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1.
刘志云  雷英 《国际眼科杂志》2011,11(11):1950-1952
目的:了解青光眼住院患者的病型构成、性别、年龄分布、族别(维吾尔族)及其变化特点,为青光眼的防治研究提供新的流行病学资料。方法:选取2005-01/2010-01在本院眼科住院的青光眼手术患者2953例,根据出院诊断分为包括急性型与慢性型闭角型青光眼(PACG),原发性开角型青光眼(POAG),先天性青光眼(CG)和继发性青光眼(SG)。统计住院患者的年龄、性别、民族分布,分析其内部构成及变化趋势。结果:PACG,POAG,CG,SG各占青光眼总数的54.6%,15.2%,2.3%,27.9%。PACG的构成比逐年(63.1%~54.1%)下降,POAG的构成比在2007-01/2008-01达高峰(21.0%),CG的构成比平稳,SG的构成比(23.9%~33.5%)逐年增高;维吾尔族患者在闭角型青光眼中所占百分比逐年增高(23.0%~35.3%),在开角型青光眼中所占百分比亦逐年增高(7.9%~26.7%),在CG中所占百分比波动较大,在SG中所占百分比平稳。<40岁的维吾尔族男性患者在闭角型、开角型青光眼中,所占百分比逐年增高,<40岁的维吾尔族女性患者开角型青光眼中,所占百分比逐年增高,在闭角型青光眼中,所占百分比有下降趋势;≥40岁的维吾尔族女性患者在闭角型青光眼中,所占百分比逐年增高。结论:闭角型青光眼仍然是我国青光眼的主要类型,SG的防治研究不容忽视,在新疆维吾尔族住院患者的青光眼构成比逐渐增加,≥40岁的维吾尔族女性人群应特别注意闭角型青光眼的筛查,但开角型青光眼的防治研究不能忽视,<40岁的维吾尔族男、女性群体均是开角型青光眼防治的重点。  相似文献   

2.
吕仲平  陈晓明 《国际眼科杂志》2011,11(11):1953-1956
目的:比较近年青光眼患者在青光眼类型、发病年龄和性别分布的差异,并与以往的资料作比较,以了解青光眼内部构成的变化趋势,为青光眼的防治研究提供新的流行病学资料。方法:收集华西医院眼科2009-01/12所有青光眼住院患者病历共577例,根据出院诊断分为原发性闭角型青光眼(PACG),原发性开角型青光眼(POAG),先天性青光眼,继发性青光眼,并将其与1978-01/1981-12,以及2001-01/2002-12青光眼住院患者971例进行比较。结果:2009年间,原发性青光眼占当年青光眼住院患者总数的60.2%所占比例下降;POAG占原发性青光眼的27.4%,在原发性青光眼中的构成比有所上升;PACG中位数年龄为62.8,总体有所增大,POAG中位数年龄为48,无明显变化;POAG中女性患者比例增加;2009年继发性青光眼占当年青光眼住院患者总数的33.4%,比例显著较往年增加。结论:POAG在原发性青光眼中的构成比有所上升,继发性青光眼患者显著增加。  相似文献   

3.
青光眼住院病人的构成及变化   总被引:16,自引:2,他引:16  
目的 :了解青光眼住院病人的内部构成比变化 ,为青光眼的防治研究提供新的流行病学资料。方法 :1996 7~ 2 0 0 2 6期间在本院住院的青光眼患者 5 2 2 2例 ,按出院诊断、性别、年龄分组 ,分析其内部构成及变化趋势。结果 :原发性闭角型青光眼、原发性开角型青光眼、皮质类固醇性青光眼、先天性青光眼、继发性青光眼各占青光眼总数的5 4 42 %、 2 1 73 %、 3 3 5 %、 6 3 2 %和 14 17%。急性闭角型青光眼的构成比 ( 2 2 5 4% )逐年下降 ,原发性开角型青光眼的构成比则逐年升高 (P <0 0 5 ) ;在原发性青光眼患者 (包括GIG)中 ,年龄大于 40岁的占 80 97% ,其中闭角型青光眼占82 0 9% ,年龄小于 40岁的 ,开角型青光眼占 89 62 %。闭角型青光眼患者男∶女 =1∶1 5 3 ,开角型青光眼患者男∶女 =2 5 5∶1;皮质类因醇性青光眼患者的年龄主要集中在 10~ 3 0岁 ,占 77 71%。结论 :闭角型青光眼仍然是我国青光眼的主要类型 ,但开角型青光眼的防治研究不能忽视 ,40岁以上的女性人群应特别注意闭角型青光眼的筛查 ,40岁以下的男性群体则是开角型青光眼防治的重点。  相似文献   

4.
目的 分析混合型青光眼(mixed glaucoma,MG)住院病人的致病机制.方法 收集 2005年~2009年连续住院患者MG 109只眼(76例)的临床资料,结合眼压、C/D、视野、前房角镜及超声生物显微镜(ultrasound biomicroscopy,UBM)等临床资料,分类分析其混合致病机制的构成.结果 (1)本组病例存在12个致病机制类型:原发性开角型青光眼(primary open-angle glaucoma,POAG、原发性闭角型青光眼(primary angle-closure glaucoma,PACG)、先天性青光眼、新生血管性青光眼、青睫综合征及以下因素:晶状体膨胀或脱位、睫状体囊肿、糖皮质激素、眼外伤或眼内手术、虹膜炎、Fuchs综合征和剥脱综合征继发性青光眼.(2) 本组病例存在7类混合机制致病:POAG合并PACG35只眼,占32.1%;PACG合并继发性闭角型青光眼32只眼(29.4%);PACG合并继发性开角型青光眼13只眼(11.9%);POAG合并继发性开角型青光眼11只眼(10.1%);POAG合并继发性闭角型青光眼10只眼(9.2%);先天性青光眼合并继发性青光眼5只眼(4.6%)及不同类型的继发性青光眼合并存在3只眼(2.8%).结论 注意对青光眼发病机制的全面分析,避免明确一种青光眼致病病机制而忽略混合致病机制的存在,以便采取恰当全面的治疗方案;UBM的应用有助于MG致病机制的分析;POAG 合并PACG是MG的主要类型.  相似文献   

5.
青光眼住院病人流行病学调查--疾病构成及其变化特点   总被引:6,自引:1,他引:6  
目的:了解青光眼住院病人的病型构成、性别、年龄分布及其变化特点,尤其是原发性青光眼内部构成的变化,为制定青光眼防治的新策略提供依据。方法:对眼科1978年1月~1981年12月以及2001年1月~2002年12月所有青光眼住院病人进行统计分析。结果:原发性青光眼患者占所有青光眼住院病人的81.35%。原发性开角型青光眼(plqmary open angle glaucoma,POAG)在原发性青光眼的比例于1978.1~1981.12为11.3%,2001.1~2002.12为23.9%。经检验POAG构成比增大有统计学意义。先天性青光眼(Congenital Glaucoma,CG)和继发性青光眼(Secondary Glaucoma,SG)分别占整个青光眼住院病人的5.05%和13.59%.其构成比均无显著性变化。PACG中位数年龄在1978.1~1981.12为54岁,在2001.1~2002.12为63岁;POAG则分别为47.5及47岁。女性患者在PACG与POAG分别占64.8%与25.8%。结论:原发性青光眼在青光眼住院病人中占绝大多数,其中原发性闭角型青光眼(Primary angle closure glaucoma,PACG)仍占主要部分,但POAG的构成有增多的趋势,分析可能有诊断,屈光不正,全身情况,环境,遗传以及社会因素等方面的原因。  相似文献   

6.
张敏  邱丽  宋艳梅  张虎  冯玮  杨志惠  王青 《国际眼科杂志》2018,18(10):1870-1873

目的:调查分析保定地区青光眼患病率现状。

方法:于2017-05/12采取整群抽样法选择保定地区市民4 960名进行青光眼排查,分析各类青光眼发病率以及发病年龄、性别分布情况,比较已诊断和新诊断青光眼患者眼部病变情况。

结果:青光眼患病率为2.72%(135/4960),其中原发性闭角型青光眼(primary angle-closure glaucoma,PACG)、原发性开角型青光眼(primary open angle glaucoma,POAG)、先天性青光眼(congenital glaucoma,CG)、继发性青光眼(secondary glaucoma,SG)患病率依次为51.85%、20.00%、17.04%、11.11%,男、女构成比例依次为1:1.92、3.50:1、2.83:1、1:1.14,青光眼患者的男女比例相比较,差异无统计学意义(P>0.05); 40岁以上PACG、POAG、SG、CG构成比例依次为95.71%、51.85%、52.17%、0,≤49岁、50~69岁、≥70岁各年龄段的PACG、POAG、SG、CG构成比依次为1:5.63:2.13、4.5:1.25:1、4.67:2:1、15:0:0,差异具有统计学意义(P<0.05); 已诊断、新诊断青光眼患者视野改变、眼压>21mmHg发生情况相比较,差异无统计学意义(P>0.05); 新诊断青光眼患者单眼低视力、单眼盲发生率比已诊断青光眼患者低,视神经改变发生率比已诊断青光眼患者高,差异具有统计学意义(P<0.05)。

结论:保定地区青光眼患病率为2.72%,其中以PACG患病率最高,其他依次为POAG、SG、CG,其发病率与性别无关,除CG发生于特定人群外,50~69岁为PACG高发阶段,POAG、SG患病率随年龄的增加而降低,青光眼新诊断患者的眼盲率较低,但病情进展程度较为严重。  相似文献   


7.
目的 探讨青光眼住院病人疾病构成的特点,为青光眼的防治研究提供新的流行病学资料.方法 选择2006年1月至2009年12月在眼科住院的青光眼患者1294例进行统计学分析.结果 原发性闭角型青光眼(PACG)、原发性开角型青光眼(POAG)、继发性青光眼(SG)、先天性青光眼(CG)各占青光眼住院病人总数的72.95%、6.18%、19.94%和0.93%.四年来青光眼住院病人疾病构成无明显改变.结论 青光眼住院病人构成与其他研究结果不完全一致.原发性青光眼也是我院青光眼的主要类型,其中PACG占第1位,但POAG的构成仍然较低.
Abstract:
Objective To analyze the characteristics of proportion in hospitalized patients with glaucoma.Methods Of 1294 cases in our Department of Ophthalmology from January 2006 to December 2009were included.Results 72.95% of the case were primary angle-closure glaucoma (PACG),while 6.18%,19.94% and 0.93% of them were primary open angle glaucoma (POAG),secondary glaucoma (SG) and congenital glaucoma (CG) respectively.There were no change in proportion of hospitalized patients with glaucoma in our department.Conclusions Compared with the constitutive portions of hospitalized patients with glaucoma in other hospitals,the results are not all the same in our department.Primary glaucoma is also the main part,with PACG constituting the greatest part.However,POAG still constitute the small part.  相似文献   

8.
目的 评价原发性青光眼患者抑郁与焦虑心理状况并分析其影响因素.方法 对24例原发性闭角型青光眼(PACG)、26例原发性开角型青光眼(POAG)和对照组(n=24)进行患者健康问卷(PHQ)调查,并对问卷评分进行比较和对年龄、性别等因素进行多重线性回归分析.结果 PACG、POAG和对照组抑郁症状阳性率分别为33.3%、19.2%和8.3%,焦虑症状阳性率分别为37.5%、26.9%和8.3%.PACG组抑郁(P =0.027)、焦虑(P=0.004)程度高于对照组,POAG与PACG和对照组差异不明显(P>0.05).抑郁焦虑评分呈正相关(P<0.01),抑郁(β=m.149,P=0.029)焦虑(β=-0.204,P=0.025)分别与年龄呈负相关,与性别无关.结论 PACG抑郁焦虑程度高于正常人,PACG与POAG之间无明显差异.青光眼患者抑郁焦虑状况与年龄相关,与性别无关.  相似文献   

9.
目的:了解成都地区原发性开角型青光眼(POAG)患者≥40 岁的一级亲属青光眼患病情况,研究家族史这一危险因素在POAG发病中的作用。方法:病例对照研究。选取2014 年2 月至2015 年10 月期间在华西医院确诊的99 例POAG患者为先证者,其≥40 岁的一级亲属290 例作为病例组。同期来院行白内障手术(无其他合并眼部疾病)的105 例患者,其≥40 岁的一级亲属355 例作为对照组。分别进行问卷调查和青光眼筛查。采用t 检验、卡方检验,多元Logistic回归等进行统计学分析。结果:①病例组总患病率高于对照组(10.7% vs . 1.4%,χ2=26.090,P <0.001)。②病例组女性青光眼患病率高于对照组女性青光眼患病率(11.7% vs . 1.6%,χ2=15.203,P <0.001),病例组男性青光眼患病率也高于对照组男性青光眼患病率(9.8% vs . 1.2%,χ2=11.098,P <0.001)。③按年龄(<50 岁、50~59岁、60~69岁、≥70岁)分层,在<50岁、50~59岁、≥70岁这3个年龄亚组,病例组青光眼患病率均明显高于对照组(χ2=14.328、4.919、6.959,P <0.05)。④在调整年龄和性别的影响后,病例组患病风险是对照组的8.45倍(95%CI:3.24~22.06),其中病例组中子女患病风险为对照组的11.53倍(95%CI:2.45~54.26)。⑤92.1%的POAG患者一级亲属无青光眼筛查意识。结论:POAG患者≥40岁以上的一级亲属患病风险明显高于其他人群,绝大多数POAG患者一级亲属缺乏进行青光眼筛查的意识。  相似文献   

10.
目的:比较正常人和青光眼(原发性开角型青光眼(primary open angle glaucoma,POAG)、闭角型青光眼(primary angle-closure glaucoma,PACG))间视盘萎缩弧β区发生率的差异。方法:选择年龄、屈光度数相匹配的正常人135例135眼、POAG58例101眼、PACG50例81眼。利用海德堡眼底照相机采集受试者30°眼底彩色照片,并用计算机图像处理软件测量青光眼患者垂直杯盘比,利用卡方检验分析不同程度青光眼损伤的患者眼底β区发生率与垂直杯盘比的关系。结果:正常人、POAG和PACGβ区发生率分别为23.0%,69.3%和49.4%(χ2=51.3,P=0.000);POAG的β区发生率高于PACG(χ2=7.5,P=0.005)。三组人群β区最多见于水平颞侧象限,鼻侧象限最少(χ2=19.4,P=0.000;χ2=50.3,P=0.000;χ2=11.7,P=0.009);POAG组中,视神经损伤较重组的β区发生率明显高于较轻组(χ2=14.0,P=0.000);PACG组中,视神经损伤较重组β区发生率与较轻组无明显差异(χ2=0.6,P=0.287)。结论:POAG和PACGβ区发生率高于正常人,POAGβ区发生率高于PACG。视神经损伤较重组POAG眼相对于较轻组更易发生β区。  相似文献   

11.
目的了解青光眼住院患者的类型构成、性别、年龄分布、变化特点及相关因素。设计回顾性病例系列。研究对象住院的青光眼患者5058例。方法对邢台眼科医院2004年6月-2009年5月间住院的青光眼患者5058例进行统计学分析。主要指标青光眼的类型、年龄、性别及所占的百分比。结果5058例青光眼住院患者中,原发性青光眼、继发性青光眼和先天性青光眼各占青光眼总数的59.07%、37.92%和3.01%,其中原发性闭角型青光眼占原发性青光眼的88.65%,原发性开角型青光眼占11.35%。在原发性闭角型青光眼中,急性闭角青光眼占53.15%,慢性闭角型青光眼占46.85%;其中40岁以上女性占69.54%,男性26.95%。而原发性开角型青光眼患者中,40岁以上女性28.02%,男性占44.5%。2004年6月-2005年5月原发性青光眼住院患者中原发性开角型青光眼占11.32%,而于2008年6月-2009年5月间原发性开角型青光眼占12.44%,统计学检验无显著性差异。结论中原地区青光眼住院患者构成仍以原发性闭角型青光眼为主要类型,原发性开角型青光眼的构成仍然较低,可能与地域经济文化状况有关。  相似文献   

12.
目的 检测不同类型青光眼患者与正常人外周血中含缬酪肽蛋白(valosin-containing protein,VCP)、α-胞衬蛋白(α-fodrin)的水平差异,评估各指标在青光眼诊断中的价值。方法 收集2015年1月至2017年9月首诊于我院和郑州大学第一附属医院眼科的青光眼患者80例,其中原发性闭角型青光眼(primary angle-closure glaucoma,PACG)组40例,原发性开角型青光眼(primary open angle glaucoma,POAG) 组40例;同期收集我院健康体检者40例作为对照组。采用ELISA法分别测定各组外周血中VCP和α-fodrin的含量,并作对比,同时对上述指标绘制受试者工作特征曲线,计算曲线下面积。采用多因素Logistic回归分析青光眼患者发病的危险因素。结果 POAG组、PACG组和对照组VCP含量分别为(124.866±34.858)ng·L-1、(94.143±28.970)ng·L-1和(44.707±8.892)ng·L-1,α-fodrin含量分别为(0.531±0.306)μg·L-1、(0.399±0.213)μg·L-1、(0.304±0.214)μg·L-1,3组间两两相比,VCP、α-fodrin含量的差异均有统计学意义(均为P<0.05)。受试者工作特征曲线下面积分析结果显示,VCP为0.754(95%CI为 0.646~0.862,P<0.001),α-fodrin为0.610(95%CI为0.486~0.733,P=0.091)。多因素Logistic回归分析提示,仅VCP是POAG患者发病的独立危险因素(OR=9.134,P<0.01)。结论 POAG患者外周血中VCP和α-fodrin的含量高于PACG患者和正常人群,提示免疫因素可能在青光眼视神经损害机制中起重要作用,VCP是POAG发病的独立危险因素。  相似文献   

13.
原发性青光眼包括原发性开角型青光眼(POAG)、原发性闭角型青光眼(PACG)及原发性婴幼儿青光眼(PCG).目前认为原发性青光眼的发病是遗传因素、环境因素、生活习惯等多种因素综合作用的结果,其中遗传因素,尤其是基因突变,在青光眼的发病过程中起着重要作用.自1997年发现CYP1B1基因为PCG的致病基因以来,关于CYP1B1基因突变与青光眼发病关系的研究成为青光眼遗传和基因研究的热点.随着研究的逐渐深入,许多学者认为CYP1B1基因也是POAG致病基因的候选基因.本研究对近十余年来对CYP1 B1基因的结构和功能以及CYP1B1基因突变与POAG发病及进展关系的研究进展进行总结.  相似文献   

14.

Purpose:

To assess demographic and clinical characteristics of glaucoma patients in an Ophthalmologic Hospital of Jinan, China from 2003 to 2012.

Materials and Methods:

Medical charts of patients with primary open-angle glaucoma (POAG), primary angle closure glaucoma (PACG), and secondary glaucoma (SG) were reviewed. The main outcome measures of patients with glaucoma included basic demographic data (age at presentation, gender, and residence), clinical characteristics (admission date, intraocular pressure, and naked vision), and previous history (injury, cardiovascular disease, diabetes mellitus, hypertension, smoking, and alcohol consumption).

Results:

Data from 1458 glaucoma patients were reviewed, of which PACG and SG patients accounted for 45.40% and 47.19%, respectively. The average age of all patients with glaucoma increased from 56.05 years in 2003 to 57.83 years in 2012, and the proportion of patients from rural areas rose from 46.43% to 59.13% during 10-year period. Female gender, cardiovascular disease, and hypertension were associated with PACG. POAG was related to smoking and alcohol consumption. There was positive correlation between SG and history of injury and diabetes mellitus.

Conclusion:

PACG and SG are the major types of glaucoma. Gender, injury, diabetes mellitus, cardiovascular disease, hypertension, smoking, and alcohol consumption were associated with different types of glaucoma.  相似文献   

15.
PURPOSE: To investigate whether primary open-angle glaucoma (POAG) is associated with increased risk of developing Alzheimer disease (AD). METHODS: In a nationwide case register linkage study of patients with hospital admission or outpatient contact during the period from 1977 to 2001 in Denmark, the rate of subsequent AD for patients with a diagnosis of POAG was compared with the rate for patients with primary angle-closure glaucoma (PACG), cataract, and osteoarthritis (OA) and with the rate for the general population. RESULTS: A total of 11,721 patients with a diagnosis of POAG (including normal tension glaucoma), 5975 patients with PACG, 162,640 patients with cataract, and 230,208 patients with OA were identified in the registers. Patients with POAG did not have increased rate of subsequent AD compared to patients with PACG, cataract, or OA or compared with the general population. CONCLUSIONS: POAG was not associated with increased risk of developing AD. It cannot be excluded that this negative finding is due to diagnostic misclassification as register data were used.  相似文献   

16.
Transforming growth factor-β2 levels in aqueous humor of glaucomatous eyes   总被引:4,自引:0,他引:4  
PURPOSE: To determine whether clinical characteristics are correlated with increased levels of transforming growth factor-beta 2 (TGF-beta 2) in aqueous humor in glaucomatous eyes. METHODS: Aqueous humor samples were collected from 91 glaucomatous eyes. Included were samples from primary open-angle glaucoma (POAG) in 40 eyes, (pseudo)exfoliation syndrome (EXS) in 18 eyes, primary angle-closure glaucoma (PACG) in 26 eyes and uveitis-related secondary glaucoma (SG) in 7 eyes. TGF-beta 2 in aqueous humor was assessed with a specific-capture ELISA. RESULTS: The mean concentration (+/- standard error) of mature (biologically active) TGF-beta 2 in the aqueous humor of eyes with POAG was 293.6 +/- 33.6 pg/ml, significantly higher than that in eyes with PACG, EXS and SG: 147.5 +/- 28.1, 135.8 +/- 30.2 and 41.0 +/- 10.7 pg/ml, respectively (P = 0.0006, P = 0.0010 and P = 0.0003; analysis of variance). The mean concentration (+/- standard error) of total TGF-beta 2 in the aqueous humor of eyes with POAG was 1647.6 +/- 124.5 pg/ml, not significantly different from that in eyes with PACG, EXS and SG: 1482.9 +/- 148.2, 1442.7 +/- 187.8 and 1929.0 +/- 367.6 pg/ml, respectively. A multivariate analysis using logistic regression showed significant correlations between mature TGF-beta 2 concentration and history of cataract surgery (P = 0.0225) and the use of carbonic anhydrase inhibitors (P = 0.0143). CONCLUSIONS: Our results indicate that increased levels of TGF-beta 2 may play an important role in the pathogenesis of POAG.  相似文献   

17.
AIM: To determine the prevalence of glaucoma in the Meiktila district of central, rural Myanmar. METHODS: A cross-sectional, population-based survey of inhabitants > or =40 years of age from villages in Meiktila district, Myanmar, was performed; 2481 eligible participants were identified and 2076 participated in the study. The ophthalmic examination included Snellen visual acuity, slit-lamp examination, tonometry, gonioscopy, dilated stereoscopic fundus examination and full-threshold perimetry. Glaucoma was classified into clinical subtypes and categorised into three levels according to diagnostic evidence. RESULTS: Glaucoma was diagnosed in 1997 (80.5%) participants. The prevalence of glaucoma of any category in at least one eye was 4.9% (95% CI 4.1 to 5.7; n = 101). The overall prevalence of primary angle-closure glaucoma (PACG) was 2.5% (95% CI 1.5 to 3.5) and of primary open-angle glaucoma (POAG) was 2.0% (95% CI 0.9 to 3.1). PACG accounted for 84% of all blindness due to glaucoma, with the majority due to acute angle-closure glaucoma (AACG). CONCLUSION: The prevalence of glaucoma in the population aged > or =40 years in rural, central Myanmar was 4.9%. The ratio of PACG to POAG was approximately 1.25:1. PACG has a high visual morbidity and AACG is visually devastating in this community. Screening programmes should be directed at PACG, and further study of the underlying mechanisms of PACG is needed in this population.  相似文献   

18.
目的了解原发性开角型青光眼(POAG)和原发性慢性闭角型青光眼(PACG)在眼压降低后视野是否发生改变及相关因素分析。方法原发性慢性青光眼32例(44眼),其中PACG19例(25眼),POAG13例(19眼)。眼压治疗前及治疗后1个月全部患者均行Humphrey静态自动视野(HFA)24-2全阈值视野检查。比较眼压降低前后视野平均缺损(MD)、模式标准差(PSD)的变化,分析眼压降低幅度、年龄及视神经杯盘比与视野MD改变是否相关。结果治疗前MD为-13.58±9.31,治疗后MD为-12.08±8.37,治疗前后MD比较差异有统计学意义(t=3.35,P=0.002);治疗前后MD差值与眼压降低幅度呈正相关(r=0.341,P=0.027)。协方差分析结果表明,校正年龄和HRT的杯盘面积比后,治疗前后视野MD的改变与眼压降低幅度呈正相关(F=4.706,P=0.037)。结论原发性慢性青光眼眼压降低后视野有所改善,视野改善的程度与降压幅度有关。  相似文献   

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