白内障超声乳化人工晶体植入联合房角分离术治疗闭角型青光眼合并白内障的临床效果观察

目的分析探讨白内障超声乳化人工晶体植入联合房角分离术治疗闭角型青光眼合并白内障的临床效果。方法随机从我院2013年2月～2017年8月期间收治的闭角型青光眼合并白内障患者中,抽取80例进行讨论,回顾分析其病历资料,依据其治疗方式分为两组,对照组40例接受白内障超声乳化人工晶体植入治疗,研究组40例接受白内障超声乳化人工晶体植入联合房角分离术治疗,观察两组患者治疗效果,并比较。结果比较两组患者最佳矫正视力状况,术前无明显差异(P0.05),术后,0.1～0.5所占比率无明显差异(P0.05)。研究组0.1所占比率5%低于对照组15%,0.5所占比率72.50%高于对照组52.50%(P0.05)。比较两组患者眼压、前房角宽度、前房深度,术前无明显差异(P0.05),术后,研究组眼压低于对照组,前房角宽度和前房深度高于对照组(P0.05)。研究组并发症总发生率7.50%低于对照组10.00%,但差异无统计学意义(P0.05)。结论建议临床治疗闭角型青光眼合并白内障疾病采用白内障超声乳化人工晶体植入联合房角分离术,高效且安全,可将其列入到首选方式中进行选择。     

A temperature-induced and shear-reversible assembly of latanoprost-loaded amphiphilic chitosan colloids: Characterization and in vivo glaucoma treatment

Hydrogels composed of assembled colloids is a material class that is currently receiving much interest and shows great promise for use in biomedical applications. This emerging material class presents unique properties derived from the combination of nanosized domains in the form of colloidal particles with a continuous gel network and an interspersed liquid phase. Here we developed an amphiphilic chitosan-based, thermogelling, shear-reversible colloidal gel system for improved glaucoma treatment and addressed how preparation procedures and loading with the anti-glaucoma drug latanoprost and commonly used preservative benzalkonium chloride influenced the mechanical properties of and drug release from the colloidal gels. The results highlight that incorporated substances and preparation procedures have effects both on mechanical properties and drug release, but that the release of drug loaded in the colloidal carriers is mainly limited by transport out of the carriers, rather than by diffusion within the gel. The developed colloidal chitosan based gels hold outstanding biomedical potential, as confirmed by the ease of preparation and administration, low cytotoxicity in MTT assay, excellent biocompatibility and lowering of intraocular pressure for 40 days in a rabbit glaucoma model. The findings clearly justify further investigations towards clinical use in the treatment of glaucoma. Furthermore, the use of this shear-reversible colloidal gel could easily be extended to localized treatment of a number of critical conditions, from chronic disorders to cancer, potentially resulting in a number of new therapeutics with improved clinical performance.     

Cese paradójico de un caso de síndrome de Charles Bonnet

Case report78-year-old male patient diagnosed with Charles Bonnet syndrome (CBS) showing secondary visual deficit toward end-stage glaucoma. He progressed to amaurosis, with an abrupt disappearance of hallucinations in parallel to the loss of residual vision.DiscussionThe paradoxical cessation of CBS occurs when the patient loses residual vision and progresses to amaurosis. The lack of stimulation, both in the corresponding retina and the cortex, lead to the disappearance of hallucinations because the desafferented and hyper-excited neurons lose the necessary stimulus that triggers CBS.     

个性化健康教育对原发性青光眼患者复诊率的影响

目的观察个性化健康教育对原发性青光眼患者复诊率的影响。方法将100例原发性青光眼患者按就诊次序分为对照组和观察组各50例。对照组采用常规护理,观察组在此基础上采取个性化健康教育,比较两组患者出院半年内的复诊率。结果两组患者复诊率比较,观察组优于对照组,差异有统计学意义(P0.01)。结论个性化健康教育增强了原发性青光眼患者的复诊意识,提高了复诊率,有利于及时发现病情变化,挽救视功能。     

Secondary glaucoma as initial manifestation of uveal melanoma

PurposeSecondary glaucoma can be induced by a variety of local ocular problems. Intraocular tumors may initially present as secondary glaucoma.Methods8 consecutive patients with secondary glaucoma were found to have uveal melanoma. Thorough examination included detailed history, fundus examination with scleral depression, B scan ultrasonography, and CT/MRI scanning techniques.ResultsA single case presented with spontaneous hyphema, two patients presented with secondary glaucoma, extraocular melanoma and metastases, a single case was found to have angle block by an iridociliary ring melanoma and 4 cases presented with neovascular glaucoma. Enucleation was necessary in all 8 cases.ConclusionsGeneral ophthalmologists should be aware of these rare initial manifestations of intraocular tumors as secondary glaucoma. Enucleation would be recommended in most cases of intraocular malignancy manifesting as secondary glaucoma. One should be extremely cautious in doing a penetrating surgery in such cases.     

A case report of a patient with Pfeiffer syndrome,an FGRF 2 mutation (Trp290Cys) and unique ocular anterior segment findings

Purpose:?To report a case of a child with Pfeiffer syndrome, unique ocular anterior segment findings and a mutation in FGFR2 (Trp290Cys).

Methods:?Case Report.

Results:?We describe a patient with Pfeiffer syndrome with a unique constellation of ocular anterior segment anomalies including microcornea, limbal scleralization, corectopia and glaucoma. Genomic DNA extraction was heterozygous for a G to T mutation at nucleotide 870 of the fibroblast growth factor receptor 2 gene (FGFR2) which changes tryptophan (TGG) to cysteine (TGT) at amino acid position 290 (Trp290Cys).

Conclusion:?This case supports the association between Pfeiffer syndrome and severe ocular anterior segment anomalies, including glaucoma, and underscores the possible role that FGFR2 has in development of the anterior segment of the eye.     

Prevalence of Glaucoma in the Wroclaw Population. The Wroclaw Epidemiological Study

Purpose: Primarily to determine the prevalence of various types of glaucoma and ocular hypertension in Wroclaw inhabitants aged 40–79 years. The second aim of the study was to determine the number of undiagnosed glaucoma cases in this population. Methods: A representative group of the Wroclaw population (4853 people aged from 40 to 79 years) was recruited by a proportional simple random sampling selection with stratification. All participants underwent the first, screening-stage examination, which included a medical history interview, intraocular pressure (IOP) measurement, anterior chamber depth assessment by the Van Herrick technique, and optic nerve head (ONH) assessment by means of indirect ophthalmoscopy (Volk's lens), confocal scanning laser ophthalmoscopy with a Heidelberg Retinal Tomograph (HRT) and scanning laser polarimetry by the GDx Nerve Fiber Analyzer (GDx). The second stage, in glaucoma-suspect patients only, included best corrected visual acuity, static perimetry, 24-hour monitoring of IOP, gonioscopy, and full eye examination with mydriasis. Glaucoma was diagnosed by the presence of any two of the following: characteristic morphological changes in the optic disc, glaucomatous visual field abnormalities, and intraocular pressure greater than 21 mmHg. Results: The overall prevalence of glaucoma was 1.6% (79 subjects). The prevalence increased with age from 0.4% in subjects belonging to the age group 40–49 years to 4.6% in people aged between 70 and 79 years. The prevalence of definite primary open-angle glaucoma was 1.0% (49 subjects). Normal-pressure glaucoma was diagnosed in 13 subjects (0.3%). Ocular hypertension was diagnosed in 92 subjects (1.9%). Conclusion: The prevalence of the different types of glaucoma was similar to that found in other white populations. Among the subjects examined, 79 had various forms of glaucoma and 71% of them had not previously been diagnosed. Undiagnosed glaucoma is a serious public health problem in Poland.     

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.