房水细胞因子对小梁切除术预后的影响研究

青光眼是一组以不可逆性视神经损害、视野缺损和视力丧失为特征的疾病,病理性眼压升高是其重要危险因素。小梁切除术是治疗青光眼的经典术式,其术后滤过区瘢痕化是手术失败的主要原因。研究表明,青光眼患者房水中细胞因子含量改变,在小梁切除术预后过程中起重要作用。本文就近年来有关房水细胞因子与小梁切除术预后关系的研究进展作一综述。     

雷珠单抗对房水中炎症相关细胞因子含量的影响

目的:比较新生血管性青光眼(neovascular glaucoma,NVG)与年龄相关性白内障患者房水中炎症相关细胞因子浓度,观察玻璃体腔内注射雷珠单抗前后房水中炎症相关细胞因子表达变化.方法:纳入21例21眼NVG患者以及20例20眼年龄相关性白内障患者作为对照.NVG患者先予玻璃体腔内注射雷珠单抗,再行青光眼房水引流阀植入术.在玻璃体腔内注射雷珠单抗以及2~7d后行青光眼房水引流阀植入术术前抽取NVG患者房水,同时在白内障手术时抽取年龄相关性白内障患者房水.用Multiplex微珠免疫分析系统检测房水中细胞因子浓度.结果:NVG组患者玻璃体腔内注射雷珠单抗前房水中IL-1β,IL-6,IL-8,MCP-1以及VEGF浓度明显高于年龄相关性白内障患者,差异均有统计学意义(均P<0.001).玻璃体腔内注射雷珠单抗后,NVG患者房水中IL-6,IL-8,MCP-1以及VEGF浓度较注射雷珠单抗前明显降低,差异有统计学意义(P<0.05).NVG患者房水中检测的炎症相关细胞因子的浓度与患者年龄、术前眼压均无明显相关性.结论:NVG患者玻璃体腔内注射雷珠单抗前房水中与炎症相关的细胞因子表达明显上调.NVG患者行雷珠单抗治疗后,房水中与炎症相关的细胞因子明显下调.     

青光眼中氧化应激标志物的研究进展

氧化应激作为青光眼发病的可能危险因素之一,其在青光眼病变过程中的作用机制尚未被完全阐明.研究已证实,青光眼患者的眼局部标本如房水、小梁网及外周血中均可观察到氧化应激标志物的显著变化.氧化物与抗氧化物水平的明显改变和氧化损伤物质的大量出现,提示氧化状态与抗氧化状态的失衡可能在青光眼中发挥着重要的损伤作用.通过对不同样本中氧化应激标志物群的检测和分析,结合眼科相关检查,将对青光眼的临床实验诊断和研究提供重要线索.本文就青光眼中氧化应激标志物的研究作一综述.     

视网膜脱离玻璃体切除硅油填充术后继发青光眼患者房水中TNF-α测定及其临床意义

目的 通过测定并比较视网膜脱离患者行玻璃体切除联合硅油填充术后继发青光眼患者房水中的TNF-α的含量,并探讨其在硅油眼继发青光眼中的发病机制,从而为临床治疗提供切人点.方法 选取因孔源性视网膜脱离行玻璃体切除联合硅油填充术后继发青光眼及术后无眼压升高、行硅油取出或联合小梁切除术的患者作为研究对象.同时选取单纯白内障患者作为对照.所有病例行手术时抽取未稀释的房水约0.1～0.2 ml,-70℃深低温冰箱冻存备用.用放射免疫法测定房水标本中的TNF-α的含量.用SAS V8软件进行统计学分析.结果 第Ⅰ组14例,房水中TNF-α含量平均(1.0404±0.2449) ng/ml,第Ⅱ组16例,房水中TNF-α含量平均(0.6894±0.3152) ng/ml,第Ⅲ组17例,房水中TNF-α含量平均(0.7099±0.1992) ng/ml.经统计学分析,房水标本中的TNF-α含量各组间差异有统计学意义,(F =8.65,P=0.0007,P＜0.05),第Ⅰ组与第Ⅱ组、第Ⅲ组间差异显著,有统计学意义,而后两组间差异不显著,无统计学意义.结论 房水标本中TNF-α的含量在视网膜脱离行玻璃体切除联合硅油填充术后继发青光眼的患眼中明显升高,TNF-α可能是硅油眼继发青光眼发病机制的一个重要的细胞因子.     

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.     

原发性闭角型青光眼房水中促炎症因子升高机制的研究进展

青光眼是一组以特征性视神经萎缩和视野缺损为共同特征的疾病,是世界上第二位致盲性眼病.原发性闭角型青光眼是我国原发性青光眼中最常见的类型,关于其发病机制目前有很多学说,如机械学说和血管学说.而近几年研究发现,炎症反应可能也参与了青光眼的发病过程,原发性闭角型青光眼患者房水中多种促炎症因子显著升高.本文总结了两种常用的房水因子的检测方法,并分析原发性闭角型青光眼患者房水中促炎症因子升高的机制.     

青光眼房水蛋白滤过率研究及并发症探讨

青光跟房水白蛋白及免疫球蛋白测定,对评价青光眼血房水屏障功能及探讨多种眼病的发病机制有重要意义。青光眼继发白内障发病率甚高,该并发症是否与房水蛋白滤过率有关,国内外尚无报导。国际上用免疫法研究青光眼已有40余年历史:Allansmich(1973)、Chose(1973)、Sen(1977),国内毛文书等人(1964)曾作青光眼房水蛋白电泳测定,但关于青光眼房水蛋白状态的免疫学研究至今尚未见报导。血房水屏障功能状态,房水蛋白浓度,房水流体动力学改变都直接影响晶状体代谢。房水屏障的通透性及蛋白分子     

關于房水循環途徑的討論--兩路房水循環說

目的房水從睫狀體冠部產生,水分兩路,進行循環人們最早發現的房水循環途徑是前路房水循環途徑,即小梁綱Schlcmm管途徑,并認為它是主要的和唯一的房水循水途徑,這種觀念持續了一百多年,我們稱其為"一路房水循環說". 後路房水循環途徑被發現是對上述傳統觀念(一路房水循環說)的補充,許多解剖生理學證據和臨床依據充分證明在前路房水循環後面,委實存在着一個後路房水循環,前後兩路房水循環構成了整個房水循環體系,并具有其獨特的生理功能--兩路房水循環說.房水循環是青光眼的基礎理論.從一路房水循環到兩路房水循環,這是對房水循環認識上的一大飛躍.過去用一路房水循環觀點,認識青光眼、研究青光眼一百多年,結果,使青光眼成了眼科的老大難;現在用兩路房水循環的觀點,重新認識青光眼、研究青光眼,很可能使青光眼研究產生新的進展.     

青光眼滤过术后瘢痕形成相关细胞因子的研究进展

青光眼滤过手术后滤过泡瘢痕化是导致青光眼手术失败的主要原因之一,术后手术区成纤维细胞广泛增殖、胶原沉积、滤过泡瘢痕形成,最终导致建立的房水引流通道再次阻塞.为预防术后瘢痕的形成,国内外学者多年来研究其发病机制,寻找其治疗措施以期提高手术成功率,目前在治疗上取得一定的进展,如丝裂霉素等已广泛运用于临床.但这些治疗药物均有其不足之处,且药物副作用大,故寻找一种新的治疗方法 仍是青光眼方面研究的重点,在瘢痕形成过程中各种细胞因子所起的作用至关重要,故研究相关的细胞因子能为预防滤过泡瘢痕化提供新的思路.此文将与青光眼术后瘢痕形成相关的细胞因子的研究进展进行总结归纳.     

炎症因子在青光眼中的作用研究进展

青光眼是一组具有特征性视神经损害和视野缺损的疾病,病理性眼压增高是其危险因素。青光眼是受多种基因的相互作用以及环境因素影响的疾病,近年来研究表明,炎症也可能参与青光眼的发病机制,大量研究已证实, 结缔组织生长因子(connective tissue growth factor,CTGF)、肿瘤坏死因子-α(tumor necrosis factor-α, TNF-α)、白细胞介素(interleukins,ILs)、核转录因子-kappa B(nuclear factor-kappa B,NF-κB)等多种细胞因子,在青光眼患者眼内房水中高表达,表明这些细胞因子与青光眼的发病机制有紧密的联系,本文就近年来有关炎症因子与青光眼关系的研究进展作一综述。     

青光眼患者血清及房水一氧化氮浓度的测定

目的 测定青光眼患者血清及房水一氧化氮(NO)浓度并探讨其在青光眼发病中的作用。方法 实验患者分为青光眼组和白内障组,应用硝酸还原酶法分别测定两组患者血清及房水NO浓度。结果 两组患者血清NO浓度无显著性差异,青光眼组内各类型之间血清NO浓度亦无显著性差异。原发性开角型青光眼患者房水NO浓度较对照组及其他类型青光眼显著降低,闭角型青光眼患者房水NO浓度较对照组显著升高(P<0.01)。 结论 眼压升高可引起房水NO浓度升高,过多的NO可损伤小梁网及邻近的葡萄膜及视网膜组织。开角型青光眼患者由于房角原生型一氧化氮合成酶的减少引起房水NO浓度的降低,此可能为眼压升高的原因之一。     

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）     

Melatonin concentrations in aqueous humor of glaucoma patients

PURPOSE: To determine whether glaucoma patients exhibit an abnormal melatonin concentration in aqueous humor. DESIGN: Case-controlled study, laboratory investigation. METHODS: Aqueous humor and plasma samples of 28 patients with primary open-angle glaucoma and 31 nonglaucoma control patients were collected during surgery, and additional plasma samples were taken the night preceding surgery. Melatonin concentrations were determined using direct radioimmunoassay. RESULTS: This study shows detectable concentrations of melatonin in the aqueous humor of healthy humans (45% of subjects) and of glaucoma patients (36% of subjects) sampled in the morning, with similar levels of aqueous humor melatonin concentrations in both groups (6.4 +/- 9.3 standard deviation (SD) pg/ml and 3.6 +/- 1.9 pg/ml, respectively). We find no significant association between the severity of glaucoma and melatonin levels in aqueous humor or in plasma. CONCLUSIONS: Moderate and severe glaucoma does not appear to be associated with abnormal melatonin concentrations in aqueous humor, at least during the morning sampling period assayed in this study.     

Aqueous humor changes after experimental filtering surgery

We studied aqueous humor of rhesus and owl monkeys for its effect on the growth of subconjunctival fibroblasts in tissue culture. Aqueous humor samples obtained before glaucoma surgery inhibited the initiation of growth of fibroblasts. However, postoperative aqueous humor samples supported growth of fibroblasts. The change in aqueous humor physiology lasted for up to two months after glaucoma surgery. Our study indicated that possibly material added to the postoperative aqueous humor inactivates an inhibitor normally present in primary aqueous humor. An alternative explanation would be that primary aqueous humor, in contrast to secondary aqueous humor, lacks sufficient nutrient material to support fibroblast growth in tissue culture.     

Vascular endothelial growth factor is increased in aqueous humor of glaucomatous eyes

PURPOSE: To assess the concentrations of vascular endothelial growth factor (VEGF) in aqueous humor in eyes with and without glaucoma. METHODS: Concentrations of VEGF were measured using a sandwich ELISA kit in aqueous humor aspirates taken during anterior segment surgery from 87 patients, of whom 54 had glaucoma (27 primary open-angle glaucoma, 8 angle-closure glaucoma, 16 exfoliative glaucoma) and 33 had cataract only. RESULTS: Vascular endothelial growth factor was detected in all samples. The concentration in eyes with cataract only without glaucoma was 102.4 +/- 29.7 pg/mL (mean +/- SD), which was significantly lower than that from eyes with glaucoma (146.7 +/- 51.8 pg/mL). There were no significant differences between primary open-angle glaucoma (140.4 +/- 51.0 pg/mL), angle-closure glaucoma (142.8 +/- 40.2 pg/mL), and exfoliative glaucoma (158.6 +/- 58.9 pg/mL). An unusually high VEGF concentration was detected in one eye with neovascular glaucoma (759 pg/mL) and two eyes with uveitic glaucoma (322 pg/mL). No effect of age, gender, or previous history of medical, laser, or surgical treatment of the aqueous humor VEGF concentration could be detected ( > 0.05). Aqueous humor and plasma VEGF concentrations were measured and compared in 46 patients. The aqueous humor VEGF concentration (144.2 +/- 107.9 pg/mL) was significantly higher ( < 0.01) than the plasma concentration (79.2 +/- 46.1 pg/mL). No significant correlation was found between aqueous humor and plasma VEGF concentrations. CONCLUSION: Aqueous VEGF concentration is increased in eyes with glaucoma.     

Cathepsin A activity in the aqueous humor in patients with cataract, absolute glaucoma and intraocular tumors]

PURPOSE: To evaluate cathepsin A activity in the aqueous humor of patients with cataract, absolute glaucoma and intraocular tumors. MATERIAL AND METHODS: The studies were performed on human aqueous humor taken from anterior chamber of eye balls of patients operated because of cataract, absolute glaucoma and intraocular tumors. Cathepsin A activity was determined by the ninhydrin method with synthetic substrate (N-Cbz-Phe-Ala) at its optimum pH 5.0. RESULTS: In the human aqueous humor of the eye with cataract cathepsin A activity was more than three times higher than in the eye with choroid tumors and absolute glaucoma. No differences of enzyme activity in aqueous humor between patients with glaucoma and intraocular tumors were found. CONCLUSION: The increasing proteolytic activity of cathepsin A in aqueous humor of patients with cataract suggests its importance in cataract pathogenesis. This implies that cathepsin A is involved in development of lens opacity and is found in the aqueous humor due to diffusion from cataractous lens in which the proteolytic process prevails.     

青光眼房水免疫球蛋白与C3的测定

报告对青光眼21例30眼手术中抽房水测定免疫球蛋白与补体C_3的含量。结果见原发性青光眼房水IgG平均值13.63mg/100ml,继发性青光眼房水IgG平均值为34mg/100ml,均比正常人房水IgG及老年性白内障房水IgG高。继发性青光眼房水IgA平均值含量为8mg/100ml,比原发性青光眼的IgA平均值为4.38mg/100ml有明显差别,均比国外正常尸眼IgA为高,但比老年性白内障房水IgA为低。继发性青光眼房水补体C_3平均值为12.25mg/100ml,明显高于原发性青光眼的补体C_3平均值4.55mg/100ml,均明显比正常尸眼补体C_3高。     

Hepatocyte growth factor is increased in the aqueous humor of glaucomatous eyes.

PURPOSE: To assess the concentrations of hepatocyte growth factor (HGF) in the aqueous humor of eyes with glaucoma compared with control eyes with cataract only. METHODS: Concentrations of HGF were measured in aqueous humor aspirates taken during anterior segment surgery from 84 patients, of whom 72 had glaucoma (38 cases of primary open-angle glaucoma, 17 angle-closure glaucoma, and 17 exfoliative glaucoma) and 12 had cataract only, using a sandwich enzyme-linked immunosorbent assay kit. RESULTS: Hepatocyte growth factor was detected in all samples. The concentration in eyes with cataract only was 563.3 +/- 178.8 pg/mL (mean +/- standard deviation), which was significantly lower than that in eyes with glaucoma (967.1 +/- 514.7 pg/mL, P < 0.01). Eyes with exfoliative glaucoma had significantly higher HGF concentrations (1,425.5 +/- 586.7 pg/mL) than did eyes with primary open-angle glaucoma (855.0 +/- 341.5 pg/mL) and angle-closure glaucoma (759.4 +/- 511.4 pg/mL) (P < 0.01). There was no effect of age, sex, or history of medical, laser, or surgical treatment on the aqueous humor HGF concentration (P > 0.05). Aqueous humor and plasma HGF concentrations were measured and compared in 28 patients. The aqueous humor HGF concentration (908 +/- 586.2 pg/mL) was significantly higher (P < 0.01) than the plasma concentration (521.3 +/- 183.1 pg/mL). No significant correlation could be found between aqueous humor and plasma HGF concentrations. CONCLUSIONS: The relatively high concentration of HGF in human aqueous humor suggests that HGF may play an important role in ocular physiology and disease. The higher concentration in patients with glaucoma may indicate a response to injury.