Falsely elevated intraocular pressure due to increased central corneal thickness

· Purpose: To evaluate whether ocular hypertensive subjects have a higher central corneal thickness than other individuals. · Methods: In this prospective study, 48 subjects with ocular hypertension, 63 patients with open-angle glaucoma, 56 nonglaucomatous patients with diabetes mellitus, and 106 control subjects were evaluated. Corneal thickness was measured by ultrasound pachymetry, and intraocular pressure was determined by Goldmann applanation tonometry. · Results: Central corneal thickness was significantly higher in the ocular hypertensive subjects, mean ±S.D., 592±39 μm, than in the patients with glaucoma (536±34 μm), the nonglaucomatous patients with diabetes mellitus (550±31 μm), and the normal subjects (545±33 μm), P<0.001. The three latter groups did not vary significantly in central corneal thickness, P>0.05. · Conclusion: In some individuals with increased transcorneal measurements of intraocular pressure, the cornea is thicker than in subjects with normal intraocular pressure readings or patients with glaucoma. It suggests that in ocular hypertensive subjects, corneal pachymetry should be performed to rule out an abnormally thick cornea as a reason for falsely high measurements of intraocular pressure. Received: 14 April 1998 Revised version received: 10 July 1998 Accepted: 23 July 1998     

视觉电生理和视野检查对原发性开角型青光眼早期诊断的敏感性

目的:探讨多种视觉电生理联合全自动视野计检查对原发性开角型青光眼早期诊断中的敏感性,为临床早期诊断提供客观敏感的指标。方法:选择10例(20眼)原发性开角型青光眼患者和正常对照者10例(20眼)分别进行闪光视网膜电图(FERG)、图形视网膜电图(PERG)、图形视觉诱发电位(PVEP)检查;还对正常对照组、青光眼组中各5例(10眼)进行多焦视网膜电图(mERG)检查;青光眼组10例(20眼)和正常对照组8例(16眼)行蓝黄视野(B/Y)、标准视野(W/W)检查。结果:PERG的异常率较高,PERG的潜伏期延长较敏感,mERG二阶反应黄斑区振幅下降,随离心度的增大,振幅逐渐变小,潜伏期延长,PVEP的P100波振幅降低,潜伏期延长。B/Y视野异常与W/W视野异常比较有显著差异(P <0.01)。结论:B/Y视野检查联合多种视功能检查对原发性开角型青光眼早期诊断较敏感。早期诊断中的B/Y视野敏感性高;若眼压差大,眼底C/D未出现改变,则PERG可作为较敏感观测指标。     

选择性激光小梁成形术治疗各类型开角型青光眼临床疗效的研究

目的观察选择性激光小梁成形术(selectlasertrabecularplasty,SLT)治疗各类型开角型青光眼(openangleglaucoma,OAG)降低眼内压的临床疗效和临床反应。方法对27例(52眼)多种类型开角型青光眼进行SLT治疗。所用设备为CoherentSelecta7000倍频Q-开关NdYAG双频激光仪。80个非重叠激光斑打击在颞侧180°范围小梁网,能量0.4～1.0mJ,激光斑400μm。术后观察眼内压和前房反应,时间为1d,1,6mo,1a。全部患者定期检查视力、裂隙灯、眼底镜、房角镜、视野(Octopus视野仪)、海德堡共焦激光断层扫描仪,(HRT-ⅡONH)和眼前节生物超声(UBM)检查。结果患者术前眼压平均(26.87±2.6)mmHg,不同时期的眼压大部分改善,术后1a为(20.21±3.4)mmHg,下降幅度为(6.66±2.8)mmHg,相当于下降24.78%,有3眼为高眼压症,没有明显降压效果出现。2眼为发育性青光眼,术后5d内降眼压效果明显,但10d左右眼压回升到接近术前水平转为手术治疗。部分病例仍需配合局部降眼压药。视力、C/D比、房角镜无明显改变。1a视野检查,9眼有改善。结论SLT治疗多种类型开角型青光眼安全有效,没有明显副作用和并发症,是治疗开角型青光眼的有效方法之一。     

早期原发性开角型青光眼的视网膜光阈值改变

目的:观察早期原发性开角型青光眼视网膜光敏度分布情况及改变特点。方法:采用日本TopconSBP2020自动视野SDT340程序检测早期原发性开角型青光眼与正常眼的中心3°视网膜光敏感度。结果:早期原发性开角型青光眼各方向的视网膜光敏度与正常眼比较有非常显著差异(P<0.01);早期原发性开角型青光眼上方视网膜光敏度与其他各方比较有显著差异(P<0.05);早期青光眼的MD,ST与正常眼比较差异非常显著(P<0.01)。结论:视网膜光敏度的定量检测能做为早期原发性开角型青光眼的较早期视功能检测。     

原发性开角型青光眼正常眼压时共焦扫描激光多普勒视网膜血流图

目的　探讨中国人中原发性开角型青光眼患者眼压在正常范围时视乳头和视网膜的血流动力学。方法　应用共焦扫描激光多普勒视网膜血流图检测 82例原发性开角型青光眼 15 0眼眼压控制在 2 2mmHg以下时视乳头和视网膜血流。结果　视乳头平均血容量、血流速和红细胞移动速率分别是 10 4 3 5± 49 2 4,3 2 43 93± 15 89 72 ,8 3 8±3 0 7;筛板处平均血容量、血流速和红细胞移动速率分别是 7 2 8± 4 18,10 8 5 5± 80 5 1,0 3 9± 0 2 5。盘沿处平均血容量、血流速和红细胞移动速率分别是 2 0 2 1± 16 86,5 2 9 91± 5 2 0 74,1 68± 1 3 2 ;盘缘外视网膜平均血容量、血流速和红细胞移动速率分别是 13 5 6± 5 97,2 5 7 90± 13 8 11,0 92± 0 46;视网膜平均血容量、血流速和红细胞移动速率分别是 17 96±6 2 3 ,3 5 0 3 9± 179 82 ,1 2 3± 0 5 7;血管、筛板和视网膜的血容量、流速和红细胞移动速率和正常眼比较都有明显下降。结论　原发性开角型青光眼患者存在着血流动力学障碍。     

Pupillomotor campimetry in normals

The pupillary light reaction is closely related to retinal function and the integrity of the visual pathway. Thus, pupil perimetry may be a useful tool to objectively assess a patient’s visual field function. To judge a patient’s ‘pupil field’ as pathological, it is necessary to know if there are any asymmetries in the pupil field of a normal. To cope with stray light problems, we presented stimuli of low intensity on a dim computer monitor. Within the central 20° field, we performed computerized infrared pupil campimetry in 43 normal subjects. Stimuli were presented on a monitor at a distance of 30 cm. We ran four trials using a grid with 15 test spots for each eye. Stimulus luminance was 54 cd/m 2 in low mesopic conditions, spot size was 2° to 3° (depending on the individual sensitivity), and stimulus duration was 200 ms. Pupillomotor sensitivity decreased from the central retina to the periphery. The nasal retina gave larger amplitudes than the temporal retina. The inferior retina was more sensitive than the superior retina. These asymmetries were subtle, but significant. The nasal inferior retina was the most sensitive area, the temporal superior retina the least sensitive. We obtained reliable results in pupillomotor campimetry using a low stimulus intensity. There are asymmetries in the pupillomotor sensitivity of the normal central retina which must be considered when pupil perimetry is performed in patients.     

曲伏前列素滴眼液治疗原发性开角型青光眼的临床效果

目的分析曲伏前列素滴眼液治疗原发性开角型青光眼的临床效果。方法将42例原发性开角型青光眼患者随机分为对照组和研究组,每组21例。对照组实施马来酸噻吗洛尔滴眼液治疗,研究组实施曲伏前列素滴眼液治疗,比较两组的临床效果。结果治疗后,研究组的眼压、视力、散光度、基础泪液分泌量、泪膜破裂时间、血浆粘度、全血粘度低切、全血粘度高切均优于对照组(P<0.05)。结论曲伏前列素滴眼液治疗原发性开角型青光眼的临床效果确切,值得临床推广应用。     

内路小梁切开联合白内障超声乳化吸除术治疗原发性开角型青光眼的短期疗效

目的 对比内路小梁切开联合白内障超声乳化吸除术和单纯内路小梁切开术治疗合并白内障的原发性开角型青光眼（primary open angle glaucoma，POAG）的早期手术效果和并发症。设计 病例对照研究。研究对象2018年3月至2019年3月在北京同仁眼科中心住院手术治疗的合并白内障的POAG患者36例（36眼）。方法 根据患者选择的手术方式，将患者分为两组：行内路小梁切开联合白内障超声乳化吸除术的POAG患者12例（12眼）为观察组，行内路小梁切开术的POAG患者24例（24眼）为对照组。记录并比较两组患眼术前、术后1、2、3、5天、1周、1个月时眼压、视力、并发症和使用降眼压药的种类。主要指标 眼压、视力、并发症和降眼压药物种类。结果 观察组和对照组术前最高眼压分别为（34.08±8.21）mmHg和（37.75±8.61）mmHg（P=0.46）,观察组术后第1天、1周、1个月的平均眼压分别为（20.75±11.89）mmHg、（21.23±8.72）mmHg、（15.00±2.22） mmHg，对照组术前、术后第1天、1周、1个月的平均眼压分别为（16.08±5.63）mm Hg、（22.08±11.48）mmHg、（16.05±5.25）mmHg，两组术后眼压整体变化趋势随时间降低（P<0.001）,两组间术后眼压波动虽然存在差异，但是无统计学意义（P=0.77）。观察组和对照组术后1个月降眼压幅度分别为53.09%±15.19%和55.68%±15.63%（P=0.64）。观察组和对照组术前降眼压药物使用种类分别为（2.67±0.99） 种和（3.08±0.72）种（P=0.16），术后1个月时分别下降至（0.17±0.58）种和（0.96±1.33）种（P=0.06）。观察组和对照组组术后眼压反跳发生率分别为16.67%和54.17%（P=0.03）。前房积血为术后最常见的并发症, 观察组发生率为83.3%，对照组为62.5%（P=0.21)。观察组和对照组睫状体脱离发生率分别为25.0%和75.0%（P=0.004）。观察组中，8眼（66.7%）术后生活视力提高，4眼（33.3%）视力恢复至术前水平，0眼视力降低；对照组中，20眼（83.3%）术后生活视力恢复至术前水平，4眼（16.7%）视力降低（P<0.001）。结论 对于合并白内障的开角型青光眼患者，内路小梁切开联合白内障超声乳化吸除术和单纯内路小梁切开术在术后1个月时降眼压作用相似。联合手术术后视力改善明显，眼压反跳发生率较单纯内路小梁切开术低，是一种安全有效的手术方式，远期效果有待进一步观察。     

Population-based glaucoma prevalence studies in Asians

Glaucoma-related population-based studies from Japan, Mongolia, India, Singapore, Thailand, China, Bangladesh, Myanmar, Sri Lanka, and South Korea show a higher glaucoma prevalence in Asian patients, including a higher incidence of primary angle-closure glaucoma, than in white patients, although primary open-angle glaucoma (POAG) is still the most commonly reported. Among POAG, normal tension glaucoma predominates over high tension glaucoma, a distinctive finding. Risk factors for glaucoma in population-based studies in both Asian and white patients are similar, except that myopia is a greater risk factor in Asian patients. Diagnostic criteria differ among studies, some using the International Society of Geographic and Epidemiologic Ophthalmology (ISGEO) classification and others not. The devices used to observe the optic disk and test the visual field are also not uniform across studies. Moreover, the ages of patients, and whether rural or urban, were different. To allow reliable comparison of the results of epidemiologic studies, efforts to standardize the diagnostic criteria, devices, and the age range of the study population are required.