血管内皮生长因子与视网膜缺血性病变

视网膜中央静脉阻塞和增殖性糖尿病视网膜缺血性病变等常伴有眼内新生血管的形成。近年的研究表明，血管内皮生长因子（ＶＥＧＦ）是一种特异性内皮细胞有丝分裂原，可刺激内皮细胞增殖。视网膜缺氧产生的ＶＥＧＦｍＲＮＡ表达升高，在新生血管的形成过程中发挥重要作用。本文主要对ＶＥＧＦ的作用，以及ＶＥＧＦ与眼内新生血管形成之间的关系加以综述     

血管内皮生长因子与视网膜新生血管性疾病

血管内皮生长因子（ＶＥＧＦ）是新近确定的一种特异性刺激血管内皮细胞增殖及新生血管形成的生长因子。视网膜血管内皮细胞存在ＶＥＧＦ高亲和受体，而且受体数目较其它组织内皮细胞多。ＶＥＧＦ的特点是它的表达受局部氧浓度的调节。视网膜血管内皮细胞、色素上皮细胞、周皮细胞、Ｍüｌｅｒ细胞均能合成并分泌ＶＥＧＦ，缺氧可上调其基因表达。ＶＥＧＦ既可刺激视网膜血管内皮细胞增殖及移行，也可诱导视网膜新生血管形成。视网膜新生血管性疾病患者玻璃体ＶＥＧＦ含量增高。组织学定位表明ＶＥＧＦ的表达主要在内核层、神经节细胞层、ＲＰＥ细胞及Ｍüｌｅｒ细胞。阻断ＶＥＧＦ的产生及生物活性，有助于治疗视网膜新生血管性疾病     

血管内皮生长因子与视网膜缺血性病变

视网膜中央静脉阻塞和增殖性糖尿病视网膜缺血性病变等常伴有眼内新生血管的形成。近年的研究表明，血管内皮生长因子（ＶＥＧＦ）是一种特异性内皮细胞有丝分裂原，可刺激内皮细胞增殖。视网膜缺氧产生的ＶＥＧＦ ｍＲＮＡ表达升高，在新生血管的形成过程中发挥重要作用。本文主要对ＶＥＧＦ的作用，以及ＶＥＧＦ与眼内新生血管形成之间的关系加以综述。     

血管内皮生长因子与视网膜新生血管性疾病

血管内皮生长因子（ＶＥＧＦ）是新近确定的一种特异性刺激血管内皮细胞增殖及新生血管形成的生长因子。视网膜血管内皮细胞存在ＶＥＧＦ高亲和受体，而且受体数目较其它组织内皮细胞多。ＶＥＧＦ的特点是它的表达受局限部氧浓度的调节。视网膜血管内皮细胞、色素上皮细胞、周皮细胞、Ｍｕｅｌｌｅｒ细胞均能合成并分泌ＶＥＧＦ，缺氧可上调其基因表达。ＶＥＧＦ既可刺激视网膜血管内皮细胞增殖及移行，也可诱导视网膜新生血管形成。     

VEGF在糖尿病性视网膜病变发病机制中的作用及抗VEGF治疗新进展

糖尿病性视网膜病变是世界新发致盲因素之一。血管内皮生长因子（ｖａｓｃｕｌａｒｅｎｄｏｔｈｅｌｉａｌｇｒｏｗｔｈｆａｃｔｏｒ,ＶＥＧＦ）是糖尿病性视网膜病变发病机制中的关键因子,成为近年研究的热点。近年来,抗ＶＥＧＦ药物成为新生血管性及血管性眼底疾病的重要治疗药物,本文就ＶＥＧＦ在糖尿病性视网膜病变病理进程中的作用及抗ＶＥＧＦ治疗新进展作一综述。     

血管内皮生长因子在视网膜缺血性病变中的应用研究

视网膜缺血性病变是一种严重的眼内病变 ,常伴有眼内新生血管形成 ,可导致严重的眼内并发症 ,如增殖性玻璃体视网膜病变 ,新生血管性青光眼和眼内出血等。近年来 ,许多学者认为视网膜缺血性病变新生血管的发生发展与血管内皮生长因子 (ＶＥＧＦ)有着密切的关系。一、ＶＥＧＦ的     

全视网膜周边冷凝治疗新生血管性青光眼

虹膜新生血管和新生血管性青光眼最常见于糖尿病和视网膜中央静脉阻塞。新生血管性青光眼的发生率,在增殖性糖尿病性视网膜病变者为5～8％,在视网膜中央静脉阻塞者为20％,尤     

增殖性糖尿病视网膜病变患者玻璃体中血管内皮细胞生长因子含量…

检测增殖性糖尿病视网膜病变患者玻璃体中血管内皮细胞生长因子的含量并与正常人进行对比研究，探讨了ＶＥＧＦ在ＰＤＲ病理过程中的作用。应用酶联免疫吸附测定法对７例正常人及１９例ＰＤＲ患者玻璃体中的ＶＥＧＦ进行定量分析研究。结果７例正常人玻璃体中，ＶＥＧＦ的含量为０．１８－０．６０ｎｇ／ｍｌ，平均值为０．３５ｎｇ／ｍｌ。     

糖尿病性视网膜病变患者玻璃体切除术同时摘出晶体对虹膜新生血管形成和新生血管性青光眼发病率的影响

虹膜新生血管形成(虹膜红变)和新生血管性青光眼是糖尿病性视网膜病变做玻璃体切除术后常见的并发症。新生血管性青光眼常导致失明,其治疗很少能保持有用视力。作者分析了一组596眼糖尿病性视网膜病变在作玻璃体切除的同时摘除晶体或不摘出晶体对术后虹膜新生血管和新生血管性青光眼的发病率     

血管内皮生长因子与眼部新生血管性疾病

血管内皮生长因子（ ＶＥＧＦ） 是一种广泛分布于大多数器官和组织血管内皮细胞的多肽类因子,它是迄今为止所发现的惟一作用于血管内皮的生长因子,可诱导血管生成。综述了ＶＥＧＦ 的生物学特性与眼部新生血管性疾病的研究进展     

穿刺巩膜隧道植入Ahmed青光眼阀治疗难治性青光眼的疗效

目的:观察用23G针头直接穿刺制作巩膜隧道的方式植入Ahmed青光眼阀(Ahmed glaucoma valve,AGV)治疗难治性青光眼的临床疗效及并发症。方法:观察44例44眼难治性青光眼患者,应用23G针头直接穿刺制作巩膜隧道,行青光眼阀植入术进行治疗。观察患者术后眼压、视力、并发症,并与术前进行对比。结果:本组患者成功率84.1%。术前眼压:52.1±10.1mm Hg,最后一次随访眼压15.6±6.9mm Hg。视力提高者11眼,视力无改变者27眼,视力降低者6眼。并发症包括:浅前房4例,脉络膜脱离3例,引流管移位1例,前房积血6例,引流管阻塞1例,脉络膜驱逐性出血1例,引流盘包裹5例。结论:直接穿刺巩膜隧道的方法植入青光眼阀,手术操作简单可行,避免了制瓣及异体巩膜移植,并简化了手术操作,防止术后房水管周渗漏,术后浅前房发生率低,为切实可行的手术方法。     

XEN‐45 collagen implant for the treatment of uveitic glaucoma

Importance

The XEN‐45 implant, a hydrophilic collagen implant which drains aqueous to the subconjunctival space, has not been investigated in the context of uveitic glaucoma.

Background

To determine the safety and efficacy of the XEN‐45 collagen implant in eyes with uveitic glaucoma.

Design

Exploratory prospective case series.

Participants

patients with medically uncontrolled uveitic glaucoma.

Methods

Twenty‐four consecutive patients (mean age ± standard deviation [SD] = 45.3 ± 18.1 years) were implanted with the XEN‐45 implant.

Main Outcome Measures

The primary outcome measure was intraocular pressure (IOP) reduction at 12 months as compared to baseline. Secondary outcome measures included ocular hypotensive medication use at 12 months, the requirement for further glaucoma surgery and failure. Intraoperative and postoperative complications were documented.

Results

The baseline mean ± SD IOP was 30.5 ± 9.8 mmHg and the mean ± SD number of glaucoma medications required was 3.3 ± 0.8. In 20 eyes (83.3%) in whom conventional glaucoma surgery was originally perceived to be inevitable, further surgery was not required after XEN‐45 implantation. The mean IOP was reduced by 60.2% from baseline to 12.2 ± 3.1 mmHg and mean medication usage was reduced to 0.4 ± 0.9 at 12 months (both P < 0.001). One patient had hypotony persisting beyond 2 months that required surgical revision and one patient developed blebitis. The 12‐month cumulative Kaplan–Meier survival probability was 79.2%.

Conclusions and Relevance

The XEN‐45 implant is effective for the treatment of patients with medically uncontrolled uveitic glaucoma. Potentially sight‐threatening complications, including bleb‐related ocular infection and persistent hypotony, may occur.     

Translational neuroprotection research in glaucoma: a review of definitions and principles

The maintenance of vision, through prevention and attenuation of neuronal injury in glaucoma, forms the basis of current clinical practice. Currently, the reduction of intraocular pressure is the only proven method to achieve these goals. Although this strategy enjoys considerable success, some patients progress to blindness; hence, additional management options are highly desirable. Several terms describing treatment modalities of neuronal diseases with potential applicability to glaucoma are used in the literature, including neuroprotection, neurorecovery, neurorescue and neuroregeneration. These phenomena have not been defined within a coherent framework. Here, we suggest a set of definitions, postulates and principles to form a foundation for the successful translation of novel glaucoma therapies from the laboratory to the clinic.     

房角金环植入术治疗顽固性青光眼的临床观察

目的　观察房角金环植入术治疗顽固性青光眼的近期和中期疗效。方法　对29例(29只眼)药物难以控制的青光眼行房角金环植入术。结果　随访2～23月,平均73±53月。眼压由术前(5134±1369)mmHg降至术后(2659±1127)mmHg。总成功率为7241%,其中非新生血管性青光眼的成功率为7692%,新生血管性青光眼的成功率为3333%。并发症包括前房积血、浅前房、术后早期低眼压、前部葡萄膜炎、金环与角膜内皮接触、金环外露、渗出性脉络膜脱离等。结论　房角金环植入术是一种治疗顽固性青光眼的有效方法。     

Predictability of success for combined iStent inject trabecular bypass implantation with phacoemulsification in the subsequent eye

Background

To investigate in combined iStent inject implantation with phacoemulsification carried out bilaterally, whether intraocular pressure (IOP)-lowering effectiveness in the first eye has a predictive potential for the outcome of the second eye in primary open-angle glaucoma (POAG).

Methods

This retrospective study included 72 eyes from 36 participants, who underwent trabecular bypass implantation in combination with cataract surgery at two study centres (Düsseldorf, Cologne). Surgery was classified as either ‘success’ or ‘failure’ based on three scores: IOP at follow-up <21 mmHg (Score A) or IOP < 18 mmHg (Score B), with an IOP reduction >20% respectively, without re-surgery and IOP ≤ 15 mmHg with an IOP reduction ≥40%, without re-surgery (Score C).

Results

The IOP lowering outcomes of first and second eyes did not differ significantly. There was a significantly higher chance of success in the second eye after effective surgery in the first eye compared with cases after a preceding failure. Within our cohort, a 76% probability of success for the subsequent eye was determined following prior success for Score A. This probability was reduced to 13% if surgery in the first eye failed. The respective probabilities were 75% and 13% for Score B and 40% and 7% for Score C.

Conclusions

In bilateral trabecular bypass implantation combined with cataract surgery, there is a high predictive potential for subsequent eyes based on the extent of IOP-lowering in the initial eye, which should be considered by the surgeon for second eye surgeries.     

Managing high risk glaucoma with the Ahmed valve implant: 20 years of experience

AIM: To estimate the efficacy and safety of the Ahmed implant in patients with high risk for failure after glaucoma surgery. METHODS: In 342 eyes of 342 patients with refractory glaucoma, even with application of medical treatment, the Ahmed valve was introduced for intraocular pressure (IOP) control, in the period of the last 20y. The nature of glaucoma was neovascular in 162 eyes, pseudophakic or aphakic in 49 eyes, inflammatory in 29 eyes and non working previous antiglaucomatic surgical interventions in 102 eyes. RESULTS: Follow-up ranged from 18 to 120mo with a mean follow-up of 63.2mo. IOP before the operation decreased from 31.6±10.4 mm Hg to 18.3±5.4 mm Hg (no systemic treatment) at the end of follow up period. When we compared the IOP values before the operation using ANOVA showed statistically significant difference (P<0.001). The success rate was 85.2% during the first semester, 76.8% at 12mo and 50.3% at the end of follow up period (18 to 120mo after implantation). Success rate was 25.7% in neovascular glaucoma, 63.2% in aphakic glaucoma and 73.8% in non working previous antiglaucomatic surgical interventions. Complications due to the implant were: serous choroidal detachment in 14.8%, blockage of the tube in 2.8%, malposition of the tube in 4.9%, suprachoroidal hemorrhage in 2.1%, cataract progression in 39.6% (phakic eyes), shallow anterior chamber in 9.2%, hyphaema in 28.9%, exposure of valve in 2.6%, exposure of tube in 9.3%, hypotony in 4.9% and conjunctival fibrosis in 41.5%. CONCLUSION: Despite the fact that Ahmed valve implant had suchlike results as other implants concerning the IOP control, complications rate due to hypotony or over filtration in the first days after the intervention are not that frequent as with other valve implants.     

Phacotrabeculectomy in Treatment of Primary Angle-closure Glaucoma and Primary Open-angle Glaucoma

Purpose To evaluate the surgical outcome of combined phacoemulsification, posterior chamber intraocular lens implantation, and trabeculectomy (phacotrabeculectomy) in patients with primary angle-closure glaucoma (PACG) or primary open-angle glaucoma (POAG).Methods The records of 57 consecutive patients (65 eyes) with PACG or POAG that were treated with phacotrabeculectomy were reviewed retrospectively. There were 31 eyes with PACG and 34 with POAG. The mean follow-up period was 21.0 ± 8.3 months. The visual acuity, intraocular pressure (IOP), number of medications, and complications were evaluated.Results The mean IOP and the number of glaucoma medications decreased significantly after phacotrabeculectomy in both groups. The mean IOP reduction was significantly greater in eyes with PACG (P < 0.05). The absolute success rates were 87.1% and 70.6% in PACG and POAG, respectively. The difference in the success rates was not significant (P = 0.297). The early postoperative complication rates were similar in both groups.Conclusions Phacotrabeculectomy results in greater IOP reduction in eyes with PACG than in those with POAG, but the overall success rates were not significantly different. Jpn J Ophthalmol 2004;48:408–411 © Japanese Ophthalmological Society 2004     

Glaucoma in China

The motivation for this paper is that, having come from China, a country which had closed herself to the outside world for three decades, I thought it might be interesting to compare glaucoma in the two countries. Since I am from only a municipal hospital of a small city Hangzhow (a sister city of Boston), whatever I say can only be accepted as personal view points. Presently I have this wonderful opportunity to be a research fellow at the world wide famous Massachusetts Eye & Ear Infirmary, which is affiliated with Harvard Medical School. The comparison therefore may not be exactly appropriate but may help to see where my country stands, what we have, what we lack and what goals to strive for to better the health of China. There may be some confusing terms in this paper such as Liberation, Cultural Revolution, etc. Table 1 may help give a clearer conception.