原发性闭角型青光眼的晶体厚度／轴长比率

我们在先前的文章中曾介绍对原发性闭角型青光眼和正常眼的一些测定研究,证实了眼的解剖结构异常是原发性闭角型青光眼的发病基础.为更精确地进行活体结构测定研究,我们采用高频(15兆赫)聚焦起声探头测定,对闭角型青光眼晶体厚度与轴长的关系以及不同类型闭角青光眼作深入研究,现将结果报告如下: 一、材料和方法 (一)材料:检查对象来自本中心医院病房及门诊,经临床检查确诊为原发性闭角青光眼142例266眼     

闭角型青光眼昼夜眼压的变化

本文对21例(40眼)闭角性青光眼及其中11例(20眼)周边虹膜切除术3个月后的昼夜曲线进行分析。21例(40眼)年龄在38—65岁,诊断为闭角性青光眼。每天测7次眼压,从早6点至午夜,用Goldmann眼压计连续测量2天。21例中有11例(20眼)行周边虹膜切除术,3个月后,该11例进行上述同样的昼夜曲线检查。     

彩色多普勒血流显像对中晚期青光眼的眼血流动力学研究

目的:观察中晚期青光眼患者的眼血流动力学变化、了解血管因素在中晚期青光眼患者视功能损害机制中的作用.方法:应用彩色多普勒检测20例(40只眼)正常人和21例(42只眼)中晚期青光眼的眼动脉、睫状后短动脉及视网膜中央动脉的血流参数.测定收缩期峰值速度(Peak Systolic Velocity,PSV),舒张末期速度(End Diast01ic Veloclty,EDV),计算其阻力指数(ResistiveIndex,RI).结果:青光眼组与正常组比较,青光眼组的眼动脉、视网膜中央动脉及睫状后短动脉的血流速度明显降低,阻力指数则明显增高,二者之间均有非常显著的差异(均P＜0.001).而慢性闭角青光眼及开角青光眼组无论在血流速度及阻力指数之间都无明显差异(P＞0.05).结论:中晚期青光眼患者因眼动脉、视网膜中央动脉及睫状后短动脉血流速度明显下降,引起局部血液循环障碍,青光眼的视功能损害与视神经的血供不足有密切联系.     

闭角型青光眼中睫状体囊肿的检测

目的 探讨睫状体囊肿与闭角型青光眼的关系.方法 用超声生物显微镜(UBM)对260例(260只眼)连续闭角型青光眼患者进行眼前段检查.结果 在260只连续检查的闭角型青光眼中有睫状体囊肿的20只眼(7.69%)共22个囊肿,其中单发性囊肿的有18只眼(90%),多发性囊肿的有2只眼(10%).囊肿分布颞侧9个(41%),下方9个(41%),鼻侧2个(9%),上方2个(9%).在22个囊肿中有13个囊肿其所对应处房角关闭,9个囊肿其所对应处房角未关闭,卡方检验P=0.394.结论 睫状体囊肿在闭角型青光眼中的发生率较高的.而且他们分布的位置多在颞侧和下方.     

小梁切除术后前房重建疗效分析

小梁切除术后浅前房 ,低眼压可引起一系列病理改变 ,影响疗效 ,已成为眼科医师所关注的问题。我院采用小梁切除术后前房重建对预防上述并发症取得满意疗效 ,现报告如下。1　资料与方法1.1　一般资料　 1997年 4月～ 1998年 12月住院患者 39例(43眼 ) ,随机分组为小梁切除术后前房重建 (治疗组 )及单纯小梁切除术 (对照组 )。治疗组 2 0例 2 2眼 ,男 12例 13眼 ,女 8例 9眼 ,平均年龄 5 6 a。急性闭角性青光眼 12眼 ,慢性闭角性青光眼 8眼 ,慢性单纯性青光眼 2眼。对照组 19例 2 1眼 ,男12例 13眼 ,女 7例 8眼 ,平均年龄 5 5 a。急性闭角性青…     

应用HRT-Ⅱ对生理性大视杯与青光眼及正常人视盘参数比较

目的 应用海得堡视网膜断层扫描仪(HRT—Ⅱ)探讨正常人及屈光不正C／D大于正常者与闭角型青光眼视乳头结构参数的差异。方法 应用HRT—Ⅱ对屈光不正C／D大于正常者(30例60眼)，正常人(100例200眼)，确诊为闭角型青光眼(30例60眼)进行HRT—Ⅱ检查，获得视乳头平均地形图和视乳头各结构参数进行比较分析。结果 将三组参数进行比较，显示视盘、视杯和缘的面积，平均杯的深度和最大杯的深度，差异具有显著性。正常人平均纤维层厚度，C／D大于正常者与闭角型青光眼有显著差异，而前二者间无显著差异。结论 应用HRT—Ⅱ通过随访可为生理性大视杯者排除青光眼。     

正常人眼及青光眼的血流动力学研究

目的 探讨正常人和青光眼患者的眼血流动力学改变。方法 采用彩色多普勒显像技术检测３０例正常人和８０例青光眼患者的眼动脉、睫状动脉和视网膜中央动脉的血流参数。结果 正常人组的各项参数与其他作者报道相接近,青光眼组的血流阻力指数显著高于正常人组,开角型青光眼组的舒张期血流速度明显低于正常人组和闭角型青光眼组。结论 彩色多普勒显像技术对青光眼的诊断和治疗有一定的价值。     

闭角型青光眼中虹膜睫状体囊肿的发病情况

目的:观察闭角型青光眼中虹膜睫状体囊肿的发病情况,虹膜睫状体囊肿与前房轴深、房角的关系。方法:利用超声生物显微镜(UBM)对闭角型青光眼患者740例1057眼进行眼前节检查。结果:闭角型青光眼740例1057眼中检出合并虹膜睫状体囊肿者42例60眼,占被检眼数的5.68%。60眼虹膜睫状体囊肿中虹膜睫状沟囊肿56眼(93.33%),睫状冠囊肿4眼(6.67%);其中单发囊肿33眼(55.00%),多发囊肿27眼(45.00%)。不伴有虹膜睫状体囊肿的患者前房轴深1.16～2.37(平均1.843)mm;合并有虹膜睫状体囊肿的患者前房轴深1.67～2.78(平均2.297)mm。伴有及不伴有虹膜睫状体囊肿的闭角型青光眼患者房角粘连>2个象限的比率分别为66.67%和44.59%。结论:虹膜睫状体囊肿在闭角型青光眼中的发病率较高,多为虹膜睫状沟囊肿,对前房轴深影响不大,但可以增加房角粘连范围,引起闭角型青光眼。     

晶状体超声乳化治疗合并白内障的闭角型青光眼

目的 评价单纯晶状体超声乳化手术治疗合并白内障的闭角型青光眼的效果.方法 回顾性分析23例(25眼)合并白内障的闭角型青光眼施行单纯晶状体超声乳化手术,观察术前术后视力、眼压、前房角及前房深度.随访时间半年.结果 23例(25眼)术后平均眼明显降低(P<0.001),术后视力均有提高,前房角均有增宽,部分重新开放,前房深度加深.结论 单纯品状体乳化吸出术是合并白内障的闭角型青光眼的一种可供选择的有效治疗方法,但应掌握其适应证.     

用透明格子计算视野法观察原发性青光眼手术后视野

Ben Esterman 在1968年报告用透明格子计算视野的方法解决了视野变化描述的一些困难,是一个既简便又较准确的方法。我们将我院1977年到1986年进行过滤性手术的原发性青光眼162眼手术前后均进行过周边视野检查的病例用Esterman 透明格子计算视野法观察手术前后的视野变化。材料和方法162眼中急性闭角青光眼88眼,其中做巩膜灼滤术62眼,小梁切除术26眼;患慢性闭角青光眼者63眼,其中做巩膜灼滤术46眼,小梁切除术17眼;开角青光眼者11眼,其中做巩膜灼滤术7眼,小梁切除术4眼。这些病例的视野均用苏州医疗器械厂出品的两用弧形视野计测得,然后以透明腔片套画的Esterman 氏格子计算视野图(见图)度量每一个视野而获得其视野大小的百分     

慢性闭角型青光眼白内障手术治疗临床探讨

目的 探讨慢性闭角型青光眼合并白内障的手术方法.方法 慢性闭角型青光眼合并白内障共64例（66眼）.其中43例（45眼）施行晶状体超声乳化吸出、人工晶状体植入联合房角分离术,21例（21眼）施行晶状体超声乳化吸出、人工晶状体植入联合小梁切除术.结果 术后视力：晶状体超乳联合房角分离手术组术后视力比术前提高者44眼（97.78%）.晶状体超乳联合小梁切除手术组术后视力比术前提高者18眼（85.72%）.术后眼压：晶状体超乳联合房角分离手术组术后第1天眼压正常;8周后有2眼眼压＞30 mmHg,给予二期行小梁切除术.晶状体超乳联合小梁切除手术组术后第1天19眼（90.48%）眼压正常,有2眼（9.52%）低眼压,4周后均恢复正常.结论 慢性闭角型青光眼合并白内障采用晶状体超声乳化吸出、后房人工晶状体植入联合房角分离术或联合小梁切除术均能有效地提高患者的视力并降低眼压.     

原发性闭角型青光眼周边虹膜的组织学观察

对原发性闭角型青光眼12例18眼的周边虹膜进行了组织学观察,以临床表现正常,在老年性白内障术中切除的周边虹膜做对照,两组的显著差别是虹膜各层组织细胞中线粒体的质和量的变化。特别突出的是急性闭角型青光眼间歇期的标本中空泡样变的线粒体显著密集。眼科学报 1993;9:106-109。     

合并视网膜色素变性的青光眼临床特征

目的 分析合并视网膜色素变性（RP）的青光眼患者的临床特征。设计 回顾性病例系列。研究对象 2008年8月至2012年9月北京同仁眼科中心RP合并青光眼患者37例（62眼）及未合并青光眼的RP患者109例（215眼）。方法 对上述患者的门诊电子病历结合门诊病案资料进行回顾分析。主要指标 青光眼类型,矫正视力及眼压。结果 37例（62眼）RP合并青光眼者中急性闭角型青光眼9例（18眼,29.0%）,慢性闭角型青光眼21例（34眼,54.8%）,原发性开角型青光眼7例（10眼,16.1%）。RP合并青光眼及未合并青光眼者盲眼（视力<0.05）比例分别为58.9%和33.6%（P=0.000）。RP合并青光眼者的平均眼压（23.1±14.0）mm Hg。结论 此回顾性研究中RP合并的青光眼多为原发性闭角型,且视力损害加重。（眼科,2013, 22：42-44）     

OCT对激光周边虹膜切开术治疗原发性闭角型青光眼效果的评价

目的：通过光学相干断层扫描技术(optical coherence tomography,OCT)观察不同临床类型原发性闭角型青光眼(primary angle-closure glaucoma,PACG)行激光周边虹膜切开术(laser peripheral iris, LPI)前、后前房角开放距离变化,评价治疗效果。方法：选择明确诊断为PACG患者46例50眼,其中急性闭角型青光眼临床前期及缓解期眼26例27眼,慢性闭角型青光眼20例23眼,行LPI治疗,通过OCT分别检查术前、术后2周距巩膜突500及750μm处前房角开放距离,采用配对t检验。结果：急性闭角型青光眼LPI术前、术后2周前房角开放距离差异有统计学意义(P<0.05);慢性闭角型青光眼术前、术后2周前房角开放距离差异无统计学意义(P>0.05)。结论：急性闭角型青光眼LPI术后前房角开放距离增加,治疗效果较好;慢性闭角型青光眼LPI术后前房角开放距离增加不明显,术后仍存在前房角闭塞趋向。     

The partner eye in unilateral malignant glaucoma

The fellow eyes of 9 Patients suffering of unilateral classical malignant glaucoma have been throughly examined short after the onset of malignant glaucoma. In 3 cases they were apparently normal, in other 3 cases they exhibited an intermittent primary angle closure glaucoma and in the remaining 3 ones an absolute glaucoma. The therapeutic options of these fellow eyes are discussed.     

Retinitis pigmentosa associated with glaucoma--clinical analysis

A clinical analysis of Retinitis Pigmentosa (RP) was made in 2,789 eyes of 1,400 patients seen over a 5 year period (1983-1987), 64 eyes of 32 cases (2.3%) of RP associated with glaucoma were investigated. Of these 32 cases, the angle closure glaucoma was much more than the open angle glaucoma (30/2). More than half of the 32 cases were without cupping of disk, 5 cases did not have the glaucomatous damage to disk in spite of persistent elevated intraocular pressure for 0.5-5 yrs under the maximum medical therapy. 31 cases (97%) had subnormal blood pressure compared with the normal blood pressure value in different age groups. Histopathologic changes of the trabecular meshwork (TM) of 14 eyes showed a little bit more pigment cells in the TM than normal subjects, no typical features that would obstruct the outflow channels.     

Ocular biometry in occludable angles and angle closure glaucoma: a population based survey

Aim: To compare ocular biometric values in a population based sample of eyes with occludable angles, angle closure glaucoma, and normal subjects. METHOD: 2850 subjects from a population based glaucoma prevalence study underwent complete ocular examination including indentation gonioscopy. Ocular biometry was performed in all subjects classified to have occludable angles (n = 143); angle closure glaucoma (n = 22), and a random subgroup of 419 normal subjects. Ocular biometry readings between the groups were compared and statistically analysed using "t," "z," and Mann-Whitney U tests. RESULTS: The mean age among subjects with occludable angles (54.43 (SD 9.53) years) and angle closure glaucoma (57.45 (8.5) years) was significantly higher (p<0.001) than normal subjects (49.95 (9.95) years). Axial length was shorter (p<0.001) in the occludable angle group (22.07 (0.69) mm) compared to the normal group (22.76 (0.78) mm). Anterior chamber depth (ACD) was shallower (p<0.001) among subjects with occludable angles (2.53 (0.26) mm) than normal subjects (3.00 (0.30) mm). Lens thickness (LT) was greater (p<0.001) in people with occludable angles (4.40 (0.53) mm) compared to normal subjects (4.31 (0.31) mm). No significant difference was noted in axial length, ACD (p = 0.451), and LT (p = 0.302) between angle closure glaucoma and occludable eyes. CONCLUSION: South Indian eyes with angle closure glaucoma and occludable angles seem to have significantly shorter axial lengths, shallower anterior chambers and greater lens thickness compared to the normal group.     

THE PRESENTATION OF ACUTE GLAUCOMA IN PSEUDOEXFOLIATION OF THE LENS CAPSULE

Up to 25% of patients with pseudoexfoliation of the tens capsule (PXF) and glaucoma may present with an acute rise in intraocular pressure (IOP) but the majority of these are not due to angle closure glaucoma. A series of 139 cases with acute presentation of PXF is described; this comprised 86 cases of acute open angle PXF glaucoma (9 bilateral), 18 cases of acute angle closure glaucoma with PXF, 21 cases of neovascular glaucoma with PXF and 14 cases of absolute PXF glaucoma. Males suffered acute open-angle PXF glaucoma and absolute PXF glaucoma significantly more frequently than females. The anterior chamber depth was 2.2 mm or less in all eyes having acute angle closure glaucoma with PXF but few cases with acute open-angle PXF glaucoma had a shallow anterior chamber, this difference being highly statistically significant (P < 0.001). The response to medical treatment was poor in most cases, while surgical treatment was successful in lowering IOP in the majority of cases. Argon laser trabeculoplasty was less successful with a risk of late high rise in IOP.     

Twenty-year follow-up of visual field defects in primary glaucoma eyes

PURPOSE: The time course of visual field defects in patients with primary glaucoma was investigated for 20 or more years. METHODS: The subjects were 51 eyes of 29 patients (open angle glaucoma, 40 eyes of 21 patients angle closure glaucoma, 11 eyes of 8 patients). The mean intraocular pressure of these subjects was within 21 mmHg during the follow-up periods. All the eyes were monitored with Goldmann's perimetry, and the visual field was graded using Kozaki's classification. RESULTS: At the 20-year follow-up, 68% of the open angle cases and 45% of the angle closure cases had significant progression of visual field defects. There was no significant difference in average intraocular pressure during the follow-up period between the progression group and the stable group. CONCLUSION: These results suggested that, in a follow-up of twenty years, visual field defects both in primary open angle glaucoma and chronic angle closure glaucoma can progress frequently, even if the intraocular pressure of these patients was well controlled.     

The presentation of acute glaucoma in pseudoexfoliation of the lens capsule

Up to 25% of patients with pseudoexfoliation of the lens capsule (PXF) and glaucoma may present with an acute rise in intraocular pressure (IOP) but the majority of these are not due to angle closure glaucoma. A series of 139 cases with acute presentation of PXF is described; this comprised 86 cases of acute open angle PXF glaucoma (9 bilateral), 18 cases of acute angle closure glaucoma with PXF, 21 cases of neovascular glaucoma with PXF and 14 cases of absolute PXF glaucoma. Males suffered acute open-angle PXF glaucoma and absolute PXF glaucoma significantly more frequently than females. The anterior chamber depth was 2.2 mm or less in all eyes having acute angle closure glaucoma with PXF but few cases with acute open-angle PXF glaucoma had a shallow anterior chamber, this difference being highly statistically significant (P less than 0.001). The response to medical treatment was poor in most cases, while surgical treatment was successful in lowering IOP in the majority of cases. Argon laser trabeculoplasty was less successful with a risk of late high rise in IOP.