急性闭角型青光眼眼压下降后中央角膜厚度与慢性闭角型青光眼的比较

目的采用前瞻性非随机对照研究比较急性闭角型青光眼和慢性闭角型青光眼的中央角膜厚度和眼部其他参数的异同。方法观察75例急性闭角型青光眼和69例慢性闭角型青光眼患者的中央角膜厚度。眼压控制后每例患者接受A超检查,检查项目包括中央角膜厚度、中央前房深度、晶状体厚度和眼轴长度。统计分析采用t检验。结果急性闭角型青光眼患者的平均中央角膜厚度是(576.97±50.93)μm,慢性闭角型青光眼患者为(543.35±35.85)μm,两组之间中央角膜厚度差异有统计学意义(P<0.001)。急性闭角型青光眼对侧眼中央角膜厚度为(544.68±33.53)μm,比急性发作眼薄,对侧眼与慢性闭角型青光眼中央角膜厚度之间差异无统计学意义(P=0.818)。急性闭角型青光眼患者眼轴长度为(21.71±1.14)mm,慢性闭角型青光眼为(22.20±1.21)mm,两组之间的眼轴长度差异有统计学意义(P=0.014)。急性闭角型青光眼前房深度(2.42±0.39)mm,慢性闭角型青光眼为(2.45±0.31)mm,急性闭角型青光眼组晶状体厚度(4.84±0.39)mm,慢性闭角型青光眼组为(4.81±0.43)mm。两组之间的前房深度和晶状体厚度差异均无统计学意义(均为P>0.05)。结论与慢性闭角型青光眼相比,急性闭角型青光眼的中央角膜厚度较厚,可能是急性高眼压后角膜水肿造成,而前房浅、眼轴短可能是其急性发病的原因之一。     

治疗后低眼压的原发性慢性闭角型青光眼患者角膜中央厚度与视野损害进展的关系

这项回顾性研究，旨在确定治疗后低眼压的慢性原发性闭角型青光眼（CPACG）患者的中央角膜厚度（CCT）与视野损害进展的关系。     

急性闭角型青光眼发作眼与对侧眼解剖参数的比较

目的对照研究急性闭角型青光眼发作眼和对侧眼的角膜中央厚度和前房深度,晶状体厚度和眼轴长度。方法共观察了急性闭角型青光眼75例。眼压控制后每个患者双眼接受A超检查,检查项目包括角膜中央厚度、前房深度、晶状体厚度和眼轴长度。统计分析采用配对t检验。结果急性闭角型青光眼发作眼的平均角膜中央厚度是（576．97±50．93）μm,对侧眼的平均角膜中央厚度为（544．68±33．53）μm（P〈0．001）。另外两组之间的前房深度、晶状体厚度和眼轴长度无差异（P〉0．05）。结论与对侧眼相比,急性闭角型青光眼的角膜中央厚度较厚,可能是发作后遗留的损害。其它眼解剖参数无统计学差异,因此对侧眼也应进行预防治疗。     

原发性闭角型青光眼对角膜内皮细胞的影响

青光眼是全球第二大致盲性眼病,除了损伤视神经、视野外还会影响虹膜、晶状体。临床观察和实验研究都表明青光眼可引起角膜内皮细胞数量减少,从而导致角膜透明性下降。我国以原发性闭角型青光眼患者居多,约占世界闭角型青光眼患者的一半,本文从原发性闭角型青光眼疾病本身、抗青光眼药物、手术及激光治疗等方面对角膜内皮细胞的影响进行综述。     

临床前期急性闭角型青光眼眼前部巩膜厚度测量

目的探讨急性闭角型青光眼(APACG)与正常人前部巩膜厚度的差异。设计前瞻性比较性病例系列。研究对象北京同仁眼科中心APACG患者57例(57眼),同期正常人57例(57眼)。方法对上述患者行超声生物显微镜(UBM)检查测量眼前部巩膜厚度及中央角膜厚度;非接触眼压计测量眼压;IOL Master测量眼轴长度。眼前部巩膜厚度的测量取自颞侧象限巩膜突后2 mm处。组间各参数比较采用独立样本t检验;眼前部巩膜厚度与中央角膜厚度、眼压、眼轴的关系采用多元线性回归分析。主要指标眼前部巩膜厚度、眼压、中央角膜厚度、眼轴长度。结果 APACG临床前期眼及正常对照眼的前部巩膜厚度分别为(625.42±41.45)μm、(594.42±46.06)μm,差异有统计学意义(t=3.78,P=0.0001);中央角膜厚度分别为(537.08±34.68)μm、(529.90±39.69)μm,差异无统计学意义(t=1.03,P=0.153);眼压分别为(16.70±3.75)、(17.00±3.92)mm Hg,差异无统计学意义(t=0.42,P=0.338);眼轴长度分别为(20.78±1.23)、(23.56±2.21)mm,差异有统计学意义(t=8.30,P=0.000)。多元线性回归显示,APACG眼前部巩膜厚度与眼轴有关(P=0.009),前部巩膜厚度=877.144–12.135×眼轴。结论 APACG患者前部巩膜厚度较正常眼厚;这可能作为发病机制之一参与了APACG的急性发作。     

急性闭角型青光眼大发作对角膜内皮细胞的影响

目的观察急性闭角型青光眼大发作后患者角膜内皮细胞的形态和数量的变化。方法采用非接触型角膜内皮显微镜对33例单眼发病的急性闭角型青光眼患者,以对侧眼为对照,测量角膜内皮各参数。结果急性闭角型青光眼急性发作组和对照眼比较,角膜内皮细胞密度(CD)、六角形细胞百分数(6A)显著性减少(P<0.05),最大细胞面积(MAX)、最小细胞面积(MIN)、平均细胞面积(AVE)、平均细胞面积的标准差(SD)和细胞面积的变异系数(CV)均有显著性增加(P<0.05)。Spearman相关性分析,角膜内皮细胞密度下降幅度与高眼压持续时间呈正相关(r=0.525,P=0.002)。结论急性闭角型青光眼大发作会引起角膜内皮细胞密度下降,体积增大,多形性增加,高眼压持续时间越长,对角膜内皮细胞的损害越严重。     

急性闭角型青光眼对角膜内皮细胞的影响分析

目的观察角膜内皮细胞在急性闭角型青光眼中的形态变化。方法采用TOPCON-2000非接触式角膜内皮显微镜(含分析仪),对45例单眼发病的急性闭角型青光眼的住院患者,以健眼作对照眼,测量角膜内皮细胞变化情况。结果急性闭角型青光眼患者平均眼压54mmHg,平均持续时间73小时(范围3~528小时),受累眼角膜内皮细胞密度为(2390.01±435.56)个/mm2,显著低于对照眼(2769.07±343.35)个/mm2,发作眼角膜内皮细胞丢失率13.68%。患眼平均最大细胞面积(MA)、最小细胞面积(M IW)、平均细胞面积(AVE)、细胞面积标准差(SD)、细胞面积变异系数(CV)均较对照眼显著增加,六角形细胞百分率(6A)下降(P<0.05)。结论急性闭角型青光眼发作会显著引起角膜内皮细胞密度降低和角膜内皮形态学的改变,这种变化与高眼压持续的时间有关。     

原发性闭角型青光眼脉络膜厚度的变化

目的:探讨原发性急性闭角型青光眼(APACG)、原发性慢性闭角型青光眼(CPACG)脉络膜厚度(CT)的变化及相关因素。方法:回顾性研究。选取APACG患者35例43眼,CPACG患者26例46眼和正常对照组46例81眼参与这项研究。EDI-OCT用于测量和比较APACG、CPACG及正常对照组黄斑中心凹下、距黄斑中心凹2mm鼻侧、颞侧、上方、下方的CT,分别标记为黄斑中心凹下脉络膜厚度(SFCT),鼻2mm(N 2mm)、颞2mm(T 2mm)、上2mm(S 2mm)、下2mm(I 2mm)。进行线性回归分析探讨CT的相关因素。使用Logistic回归模型分析CT与APACG、CPACG的关系。结果:APACG,CPACG和正常对照组在所有位点的CT均无差异(P>0.05)。所有位点的CT与眼轴长度(AL)呈负相关。N 2mm、I 2mm还与年龄、前房深度(ACD)呈负相关,SFCT与年龄、AL呈负相关(P<0.05)。多因素Logistic回归分析表明,S 2mm与APACG存在相关性(P=0.029),OR值和95%的置信区间为0.975(0.953,0.997)。各位点CT与CPACG无相关性(P>0.05)。结论:年龄、AL、ACD是CT的相关因素。S 2mm的变薄与APACG相关。然而,CPACG与各位点CT不存在相关性。     

急性闭角型青光眼视网膜神经纤维层改变的一年动态观察

目的观察急性闭角型青光眼视网膜神经纤维层（RNFL）厚度在发病后不同时间段的变化特征。设计前瞻性病例系列。研究对象2007—2009年就诊的急性闭角型青光眼单眼发病者35例35眼。方法人选患者经过临床治疗后眼压控制正常,利用相干光断层扫描（StratusOCT3）技术在发病后2周、3个月、6个月和12个月进行双眼RNFL扫描,并对发作眼压与RNFL厚度进行相关性分析。主要指标RNFL厚度。结果发作后2周发作眼RNFL明显较对侧眼增厚,分别为（141．85±25．22）μm、（112．95±10．54）μm（P=-0．000）;第3个月时两眼没有差异,RNFL厚度分别为（112．38±16．15）μm、（112．26±16．04）μm（P=0．966）;6个月时发作眼较对侧眼稍薄,分别为（101．22±14．06）μm、（108．65±15．03）μm（p=0．021）;12个月时发作眼明显较对侧眼薄,分别为（92．29±13．05）um、（106．77±14．90）μm（P=0．000）。发作眼在观察期内RNFL进行性变薄（阽51．48,P=0．000）,而对侧眼则无显著改变（F=1．599,P=0．192）。早期（3个月内）眼压越高,RNFL越厚（r=0．692,P=-0．000）,但在12个月RNFL的变化中,发作眼压与之无显著相关（r=0．242,P=0．081）。结论急性闭角型青光眼发作眼缓解后RNFL仍进行性丢失,发作时眼压的高低并不是决定最终病变的惟一因素;对侧眼在12个月的观察中也存在一定程度RNFL损害,其临床意义有待进一步研究。     

Central corneal thickness changes after phacoemulsification cataract surgery

PURPOSE: To evaluate changes occurring in central corneal thickness (CCT) immediately after uneventful cataract surgery. METHODS: Thirteen consecutive patients who had uneventful phacoemulsification surgery by the same experienced surgeon were prospectively evaluated for CCT measurements 1 hour preoperatively and 1 hour, 1 day, and 1 week postoperatively. The unoperated eye also had CCT measurements simultaneously on all occasions and served as a control. All patients provided informed consent. SETTING: Department of Ophthalmology, Royal Glamorgan Hospital, Llantrisant, UK RESULTS: Mean age of the patients was 69 years. Central corneal thickness was 550.34 microm preoperatively, 626.39 microm at 1 hour, 585.80 microm at 1 day, and 553.80 microm at 1 week. In the control group, CCT remained stable, within +/-2 microm of preoperative readings. CONCLUSIONS: Central corneal thickness increased by approximately 13.81% in the immediate postoperative period (at 1 hour). It remained increased by 6.44% on day 1 compared with preoperative values and gradually reduced to preoperative levels by the 1-week postoperative period (0.57% difference). Intraocular pressure (IOP) measured postoperatively in the first week may be falsely elevated to some extent because of the increased corneal thickness in the immediate postoperative period; thus, not all IOP rises have be treated in this period in healthy uncompromised eyes.     

Central corneal thickness in primary open angle glaucoma, pseudoexfoliative glaucoma, ocular hypertension, and normal population

PURPOSE: This study was designed to determine the relationship between central corneal thickness (CCT) and intraocular pressure (IOP) measured by applanation tonometer in glaucomatous, ocular hypertensive, and normal eyes. METHODS: A total of 125 subjects were included in the study. Twenty-six had primary open angle glaucoma (POAG), 25 had pseudoexfoliative glaucoma (PXG), 24 had ocular hypertension (OHT), and 50 of them were normal. IOP values were measured by Goldmann applanation tonometer whereas CCT values were measured by ultrasonic pachymeter. RESULTS: CCT values in the OHT group (595.75+/-22.52 microm) were greater than the CCT values of the POAG group (539.92+/-21.50 microm), the PXG group (526.28+/-31.73 microm), and the normal group (533.96+/-29.25 microm) (p<0.05). Eight patients who were diagnosed with OHT showed IOP values of 21 mm Hg or lower with corrected IOP values according to CCT. CONCLUSIONS: Increased CCT may lead to falsely high values of IOP measured with Goldmann applanation tonometer. In this study, when IOP values of the OHT group were redefined according to the formulae regarding the CCT, the authors noted that one third of them were normal. Determination of the CCT in OHT cases is crucial since it has great impact on IOP values, measured with applanation tonometer, which is the main parameter in the diagnosis and follow-up of glaucoma.     

Central corneal thickness measurements in patients with normal tension glaucoma, primary open angle glaucoma, pseudoexfoliation glaucoma, or ocular hypertension.

BACKGROUND/AIMS: Recent studies have revealed patients with ocular hypertension to have thicker than normal central corneas and those with normal tension glaucoma to have thinner than normal ones, as determined by ultrasonic pachymetry. Since corneal thickness measurements and applanation tonometric estimates of intraocular pressure (IOP) correlate positively, monitoring of the former parameter have served as the basis for adjusting readings pertaining to the latter, with the consequence that many patients have had to be reclassified. With a view to validating these pachymetric studies, the central corneal thickness was determined in patients with normal tension glaucoma, primary open angle glaucoma, pseudoexfoliation glaucoma, or ocular hypertension, as well as that of normal subjects, using optical low coherence reflectometry, which is a new and more precise method than ultrasonic pachymetry. METHODS: 34 patients with normal tension glaucoma, 20 with primary open angle glaucoma, 13 with pseudoexfoliation glaucoma, and 12 with ocular hypertension, together with 21 control subjects, were included in this observational, concurrent case-control study. One eye per individual was randomly selected for investigation. IOP was measured by Goldmann applanation tonometry and central corneal thickness by optical low coherence reflectometry. RESULTS: Central corneal thickness was significantly higher (p < or =0.001) in patients with ocular hypertension than in normal individuals or in subjects with either normal tension glaucoma, primary open angle glaucoma, or pseudoexfoliation glaucoma, there being no significant differences between the latter four groups. Patients with ocular hypertension were also significantly younger (p < or =0.003) than those within any of the three glaucomatous groups. CONCLUSION: This study confirms that a significant number of patients with ocular hypertension have normal IOPs after the appropriate adjustments have been made for deviations from normal in their central corneal thickness. The accurate measurement of this latter parameter is important not only for individual patient care, in permitting more precise estimations of IOP, but also for clinical studies, in assuring a more reliable classification of subjects.     

Cataract surgery in primary open angle glaucoma

Cataract surgery has a moderate lowering effect on the intraocular pressure. When glaucoma seems controlled by medication, phacoemulsification gives a chance of improving the situation. Those eyes are most likely to get an intraocular pressure rise by retention of visco-elastic substance.     

Longitudinal changes in retinal nerve fiber layer thickness after acute primary angle closure measured with optical coherence tomography

PURPOSE: Longitudinal follow-up of peripapillary retinal nerve fiber layer (RNFL) thickness after an episode of acute primary angle closure (APAC) using Stratus optical coherence tomography (OCT). METHODS: Seventeen patients who had experienced a single unilateral APAC episode (intraocular pressure, >50 mm Hg) were enrolled. The average and superior, temporal, inferior, and nasal quadrant RNFL thicknesses of the affected and fellow eyes at 1, 4, and 12 weeks after remission were compared by using StratusOCT. The relationship between average RNFL thickness and interval of follow-up were evaluated with regression analysis. RESULTS: The mean duration of the APAC episode was 13.8 hours (range, 3-40). Comparison of the average and four quadrant RNFL thicknesses in the affected eyes longitudinally showed significant differences between 1 and 4, and 1 and 12 weeks, but not between 4 and 12 weeks. The average and four-quadrant RNFL thicknesses for the affected eyes were greater than the analogous values for fellow eyes at 1 week. In contrast, the inferior- and superior-quadrant RNFL thicknesses for the affected eyes were lower at 4 and 12 weeks, whereas the average and nasal quadrant values for the affected eyes were lower than those in fellow eyes at 12 weeks. Average RNFL thickness for the affected eyes was correlated with the interval of follow-up by using inverse regression analysis (P < 0.001; R(2) = 0.60). Controlling for duration of APAC episode, the interval of follow-up on RNFL thickness reduction remained significant (P < 0.001, r = -0.69). CONCLUSIONS: This study demonstrated an initial increase in diffuse RNFL thickness after a single APAC episode, followed by a subsequent decrease.     

Ocular decompression retinopathy after resolution of acute primary angle closure glaucoma

A patient presented with acute primary angle closure glaucoma with markedly elevated intraocular pressure. Two weeks after laser peripheral iridotomy and resolution of the acute attack, the patient was noted to have developed scattered retinal haemorrhages. The haemorrhages resolved over time with no visual sequelae. This is the first reported case of ocular decompression retinopathy after resolution of acute primary angle closure glaucoma.     

小梁切除治疗急性原发性闭角型青光眼

目的　对比观察小梁切除术联合丝裂霉素C(mitomycin C ,MMC)和单纯小梁切除术治疗急性原发性闭角型青光眼的结果。方法　 67例 (67眼 )分为两组 ,分别采用小梁切除术联合MMC和单纯小梁切除术治疗。结果　术后随访时间 6～ 18月 ,平均 (11. 12± 3 . 5 7)月。小梁切除术联合MMC组 (3 5眼 ) ,眼压控制绝对成功率为 82 . 86%(2 9眼 ) ,相对成功率为 94 .2 9%(3 3眼 ) ;单纯小梁切除术组 (3 2眼 ) ,眼压控制绝对成功率为 5 9. 3. 8%(19眼 ) ,相对成功率为 75 . 0 0 %(2 4眼 ) ;两组在眼压控制方面的差异具有显著意义 (P <0 . 0 5 )。术后主要并发症是前葡萄膜炎和虹膜后粘连。结论　小梁切除术联合MMC是药物治疗无反应的急性原发性闭角型青光眼治疗可供选择的手术方法。     

Hormonal changes in male patients with primary open angle glaucoma

INTRODUCTION: Primary open angle glaucoma (POAG) is the most common type of glaucoma, pathogenesis of which is not completely known. Several clinical studies show that glucocorticoid hormones may be implicated in the pathogenesis of POAG and ocular hypertension. Glucocorticoid receptors have been identified in human outflow tissue of the eye. AIMS: The purpose of this study, therefore, was to evaluate the serum concentration of total cortisol (TF), total testosterone (TT), free testosterone (FT), FSH (follitropin), LH (lutropin), ACTH (adrenocorticotropin), SHBG (sex hormone-binding globulin), DHEA-SO4 (dehydroepiandrosterone sulfate) as well as free cortisol (UFF) and 17-OHCS in 24 hours urinary samples in patients treated because of POAG. PATIENTS AND METHODS: Studies were performed in the group of 30 male patients, aged 55 +/- 13 years, treated because of glaucoma for more than two years. Serum and urinary concentration of hormones were studied using RIA methods (DPC). RESULTS: The serum concentration of TF (652.03 +/- 315.43 nmol/l), UFF (248.75 +/- 99.39 nmol/l) and 17-OHCS (5.47 +/- 2.64 mg/24 h) in urine was increased compared with control group. There was not significant difference in concentration of pituitary-gonadal axis hormones in glaucomatous and control groups of patients. CONCLUSION: The results could point to the fact that changes in the endocrine system are one of the factors involved in the pathogenesis of POAG. We conclude that an elevated level of cortisol, free cortisol and its metabolites is closely related to the POAG.