原发性窄角型开角型青光眼误诊临床分析

目的分析原发性窄角型开角型青光误诊的原因、临床表现及治疗方法。方法收集2001年12月至2005年8月我院收治的被误诊为急性闭角型青光眼的原发性窄角型开角型青光眼15例(17眼)的临床资料,进行回顾性总结,分析其临床特点、误诊的原因和治疗效果。结果1.眼压:入院时的眼压43.38～81.78mmHg,平均为(51.66±5.46)mmHg;手术后的两年随访,在没有用降眼压药物的情况下,眼压在10mmHg以下有2例,10～15mmHg有4例,15～20mmHg有7例,20～25mmHg有2例,平均为(15.92±4.55)mmHg。经统计学处理,手术前后的眼压差异有显著性(p<0.001);2.视力:手术前的视力在0.3～1.0,手术后视力0.4～1.2,手术前后视力差异无显著性(p>0.05)。3.误诊原因:7例病人根本无房角检查情况,4例病人房角检查情况因为医师经验不足而有误,4例病人是手术前没有停用降眼压药物,其中有1例手术前匹罗卡品眼药水每小时点眼一次,而单单根据眼压控制,房角开放而采用周边虹膜切除。4.误诊情况:误诊为急性闭角型青光眼急发作的4例(4眼),误诊为急性闭角型青光眼慢性期的7例(9眼),已行周边虹膜切除后残余性青光眼4例(4眼)。结论原发性窄角型开角型青光眼可以有急性闭角型青光眼发作的临床表现,临床的确诊要靠房角检查,治疗要按照开角型青光眼进行处理。     

正常眼压型青光眼与高眼压型原发性开角型青光眼是否为同一类型疾病

基于临床考虑,在《我国原发性青光眼诊断和治疗专家共识》中,将正常眼压型青光眼与高眼压型原发性开角型青光眼同归类为原发性开角型青光眼,归属于一类疾病的两个亚型,分界点在于眼压是在正常范围还是高于21 mm Hg(1 mm Hg=0.133 kPa)。但是正常眼压型青光眼与高眼压型原发性开角型青光眼是否应属同一类型疾病,眼...     

原发性闭角型青光眼激光治疗术后的房角镜检查及临床意义

目的观察原发性闭角型青光眼激光治疗术后的房角改变,探讨激光治疗术后房角改变及随访的临床意义.方法62眼(53例)原发性闭角型青光眼,房角关闭小于180°,行激光房角成型术以及激光虹膜切开术,术后用房角镜随访房角变化共22月.结果在随访期内62眼中有2眼(慢闭青)因为房角进行性关闭,眼压不能控制行小梁切除术,有6眼(慢闭青)房角虽然没有发现明显的进行性关闭,但是激光术后房角开放不明显,需局部用药才能使眼压控制在正常范围.房角成型和虹膜切开术对急闭青和慢闭青的房角有效开放率行x2检验,结果p=0.0252激光治疗术后两者的房角开放程度有显著性差异.结论激光房角成型术以及激光虹膜切开术对于早期原发性闭角型青光眼是一种安全有效的治疗方法,但由于原发性闭角型青光眼房角关闭机制的多样性,术后需要密切观察眼压、房角以及视神经和视野的变化.     

选择性激光小梁成形术治疗原发性青光眼

目的评价选择性激光小梁成形术治疗原发性开角型青光眼(primaryopenangleglaucome,POAG)及原发性闭角型青光眼(prionaryangleclosureglaucome,PACG)虹膜周切术后残余青光眼的疗效和安全性。方法前瞻性、非随机性选择局部用药眼压不能控制的原发性开角型青光眼患者(13例16眼),或已行周边虹膜切除或激光虹膜打孔术,房角大部开放而眼压高的原发性闭角型青光眼患者(22例32眼)。应用选择性激光小梁成形术治疗。观察患者术后6个月眼压的变化。结果两组患者的眼压在激光治疗后均有显著下降:POAG组由术前的(25.3±3.9)mmHg降低至术后6个月的(18.0±4.2)mmHg;PACG组由术前的(23.9±3.0)mmHg,降低至术后6个月的(18.8±3.8)mmHg(1kPa=7.5mmHg)。术后暂时的眼压升高为最常见的并发症。结论选择性激光小梁成形术不仅可用于原发性开角型青光眼的治疗,也可以作为治疗残余闭角型青光眼的一种安全有效的方法。     

超声乳化联合房角分离术治疗白内障合并闭角型青光眼

目的 观察超声乳化(超乳)白内障吸除,联合黏弹剂房角分离术,治疗合并白内障的原发性急、慢性闭角型青光眼的疗效.方法 超乳联合房角分离术治疗急性闭角型青光眼(以下简称急闭)20只眼,慢性闭角型青光眼(以下简称慢闭)18只眼.均有不同程度的晶状体混浊.随访时间为3～18个月.结果 急、慢闭组术后平均眼压均较术前明显下降(p＜0.01),使用抗青光眼药物例数明显减少,前房深度较术前增加,前房角较术前增宽.结论 超声乳化白内障吸除联合黏弹剂房角分离术可治疗急、慢性闭角型青光眼,前者疗效优于后者.     

超声乳化术治疗合并白内障的闭角型青光眼临床分析

目的观察超声乳化白内障摘除人工晶状体植入治疗合并白内障的原发性闭角型青光眼的临床疗效。方法 32例(37只眼)合并白内障的原发性闭角型青光眼患者行超声乳化白内障摘除人工晶状体植入术,观察患者术前术后视力、眼压、周边前房深度、房角等情况。术后随访时间为3个月。结果术后所有患者的矫正视力均有不同程度的提高;眼压较术前有所下降;周边前房深度均≥1CT;房角变宽。结论对术前眼压药物控制正常水平,房角关闭范围≤1/2圆周者,超声乳化白内障摘除术可有效治疗合并白内障的原发性闭角型青光眼。     

视盘形态分析在基层医院原发性开角型青光眼早期诊断中的作用

目的:探讨视盘形态分析在原发性开角型青光眼早期诊断中的作用。方法:选取72例视乳头杯盘比在0.5~0.8之间的受检者进行视力、裂隙灯、直接检眼镜检查、测眼压及24h眼压曲线、检影验光,并行房角镜、电脑视野和光学相干断层成像(optical coherence tomography,OCT)检查,并对上述检查结果进行分析。结果:视盘形态正常者仅有10例眼压在可疑范围,视野、OCT检查未见异常;而视盘形态异常者中眼压、视野及OCT异常者占较大比例。结论:视盘形态在原发性开角型青光眼早期诊断中是一敏感因素。     

原发性开角型青光眼治疗的进展和新认识

本综述了近年来对原发性开角型青光眼治疗方法的评价和研究进展。小梁切除术作为原发性开角型青光眼最初治疗手段的研究表明手术治疗可获得更稳定的眼压控制和更高的成功率，术后较少发生视野进行性损害。现认为原发性开角型青光眼小梁切除术的适应证是治疗前眼压大于３０ｍｍＨｇ和视野检查有绝对暗点存在。根据眼压和视功能损害程度为原发性开角型青光眼选择合理地治疗方法，尽可能地把眼压控制在安全的水平（１５ｍｍＨｇ以下）     

选择性激光小梁成形术治疗原发性开角型青光眼的一年疗效观察

目的研究选择性激光小梁成形术(SLT)治疗原发性开角型青光眼的安全性和有效性。设计回顾性病例系列。研究对象47例62眼早期原发性开角性青光眼患者。方法所有患者应用Q开关、倍频532 nm、Nd:YAG激光器(Selecta Duet型)行SLT治疗,范围下方房角180度,50个点,单脉冲能量0．5～1．4mJ。激光手术前后抗青光眼药物保持不变。随访12个月。主要指标眼压与并发症。结果在62眼中有72．5%眼压控制。SLT术前平均眼压(24．3±3．7)mmHg,手术后12个月的平均眼压(19．1±3．9)mmHg,眼压的下降差异有统计学意义(P＜0．001)。所有病例在手术后1小时均出现轻度前房炎症反应,3天后消失。结论SLT治疗早期原发性开角型青光眼随访一年是安全有效的。(眼科,2007,16:37-39)     

应用闭角型青光眼新的分类和定义指导临床治疗

用国际上新的闭角型青光眼分类和定义指导临床治疗具有简捷和可操作性的优点。对可疑原发性房角关闭除了密切随访外，有选择性地行周边虹膜切除术；对急性和慢性原发性房角关闭可根据发生机制和临床特征对患者进行不同的临床处理；对原发性闭角型青光眼可根据视神经损害程度和靶眼压选择药物、激光或滤过性手术等治疗。（眼科,2007,16：12-13）     

Pocket gonioscopy

A simple and effective method for viewing the anterior chamber angle allowing a physician to adequately grade the depth of the anterior chamber angle is described. Such a judgment is necessary for distinguishing narrow angle from open angle type of glaucoma.     

Non-steroidal drug-induced glaucoma

Numerous systemically used drugs are involved in drug-induced glaucoma. Most reported cases of non-steroidal drug-induced glaucoma are closed-angle glaucoma (CAG). Indeed, many routinely used drugs that have sympathomimetic or parasympatholytic properties can cause pupillary block CAG in individuals with narrow iridocorneal angle. The resulting acute glaucoma occurs much more commonly unilaterally and only rarely bilaterally. CAG secondary to sulfa drugs is a bilateral non-pupillary block type and is due to forward movement of iris-lens diaphragm, which occurs in individuals with narrow or open iridocorneal angle. A few agents, including antineoplastics, may induce open-angle glaucoma. In conclusion, the majority of cases with glaucoma secondary to non-steroidal medications are of the pupillary block closed-angle type and preventable if the at-risk patients are recognized and treated prophylactically.     

Long-term results of Nd-YAG laser iridotomy and indications deriving from it

Of 132 patients who had undergone Nd-YAG laser iridotomy, 70 were randomly selected for follow-up examinations. Nd-YAG laser iridotomies were subsequently performed on 124 eyes (of these 70 patients), 12 for acute angle-closure glaucoma, 19 fellow eyes of those which had angle-closure glaucoma, 70 for chronic angle-closure glaucoma, and 23 eyes with increasingly narrow chamber angle under miotic therapy. The follow-up period ranged from 1 to 25 months (median = 9 months). Eighty-seven percent of the iridotomies remained visibly open. Of 12 acute glaucomas, 10 were successfully treated, whereas only 2 required a basal iridectomy. In the large group of 106 eyes with a "narrow angle condition," a significant pressure reduction from 20.9 +/- 5.8 to 16.7 +/- 3.4 mm Hg and a significant enlargement of the chamber angle resulted. Since fistulizing procedures involve a risk of malignant glaucoma, Nd-YAG laser iridotomy, which this investigation showed to be risk-free, is the initial procedure of choice in narrow-angle conditions, especially subacute and chronic angle-closure glaucoma, in order to alleviate the angle-closure component in such angle-closure situations, to diagnose its contribution to peak IOP, and to facilitate argon laser trabeculoplasty when needed.     

Is the season of birth a risk factor in glaucoma?

Several lines of research suggest that some systemic diseases, often associated with age-related conditions, may present with enhanced prevalences owing to very early influences on human development. This paper describes an analysis of 1264 adult Caucasian patients presenting either with primary open angle or narrow angle/angle closure glaucoma on the one hand, or with age-related cataract on the other. In addition, data on cataracts and primary open angle glaucoma on 254 patients of Caribbean origin and 190 of south east Asian origin were also examined. Patients were classified with respect to sex and season of birth. These variables can play a statistically significant role in the prevalence of glaucoma, which raises the possibility that environmental influences may be involved.     

Genetic factors in open-angle (simple and capsular) glaucoma. A population-based twin study

A nationwide record linkage of the Finnish Twin Cohort Study (FTCS) with the Hospital Discharge Registry and the Registry of Rights for Free medication is presented. This study consists of 108 pairs (114 individuals) of twins with chronic open-angle glaucoma. Of the twin pairs 29 were monozygotic (MZ), while 79 pairs were dizygotic (DZ). Three monozygotic and 3 dizygotic pairs were concordant for chronic open-angle glaucoma (OAG), while 26 monozygotic and 76 dizygotic pairs were discordant. Seventy-three twins had chronic simple glaucoma, while 34 twins had capsular glaucoma, and in 7 patients chronic simple glaucoma was noted in one eye and capsular glaucoma in the second eye. The heritability of chronic open angle glaucoma was 13%. The higher O/E-ratio of concordant twin pairs among MZ twins indicates that genetic factors play a role in this disease. The difference is anyhow surprisingly low compared to former estimates of heritability of open angle glaucoma. The steep rise in prevalence in older age groups was confirmed. The age-adjusted prevalence of chronic open-angle glaucoma in this study was 0.63%.     

Can the pilocarpine phenylephrine provocative test be used to detect covert angle closure?

Mapstone introduced the term 'partial angle closure' to describe how eyes with apparently open angles could be damaged by a covert angle closing mechanism, identifiable by a positive result of the pilocarpine phenylephrine provocative test (PPPT). This paper presents a 10-year follow-up of 68 patients with narrow but open anterior chamber angles who, on the basis of a positive PPPT, underwent peripheral iridectomy (PI) or laser iridotomy LI). In the 42 patients with glaucoma or ocular hypertension the mean intraocular pressure (IOP) was unchanged following iridectomy; 45% of eyes which showed glaucomatous optic disc damage at presentation and 25.6% of ocular hypertensive eyes subsequently required trabeculectomy to achieve IOP control. In 16 patients with no ocular abnormality other than a narrow angle 19 eyes had positive PPPTs and underwent PI. After a 10-year follow-up only one of the 13 untreated fellow eyes developed angle closure glaucoma. As this is usually bilateral, many of the positive tests in this group of patients may therefore have been false positives. This study shows that eyes with narrow angles which had positive PPPT results did not benefit from PI iridectomy or LI and therefore a positive PPPT is not indicative of the presence of an angle closing mechanism.     

原发性房角关闭--闭角型青光眼的新定义?

最近在国际上提出了对原发性闭角型青光眼（PACG）的新定义和分类系统,强调在青光眼视神经病变方面应与原发性开角型青光眼取得相同意义的定义,其中对尚未发生青光眼性视神经损害,但有急性发作或者慢性房角-虹膜前粘连的患者,改称为原发性房角关闭,虽然这个新的分类系统后来为美国眼科学会和东南亚青光眼学会采用,但是对于是否在国内采用这个定义和分类系统,一直存在很大的争议,笔者旨在说明提出这个分类系统的背景,讨论新定义的益处和存在问题,以便与广大眼科同道交流。     

Central retinal artery and vein collapse pressure in eyes with chronic open angle glaucoma

AIMS: To determine central retinal vessel collapse pressure in chronic open angle glaucoma. METHODS: For 19 eyes with chronic open angle glaucoma and 27 eyes of a control group, central retinal vessel collapse pressure was measured by a Goldmann contact lens fitted with a pressure sensor in its holding grip. RESULTS: Central retinal vein collapse pressure was significantly (p=0.001) higher in the glaucoma group than in the control group (26.1 (SD 26.4) relative units versus 6.1 (8.4) relative units). CONCLUSIONS: Measured by a new ophthalmodynamometer, central retinal vein collapse pressure measurements may be abnormally high in eyes with chronic open angle glaucoma.     

DIURNAL VARIATIONS IN INTRAOCULAR PRESSURE Chronic Open Angle Glaucoma: Preliminary Report

Human beings have a diurnal variation in their intraocular pressure and this variation is related to the sleep-wake cycle. Patients with chronic open angle glaucoma have a similar fluctuation in intraocular pressure and, even without medication, may achieve a "normal" intraocular pressure several hours into their sleep period. Two patients with chronic open angle glaucoma, maintained on their usual miotic therapy, also maintained a normal diurnal fluctuation in intraocular pressure as did one patient with a unilaterally transected optic nerve and another with a surgically divided trigeminal nerve.     

Mutations in the third exon of the MYOC gene in spanish patients with primary open angle glaucoma

Primary open angle glaucoma (POAG) is the second most common cause of blindness in developed countries. It is an optic neuropathy in which a degeneration of the retinal ganglion cells causes a characteristic excavation in the optic disc. Several loci have been identified to be responsible for different types of glaucoma, including the MYOC gene located on chromosome 1. In this work, six mutations have been identified in the third exon of the MYOC gene in patients with POAG. We studied 79 Galician patients with chronic POAG glaucoma and 90 control individuals from the same general population. We identified six mutations, including three novel ones. Two of the six mutations were considered to be polymorphisms, while the other four met the criteria for pathogenicity in this disease as they altered the amino acid sequence and were found in one or more patients with glaucoma and in less of 1% of the control population. These mutations were detected in eight patients suffering from POAG (7.5%) and in two people from the control population (2.2%). POAG can be due to mutations in the myocilin gene (MYOC) on chromosome 1. The glaucoma phenotype associated with this gene may vary from a juvenile severe form to a late-onset chronic open angle glaucoma.