4.2%), Hyphema (2.1%), hypotony maculopathy (2.1%) and choroidal detachment (2.1%).

Conclusions

LGP is an efficient IOP lowering procedure after NPDS, when it is indicated. It is a simple and noninvasive procedure. However, certain precautions should be taken to avoid complications.     

可疑青光眼患者视野指数与眼底血管变化的关系

目的探讨可疑青光眼者眼底血氧饱和度的基本特征及其与视野指数的关系。方法采用横断面研究设计,对可疑青光眼者及正常对照者应用视网膜血氧饱和度测量仪测量眼底血氧饱和度,同时进行中心30°阈值视野检测;统计分析平均视网膜光敏感度（ MS）、平均视野缺损度（MD）及丢失方差（LV）三个视野指数,以及视网膜血氧饱和度,并进行相关分析。结果可疑青光眼者与正常者MD存在统计学差异（P ＜0．05）;可疑青光眼者平均视网膜动脉血氧饱和度及视网膜鼻下支动脉血氧饱和度与正常者比较存在统计学差异（P ＜0．05）;可疑青光眼者视野检测的MD与NIA存在相关性,（r ＝0．368,P ＝0．045）。结论可疑青光眼者眼底血管可能发生了相应的变化,视网膜血氧饱和度状况与视野指数间存在一定联系。     

Terminology of Peters’ anomaly variants: Summary of histopathological findings in 6 corneas and detailed clinicopathological correlation in 2 cases

Peters’ anomaly accounts for the highest type of Anterior Segment Dysgenesis (ASD). The main features of Peters’ anomaly are: congenital corneal opacity centrally, defect in the posterior stroma and absence of Descemet’s membrane and the endothelium. However, this condition has wide clinical and histopathological variations in appearance, associations and severity. In this case series, we summarize 6 corneas in 5 Saudi cases of Peters’ anomaly (and describe 2 in detail) with unique histopathological findings that are additional to the typical known ones, shedding some light on the nomenclature of these variants according to the reported cases in the English-written literature. This will widen the spectrum of findings known to ophthalmic pathologists and ophthalmologists about this anomaly. This is also of importance in the assessment of the congenital glaucoma cases commonly seen in Saudi Arabia that often happens in association with ASD.     

Combined cilioretinal artery and hemi-retinal vein occlusion in Sturge Weber syndrome: Expanding the clinical spectrum

A 9-year-old boy with the diagnosis of Sturge-Weber Syndrome, and port-wine stain involving the right side of the face, presented with acute visual loss of the right eye. Examination revealed a high intraocular pressure and a combined cilioretinal artery and inferior hemi-retinal vein occlusion in the right eye. Systemic work-up was negative. After controlling the intraocular pressure, gradual improvement of vision was noticed with simultaneous disappearance of signs of vascular occlusion.