青光眼的房水排出率和睫状体病理变化

本文对６０例６７只原发性青光眼的房水排出率应用荧光光度计进行了测定，对其中５只绝对期青光眼眼球标本进行了睫状体组织病理观察，并以正常眼作对照。青光眼的房水排出率下降，下降程度与病程及眼压水平成正比，病程３年以上，眼压未很好控制在５ｋＰａ以下者，房水排出率显著下降。绝对期青光眼的睫状体病理特征主要是萎缩性改变，睫状上皮细胞减少，排列稀疏、部分脱落，细胞层表面和基质中纤维成分大量增多，血管退化，管腔狭窄，部分闭塞。文中分析讨论了房水生成与睫状体结构变化的关系及临床意义。     

房水动力学临床研究进展

房水动力学研究主要研究房水生成、房水经小梁网和葡萄膜巩膜途径排出的阻力等,这些参数决定了眼压高低.近年来,随着对青光眼、高眼压症发生机制研究的不断深入,房水动力学差异变化重新得到关注.黑种人较白种人有较薄的角膜,这可能对房水动力学参数有一定影响.随着年龄增长,前房容量、房水流动率、葡萄膜巩膜途径房水流动率有不同程度下降.高眼压症患者眼压升高的主要原因是房水流畅系数和葡萄膜巩膜途径房水流动率的下降.色素播散综合征及剥脱综合征等眼病也均有眼压升高、房水流畅系数下降等房水流动系数的改变.     

穿透性角膜移植聊合房水引流装置植入治疗严重角膜病变合并青光眼

目的：观察穿透性角膜移植聊合房水引流装置植入术治疗严重角膜病变合并离治性青光眼的临床效果和安全性。方法：1996年以来对13只严重角膜病变合并离治性青光眼的患眼一次施行穿透性角膜移植术和Ahmed青光眼阀植入术。术后随诊观察至少11个月,平均20个月,观察项目主要是角膜移植片的透明情况,房水引流装置的硅管有无阻塞,视力,眼压和并发症,结果：视力提高10只眼（76．9％）,眼压降至正常11只眼（84．6％）,角膜植片透明9只眼（69．2％）,房水引流管通畅12只眼（92．3％）,结论：穿透性角膜移植术同时联合房水引流装置植入术治疗严重角膜病变合并青光眼可达到满意的降眼压效果,改善角膜移植片的透明度,提高患的视功能。     

发慢性闭角青光眼房水动力学改变与房角关闭范围,眼压及视功能损害…

对４０例５７眼原发性慢性闭角型青光眼（ＰＣＡＣＧ）和正常对照组３０例６０眼，进行了房水荧光素度曲线的测定。结果明显示，ＰＣＡＣＧ房角关闭≥１８０＾。组，房水荧光素下降率比对照组减少３０．２１％，所致视功能损害为青光眼早期和中期改变。而房角关闭≥２７０＾。组，房水荧光素下降比组减少５８．９５％，所致视功能损害主要是青光眼晚期改变。证明ＰＣＡＣＧ房角关闭范围越大，房水荧光素下降越低，眼压越高，视功能功     

原发慢性闭角青光眼房水动力学改变与房角关闭范围,眼压及视功能损害的关系

对40例57眼原发性慢性闭角型青光眼(PCACG)和正常对照组30例60眼,进行了房水荧光素浓度曲线的测定。结果显示,PCACG房角关闭≥:180°组,房水荧光素下降率比对照组减少30.21%,所致视功能损害为青光眼早期和中期改变。而房角关闭≥270°组,房水荧光素下降率比对照组减少58.95%,所致视功能损害主要是青光眼晚期改变。证明PCACG房角关闭范围越大,房水荧光素下降率越低,眼压越高,视功能损害也就越严重。     

青光眼房水引流物置入术概况（一）

青光眼房水引流物置入术概况（一）湖南医科大学附属第二医院段宣初综述蒋幼芹审校现代显微小梁切除术治疗原发性青光眼，效果良好．然而，对干各种顽固性青光眼，手术成功率不高，这些青光眼眼压甚高，视力下降迅速，对药物及激光疗法毫无反应，这种情况下，通常需要选用...     

三种途径植入房水引流物治疗难治性青光眼的疗效观察

目的观察3种途径(经角膜缘植入前房、经角膜缘后植入后房及经睫状体平坦部植入玻璃体腔)植入房水引流物治疗难治性青光眼的效果.方法对99例(99只眼)难治性青光眼患者行房水引流物植入术.根据植入途径分为3组经角膜缘植入前房组58例(58只眼),经角膜缘后植入后房组16例(16只眼),经睫状体平坦部植入玻璃体腔组25例(25只眼).结果术后随访6～34个月,平均19.6个月.引流物经角膜缘植入前房组眼压＜21 mm Hg(1 mm Hg=0.133 kPa)者46例(79.3%),其中需加用局部降眼压药物者6例(10.3%);经角膜缘后植入后房组眼压＜21 mm Hg者12例(75.0%),其中需加用局部降眼压药物者1例(6.2%);经睫状体平坦部植入玻璃体腔组眼压＜21 mm Hg者13例(52.0%),其中需加用局部降眼压药物者3例(12.0%).3组的手术成功率差异有显著性(χ2=6.525, P<0.05).经睫状体平坦部植入玻璃体腔组成功率较低.但经除外新生血管性青光眼患者后,3组的手术成功率分别为83.3%、75.0% 及58.8%,差异无显著性(χ2=4.231, P>0.05).结论通过3种途径植入房水引流物治疗难治性青光眼的效果基本相同,可根据患者具体情况选择合适的植入途径.     

房水流出通道形态及功能在体评估进展

青光眼病理性高眼压的常见原因是房水流出受阻,因此房水流出通道的形态观察和功能研究是青光眼防治的重点。研究房水流出通道的形态及功能对研究青光眼发病机制、选择手术方式和开发靶向药物均有重要意义。房水流出成像方式中眼前段相干光断层扫描及血管成像、超声生物显微镜活体显像,可对房水流出通道进行结构性评估;而静态和实时房水血管造影为功能性评估。目前尚缺乏房水结构流出特征与功能流量值之间的精确关系研究。使用房水血管造影术可研究与评价青光眼的药物疗效。房水血管造影术有助于引导小梁网靶向的微创青光眼手术以获得更好的降眼压效果。但房水血管造影术有创,目前只能在手术室使用。未来尚需进一步改进评估房水流出通道的方法,以期在临床上通过结构和功能评估相结合,更好地了解房水流出通道和眼前段结构,提高青光眼诊治水平。（国际眼科纵览,2020, 45：397-403）     

房水引流物植入术治疗玻璃体手术后的难治性青光眼

目的 评价房水引流物植入术治疗玻璃体手术后难性青光眼的效果。方法 对15例（16只眼）眼部条件极差,经硅油取出和（或）最大剂量药物治疗不能控制眼压的玻璃体手术后继发性青光眼患者,行房水引流物植入术。其中13只眼植入Ahmed减压阀,3只眼植入Krupin减压阀。结果 患者平均随访18．5个月。手术成功率：3个月时为76．9％,6个月时为70．0％,1年以上为66．7％。术后常见并发症包括短暂性前房出血、早期低眼压、脉络膜脱离、前房延缓形成及引流口阻塞等。结论 房水引流物植入术是治疗玻璃体手术后难治性青光眼的一种安全、有效方法。     

房水流出率测量方法及其影响因素

评价房水循环的技术有眼压测量、眼压描记、巩膜静脉压测量、巩膜葡萄膜外流和房水流出率测量.临床上经常使用的只有眼压测量.然而,对于了解眼球的生理和病理情况,尤其是研究房水动力学和抗青光眼药物的作用机制,其他测量技术亦非常重要且必不可少.本文就人们较少了解的用荧光光度计测量房水流出率的基本理论和方法,以及房水流出率的生理周期、疾病和药物对房水流出率的影响作一综述.     

Effects of ibopamine eye drops on intraocular pressure and aqueous humor flow in healthy volunteers and patients with open-angle glaucoma

PURPOSE: On the basis of intraocular pressure measurements and fluorophotometry we assessed the effects of 2% ibopamine eye drops on aqueous humor production in normal and glaucomatous eyes. METHODS: Thirty subjects (15 healthy volunteers and 15 open-angle glaucoma patients with ocular hypertension) were included in a placebo-controlled study with random assignment of treatment from masked containers. All subjects underwent ophthalmologic examinations and intraocular pressure (IOP) measurements. Fluorophotometry was done in both eyes at baseline (without treatment) and during treatment. Each subject was treated with 1 drop of 2% ibopamine in one eye and 1 drop of placebo in the fellow eye 30 minutes before fluorophotometric scans and every hour after the first instillation (for a total of 4 times). Safety was evaluated by recording adverse events and ocular symptoms and signs. Aqueous humor flow data were analyzed using the paired t-test, comparing ibopamine and placebo-treated eyes. RESULTS: No changes in IOP were detected in normal eyes, whereas glaucomatous eyes showed a mean increase of 4 mmHg (95% CI 3.46-4.51) from baseline. The difference in IOP between healthy eyes and those with glaucoma was significant (p < 0.0001). In normal eyes and patients with glaucoma ibopamine led to a significant increase in aqueous humor flow compared with placebo-treated eyes (p < 0.01). The safety profile of ibopamine was very good. CONCLUSIONS: The results seem to confirm that ibopamine increases aqueous humor production in normal and glaucomatous eyes, raising IOP only in eyes with glaucoma.     

Experimental perfusions through the anterior and vitreous chambers with possible relationships to malignant glaucoma

Enucleated eyes were perfused alternately via the anterior and vitreous chambers. At low intraocular pressure (IOP), vitreous humor presented considerable resistance to forward flow of perfusion fluid in calf eyes, but not in human eyes. In human eyes when the perfusion pressure was increased to 60 mm Hg, the resistance to flow forward from the vitreous body increased, but became practically nil again when the IOP was decreased. At high pressure the volume of the vitreous body apparently increases and the anterior hyaloid membrane probably presses against the ciliary body, reducing the area of hyaloid membrane through which fluid can flow. Whether increased perfusion pressure can in some other manner change the permeability of human vitreous to resemble that of the calf remains unanswered. Our results suggest that factors other than, or in addition to, simple diversion of aqeous humor must be important in malignant glaucoma.     

Noninvasive assessment of aqueous humor turnover in the mouse eye

PURPOSE: To develop a noninvasive test for monitoring changes in aqueous humor turnover in the mouse eye. METHODS: After topical instillation of fluorescein, the rate of decay of fluorescence from aqueous humor and cornea was monitored in Black Swiss, C57 Bl6, and DBA 2J mice with a microscope equipped with epifluorescence and a charge-coupled device (CCD) camera. RESULTS: The rate of decay of fluorescence was identical in right and left eyes over an approximately 70-minute measurement period. The rate of decay was similar in normal mice aged 2 and 18 months. Pilocarpine and latanoprost, known to enhance aqueous humor outflow in humans, accelerated the decay of fluorescence. Levobunolol, known to inhibit aqueous humor inflow in humans, slowed decay. Dimethylamiloride, an inhibitor of the Na(+),H(+) exchanger that is known to act on cultured cells of both the ciliary epithelium and trabecular meshwork and to lower mouse intraocular pressure (IOP), enhanced decay. DBA 2J mice, in which secondary glaucoma develops, displayed a slower decay of fluorescence at 18 months of age than age-matched unaffected animals. CONCLUSIONS: Monitoring decay of fluorescence provides a noninvasive index of aqueous humor dynamics in the mouse eye that facilitates study of ocular hypotensive drugs and mouse models of glaucoma. Coupled with knowledge of IOP, it permits semiquantitative conclusions about the relative roles of aqueous humor inflow and outflow in conditions with altered IOP. Based on this approach, dimethylamiloride appears to lower mouse IOP primarily by enhancing outflow of aqueous humor.     

青光眼术前睫状体脱离的超声生物显微镜观察

目的：应用超声生物显微镜对急性闭角型青光眼术前睫状体脱离的组织结构进行形态学检查,方法：对青光眼病入术前常规进行超声生物显微镜检查,发现有睫状体脱离。对睫状体脱离者与非睫状体脱离者按年龄、性别、眼压降低幅度,眼前节解剖结构的测量数据进行统计学处理。结果：术前睫状体脱离多出现于眼压50mmHg以上,迅速降至正常或更低,房角大部分关闭但未完全关闭的病人,在272眼急性闭角型青光眼中发现有睫状体脱离者37眼占13．6％,与病人年龄、性别、眼前节解剖参数无显著性的差异,结论：术前睫状体脱离与眼压迅速下降有关。     

Melatonin receptor mRNA and protein expression in Xenopus laevis nonpigmented ciliary epithelial cells.

Melatonin is an output signal of the circadian clock, and may regulate diurnal rhythms in ocular tissues. A role for melatonin has been suggested in the circadian changes in intraocular pressure (IOP). Changes in IOP may be due partially to changes in the rate of aqueous humor secretion, which is produced by the nonpigmented epithelium of the ciliary body. To examine the mechanism by which melatonin may influence ciliary epithelium function and perhaps the IOP diurnal rhythm, immunocytochemistry with an antibody directed against the Mel(1c) melatonin receptor subtype was performed on sections of Xenopus eyes. Melatonin receptor immunoreactivity was observed in the basolateral regions of the nonpigmented epithelial cells of the ciliary body. Receptor immunoreactivity was also observed in cells of the retina, as has been previously reported. Specific immunoreactivity was not observed in the epithelium of the iris or pigmented ciliary epithelium. In situ hybridization of the Xenopus eye revealed expression of Mel(1c) but not Mel(1b) receptor mRNA in the nonpigmented ciliary epithelium. These results provide evidence that the nonpigmented epithelia of the ciliary body are direct targets for melatonin, and supports previous work that melatonin may influence the rate of aqueous humor secretion by ciliary epithelium, and perhaps the circadian rhythm of IOP.     

超声睫状体成形术治疗难治性青光眼的临床效果及安全性

目的　探讨超声睫状体成形术治疗难治性青光眼的临床效果及安全性。方法　收集我院确诊的20例20眼难治性青光眼患者,其中11例为闭角型青光眼,9例为外伤及糖尿病等其他疾病引起的继发性青光眼（或新生血管性青光眼）,行超声睫状体成形术治疗。术后随访患者眼压、疼痛等级评分、眼表以及并发症发生情况。结果　术后1 d、1周、1个月、2个月及3个月闭角型青光眼患者以及继发性青光眼患者眼压均较术前下降,差异均有统计学意义（均为P＜0.05）。术后1 d、1周、1个月、2个月、3个月闭角型青光眼患者眼压降低率依次为25.91％、42.07％、51.66％、51.99％、64.15％,继发性青光眼患者依次为35.96％、45.66％、45.86％、50.30％、51.72％,两组患者术后较术前眼压均明显下降,但闭角型青光眼患者的降眼压效果更好。术后1 d、1周、1个月、2个月及3个月闭角型青光眼患者以及继发性青光眼患者疼痛等级评分均较术前下降,差异均有统计学意义（均为P＜0.05）。术后第1天17眼出现球结膜充血,2眼发生明显角膜水肿;术后第2天12眼出现球结膜充血,之前2眼角膜水肿明显减轻;术后1周球结膜未见明显充血,之前2眼角膜轻度水肿,术后1个月所有患者球结膜均无充血、角膜透明。术后第1天大部分患者眼痛较以前减轻,其中1眼疼痛与术前相同,之后给予药物止疼后症状缓解,术后1周疼痛感自行消失。结论　超声睫状体成形术治疗难治性青光眼安全性高,降眼压效果明显,可减轻患者眼部疼痛,改善眼部症状。     

Corneal endothelial permeability and aqueous humor dynamics in normal pressure glaucoma

Corneal endothelial permeability and aqueous humor dynamics were studied in 17 non-treated normal pressure glaucoma patients in order to analyse the relevance of these parameters in the pathophysiology of this disease. Corneal endothelial permeability and aqueous humor flow were measured by fluorophotometry and aqueous outflow facility was determined by tonography. The results were compared with those of 17 healthy controls of similar age. The mean corneal endothelial permeability values and the aqueous flow and outflow facility values of the patients did not differ significantly from those of the healthy controls (P=0.8, P=0.2 and P=0.5, respectively). Normal pressure glaucoma does not affect the corneal endothelial permeability. The aqueous humor dynamics are not primarily involved in the pathophysiology of normal pressure glaucoma.Abbreviations IOP intraocular pressure - NPG normal pressure glaucoma - POAG primary open-angle glaucoma Part of this study was presented at the Annual Meeting of the Association for Eye Research on September 16, 1993 in Granada, Spain     

Modulation of ocular hydrodynamics and iris function by bremazocine, a kappa opioid receptor agonist

This study was designed to determine the activity of bremazocine (BRE), a relatively selective kappa opioid receptor agonist, on intraocular pressure (IOP), aqueous humor formation and pupil diameter (PD) in conscious, normal, dark-adapted New Zealand white (NZW) rabbits. IOP was measured in normal and unilaterally sympathectomized rabbits using a calibrated pneumatonometer and the aqueous flow rate was determined by the use of a Fluorotron Master. A masked-design study was conducted in which the rabbits' eyes were treated with BRE topically and unilaterally; the fellow eyes received vehicle. IOP and PD measurements were taken at 0.5 hr and 0 time before BRE and 0.5, 1, 2, 3, 4 and 5 hr post-treatment. Fluorophotometry recordings were taken at 1 hr before and 0.5, 1.5, 2.5 and 3.5 hr after topical application of the drug or vehicle. The effect of the relatively selective kappa opioid receptor antagonist, nor-binaltorphimine (nor-BNI), on bremazocine-induced changes in IOP, PD and aqueous flow was also determined. BRE (10 and 100 micrograms 25 microliters-1 vehicle) produced dose-related, bilateral reductions in IOP, PD and aqueous humor flow. A large increase in IOP (14 mmHg) was observed when BRE (100 micrograms) was applied to sympathectomized eyes. This ocular hypertensive effect was antagonized when the sympathectomized eyes were pretreated with naloxone (200 micrograms), a non-selective opioid receptor antagonist. BRE (10 and 100 micrograms) decreased the aqueous humor flow rate bilaterally by approximately 48 and 60%, respectively, at 0.5 hr after administration to the ipsilateral eye. Nor-BNI (100 micrograms) antagonized the effect of BRE (10 micrograms) on IOP and aqueous flow rates more effectively than on PD. These data indicate that bremazocine causes reductions in IOP by suppressing aqueous flow, but the ocular hypotensive effects are dependent on the presence of intact sympathetic nerves. Antagonism of BRE's effects on aqueous humor dynamics by nor-BNI suggests that the mechanism of IOP and aqueous flow reduction may involve, in part, an action on kappa receptors. Further experiments are necessary to fully define the opioid receptor populations in the ciliary body.     

Trabeculectomy with anterior vitrectomy in aphakic and pseudophakic glaucoma

In 15 eyes with uncontrolled aphakic/pseudophakic glaucoma, trabeculectomy with anterior vitrectomy was performed. Mean pre-operative intraocular pressure (IOP) was 38.2 ± 6.7 mmHg and mean post operative IOP was 19.3 ± 5.2 mmHg after follow-up of 11.2 2 months. The anterior chamber maintainer technique during vitrectomy has been employed. Success rate (IOP < 21 mmHg with or without glaucoma medication) was 80 %. Visual acuity remained unchanged in 4 eyes, improved in 5 eyes and worsened in 6 eyes. Post-operative complications included: two eyes with cystoid macular edema, two eyes with choroidal effusion and prolonged hypotony, one eye with self-absorbing vitreus hemorrhage and one eye with some opacification of the corneal graft. In aphakic/pseudophakic glaucoma where vitreus is filling the anterior chamber - a combined trabeculectomy with anterior vitrectomy is indicated for removal of vitreus from the sclerostomy site with better aqueous flow through the sclerostomy and adequate control of IOP.     

Effects of laser trabeculoplasty on the human aqueous humor dynamics: a fluorophotometric study

Thirteen eyes, seven with primary open-angle glaucoma and six with capsular glaucoma, were treated with laser trabeculoplasty (a fluorophotometric examination was performed about one week prior to it). The intraocular pressure was reduced below 20 mm Hg in eight eyes, and the second fluorophotometric examination could be carried out in six successfully treated eyes about three months later. In the six successfully treated eyes, the pre-laser trabeculoplasty examination showed the following results: IOP: 22 +/- 2 mm Hg; the cornea-aqueous transfer coefficient for fluorescein: 0.32 +/- 0.10 hour-1; and the aqueous flow rate: 1.31 +/- 0.53 microliter min-1. The post-laser trabeculoplasty examination gave the following results: IOP: 15 +/- 2 mm Hg; the cornea-aqueous transfer coefficient: 0.29 +/- 0.08 hour-1; and the aqueous flow rate: 1.23 +/- 0.41 microliter min-1. No significant difference was found in the aqueous flow rate or the cornea-aqueous transfer coefficient before and after.