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。     

单基因青光眼的临床实践指南

青光眼(glaucoma)是一组视网膜神经节细胞及其轴突变性的进行性视神经病,其典型临床特征为视乳头凹陷性萎缩和特征性视野缺损,遗传因素在其发病过程中起着重要作用。本指南主要介绍单基因变异相关的青光眼,包括原发性先天性青光眼(primary congenital glaucom a,PCG)和原发性开角型青光眼(primary open-angle glaucoma,POAG)的致病基因、疾病诊断以及临床咨询等方面,旨在规范单基因青光眼临床分子遗传诊疗,为临床医生对单基因青光眼诊治和遗传咨询服务提供参考。     

原发性开角性青光眼与高度近视的相关性

目的 探索原发性开角性青光眼(POGA)与高度近视患者的临床特点及其相关性。 方法 回顾性分析57例(98眼)POGA和59例(97眼)非POGA患者的近视状况及其相关性。比较两组患者的近视率和在不同视力的情况下患者眼底4个象限平均光敏感度。 结果 两组高度近视、中低度近视和正常视力情况的分布差异有统计学意义(Z=-5.424,P<0.001); POGA组近视率(77.56%)明显高于非POAG组(63.92%),组间差异有统计学意义(χ²=4.380,P<0.05)。POAG组的高度近视率(25.51%)明显高于非POAG组(9.28%),组间差异有统计学意义(χ²=8.922,P<0.05)。在不同视力水平的情况下,POAG组患者眼底4个象限平均光敏感度均差异有统计学意义(P<0.05)。POAG组中,高度近视和中低度近视患者的眼压与角膜厚度和眼轴长度之间存在显著的相关关系(r₁=0.262、0.224;r₂=0.183、0.167;均P<0.05);非POAG组中,高度近视患者的眼压与角膜厚度和眼轴长度之间存在显著的相关关系(r₁=0.206;r₂=0.135;均P<0.05)。 结论 POGA与高度近视具有较高的相关性,POAG患者同时伴有高度近视的发生率较高。     

Comparison of corneal biomechanics among primary open-angle glaucoma with normal tension or hypertension and controls

Background:Normal tension glaucoma (NTG) is a less pressure-dependent type of glaucoma with characteristic optic neuropathy. Recently, the biomechanical mechanism has been thought to account for glaucomatous optic neuropathy to some degree. We intended to compare dynamic corneal response parameters (DCRs) among patients with primary open-angle glaucoma with normal tension or hypertension and controls. The correlations between DCRs and known risk factors for glaucoma were also analyzed.Methods:In this cross-sectional study, 49 NTG subjects, 45 hypertension glaucoma (HTG) subjects, and 50 control subjects were enrolled. We compared the differences in DCRs using corneal visualization Scheimpflug technology among the NTG, HTG, and control groups. We also analyzed the correlations between DCRs and known risk factors for glaucoma (eg, central corneal thickness [CCT], intraocular pressure [IOP], etc).Results:The maximum inverse concave radius (NTG: 0.18 [0.17, 0.20] mm⁻¹; control: 0.17 [0.16, 0.18] mm⁻¹; P = 0.033), deformation amplitude ratio of 2 mm (DAR 2 mm, NTG: 4.87 [4.33, 5.39]; control: 4.37 [4.07, 4.88]; P < 0.001), and DAR 1 mm (NTG: 1.62 [1.58, 1.65]; control: 1.58 [1.54, 1.61]; P < 0.001) were significantly higher in NTG than in the controls. The integrated radius (IR, NTG: 8.40 ± 1.07 mm⁻¹; HTG: 7.64 ± 1.31 mm⁻¹; P = 0.026) and DAR 2 mm (NTG: 4.87 [4.33, 5.39]; HTG: 4.44 [4.12, 5.02]; P < 0.007) were significantly higher, whereas the stiffness parameter at the first applanation (SP-A1, NTG: 91.23 [77.45, 107.45]; HTG: 102.36 [85.77, 125.12]; P = 0.007) was lower in NTG than in HTG. There were no significant differences in the DCRs between HTG and control groups (P > 0.05). In the univariate and multivariate analyses, some of the DCRs, such as IR, were negatively correlated with CCT and IOP, whereas SP-A1 was positively correlated with CCT and IOP.Conclusions:The cornea was more deformable in NTG than in HTG or controls. There were no significant differences in corneal deformability between HTG and controls. The cornea was more deformable with the thinner cornea and lower IOP.     

不同年龄原发性开角型青光眼患者手术前后心理特征和生存质量的变化

目的探讨不同年龄原发性开角型青光眼(POAG)患者手术前后心理特征及生存质量变化的差别。方法纳入POAG患者76例,其中青年患者38例、中老年患者38例。所有POAG患者术前采用家庭支持量表、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)及低视力者生活质量量表(LVQOL)进行测试;术后3 d采用HAMA、HAMD进行测试,术后1个月采用HAMA、HAMD、LVQOL进行测试。结果术后1个月,青年组HAMA总分A、HAMD总分B与术后3 d差异无统计学意义(PA=0.585,PB=0.313);而中老年组HAMA总分A、HAMD总分B较术后3 d下降(PA=0.012,PB=0.014)。术后1个月,LVQOL总分较术前升高,差异有统计学意义(P=0.007);青年患者LVQOL总分与术前差异无统计学意义(P=0.238)。多元逐步回归分析显示,术后1个月LVQOL总分的主要影响因素是较好眼视野MD(β=0.410,P=0.002)、健康教育(β=10.134,P<0.01)、术后1个月HAMD总分B(β=-0.795,P<0.01)。结论心理特征及生存质量在青年及中老年POAG患者手术治疗前后发生不同变化,尤其对于青年POAG患者应加强必要的心理支持。     

Response to travoprost in black and nonblack patients with open-angle glaucoma or ocular hypertension

Two prospective, controlled, multicenter, double-masked studies—one lasting 6 months (n=594) and the other, 12 months (n=787)—examined the intraocular pressure (IOP)-lowering efficacy of travoprost in 1381 black and nonblack patients with open-angle glaucoma or ocular hypertension. Investigated regimens were travoprost 0.004% once daily, latanoprost 0.005% once daily, and timolol 0.5% twice daily. In both studies, mean IOP was significantly lower in blacks treated with travoprost. The IOP reduction was also significantly greater in blacks after adjustments for age, sex, iris color, diagnosis, and corneal thickness. Timolol lowered mean IOP to a greater extent in nonblack patients. The significantly larger IOP reduction with travoprost compared with timolol in both racial groups was more pronounced in blacks. Travoprost also was superior to latanoprost in blacks. Mean changes from baseline generally were greater for black than for nonblack patients, although the differences did not achieve statistical significance. The response rate to travoprost was higher in blacks. The most common adverse effect was hyperemia.     

保留颈后方韧带复合体对颈椎后路单开门椎板成形术椎板开门角度的影响

目的探讨保留颈后方韧带复合体对术后椎板开门角度及神经功能改善率产生的影响。方法对28例脊髓型颈椎病患者采用后路单开门颈椎椎板成形术。根据不同治疗术式分为两组:17例采用不保留颈后方韧带复合体术式为A组,11例采用保留颈后方韧带复合体单开门术式为B组。通过术后2周及末次随访时(≥10个月)CT影像学资料测得椎板开门角;同时评定神经功能改善情况。结果术后2周椎板开门角:A组为38.0°~44.0°(40.3°±1.0°),B组为37.2°~42.5°(40.7°±0.7°),差异无统计学意义(P0.05)。末次随访时椎板开门角:A组为34.8°~45.0°(39.0°±3.1°),B组为34.0°~36.5°(35.7°±0.4°),差异有统计学意义(P0.05)。两组术后2周及末次随访时神经功能改善率:A组为27.8%~37.0%(32.4%±4.3%)及53.3%~68.0%(59.7%±5.6%),B组为26.3%~38.2%(32.1%±5.0%)及44.4%~67.0%(58.5%±5.9%),两组比较差异均无统计学意义(P0.05)。两种术式术后2周及末次随访时再关门率均为0。结论保留颈后方韧带复合体单开门术式的椎板开门角度小于不保留颈后方韧带复合体术式。两组的神经功能改善率无差异。     

拉坦前列腺素对原发性开角型青光眼患者的疗效

目的:研究拉坦前列腺素对原发性开角型青光眼(POAG)患者的治疗效果.方法:POAG患者135例,随机分为观察组(n=70)和对照组(n=65),观察组给予拉坦前列腺素治疗,对照组给予噻吗心安治疗;记录2组患者治疗前后的眼压及波动值、视野缺损及视网膜纤维层(RNFL)厚度及不良反应.结果:两组患者治疗后昼夜平均眼压、眼压波动值及视野缺损范围均较治疗前明显降低,差异有统计学意义(P＜0.05);治疗后观察组昼夜平均眼压、眼压波动值较对照组降低更明显,下方视野、颞侧视野及鼻侧视野缺损范围较对照组明显缩小,上方视盘、下方视盘、颞侧视盘及鼻侧视盘较对照组明显增厚,差异均有统计学意义(P＜0.05);治疗后观察组9例(12.86％)、对照组11例(16.92％)出现不良反应,差异无统计学意义(P＞0.05).结论:拉坦前列腺素治疗原发性开角型青光眼效果优于噻吗心安.