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。     

年龄小于45岁原发性慢性闭角型青光眼的显微手术治疗

目的探讨原发性慢性闭角型青光眼年轻患者临床治疗的经验和体会。方法对临床收治的41例52眼、年龄〈45岁、临床确诊为进展期或晚期原发性慢性闭角型青光眼的病例进行抗青光眼显微手术处理的病例进行回顾性分析。结果随访时间平均（32．50±5．08）个月；男16例，女25例；进展期28眼，晚期24眼；52眼均行抗青光眼手术-复合式小梁切除手术治疗；眼轴长平均（22．40±1．63）mm，其中〈21mm占17．31％，小眼球占13．46％；前房深度平均（1．90±0．39）mm，其中〈1．9mm占61．46％；超声生物显微镜检查高褶虹膜构型占59．62％，其中睫状突位置靠前者10眼；术前平均眼压（41．73±12．26）mmHg，末次术后平均眼压（12．03±4．57）mmHg，术前后眼压差异有统计学意义（t=3．520，P〈0．001）。术后并发症主要有浅前房，恶性青光眼。恶性青光眼手术处理方式包括玻璃体抽液、前段玻璃体切割以及超声乳化白内障吸除加人工晶状体植入术治疗。4眼因眼压控制不理想，行二次抗青光眼手术治疗。结论年轻原发性慢性闭角型青光眼患者，女性多见，多伴有眼轴短、前房浅等特点，抗青光眼复合式小梁手术治疗要注意防治术后浅前房、恶性青光眼的发生。术前详细检查、手术操作精细以及有效处理术后并发症将有助于提高手术成功率和减少并发症。     

华南地区与西南地区先天性青光眼临床特点的比较

目的通过对中山眼科中心与华西医院眼科中心收治的原发性先天性青光眼患者进行对比,探讨我国华南、西南地区先天性青光眼发病的异同性。方法以华西医院眼科中心（WCHOC）报道的原发性先天性青光眼的研究结果为参照,与中山眼科中心（ZOC）在同一时段（2002年1月至2004年12月）收治的原发性先天性青光眼患者进行回顾性对比分析。结果ZOC入组的原发性先天性青光眼患者有51例（102眼）,WCHOC患者40例（80眼）。两组患者均以男性为多,分别为3.25：1和2.07：1;双眼发病为主：家族史均不明显;发现年龄在两地患者中无显著性差异（P〉0.01）：但WCHOC患者就诊年龄远远大于ZOC患者（分别为36个月与9个月）;就诊时已有视功能严重损害者以WCHOC患者为多：手术治疗均以小梁切开联合小梁切除术为主。结论与中山眼科中心原发性先天性青光眼患者比较,华西眼科中心患者就诊较晚,视功能损害严重,诊断、治疗相对滞后。在一定程度上可能与地区经济水平对该病诊治的影响有关。中国先天性青光眼的防治工作仍存在很大的不平衡性,值得关注。     

原发性先天性青光眼患者术后生活质量的评价

Objective To evaluate the 23-item scale of Quality of Life (QOL) for patients with primary congenital glaucoma (PCG). Methods It was a cross-sectional study. The QOL scale specific for patients with PCG was firstly evaluated on 51 patients with PCG following antiglaucomat surgery at last follow-up visit (7.80 years±2.93 years with a median at 7 years) and 50 participants with normal visual acuity (VA) as control. All participants were aged 5-20 years old. The QOL of PCG was evaluated with type of disease, severity, surgical outcome, postoperative VA, age, gender and personality by using single-factor correlation analysis and multiple-factor stepwise regression analysis. Results The PCG-QOL scale achieved good reliability, validity and responsibility for PCG and 23-item were all qualified for QOL evaluation of PCG. The total scores of QOL in patients with PCG were significantly lower than those of normal individuals (PCG 60.22±10.02,normal individuals 71.41±10.11;t=5.682, P=0.000). Single-factor correlation analysis showed that the total scores of QOL were associated significantly with the severity of glaucoma (F=24.026, P=0.000), surgical outcome (t=2.638, P=0.009) and postoperative VA (F=11.248, P=0.000) ; The visual function scores were associated significantly with the severity (F=12.677, P=0. 000) and postoperative VA (F=10.369, P=0.000) ; The self-care ability scores were associated significantly with the severity (F=11.064, P=0.000) and surgical outcome (t=2.297, P=0.042) ; The social and mental scores were all correlated significantly with the severity (F=6.869, P=0.020; F=5.721, P=0.019) and personality (t=4.352, P=0.009 ; t=2.297, P=0.042). Multiple-factor stepwise regression analysis showed that there were significant correlations between total scores and the severity (β=-6.985, P=0.001 ), postoperative VA (β=-4.978, P=0.003 ) and personality (β=-5.201, P=0.020). Conclusions The PCG-QOL scale could be used for evaluating the QOL of PCG patients aged 5-20 years. The main factors that influence on the QOL of patients with PCG are severity of the disease, postoperative VA and personality. Preventing progression of glaucoma, improving VA and giving right psychological guidance may improve the QOL of patients with PCG.     

原发性先天性青光眼患者术后生活质量的评价

Objective To evaluate the 23-item scale of Quality of Life (QOL) for patients with primary congenital glaucoma (PCG). Methods It was a cross-sectional study. The QOL scale specific for patients with PCG was firstly evaluated on 51 patients with PCG following antiglaucomat surgery at last follow-up visit (7.80 years±2.93 years with a median at 7 years) and 50 participants with normal visual acuity (VA) as control. All participants were aged 5-20 years old. The QOL of PCG was evaluated with type of disease, severity, surgical outcome, postoperative VA, age, gender and personality by using single-factor correlation analysis and multiple-factor stepwise regression analysis. Results The PCG-QOL scale achieved good reliability, validity and responsibility for PCG and 23-item were all qualified for QOL evaluation of PCG. The total scores of QOL in patients with PCG were significantly lower than those of normal individuals (PCG 60.22±10.02,normal individuals 71.41±10.11;t=5.682, P=0.000). Single-factor correlation analysis showed that the total scores of QOL were associated significantly with the severity of glaucoma (F=24.026, P=0.000), surgical outcome (t=2.638, P=0.009) and postoperative VA (F=11.248, P=0.000) ; The visual function scores were associated significantly with the severity (F=12.677, P=0. 000) and postoperative VA (F=10.369, P=0.000) ; The self-care ability scores were associated significantly with the severity (F=11.064, P=0.000) and surgical outcome (t=2.297, P=0.042) ; The social and mental scores were all correlated significantly with the severity (F=6.869, P=0.020; F=5.721, P=0.019) and personality (t=4.352, P=0.009 ; t=2.297, P=0.042). Multiple-factor stepwise regression analysis showed that there were significant correlations between total scores and the severity (β=-6.985, P=0.001 ), postoperative VA (β=-4.978, P=0.003 ) and personality (β=-5.201, P=0.020). Conclusions The PCG-QOL scale could be used for evaluating the QOL of PCG patients aged 5-20 years. The main factors that influence on the QOL of patients with PCG are severity of the disease, postoperative VA and personality. Preventing progression of glaucoma, improving VA and giving right psychological guidance may improve the QOL of patients with PCG.     

POAG患者黄斑区脉络膜厚度分析

目的 评价POAG患者的黄斑区脉络膜厚度,并与相同年龄段正常人群比较,分析其临床意义.方法 临床对照研究.共纳入POAG患者46例(46眼)和正常人50例(50眼),采用频域OCT增强深度成像(EDI)测定中心凹下脉络膜厚度(SFCT)、距中心凹1 mm和3 mm处上、下、鼻、颞4个方位脉络膜厚度(S1CT、S3CT、I1CT、I3CT、N1CT、N3CT、T1CT、T3CT).比较POAG患者与正常人黄斑区脉络膜厚度的差异,并分析POAG患者脉络膜厚度与年龄、IOP、眼部生物参数及视野平均缺损(MD)间的相关性.结果 POAG患者黄斑区脉络膜厚度分布趋势与正常人相似,均表现为黄斑中心凹下脉络膜(SFCT)最厚和鼻侧3 mm(N3CT)最薄;POAG患眼与正常人黄斑区脉络膜厚度差异无统计学意义;不同病程阶段POAG患者脉络膜厚度亦未观察到明显不同.POAG患者SFCT、I1CT、N1CT、N3CT及黄斑区平均脉络膜厚度与MD之间存在负相关(r=-0.509、-0.515、-0.495、-0.480、-0.478,P＜0.05).结论 POAG患者和正常人黄斑区脉络膜厚度有类似分布特征,但且其黄斑区脉络膜厚度与正常人无明显差异.     

可疑青光眼患者视野检测的表现特征及相关分析

目的 探讨可疑青光眼患者中心30°阈值视野检测的表现特征及其影响因素.方法 采用横断面研究设计,对就诊的可疑青光眼患者应用Octopus- 101型视野计进行中心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)视野指数,并进行视野指数影响因素相关分析.结果 可疑青光眼者不同眼别、不同性别间的视网膜光敏感度比较差异无统计学意义(P＞0.05)；高眼压者与仅有可疑症状者视野指数比较差异有统计学意义(P＜0.05)；杯盘比大者与可疑症状者视野指数比较差异有统计学意义(P＜0.05).Pearson相关统计分析显示:＞21 mm Hg的可疑青光眼者眼压与平均视网膜光敏感度存在负相关(r =-0.654,P＜0.05);＞21 mm Hg的可疑青光眼者眼压与平均视野缺损值存在正相关(r =0.792,P＜0.05).结论 可疑青光眼者的视网膜光敏感度不受眼别和性别的影响,可疑青光眼视野指数主要受可疑指标影响,存在杯盘比大或者眼压高者应慎重筛查并积极复查随诊.     

原发性先天性青光眼患者长期手疗效比较分析

目的 评价原发性先天性青光眼患者长期手术疗效.方法 对过去11年间(1997年9月至2008年9月)收入中山大学中山眼科中心首次行手术治疗,并能长期随访到的48例81只眼原发性先天性青光眼患者进行回顾性分析.结果 所有患者在小梁切除术、小梁切开术与联合手术者间手术成功率无明显差异(P=0.492);在随访超过4年者中:Kaplan-Meier分析显示行小梁切除术与联合手术者成功率曲线下降较平稳,其中联合手术者成功率曲线下降最缓慢,但小梁切开术曲线下降较明显(P=0.022).结论 长期随访(≥4年)能更好地评价原发性先天性青光眼术后长期临床疗效;三种手术方式治疗原发性先天性青光眼患者远期成功率均随着时间的延长而下降,但以联合手术组成功率曲线下降最缓慢,其次是小梁切除术组,小梁切开术组成功率曲线下降最明显.术后远期的手术成功率与术后患者随访的依从性相关,患者依从性好术后远期的手术成功率高.     

晶状体不全脱位致急性闭角型青光眼的显微手术处理方式探讨

目的探讨晶状体不全脱位致急性闭角型青光眼的临床诊治经验。方法回顾性分析我院确诊为晶状体不全脱位致急性闭角型青光眼的患者资料。本组病例共20例（21眼），临床表现均为急性闭角型青光眼；所有病例皆已根据患者晶状体移位程度及视力情况给予相应手术治疗。结果患者出院后平均随访（16．95±15．69）个月。1例患者经保守治疗后出院。余患者术后最佳矫正视力3眼0．01～0．10，7眼0．10—0．30，4眼0．30～0．50，7眼〉0．50，眼压均控制在正常范围。经保守治疗的患者眼压控制在正常范围，无晶状体移位加重的情况出现；手术后患者无一例严重并发症，无再次手术者，眼压控制及视力恢复良好。结论晶状体不全脱位致急性闭角型青光眼的临床特点与原发性急性闭角型青光眼类似，易误诊。细致的眼科检查将有助于提高正确诊断率。正确诊断是有效治疗的基础。     

原发性先天性青光眼患者术后生活质量的评价

Objective To evaluate the 23-item scale of Quality of Life (QOL) for patients with primary congenital glaucoma (PCG). Methods It was a cross-sectional study. The QOL scale specific for patients with PCG was firstly evaluated on 51 patients with PCG following antiglaucomat surgery at last follow-up visit (7.80 years±2.93 years with a median at 7 years) and 50 participants with normal visual acuity (VA) as control. All participants were aged 5-20 years old. The QOL of PCG was evaluated with type of disease, severity, surgical outcome, postoperative VA, age, gender and personality by using single-factor correlation analysis and multiple-factor stepwise regression analysis. Results The PCG-QOL scale achieved good reliability, validity and responsibility for PCG and 23-item were all qualified for QOL evaluation of PCG. The total scores of QOL in patients with PCG were significantly lower than those of normal individuals (PCG 60.22±10.02,normal individuals 71.41±10.11;t=5.682, P=0.000). Single-factor correlation analysis showed that the total scores of QOL were associated significantly with the severity of glaucoma (F=24.026, P=0.000), surgical outcome (t=2.638, P=0.009) and postoperative VA (F=11.248, P=0.000) ; The visual function scores were associated significantly with the severity (F=12.677, P=0. 000) and postoperative VA (F=10.369, P=0.000) ; The self-care ability scores were associated significantly with the severity (F=11.064, P=0.000) and surgical outcome (t=2.297, P=0.042) ; The social and mental scores were all correlated significantly with the severity (F=6.869, P=0.020; F=5.721, P=0.019) and personality (t=4.352, P=0.009 ; t=2.297, P=0.042). Multiple-factor stepwise regression analysis showed that there were significant correlations between total scores and the severity (β=-6.985, P=0.001 ), postoperative VA (β=-4.978, P=0.003 ) and personality (β=-5.201, P=0.020). Conclusions The PCG-QOL scale could be used for evaluating the QOL of PCG patients aged 5-20 years. The main factors that influence on the QOL of patients with PCG are severity of the disease, postoperative VA and personality. Preventing progression of glaucoma, improving VA and giving right psychological guidance may improve the QOL of patients with PCG.