FP7 Ahmed青光眼房水引流阀与S2 Ahmed青光眼房水引流阀治疗难治性青光眼临床研究

目的:比较FP7 Ahmed青光眼房水引流阀与S2 Ahmed青光眼房水引流阀治疗难治性青光眼的医学效能。方法:回顾性分析57例(59眼)难治性青光眼患者在经Ahmed青光眼房水引流阀植入术前、术后临床资料,观察手术后1 d、1周、1个月、3个月、6个月眼压情况,对比分析FP7组36例(38眼)和S2组21例(21眼)青光眼房水引流阀植入术疗效。结果:FP7组和S2组患者的术前眼压分别为(43.00±9.72)mm Hg(1 mm Hg=0.133 k Pa)和(41.70±10.83)mm Hg。术后6个月FP7组眼压(15.72±4.43)mm Hg,成功36眼(94.7%),S2组眼压(18.37±5.78)mm Hg,成功16眼(76.2%)。结论:在控制眼压、手术成功率以及安全性方面,FP7 Ahmed青光眼房水引流阀比S2 Ahmed青光眼房水引流阀具有更显著的效果。     

阀植入治疗青光眼临床分析

目的 探讨Ahmed青光眼阀植入术治疗难治性青光眼的有效性和安全性.方法采用 Ahmed青光眼阀治疗难治性青光眼2例.对他们手术前后的视力、眼压、术后并发症等分析.结果 难治性青光眼2例行Ahmed青光眼引流阀植入后,术后平均观察3～18个月,视力提高1行1例,视力无变化1例,术后平均眼压(17.2±4.3)mm Hg...     

复合式小梁切除术治疗难治性青光眼临床观察

目的 观察复合式小梁切除术对难治性青光眼的治疗效果.方法 回顾性分析24例(26只眼)难治性青光眼应用复合式小梁切除术治疗患者的临床资料.结果 治疗后20眼形成功能性滤过泡;16眼不用任何药物眼压＜21 mm Hg,8眼加用1～2种降眼压药物眼压＜21 mm Hg.手术前平均眼压(38.2±5.6) mm Hg,手术后1周、1个月、3个月、6个月、12个月平均眼压分别为(7.9±3.1)mm Hg、(13.5±3.7)mm Hg、(18.2±3.8)mm Hg、(18.1±3.5)mm Hg、(19.1±4.8)mm Hg,治疗前后眼压差异有统计学意义(P＜0.01).结论 复合式小梁切除术治疗难治性青光眼效果满意.     

浅析难治性青光眼的临床治疗进展

目的分析不同手术方式对难治性青光眼的临床治疗效果,为其今后治疗提供更科学的依据。方法选取2011年7月至2012年7月在我院住院处进行手术治疗的难治性青光眼病患38例(62眼),使用抽签方式将这些病患分成两组,治疗组和对照组,每组共有病患19例(31眼),为对照组中的病患提供植入物引流手术,为治疗组中的病患提供移植羊膜与小梁联合手术。手术后对两组病患进行6²4个月的随访,检查两组病患视力恢复、过滤泡、术后并发症、眼压等基本情况。结果随访过程中,治疗组中病患术前眼压为(40.06±7.81)mm Hg(1 mm Hg=0.133 kPa),术后眼压为(17.29±7.36)mm Hg,对比手术前后治疗组病患的眼压下降程度,P<0.01,具有显著地统计学差异意义;对照组中病患术前眼压为(42.36±8.79)mm Hg,术后眼压为(20.94±8.35)mm Hg,对比手术前后对照组病患眼压下降程度,P<0.01,具有显著的统计学差异意义。治疗组术后总成功率为94.7%明显高于对照组64.5%的术后总成功率,P<0.01,具有显著的统计学差异意义。结论在临床治疗难治性青光眼病患时,使用移植羊膜与小梁联合手术,不仅能够有效降低过滤到产生的瘢痕,同时还能使手术成功率得到有效提高,是现阶段难治性青光眼最有效、最安全的治疗方法之一。     

Ex-press青光眼引流器植入术治疗难治性青光眼的疗效及并发症分析

目的探讨难治性青光眼采用Ex-press青光眼引流器植入术治疗的临床效果及并发症发生情况。方法在2015年1月至2016年1月本院收治的难治性青光眼患者中随机抽取114例(114只眼),所有患者均经临床检查,确诊为难治性青光眼,并知情同意。将114例患者按照随机数字表法分为实验组(Ex-press青光眼引流器植入术)与对照组(小梁切除术)。治疗后随访3个月,对比两组治疗效果和并发症发生情况。结果治疗前,两组患者眼内压对比,结果无显著性差异(P>0.05);治疗后3个月,实验组患者眼内压明显优于对照组,结果有显著性差异(P<0.05);实验组患者视力变化情况优于对照组,结果有显著性差异(P<0.05);实验组并发症发生率为5.3%(3/57),明显低于对照组的21.1%(12/57),结果有显著性差异(P<0.05)。结论在难治性青光眼患者的临床治疗过程中,采用Ex-press青光眼引流器植入术进行治疗,能获得较好的临床效果,可改善患者眼内压和视力,且并发症少,安全可靠,值得进行深入研究和推广。     

新生血管性青光眼的手术治疗分析

目的 探讨新生血管性青光眼进行手术治疗的效果分析.方法 2009年01月至2011年01月期间,我院诊治的新生血管性青光眼100例80眼,术前视力:眼前数指26眼,光感39眼,无光感15眼.术前眼压:(48.53±5.24)mm Hg.根据相关适应证,对80例眼进行手术方法的治疗.结果 手术治疗后随访6个月,术后视力:视力0.1～0.2有28眼,眼前数指38眼,光感12眼,无光感2眼.100例患者80眼中73眼控制,眼压为(10.28±3.49)mm Hg,手术治疗有效率91.25%;5眼需要局部使用2种降低眼压的药物治疗,眼压控制在30 mm Hg以下;2眼手术后眼压不易控制在理想压力,需要再次进行手术.结论 新生血管性青光眼进行手术治疗,是首选的治疗方式,但是要注意手术方式的正确选取.     

闭角型青光眼患者激光周边虹膜切除术的临床观察

目的观察闭角型青光眼行激光周边虹膜切除术的临床疗效。方法收集2013年7月至2014年12月山西省长治市第二人民医院收治的闭角型青光眼共60例(63只眼)青光眼患者作为研究对象。所有患者病眼均为临床前期或先兆期,均行激光周边虹膜切除术治疗。分别于术前、术后1 d、1个月、6个月、12个月、24个月对患者的视力、眼压和中央前房深度进行检查。随访时间为12~24(平均16.8±6.0)个月。结果 60例(63眼)患者中,男性26例(26只眼),女性34例(37只眼);年龄35~72岁,术前视力0.08~1.2(平均0.43±0.22),术前眼压17.35~34.24(平均22.86±3.35)mm Hg,术前中央前房平均深度为(2.27±0.30)mm。术后1 d、1个月、6个月、12个月、24个月随访,平均视力分别为(0.48±0.20)、(0.47±0.19)、(0.48±0.19)、(0.48±0.19)、(0.49±0.15),术后12、24个月与术前比较差异有统计学意义(t值=-1.49,P<0.05)、(t值=-1.30,P<0.05);平均眼压分别为(18.16±1.48)mm Hg、(17.25±0.93)mm Hg、(17.17±0.64)mm Hg、(17.07±0.61)mm Hg、(17.08±0.60)mm Hg,与术前比较眼压明显下降,差异均有统计学意义(P值均<0.05,t值分别为10.16、12.78、13.23、13.48、8.54)。中央前房深度分别为(2.80±0.16)mm、(2.82±0.11)mm、(2.83±0.10)mm、(2.81±0.87)mm、(2.82±0.10)mm,较术前明显加深,与术前比较差异均有统计学意义(P值均<0.05,t值分别为-13.23、-14.99、-15.30、-15.19、-9.97)。术中58只眼(93.55%)1次形成虹膜激光孔,4只眼(6.45%)2次形成虹膜激光孔。术后出现前房出血1例(1只眼),前房炎性反应2例(2只眼),角膜水肿1例(1只眼),一过性眼压升高2例(2只眼),1例(1只眼)患者在术后6个月时虹膜激光孔闭合,经对症处理后均恢复,无严重并发症出现。结论激光周边虹膜切除术治疗临床前期或先兆期闭角型青光眼的临床疗效显著,能快速降低眼压,加深中央前房深度,具有方法简便、疗效好、患者无痛苦等优点,可替代传统手术应用于临床。     

二联冷凝术治疗新生血管性青光眼的临床观察

目的 探讨二联冷凝术对新生血管性青光眼的治疗效果.方法 选择2005年1月至2010年6月新生血管性青光眼患者共26例,26眼.视力无光感～0.05的21例,0.05～0.1的3例,＞0.1的2例;应用2种降眼压药物的情况下眼压波动于32～55 mm Hg,平均(42±11)mm Hg.所有患者均采用全视网膜冷凝联合睫状体冷凝方法治疗.术后观察视力、眼压、前房反应、患者症状,随访6个月～2年,平均12.8个月.结果 术后所有患者症状均明显好转,眼压控制良好,术后1周、1个月、3个月、6个月平均眼压分别为(23±12)mm Hg,(21±8)mm Hg,(18±11)mm Hg及(加±9)mm Hg.手术前后眼压差异有统计学意义(P＜0.05).术后不用药物25例,需用一种药物眼压控制在21 mm Hg以下的有1例,患者较为年轻,手术中睫状体冷冻的范围较小.1例发生眼球萎缩.视力提高5例,由原来的光感提高至0.02,视力下降2例,由术前＞0.1下降至0.08.患者术后前3天前房反应较重,眼压偏高,第四天眼压开始下降,一月左右眼压维持恒定.结论 二联冷凝术治疗新生血管性青光眼是一种简单有效的方法.     

引流阀植入治疗难治性青光眼疗效观察

目的观察引流阀植入治疗难治性青光眼的疗效及安全性。方法分析2000年6月～2007年1月已行引流阀植入治疗的难治性青光眼患者20例的临床资料。结果青光眼眼压控制标准6mmHg≤眼压≤21mmHg,该组患者随访6个月,7年,平均24个月,术前眼压40．43＋13mmHg,术后末次随诊眼压14．2±6．5mmHg,其中3例用降眼压眼液控制眼压在21mmHg内,术后裸眼视力保留术前视力或有所提高,无1例下降者,并发症：早期低眼压5例．浅前房2例,前房积血3例,3例引流盘包裹。结论选择合适的患者,避免和积极处理术中及术后各种并发症．在治疗难治性青光眼的手段中．引流阀植入不失为一种有效的良好方法。     

改良小梁切除术治疗青光眼的临床疗效

目的探讨改良小粱切除术治疗青光眼的手术方法以及临床效果。方法 82例(82眼青光眼患者,均采用改良小梁切除术治疗,术后随访1年,观察患者前房、眼压、视力、并发症情况。结果 82例(82眼)患者术后1 d前房开始形成,术后1~5 d, 14例患者出现Ⅱ度浅前房,经调整缝线后恢复。术后1周内眼压≥21 mm Hg(1 mm Hg=0.133 kPa) 10眼,眼压11~20 mm Hg 50眼,眼压6~10 mm Hg22眼,行眼球按摩, 77眼眼压维持在12~18 mm Hg, 5眼眼压≥21 mm Hg。术后视力保持不变29眼,提高1~3行50眼,视力下降2~3行3眼。术后前房出血5眼,虹膜睫状体炎3眼,经药物保守对症治疗1周内消退。结论改良小梁切除术治疗青光眼操作简便,创伤小,安全性高,临床疗效较好,减少手术并发症的同时保证了手术的成功率,值得在基层医院推广应用。     

Ahmed青光眼阀置入术治疗难治性青光眼

目的探讨Ahmed青光眼阀植入术治疗难治性青光眼的手术方法及疗效。方法用Ahmed青光眼阀植入术治疗难治性青光眼27例(27眼),其中新生血管性青光眼11眼、葡萄膜炎性青光眼3眼、无晶体眼青光眼7眼、外伤性青光眼6眼。其中有5眼曾行小梁切除术后失败。结果术后随访1～3年。术前眼压36～70mmHg,平均(41.12±10.04)mmHg,末次随访时平均眼压(20.04±9.15)mmHg,手术前后眼压存在显著性差异(P<0.01)。其中术后不用药物治疗眼压控制在21mmHg以下者15眼,联合局部降眼压药物治疗眼压控制在21mmHg以下者7眼,总有效率为81.48%。术后9眼视力较前有不同程度提高,最好视力达0.2。结论Ahmed青光眼阀植入术治疗难治性青光眼,操作简便,疗效满意,是目前值得推荐的治疗方法。     

Advances in glaucoma therapeutics

Glaucoma is a major cause of irreversible blindness in the world. The prevalence of glaucomatous loss in vision will continue to grow as our populations age. Ocular hypertension is a major risk factor for the development of glaucoma and current glaucoma therapy is directed at lowering intraocular pressure. Several new ocular hypotensive agents have been introduced in the past several years providing a variety of treatment options. In addition, various classes of neuroprotective agents demonstrating activity in a wide variety of animal models have been proposed as potential new glaucoma therapeutics. Although these approaches will slow the progression of vision loss, they do not directly intervene in the disease process(es). Advances have been made attempting to understand the pathogenic pathways involved in glaucomatous damage to the eye and in methods to clinically measure glaucoma damage. An increased understanding of the pathophysiology of glaucoma will lead to the development of new therapeutic agents that intervene and perhaps even reverse glaucomatous damage to the eye. There also is a need to develop new methods to clinically measure glaucoma damage because, currently, considerable damage occurs before glaucoma is diagnosed and glaucoma remains underdiagnosed in the general population.     

Advances in glaucoma therapeutics

Glaucoma is a major cause of irreversible blindness in the world. The prevalence of glaucomatous loss in vision will continue to grow as our populations age. Ocular hypertension is a major risk factor for the development of glaucoma and current glaucoma therapy is directed at lowering intraocular pressure. Several new ocular hypotensive agents have been introduced in the past several years providing a variety of treatment options. In addition, various classes of neuroprotective agents demonstrating activity in a wide variety of animal models have been proposed as potential new glaucoma therapeutics. Although these approaches will slow the progression of vision loss, they do not directly intervene in the disease process(es). Advances have been made attempting to understand the pathogenic pathways involved in glaucomatous damage to the eye and in methods to clinically measure glaucoma damage. An increased understanding of the pathophysiology of glaucoma will lead to the development of new therapeutic agents that intervene and perhaps even reverse glaucomatous damage to the eye. There also is a need to develop new methods to clinically measure glaucoma damage because, currently, considerable damage occurs before glaucoma is diagnosed and glaucoma remains underdiagnosed in the general population.     

青光眼药物治疗的新进展

青光眼是一种多元性的视神经和视网膜病变。全世界大约有 70 0万病人因青光眼而失明。眼压升高是青光眼发病过程中的主要危险因素。本文简要地回顾目前常用的药物疗法 ,并介绍正在研发中的新降眼压药的药效和药理机制。     

Autoimmune biomarkers in glaucoma patients

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Highlights► Changes in autoantibody profiles and IgG-antibody deposits in the retina occur in glaucoma. ► Elicited autoimmunity causes glaucomatous-like damage in an animal model. ► Antibodies of glaucoma patients influence proteins in retinal ganglion cells. ► Autoantibodies have a neuroprotective potential. ► Autoantibody patterns could be useful biomarkers for glaucoma diagnosis.     

Cutaneous corticosteroid-induced glaucoma

Skin contact with nonylphenol ethoxylates (NPE), a group of widely used surfactants, is the primary source of human exposure. Previous studies have shown that the absorption of NPE through human and animal skin in vitro is limited (<1% over 8 hr) [Monteiro-Riviere et al. Toxicol Indust Health 2000; 16:49–57]. The purpose of this study was to examine the percutaneous absorption of NPE and the chemical precursor, nonylphenol (NP), in the isolated perfused porcine skin flap (IPPSF) model for comparison to the in vitro porcine skin flow through (PSFT) diffusion studies. The IPPSF model is considered to accurately predict absorption of chemicals through human skin. The IPPSF was dosed with 100 μl of 1% ¹⁴C ring-labeled NP, ¹⁴C ring-labeled NPE-4, or ¹⁴C ring-labeled NPE-9 in aqueous polyethylene glycol (PEG-400) solution and perfused for 8 hr. All three chemicals were minimally absorbed, with only approximately 0.1% of the applied dose found in the perfusate over the 8-hr collection. This absorbed material represents the systemic exposure expected following skin contact in humans. In addition, less than 1% of the applied dose penetrated into the stratum corneum and underlying dermis, but remained within the skin and did not go through to the perfusate. Thus, the overall potential systemic exposure to these chemicals from skin contact, using a model considered similar to human skin in vivo, is less than 1%. The absorption results of this study were consistent with previous studies in the PSFT model. The penetration of NPEs and NP in the IPPSF was less than the PSFT and is probably more predictive of in vivo human absorption as this model is physiologically closer to human skin. This suggests that the overall potential for skin absorption of these chemicals in humans is even lower than previous estimates.