Decreased response of plasma cortisol to intravenous metyrapone in ocular hypertension and primary open-angle glaucoma

PURPOSE: To determine if there is a difference in response to metyrapone, which blocks the conversion of 11-deoxycortisol to cortisol in the adrenal gland between normals and ocular hypertensives (OH) plus primary open-angle glaucomas (POAG) without pigmented angles. METHODS: Intravenous metyrapone was given to 20 normals and 15 ocular hypertensives plus primary open-angle glaucomas without pigmented angles. Blood samples were obtained at 4, 6, and 8 hours after administration of intravenous metyrapone for analyses of 11-deoxycortisol and cortisol. RESULTS: The ocular hypertensives plus primary open-angle glaucoma group showed significantly lower cortisol values compared with the normal group at 6 hours (P = 0.002) but not at 4 or 8 hours. There were no significant differences between the two groups for 11-deoxycortisol values at 4, 6, or 8 hours. The percent decrease of plasma cortisol from baseline was significantly greater for the ocular hypertensives plus open-angle glaucoma group compared with the normals at 4 hours (P = 0.010) and 6 hours (P = 0.0004). Significant negative correlations were observed for the total group of subjects between levels of plasma cortisol at 6 hours and intraocular pressure, worse eye (P = 0.029), percent area of cupping, worse eye (P = 0.045), pallor, worse eye (P = 0.001), and visual field loss, worse eye (P = 0.048), so that the less the plasma cortisol, the greater the abnormality of the glaucomatous parameters. Multivariate analyses with the 6-hour plasma cortisol level as the dependent variable showed that the only significant (P = 0.0004) independent variable was the percent area of pallor, worse eye, associated with a smaller level of plasma cortisol at 6 hours. Similarly, the multiple regression models using the percent change from baseline of the 6-hour plasma cortisol value showed a significant association of larger percent decreases of plasma cortisol in the ocular hypertensives plus open-angle glaucoma compared with the normals. CONCLUSIONS: The ocular hypertensives plus primary open-angle glaucoma subjects show greater adrenal inhibition to metyrapone in the synthesis of cortisol from 11-deoxycortisol compared with normals. This observation suggests an adrenal abnormality in the ocular hypertensive plus primary open-angle glaucoma subjects.     

Hormonal changes in male patients with primary open angle glaucoma

INTRODUCTION: Primary open angle glaucoma (POAG) is the most common type of glaucoma, pathogenesis of which is not completely known. Several clinical studies show that glucocorticoid hormones may be implicated in the pathogenesis of POAG and ocular hypertension. Glucocorticoid receptors have been identified in human outflow tissue of the eye. AIMS: The purpose of this study, therefore, was to evaluate the serum concentration of total cortisol (TF), total testosterone (TT), free testosterone (FT), FSH (follitropin), LH (lutropin), ACTH (adrenocorticotropin), SHBG (sex hormone-binding globulin), DHEA-SO4 (dehydroepiandrosterone sulfate) as well as free cortisol (UFF) and 17-OHCS in 24 hours urinary samples in patients treated because of POAG. PATIENTS AND METHODS: Studies were performed in the group of 30 male patients, aged 55 +/- 13 years, treated because of glaucoma for more than two years. Serum and urinary concentration of hormones were studied using RIA methods (DPC). RESULTS: The serum concentration of TF (652.03 +/- 315.43 nmol/l), UFF (248.75 +/- 99.39 nmol/l) and 17-OHCS (5.47 +/- 2.64 mg/24 h) in urine was increased compared with control group. There was not significant difference in concentration of pituitary-gonadal axis hormones in glaucomatous and control groups of patients. CONCLUSION: The results could point to the fact that changes in the endocrine system are one of the factors involved in the pathogenesis of POAG. We conclude that an elevated level of cortisol, free cortisol and its metabolites is closely related to the POAG.     

原发性开角型青光眼患者24小时眼压变动规律的临床研究

目的:研究原发性开角型青光眼患者的24h眼压变动规律。方法:选择原发性开角型青光眼患者30人(52只眼,30～60岁),进行24h眼压测量。测量自清晨7∶30开始至第2天清晨7∶30,每2h测1次眼压,共测12次。在7∶00～23∶00时间段测量中,测受检者的坐位眼压和卧位眼压。在23∶00～7∶00时间段测受检者的平卧位眼压。结果:原发性开角型青光眼患者的眼压高峰出现在1∶30,眼压低谷出现在17∶30,24h坐、卧位眼压变动幅度大于24h卧位眼压变动幅度。结论:原发性开角型青光眼患者的眼压高峰大多出现在夜间睡眠时间,夜间眼压控制应引起重视。     

正常眼压性青光眼与原发性开角型青光眼24小时眼压曲线的比较

目的 通过24 h眼压的测量来深入分析比较正常眼压性青光眼(NTG)与原发性开角型青光眼(POAG)的眼压曲线特征.方法 前瞻性病例对照研究.收集2006年4月至2009年4月在上海市闸北区北站医院和复旦大学附属眼耳鼻喉科医院门诊就诊的NTG患者131例及POAG患者102例,测量24 h眼压,用非接触性眼压计从8 am起每隔2 h测一次眼压,0 am至6 am之间测得的为唤醒后即刻坐位眼压.主要观察指标为眼压波动曲线、平均眼压、峰值时间及眼压、谷值时间及眼压和眼压波动值.采用独立样本t检验和卡方检验比较各指标在两组之间的差异.结果 NTG组双眼平均眼压为(14.2±2.1)mmHg,低于POAG组[(19.9±3.5)mmHg];NTG组双眼峰值眼压为(17.0±2.4)mmHg,低于POAG组[(24.7±4.3)mmHg];NTG组双眼谷值眼压为(11.8±2.2)mmHg,低于POAG组[(16.5±3.1)mmHg];NTG组双眼眼压波动值为(5.2±1.8)mmHg低于POAG组(8.2±3.1)mmHg];两组的平均眼压、峰值、谷值及眼压波动值的差异均有统计学意义(t=-14.52、-16.44、-13.16、-8.90,P均＜0.01).NTG组63.3%患者、POAG组73.5%患者的峰值眼压位于门诊工作时间以外;尤其是NTG组有51.5%患者、POAG组有64.7%患者的峰值位于0 am至6 am时间段,两组差异有统计学意义(X2=8.150,P=0.017).结论 NTG及POAG患者24 h眼压曲线的变化规律具有相似性,是诊断和个体化治疗方案制订的依据,并可用作治疗随访中评价疗效和调整方案的重要参考指标.     

Hypothalamic–pituitary–adrenal axis function following intravitreal triamcinolone acetonide injection

To evaluate the pituitary–adrenal axis function by means of the adrenocorticotropic hormone (ACTH) stimulation test following a single intravitreal injection of triamcinolone acetonide (IVTA). Prospective comparative clinical interventional study. Twenty-eight patients (28 eyes) received a single IVTA (4 mg in 0.1 ml) for macular edema. The basal cortisol level and the response to 1 μg adrenocorticotropic hormone stimulation were determined on the morning before IVTA injection and at 1 day and 1, 2, and 4 weeks after IVTA injection. Results were compared with those obtained from a control group of 50 healthy subjects. All patients in the study had normal basal cortisol and normal response to ACTH challenge before receiving IVTA. 1 day following IVTA, basal cortisol was suppressed in one patient in the study group. Fasting serum cortisol levels at 1, 2, and 4 weeks after IVTA injection were normal in all patients in the study group. 1 day following IVTA, the peak response to ACTH at 30 min was blunted in four patients (14.3 % of the study group, p = 0.05) and the cortisol response at 60 min was suppressed (p = 0.009). 1 week following IVTA, the response to ACTH challenge was blunted in only one patient. A single IVTA injection may be associated with impaired hypothalamic–pituitary–adrenal function in some patients during the first 24 h following IVTA.     

高眼压症及原发性开角型青光眼患者的24 h眼压波动规律

目的 通过24 h眼压测量来深入分析对比高眼压症与原发性开角型青光眼(POAG)患者的眼压曲线特征。方法 收集2016年1月~2019年3月在我科门诊诊断为高眼压症的患者52例(104眼)及POAG尚未接受降眼压治疗的患者38例(76眼)。入院后行24 h眼压检查,用非接触性眼压计从早9时起每隔2 h测量眼压1次,至次日7时结束。分析2组患者的平均眼压,峰值眼压及时间点,谷值眼压及时间点,昼夜眼压波动及双眼眼压压差值及其分布情况,比较2组眼压波动的异同点。结果 104眼高眼压症患者的平均眼压为(18.73±1.71)mmHg(1 mmHg=0.133 kPa),平均峰值眼压为(22.36±2.40) mmHg,平均谷值眼压为(15.63±2.09) mmHg,平均昼夜眼压波动为(6.72±2.24) mmHg。76眼POAG患者的平均眼压为(20.65±2.53) mmHg,平均峰值眼压为(25.78±2.81) mmHg,平均谷值眼压为(17.45±2.54) mmHg,平均昼夜眼压波动为(8.34±2.37) mmHg。2组的峰值及谷值眼压值分布最多的时间点均为凌晨3时及夜晚21时,大部分患者的峰值眼压时间点在门诊时间之外。高眼压症组中昼夜眼压波动位于5~8 mmHg的占比最大,为54.81%(57/104),POAG组中昼夜眼压波动>8 mmHg的占比最大,为53.95%(41/76)。高眼压症组中,16例患者经24 h眼压检查后监测到眼压波动异常,占比为30.77%(16/52);POAG组中经24 h眼压检查后有29例患者可以监测到眼压波动异常,占比为76.32%(29/38)。结论 24 h眼压监测中,POAG患者较高眼压症患者的平均眼压、峰值眼压、谷值眼压、昼夜眼压波动及双眼压差均有增加。对于24 h眼压发现眼压波动较大的高眼压症患者应在后续加强密切随访,而对于POAG患者24 h眼压监测可在治疗前提供眼压的基线水平,为后续治疗提供参考及评估依据,因此建议将24 h眼压作为高眼压症及POAG的常规检查手段。     

Reduced plasma cortisol binding to albumin in ocular hypertension and primary open-angle glaucoma.

PURPOSE: To compare plasma cortisol binding as well as total plasma cortisol, free cortisol and percent free cortisol in normals, ocular hypertensives and primary high pressure open-angle glaucomas. METHODS: Blood samples were obtained on outpatient visits of 18 normals, 19 ocular hypertensives and 18 primary open-angle glaucomas. Plasma cortisol binding was determined after the endogenous steroids were removed by charcoal absorption. Scatchard analysis was used to determine both the affinity of binding and the cortisol binding capacity of corticosteroid binding globulin and albumin. Plasma total and free cortisol were measured by radioimmunoassay. RESULTS: Both the ocular hypertensive and the open-angle glaucomas in comparison to normals were found to have a highly significant reduced cortisol binding capacity to albumin (p = 0.006) with a borderline significantly increased binding affinity to plasma corticosteroid binding globulin (p = 0.0495) and no significant difference in binding affinity to albumin or cortisol binding capacity to plasma globulin. Both the ocular hypertensives and the open-angle glaucomas in comparison to normals were found to have significantly elevated levels of free cortisol (p = 0.012) and percent free cortisol (p = 0.003). Multivariate analyses showed that the reduced cortisol binding capacity to albumin was significantly associated with an increased percent free cortisol, with ocular hypertension and open-angle glaucoma and with male gender. CONCLUSION: Both ocular hypertension and primary open-angle glaucoma are associated with elevated levels of plasma free cortisol which are related to a reduced cortisol binding capacity to albumin.     

Effect of glucocorticoids on the composition of the aqueous humour of the rabbit eye

Exogenous corticosteroids (dexamethasone, cortisol) inhibit the adrenal secretion of corticosterone in the rabbit and decrease the concentration of corticosterone in aqueous humour, increase glycaemia and cause a rise in glucose concentration in the aqueous. Except for a slight rise 16 h after the corticosteroid administration no effect on plasma or aqueous content of total protein was observed. This is in striking contrast with the increase of proteins in aqueous humour after ACTH injection. Thus it seems likely that corticosteroids do not mediate the effect of ACTH on the disruption of the blood-aqueous barrier.     

药物治疗中的青光眼患者自我监测24小时眼压的临床效果

目的：评估自我监测24 h眼压在药物治疗原发性开角型青光眼（POAG）患者中的临床效果。方法： 系列病例研究。选取2017年8月至2019年1月就诊于沈阳爱尔眼视光医院行药物治疗且随访眼压控制良 好的POAG患者42例（73眼）,根据基线眼压分为A组：眼压为（12.86±1.40）mmHg（1 mmHg=0.133 kPa）; B组：眼压为（17.82±1.40）mmHg。入组患者通过iCare HOME回弹式眼压计使用培训认证后于家中 自行测量24 h眼压,自730起每隔2 h测量1次,夜间2330-530测量苏醒后即刻的坐位眼压。比 较组间各时间段眼压均值、峰值及波动值,并统计眼压峰值时间点和更改治疗方案的患者比例。数 据采用单因素方差分析、Kruskal-Wallis H检验、t检验以及χ2 检验进行分析。结果：入组患者随访、 门诊时间以及24 h的平均眼压总体差异无统计学意义（F=1.314,P=0.271）。入组患者24 h眼压峰值高 于门诊时间的眼压峰值、随访眼压峰值（H=-40.979、-51.363,均P<0.001）。83.6%的患者眼压峰值 出现在非门诊时间（A组86.5%、B组80.6%）,尤其是发生在夜间睡眠时间,其比例高达67.1%（A组 64.9%、B组69.4%）。入组患者以及A、B亚组患者的24 h眼压波动值均高于其门诊时间眼压波动 值（t=11.166、8.110、7.929,均P<0.001）,其中63.0%的患者24 h眼压波动值≥8 mmHg（A组51.4%、 B组75.0%）。根据自我监测24 h的眼压结果,49.3%的患者更改治疗方案,且B组患者更改比例（63.9%） 高于A组（35.1%）,差异有统计学意义（χ2 =6.035,P=0.014）。结论：药物治疗中的POAG患者自行监测 24 h眼压,能发现临床常规随访中无法监测到的眼压峰值和波动值,可作为医师评价疗效和调整治疗 方案的重要依据。     

Verification of the biphasic response in intraocular pressure during treatment of glaucoma patients with 3% guanethidine and 0.5% adrenaline

In a long-term study with 3% guanethidine and 0.5% adrenaline in one eye drop (GA) the combined results of patients with primary open angle glaucoma (POAG) and glaucoma suspects showed a biphasic response in intraocular pressure (IOP). The hypertensive phase peaked 3 hrs after administration (at noon) and reached a maximum of 3.5 mm Hg (p < 0.005) above the hypotensive phase. It is reported in the literature that during office hours untreated glaucoma patients show a peak near noon, suggesting that the initial increase in IOP may be the normal IOP pattern.When the data of untreated patients with POAG and glaucoma suspects were separated, an increase in IOP around noon in the first group and a decrease around noon in the glaucoma suspects was found. However, during GA-treatment both groups showed a hypertensive response at noon (3 hrs). In addition, the highest IOP's in daycurves were timed during and without GA. It was shown that during GA there was a shift in the incidence of the highest IOP's towards noon (from 8.3% to 73.2% for patients with suspected glaucoma and from 32% to 63.6% for those with POAG).It was therefore concluded that GA induces a characteristic biphasic IOP pattern in patients with POAG as well as in glaucoma suspects. Also, glaucoma suspects may have higher peak pressures more frequently than POAG patients. Furthermore, the study showed that during office hours untreated glaucoma suspects have daycurves with higher pressures in the morning while patients with POAG have higher pressures near noon.     

纤维连接蛋白对原发性开角型青光眼小梁网细胞增殖、黏附和迁移的影响

目的通过研究纤维连接蛋白（FN）对体外培养的原发性开角型青光眼（POAG）患者小梁网细胞增殖、黏附、迁移的影响,探讨FN与POAG发病机制的关系。方法取临床确诊的POAG患者小梁网切除术中的深层巩膜组织块,进行小梁网细胞体外原代和传代培养．并对其进行免疫细胞化学和电镜鉴定。取第3代小梁网细胞,实验组分别加入浓度为5、10、20、40、100μg／ml的FN（含无血清DMEM／F12培养液）培养,对照组不加FN。培养24h后,采用CCK-8比色法和Transwell试剂盒检测各组光密度值,分析FN对POAG小梁网细胞增殖、黏附、迁移的影响。采用SPSS17．0统计软件,组间比较采用One-Way ANOVA分析,两两比较采用SNK检验。结果经过免疫细胞化学和电镜鉴定后,确定培养的细胞为POAG小梁网细胞。不同浓度FN对小梁网细胞均有影响。FN对POAG小梁网细胞有促增殖作用,在FN为5～10μg／ml浓度范围,小梁网细胞增殖相对缓慢,10μg／ml以后呈现上调趋势,在40μg／ml时达到增殖高峰,100μg／ml仍促进增殖,但是相对缓慢。各实验组光密度值分别与阴性对照组比较,差异均有统计学意义（P〈0．01）;各实验组不同浓度组间比较,差异有统计学意义（F=81．778,P〈0．05）。FN浓度为5、10、20、40、100μg／ml时．小梁网细胞的增殖率分别为18．6％、54．7％、67．9％、98．7％和121．5％。同样,FN对POAG小梁网细胞有明显的促黏附、迁移作用。小梁网细胞的黏附、迁移能力随FN浓度的增加而增强,基本呈现曲线上升趋势,与阴性对照组比较,差异均有统计学意义（P〈0．05）。结论FN能促进POAG患者小梁网细胞增殖、黏附和迁移,其在POAG发病机制中的作用可能为通过影响POAG小梁网细胞的增殖、黏附、迁移功能参与房水流出的调节过程。     

Systemic arterial stiffness in glaucoma patients

PURPOSE: To investigate systemic arterial stiffness in glaucoma patients. SUBJECTS AND METHODS: One hundred and forty glaucoma patients and 121 control subjects were enrolled in the study. Among these subjects, 51 glaucoma patients [normal-tension glaucoma (NTG), 31; primary open angle glaucoma or ocular hypertension (POAG/OH): 20] and 61 control subjects without glaucoma, who presented with no risk factors for arteriosclerosis, were extracted for further analysis of systemic arterial stiffness by glaucoma type. Subjects presenting with risk factors for arteriosclerosis were classified into group A, and those presenting with no risk factors were classified into group B. Brachial-ankle pulse wave velocity (baPWV), a marker of systemic arterial stiffness, was determined with a volume-plethysmographic apparatus. The correlation between baPWV and mean deviation obtained from Humphrey Field Analyzer program 30-2 test was compared between 13 each of age-matched and sex-matched NTG and POAG/OH patients. RESULTS: There was a significant difference in baPWV between groups A and B [P<0.0001; 1748+/-393 cm/s (group A) and 1467+/-282 cm/s (group B)]. The baPWVs of control, NTG patients, and POAG/OH patients with no risk factors showed no significant difference. baPWV was positively correlated with age in all the 3 groups, but there were no significant differences among the 3 groups. baPWV tended to be negatively correlated with mean deviation in NTG patients (r2=0.25, P=0.08); in contrast, no correlation was observed in POAG/OH patients. CONCLUSION: Systemic arterial stiffness seems not to be strongly associated with glaucoma.     

Altered peripheral sensitivity to glucocorticoids in primary open-angle glaucoma

PURPOSE: Increased levels of glucocorticoids are associated with raised intraocular pressure (IOP). The activity of glucocorticoids is regulated at a prereceptor level by 11beta-hydroxysteroid dehydrogenases (11beta-HSD). This study was an investigation of the central and peripheral sensitivity to glucocorticoids in patients with POAG or ocular hypertension (OHT) and the differential metabolism of glucocorticoids by 11beta-HSDs. METHODS: Patients with POAG or OHT and normal control subjects were studied. Peripheral sensitivity to glucocorticoids was assessed as dermal blanching and central sensitivity by dexamethasone suppression testing. Daily production rates of glucocorticoids were determined by quantifying metabolites in 24-hour urine. Plasma cortisol levels were determined at baseline (9 AM) and after an overnight low-dose dexamethasone suppression test. In a separate study, plasma and aqueous humor cortisol levels were determined in patients with POAG and normal subjects. RESULTS: Patients with POAG exhibited a greater cutaneous vasoconstrictor response to glucocorticoids than patients with OHT and normal subjects (20.7 +/- 3.1 vs. 8.5 +/- 4.4 and 8.6 +/- 4.5 arbitrary units, respectively; P < 0.05 in each case). Total glucocorticoid production rates were not different between groups, nor were total circulating cortisol levels before or after suppression of the hypothalamic-pituitary-adrenal axis by dexamethasone or concentrations in aqueous humor. The ratio of urinary cortisol to cortisone metabolites was elevated in POAG versus normal control and OHT (1.74 +/- 0.13 vs. 1.34 +/- 0.11 and 1.32 +/- 0.14; P < 0.05 in each case), indicating a change in the balance of 11beta-HSDs, without a change in other metabolic pathways. CONCLUSIONS: Patients with POAG exhibit increased peripheral vascular sensitivity to glucocorticoids. Increased sensitivity of glucocorticoid receptors, may enhance local glucocorticoid action in the eye and exacerbate the adverse effects of glucocorticoids in this condition.     

PNT治疗开角型青光眼及高眼压症的临床观察

目的:对比研究真空小梁成形术（pneumatic trabeculoplasty, PNT）与0.05g/L拉坦前列腺素滴眼液治疗开角型青光眼及高眼压症患者的临床效果。方法:选取我院就诊的开角型青光眼及高眼压症患者30例48眼,随机分为A,B两组,A组12例24眼行PNT治疗,B组18例24眼给予0.05g/L拉坦前列腺素滴眼液点眼,频次1次/睡前。记录两组治疗前后的视力、眼压、视野及视盘周围神经纤维层厚度变化,进行统计分析。结果:眼压:A组治疗后1~3mo平均眼压值较治疗前明显降低（P＜0.01）。B组整个治疗过程平均眼压均较治疗前明显降低（P＜0.01）。治疗后1~6mo眼压降低≥20%的眼数,A组分别占79%,62%,50%,25%,12%,0;B组分别为92%,83%,83%,79%,71%,62%,两组第3mo开始差异有统计学意义（P=0.014）。在治疗随访过程中,两组患者的视力、视野及视盘周围神经纤维层厚度均无明显变化（P＞0.05）。不良反应:A组多为一过性结膜充血及结膜下出血,且均在1wk内吸收消失;B组有8眼治疗后持续结膜充血较明显,有5例8眼患者诉不同程度刺激症状。结论:真空小梁成形术和0.05g/L拉坦前列腺素滴眼液均能有效降低开角型青光眼及高眼压症患者眼压,但前者副作用更小,而后者降眼压效果持久。     

原发性开角型青光眼全身危险因素及眼体同治的系统回顾和Meta分析

目的系统回顾原发性开角型青光眼(POAG)存在的全身危险因素,分析眼体同治对POAG的治疗效果。 方法对Embase、Medline、Pubmed、Google Scholarship、ISI Web of Knowledge及the Cochrane Central Register of Controlled Trials等英文文献数据库和维普、万方、中国知网及生物医学文献数据库等中文文献数据库进行检索。在检索结果中,选取以POAG患者作为研究对象,以身体质量指数(BMI)、雌激素相关情况、甲皱襞微循环情况、传统降眼压治疗联合口服硝苯地平以及中西医结合治疗效果为主要分析因素的研究。用Meta分析评估POAG患者BMI情况;并对雌激素及微循环异常在POAG发病中的作用、传统降眼压联合口服硝苯地平及中西医结合对POAG的治疗效果进行系统回顾。 结果BMI相关文献中共6篇文章符合纳入标准进行Meta分析。总样本量26 835例,包括POAG患者3058例,正常对照23 777例。POAG患者BMI (MD＝-0.64,95% CI：-1.06,-0.21)较正常人明显降低,差异有统计学意义( I²＝99%,P<0.05)。共分析雌激素相关文献7篇,其中2项研究结果表明女性停经时间相对较迟可以降低POAG的发病风险,3项研究结果表明停经后雌激素替代治疗降低POAG发病的风险。分析微循环相关文献5篇,研究结果表明POAG患者存在甲皱襞毛细血管出血、扩张、无血管区、血管形态异常、血流流速减慢、流量降低情况。分析传统降眼压治疗联合口服硝苯地平治疗青光眼相关文献10篇,其中4项研究结果表明口服硝苯地平后视野无明显进展或较传统治疗方法视野进展缓慢,5项研究针对口服硝苯地平后青光眼患者眼部血流情况进行研究,其中2项证明眼部血流有改善并且差异有统计学意义(P<0.05),3项无统计学意义( P>0.05)。分析5篇中西医结合治疗POAG相关研究,其中4项研究结果表明中西医结合治疗效果更好,1项研究结果表明组间差异无统计学意义(t＝-0.510,0.140; P>0.05)。 结论POAG患者BMI较正常人低,低雌激素、微循环异常可能增加POAG发病风险。联合硝苯地平及中西医结合的眼体同治方法对POAG治疗效果较传统降眼压治疗效果好。     

外路全周缝线小梁切开术对原发性开角型青光眼患者24 h眼压波动规律的影响

目的：评估外路全周缝线小梁切开术(CST)对原发性开角型青光眼(POAG)24 h眼压波动规律的影响。

方法：回顾性研究。纳入2021-03/2022-05在我院就诊的药物治疗眼压控制不佳的POAG患者18例18眼,均行CST治疗,分别在术前,术后1 a进行24 h眼压检查(选择时间点为9：00 AM、12：00 AM、3：00 PM、6：00 PM、9：00 PM、12：00 PM、3：00 AM、6：00 AM),比较术前,术后1 a 24 h眼压均值、峰值及峰值时间、谷值及谷值时间、波动范围及昼夜平均眼压差变化。

结果：术前,术后1 a 24 h眼压曲线均呈现日间下降、夜间升高的变化趋势,下午降至波谷,夜间升至波峰; 与术前相比,术后1 a 24 h眼压谷值、峰值时间较术前提前,术后1 a 24 h眼压均值、峰值、谷值明显下降,波动范围无明显差异,昼夜平均眼压差明显增加。

结论：CST可降低POAG患者眼压,但不改变 24 h眼压波动范围,反而升高昼夜平均眼压差,提示CST不能改善POAG患者昼夜眼压波动。     

POAG患者习惯性体位眼压及眼灌注压昼夜波动趋势的研究

目的：探讨初诊未行治疗的原发性开角型青光眼( prilary open angle glaucola,POAG)患者习惯性体位眼压及眼灌注压(ocular perfusion pressure,OPP)波动趋势,并验证由日间平均坐位及卧位眼压推导夜间峰值眼压的可行性。
　　方法：选取POAG患者19例19眼及正常对照组18例18眼,分别于10：00,14：00,18：00及22：00时行坐位眼压及血压监测,为验证由日间卧位眼压推导夜间峰值眼压的可行性,另对POAG组于卧位5 lin后再行监测。2：00,5：00及7：00行卧位监测,计算出OPP并行数据分析。由已知公式通过日间眼压计算夜间峰值眼压,并与实际值对比。
　　结果：24h习惯性体位下,POAG患者平均眼压及眼压波动均高于正常对照组(P<0.05),POAG组平均眼压峰值出现于凌晨5：00,对照组则为7：00。两组夜间眼压均值均大于日间,差异有统计学意义(P<0.05)。两组内习惯性体位平均眼灌注压( MOPP )均表现为夜间低于日间( P<0.05),而两组间 MOPP 无明显统计学差异( P>0.05)。POAG患者MOPP波动较对照组大,差异有统计学意义( P<0.05)。由两公式推导所得夜间眼压峰值均与所测值无明显统计学差异(P>0.05)。
　　结论：习惯性体位下POAG组及正常人的眼压峰值多出现在凌晨至上午,POAG患者的习惯性体位平均眼压及眼压波动均高于对照组。两组内夜间灌注压均较日间低,且POAG患者有更大的MOPP波动。由日间眼压推导夜间峰值眼压具有一定的可行性。     

Comparison of central corneal thickness in patients participating in a glaucoma screening programme and those who were examined in the glaucoma unit

BACKGROUND: The aim of this study was to compare central corneal thickness (CCT) and intraocular pressure in patients participating in a glaucoma screening programme and patients who were examined in the glaucoma unit. MATERIALS AND METHODS: 406 patients of a glaucoma screening programme (Salzburg-Moorfields collaborative glaucoma study) were included in this study. In addition a group of 406 patients who were admitted to the glaucoma clinic for a detailed glaucoma examination was included (outpatient clinic group). In all participants central corneal thickness (CCT) was measured and possible relations of CCT within the study groups were statistically analysed. RESULTS: In the population screening group the mean central corneal thickness in normal subjects was 536+/-4.3 microm, in patients with ocular hypertension (OHT) 552+/-5.7 microm, patients suffering from a normal tension glaucoma (NTG) showed a mean CCT of 534+/-14.2 microm and those with primary open angle glaucoma (POAG) had a value of 521+/-17.9 microm. In the 'outpatient clinic group' the OHT subgroup had a mean CCT of 553+/-6.8 microm, the NTG subgroup of 529+/-26.5 microm and the one with POAG had a mean of 527+/-19.8 microm. In addition, CCT was measured in all glaucoma patients whose "partner" eye was healthy (544+/-5 microm) and included in this study as part of the normal subgroup. In both groups (screening group and outpatient group), CCT was significantly higher in OHT patients than in normals. In contrast, no statistically significant difference between normals and NTG or POAG patients was detected. Intraocular pressure was significantly lower in the screening groups than in the other ones. CONCLUSIONS: Our data confirm the previously published results concerning OHT and healthy subjects. In this study no significant difference between NTG or POAG subjects and normal eyes was detected. The lower IOP in the screening population can be explained by the fact that patients contacting the screening program are self selected whereas patients of the glaucoma unit are admitted by practising ophthalmologists and are, therefore, rather advanced cases or carrying special risk factors.     

Myopia and plasma cortisol

Estimation of plasma cortisol by fluorometric technique desorbed by Mallingly's was carried out in 56 cases, including 38 cases of myopia (19 cases of simple myopia and 19 cases of degenerative myopia) and 18 normal individuals. Urinary 17-keto steroids/24 hours was also estimated by Zimmermann technique in 12 out of the 56 cases, which include 8 cases of myopia (4 cases of simple myopia and 4 cases of degenerative myopia) and 4 normal individuals as control. Plasma cortisol level is lower in simple and degenerative myopia than in normal subjects, but on statistical analysis the difference was not of much significance. Patients with simple myopia with positive family history showed lower value of plasma cortisol than patients with simple myopia with negative family history, the difference was also statistically insignificant (P-0.1). In degenerative myopia patients, with and without family history, there was very little difference in plasma cortisol level and statistically highly insignificant (P-0.8). Urinary 17 keto steroid/24 hour values are lower in simple and degenerative myopia than in normal subjects.     

Association of ocular pressure and optic disc cup volume with red blood cell sodium-potassium ATPase inhibition

PURPOSE: To determine if there were significant differences between the number of red blood cell ouabain binding sites in normals and untreated ocular hypertensives plus one open-angle glaucoma patient. METHODS: We measured the binding of (3)H ouabain to erythrocyte membranes of 23 normals, 25 ocular hypertensives and one open-angle glaucoma. We also measured the levels of plasma cortisol and digoxin in these subjects. Characteristics of cupping of the optic disc and thickness of the retinal nerve fiber layer, as well as area of optic disc pallor of these subjects were measured by stereophotogrammetry and by computerized image analysis from single and stereo photographs. RESULTS: The number of (3)H ouabain binding sites was observed to be significantly less in the ocular hypertensives and one glaucoma compared to the normals (p = 0.0009). In multi-variate analyses, to determine what other factors affected this difference, there was a significant negative association with mean intraocular pressure (p = 0.003) (average of both eyes) and total cup volume (average of both eyes) (p = 0.005), diagnosis of ocular hypertension and glaucoma (p = 0.0005) and male gender (p = 0.019). There was a significant positive association with plasma cortisol levels (p = 0.048), and diastolic blood pressure (p = 0.037). CONCLUSIONS: The number of (3)H ouabain binding sites in red blood cells decreases significantly with increasing ocular pressure and increasing cup volume indicating the possible presence of an increased systemic endogenous digoxin-like inhibitor and/or difference in the isozymes of Na(+), K(+)-ATPase which may be associated with increased levels of plasma cortisol in ocular hypertensives and glaucomas.