高眼压下行抗青光眼术的疗效观察

高眼压是造成视功能损害的重要原因之一。有实验结果表明高于6.67kPa的眼压持续超过24h,即可引起视神经节细胞及其突起的变性坏死。在临床上常遇到一些急性或慢性青光眼患者经药物治疗后,眼压却难以控制在6.67kPa水平以下。为了保护患者的视功能,我们尝试了在高眼压状态下行抗青光眼手术。1　资料与方法1.1　一般资料　本组病例共17例19只眼。其中男7例8只眼、女10例11只眼。平均年龄66.5a。急性闭角型青光眼11例13只眼,慢性闭角型青光眼4例4只眼,新生血管性青光眼2例2只眼。经药物治疗2d后眼压均在6.25kPa以上。1.2　手术方法　全部患者…     

高眼压下原发性闭角型青光眼的手术治疗

高眼压下原发性闭角型青光眼的手术治疗喀左县医院眼科魏艳珍，贾树辉原发性闭角型青光眼（ＰＡＣＧ）患者急性发作期，眼压急剧升高，尽管用各种抗青光眼药物治疗，眼压仍有不降者。此种情况下如不采取手术治疗措施，将严重损害视神经，造成不可逆转的视功能低下，直至失...     

神经生长因子凝胶对青光眼视神经保护的初步临床评价

目的:评价神经生长因子(nerve growth factor,NGF)眼用凝胶对急性闭角型青光眼术后视神经保护的疗效及其安全性。方法:选取2011-12/2013-10在厦门大学附属厦门眼科中心行小梁切除术治疗的急性闭角型青光眼患者并完成全部的治疗和随访患者45例61眼,其中23例32眼(治疗组)急性闭角型青光眼患者行小梁切除术后采用NGF眼用凝胶治疗3mo,22例29眼(对照组)以生理盐水替代NGF。所有患者随访12mo以上,治疗期间定期随访视力、视野、视网膜神经纤维层厚度和视乳头杯盘比改变,并观察凝胶眼部应用的安全性。结果:两组患者的术后1mo的眼压控制在21mm Hg以下,视力比术前明显提高。治疗组患者术后眼压和视力与对照组相比无显著差异(P>0.05),但术后6,12mo的视野平均光敏度、平均缺损优于对照组;光学相干断层扫描(OCT)和海德堡视网膜断层扫描检查(HRT-Ⅲ)的结果均显示治疗组患眼在术后6,12mo的视网膜神经纤维层厚度显著大于对照组,而杯/盘比显著小于对照组。治疗组患眼未观察到眼表损伤、角膜内皮减少等眼部并发症。结论:急性闭角型青光眼术后给予NGF治疗是视神经保护的安全和有效措施。     

青光眼发作后继发角膜炎2例

闭角型青光眼急性发作可引起许多眼部病变 ,如瞳孔散大、虹膜周边前粘连甚至视神经萎缩等。一般情况下 ,高眼压降至正常后 ,角膜多可转为透明 ,无需特殊治疗。然而 ,笔者曾遇 2例高眼压下降后出现角膜炎的病例 ,现报告如下。1　临床资料例 1:女 ,6 5 a,以“左眼慢性闭角型青光眼急性发作”入院 ,当时眼压 38mm Hg(1k Pa=7.5 m m Hg)。给予降眼压药物后 ,眼压降至 2 0 mm Hg,发现角膜中央横行树枝状灰白色浸润。例 2 :女 ,6 3a,以“左眼慢性闭角型青光眼急性发作”入院 ,眼压 33m m Hg。 1d后眼压降至 19m m Hg,查体发现角膜中央散在针尖…     

周边虹膜切除术后疗效分析

目的探讨周边虹膜切除术的适应证及疗效。方法对闭角型青光眼患者，房角开放超过2／3，行周边虹膜切除术，术后随诊4～10年，统计眼压升高及进行性视野损害情况。结果在本组病例2986例2996眼中，均行周边虹膜切除术，随诊4～10年，眼压控制在21mmHg以下者2086眼，其中，急性闭角型青光眼1234眼，慢性闭角型青光眼852眼；眼压高于30．39mmHg，有进行性视神经损害者610眼，其中急性闭角型青光眼54眼，慢性闭角型青光眼556眼。结论以往对闭角型青光眼的发病机制及类型认识不足，不能很好地掌握周边虹膜切除术的适应证，今后应对闭角型青光眼要多做检查，特别是超声生物显微镜，以确定类型和发病机制，正确选择手术方式。     

改良前房穿刺术在急性闭角型青光眼持续高眼压中的应用

目的:探讨改良前房穿刺术处理急性闭角型青光眼持续高眼压状态下的疗效。方法:对33例33眼急性闭角型青光眼急性发作患者(术前眼压均>60mmHg)在应用常规降眼压药物治疗未能有效降低眼压后,采用改良前房穿刺术,放出房水。结果:所有患者经改良前房穿刺放液后高眼压及眼痛迅速缓解,视力有不同程度的提高,术后眼压平均为15mmHg,未发生与前房穿刺有关的并发症。结论:改良前房穿刺术处理急性闭角型青光眼持续高眼压,损伤小、反应轻、简便高效,可以避免长期大量应用降眼压药物引起的副作用,迅速降低眼压,可以缓解患者痛苦,减轻因高眼压造成的视功能损害。     

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。     

急性闭角型青光眼视神经损害及机制的研究进展

急性闭角型青光眼是前房角突然关闭而引起眼压急剧升高的一种青光眼类型,在亚洲人中的发病率较高。其引起的视神经损害主要表现为杯盘比扩大、视网膜神经纤维层缺失和视野缺损等。迄今有关其视神经损害机制的研究主要集中在机械压力因素、血管及血流动力学因素、分子因素等方面。一氧化氮、视网膜内谷氨酸水平与Ca2+超载、内皮素-1、大胶质细胞活化、自身免疫功能失调可能会导致急性闭角型青光眼视神经损害。     

虹膜周边切除术后眼压不降原因分析

虹膜周边切除对解除原发性急性闭角型青光眼临床前期,先兆期、缓解期以及慢性闭角型青光眼早期的瞳孔阻滞,防止青光跟发作的疗效,已得到充分肯定。近5年来,我们曾遇到20例被诊断为原发性急性闭角型青光眼缓解期和慢性闭角型青光眼早期,并行虹膜周边切除术后眼压不降的患者。为了提高对原发性闭角型青光眼的诊断水平,更好地掌握虹膜周边切除术的适应征。现对20     

前房穿刺术在急性闭角型青光眼高眼压持续状态下临床应用

目的 分析前房穿刺术在急性闭角型青光眼急性发作期药物不能控制眼压中的疗效及其并发症情况.方法 对21例22眼急性闭角型青光眼急性发作患者在应用常规降眼压药物治疗未能有效降压后,采取表麻下手术,显微镜下进行前房穿刺术放液,观察眼压控制以及并发症情况.结果 术前眼压均≥50mmHg,所有患者经穿刺放液后,症状缓解,眼压下降,平均为21.5mmHg,视力提高,角膜水肿及睫状充血明显好转,8例患眼术后次日复查眼压复上升,于原穿刺切口再放液,眼压控制后予以相应手术,术后恢复良好.结论 前房穿刺术是治疗急性闭角型青光眼急性发作期高眼压持续状态的有效方法,损伤小,反应轻,并发症少,为急性闭角型青光眼进一步治疗创造了条件,并且能够改善其预后.     

先天性白内障患儿术后中央角膜厚度变化及其对眼压测量的影响

先天性白内障术后易发生青光眼、高眼压征、虹膜粘连、囊膜机化等并发症,其中青光眼对患者视神经产生不可逆损伤,尤其需要引起临床医生的关注。但是,先天性白内障患者视野、视神经损伤等方面难以获得可靠数据为诊断提供依据,因此眼压精确测量对青光眼诊断尤为重要。先天性白内障术后常伴有角膜厚度改变,会影响眼压测量的准确性。本文就先天性白内障术后中央角膜厚度(CCT)、眼内压(IOP)的变化及变化的原因作一综述。     

Bilateral nonarteritic anterior ischemic neuropathy following acute angle-closure glaucoma in a patient with iridoschisis: case report

A 55-year-old woman was referred to our clinic because of a one-week history of visual loss and raised intraocular pressure in the left eye followed 4 days later by visual loss in the right eye. Slit-lamp examination showed bilateral conjunctival hyperemia, slight diffuse corneal edema, shallow anterior chamber and fixed and dilated pupil in both eyes. Splitting of the anterior layers of the iris with fibrillar degeneration extending for approximately one quadrant inferiorly was presented in each eye. Fundus examination showed optic disc edema with no vascular tortuosity and no cup in both eyes. The condition was treated as bilateral acute angle-closure glaucoma in a patient with irisdoschisis. After medical treatment and improvement of visual acuity, perimetry revealed a significant visual field defect especially in left eye; this case represents a rare concurrence of acute angle-closure glaucoma and bilateral nonarteritic ischemic optic neuropathy. Although most cases of elevated intraocular pressure, including acute angle-closure glaucoma, do not result in optic disc edema and irreversible vision loss, variations in the vascular supply of the nerve optic head along with others ocular systemic risk factors, may predispose certain individuals to nonarteritic ischemic optic neuropathy during periods of elevated intraocular pressure.     

超声乳化白内障手术对剥脱综合征性青光眼的降眼压作用

目的 观察和分析剥脱综合征性青光眼患者行超声乳化白内障摘除人工晶体植入术后的眼压变化。方法 对7例伴有高眼压、明显影响视力的白内障但尚无严重的视神经、视野损害的剥脱综合征患者施行超声乳化白内障摘除人工晶体植入术，比较手术前后的眼压变化。结果 术前平均眼压31．57mmHg，术后1周时平均眼压18．19mmHg，降幅为13．38mmHg，术前术后眼压差异极显著。结论 伴有明显影响视力白内障的剥脱综合征性青光眼病人在行超声乳化白内障摘除人工晶体植入术后眼压会显著下降，对那些尚未发生明显视神经视野损害的剥脱综合征性青光眼患者，行超声乳化白内障摘除人工晶体植入术可有效降低眼压。     

Exfoliation syndrome and exfoliation glaucoma

Exfoliation syndrome abnormal deposition in the anterior segment of the eye of an unknown substance thought to be related to elastic fibres and basement membrane components is associated with accelerated cataract progression. increased frequency of intraoperative and postoperative complications and increased risk for glaucoma and. therefore, is a clinically important finding. A clear association has been shown with age. The syndrome occurs worldwide but its prevalence seems to vary from country to country. The best-known sign of exfoliation syndrome is deposits of greyish-white material on the anterior lens surface. Sometimes exfoliation material can also be seen at the pupillary border, on the anterior iris surface, corneal endothelium, and on the anterior vitreous face. When clinically detected, exfoliation syndrome is somewhat more often unilateral than bilateral. According to recent investigations clinically unilateral exfoliation syndrome is probably never truly unilateral but rather asymmetric, because exfoliation material has been detected ultrastructurally and immunohistochemically around iris blood vessels of the nonexfoliative fellow eyes. Indeed, electron microscopy identifies in various organs of patients with exfoliation syndrome fibrils similar to those seen in intraocular exfoliation deposits. Other clinical signs associated with exfoliation syndrome are pigment dispersion, transillumination defects of the iris and reduced response to mydriatics. In unilateral exfoliation syndrome, intraocular pressure (IOP) of the exfoliative eye is approximately 2 mmHg higher than IOP of the nonexfoliative fellow eye. Whether elevated IOP, vascular changes or exfoliation syndrome itself is the main factor causing optic nerve head damage and conversion of an exfoliative eye to glaucomatous, is not known. Glaucoma in the exfoliation syndrome has been shown to have a more serious clinical course than in primary open-angle glaucoma (POAG). At the time of diagnosis, IOP and its diurnal variation are generally higher and visual field defects tend to be greater in exfoliation glaucoma than in POAG. Because the decrease in lOP variation and lowering of the mean IOP level has been shown to improve visual field prognosis more in exfoliation glaucoma than in POAG, the glaucomatous process is considered to be more pressure-related in exfoliation glaucoma. Furthermore, progression of optic disc damage has been shown to be similar in exfoliation glaucoma and POAG when lOPs are lowered to a comparable level by the treatment. However, vascular disturbances in the posterior segment of the eye might after all be of equal importance in these two types of glaucoma; optic disc haemorrhages and venous occlusions have been reported to be as frequent in exfoliation glaucoma as in POAG. Perhaps in exfoliation glaucoma circullatory disturbances combined with high IOP lead to a particularly relentlessly progressing form of the disease.     

Lensectomy in the management of glaucoma in spherophakia

A 42-year-old woman presented with uncontrolled glaucoma despite patent peripheral iridotomies after a previous episode of acute angle-closure glaucoma. Spherophakia was diagnosed by anterior segment findings, refraction, A-scan biometry, and ultrasound biomicroscopy. Continuous curvilinear capsulorhexis, phacoemulsification, and infusion/aspiration were performed in the right eye. Attempted intraocular lens (IOL) implantation failed, and the eye was left aphakic. Six months later, the intraocular pressure (IOP) was normal without glaucoma therapy and visual acuity was 6/6 with a contact lens. The patient then had phacoemulsification in the left eye, removal of the capsular bag, anterior vitrectomy, and insertion of an anterior chamber IOL. Four months after surgery, the uncorrected visual acuity was 6/9 and the IOP was normal without glaucoma therapy.     

New Management of Angle—closure Glaucoma by Phacoemulsification with Foldable Posterior Chamber Intraocular Lens Implantation

Objective: To investigate the management oi angle-closure glaucoma byphacoemulsification with foldable posterior chamber intraocular lens (PC-IOL)implantation.Design: Retrospective, noncontrolled interventional case series.Participants: In 36 eyes with angle-closure glaucoma (ACG) , there were 18 eyes withprimary acute angle-closure glaucoma (PACG) , 14 eyes with primary chronicangle-closure glaucoma (PCCG) , 3 eyes with secondary acute angle-closure glaucoma(SACG) and 1 eye with secondary chronic angle-closure glaucoma (SCCG).Intervention: Phacoemulsification with posterior chamber intraocular lens implantation.Main Outcome Measures: Postoperative visual acuity, IOP, axial anterior chamberdepth.Results: After a mean postoperative follow-up time of 8. 81±7. 45 months, intraocularpressure was reduced from a preoperative mean of 23. 81 ±17. 84 mmHg to apostoperative mean of 12. 54 4. 73 mmHg ( P =0. 001). Mean anterior chamber depthwas 1. 75 ± 0. 48 mm preoperatively and 2. 29 ?0. 38 mm postoperatively     

Effects of antiglaucoma drugs on the blood flow in rabbit eyes

Although it is essential that intraocular pressure (IOP) be reduced in glaucoma treatment, it is also vitally important to provide sufficient blood flow to eye tissues so that healthy visual field is maintained. It is possible for an agent to reduce IOP and blood supply to the eye. In that case, glaucoma appears to be under control since IOP has been reduced to within normal range, yet the disease is actually progressing, causing damage to the retina, optic nerve, and other tissues. The 85Sr-microsphere technique was used to study the effects of several antiglaucoma drugs on blood supply to various eye tissues. It was found that pilocarpine, L-timolol, D-timolol and haloperidol are good drugs to use in treating glaucoma because they do not reduce ocular blood flow. D-timolol is particularly good because it does not cause side effects through beta-adrenergic blockade or cholinergic stimulation. On the other hand, trifluperidol and moperone reduce IOP effectively, but also decrease blood supply.     

Management of refractory glaucoma in childhood

Glaucoma in children is characterized by marked intraocular pressure (IOP) elevation with resultant atrophy of the optic nerve and loss of retinal ganglion cells. In very young children, secondary expansion of the globe with damage to anterior segment structures, such as the cornea and zonule, often occurs. Permanent, severe visual dysfunction may result from optic nerve damage as well as from amblyopia arising from anisometropia and corneal opacification. The treatment of childhood glaucoma often involves surgery. Goniotomy and trabeculotomy remain the first line surgical procedures for open-angle glaucoma in children. Trabeculectomy with adjunctive antifibrosis therapy, aqueous shunt surgery, and cyclodestructive procedures are undertaken when angle surgery fails to control the IOP or is unlikely to succeed. The choice of surgical procedure is individualized according to factors such as the age of the patient, the specific type of glaucoma, the number of prior surgical procedures, and the visual potential of the eye. Achieving and maintaining an adequate IOP to prevent progressive optic nerve damage, avoiding complications, and preserving vision are the goals that must be considered in deciding on a surgical plan.     

Visual-field loss with optic nerve drusen and ocular hypertension: a case report.

BACKGROUND: Patients with optic nerve drusen are often asymptomatic and free of visual symptoms. However, ocular complications such as visual-field defects may develop. This article presents the case of a patient with optic nerve drusen, ocular hypertension, and a visual-field defect. The diagnosis and management of patients with such findings will be presented. CASE REPORT: A 75-year-old man came to the eye clinic with a history of being treated for glaucoma. On examination, optic nerve drusen were found in both eyes. Subsequent testing revealed ocular hypertension and a visual-field defect that could be related to either optic nerve drusen or glaucoma. After re-establishment of baseline intraocular pressures (IOP) and re-initiation of treatment, the patient is being monitored for IOP control and visual-field progression. CONCLUSION: Optic nerve drusen and glaucoma can both cause visual-field defects. When a patient manifests optic nerve drusen, ocular hypertension, and visual-field defects, a diagnostic and management dilemma exists. Regardless of the etiology for the field defects, a treatment regimen designed to reduce the intraocular pressure to a level that potentially reduces the risk of ocular sequelae is recommended.