Muller细胞对青光眼视网膜神经节细胞影响的研究进展

视网膜神经节细胞（RGCs）的过度凋亡是青光眼病理改变的基础。Mller细胞作为视网膜的主要神经胶质细胞,对于维持神经元的完整性、代谢、内环境稳态以及信号转导等均具有重要的作用。随着对Mller细胞研究的逐渐深入,发现Mller细胞不仅参与了青光眼性RGCs的凋亡机制,而且还参与了RGCs的代偿性保护机制。那么Mller细胞是如何对RGCs起作用,它又是通过什么机制参与青光眼引起的RGCs凋亡以及代偿性保护作用呢？就这些问题的最新研究进展进行综述。     

Ahmed青光眼阀治疗难治性青光眼的作用和现状

青光眼是致盲性疾病,难治性青光眼的治疗更为棘手.青光眼房水引流物的出现,是治疗难治性青光眼的突破性进展,提高了中短期治疗成功率,同时也存在较多并发症.本文就常用的引流植入物-Ahmed青光眼阀在治疗难治性青光眼中的作用和研究现状作一综述.     

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.     

自噬在青光眼和视网膜退行性病变中的研究进展

自噬是细胞的管家程序,是细胞维持内环境稳定的必需途径。主要通过移除错误折叠的蛋白和损伤的细胞器来实现目的。自噬途径涉及到人体多种疾病,包括肿瘤、神经退行性疾病以及传染性疾病。神经退行性疾病与许多眼部疾病的病理机制密切相关,比如青光眼以及年龄相关性黄斑病变。此外,眼内细胞持续暴露于各种应激因子中,可导致自噬的发生,自噬通过回收利用代谢前体细胞,或者促进受损细胞的死亡来提高整体存活率。自噬与凋亡也被证实在不同的实验环境中存在协同和拮抗作用,而这一切与许多疾病的病理机制息息相关。本文对自噬的机制及调控进行了回顾,并总结了较新的有关青光眼中视网膜神经元自噬的理论以及运用自噬的治疗手段。     

Australian and New Zealand Registry of Advanced Glaucoma: methodology and recruitment

Background: Glaucoma is a sight‐threatening disease affecting 3% of the population over the age of 50. Glaucoma is treatable, and severe vision loss can usually be prevented if diagnosis is made at an early stage. Genetic factors play a major role in the pathogenesis of the condition, and therefore, genetic testing to identify asymptomatic at‐risk individuals is a promising strategy to reduce the prevalence of glaucoma blindness. Furthermore, unravelling genetic risk factors for glaucoma would also allow a better understanding of the pathogenesis of the condition and the development of new treatments. Design: The Australian and New Zealand Registry of Advanced Glaucoma is a prospective study that aims to develop a large cohort of glaucoma cases with severe visual field loss to identify novel genetic risk factors for glaucoma blindness. Methods: Clinical information and blood are collected from participants after referral by eye practitioners. Samples are collected across Australia and New Zealand using postage kits. Participants: Our registry has recruited just over 2000 participants with advanced glaucoma, as well as secondary and developmental glaucomas. Results: A positive family history of glaucoma is present in more than half of the advanced glaucoma cases and the age at diagnosis is significantly younger for participants with affected relatives, which reinforces the involvement of genetic factors in glaucoma. Conclusions: With the collection of glaucoma cases recruited so far, our registry aims to identify novel glaucoma genetic risk factors to establish risk profiling of the population and protocols for genetic testing.     

微创青光眼手术在儿童青光眼治疗中的应用现状和展望

儿童青光眼是一类难治性青光眼,微创青光眼手术(MIGS)为儿童青光眼提供了安全有效的治疗选择。多数已发表的研究倾向于支持应用全周内路小梁切开术,其治疗儿童青光眼的安全性和有效性与非MIGS的全周外路小梁切开术相似。关于KDB刀、小梁消融术和Xen凝胶支架的研究较为有限,但在某些特定的病例中可能有其各自的优势。每一种MIGS手术在考虑其优势之处的同时须特别权衡每种手术方法的长期效果。此外,还需要更多的前瞻性和比较性研究、更大的样本量和更长的随访时间来验证MIGS手术治疗儿童青光眼的安全性和有效性。     

Changes in visual fields and lateral geniculate nucleus in monkey laser-induced high intraocular pressure model

Monkey eyes are useful for ophthalmologic research into eye diseases because their histological and functional properties are very similar to those of humans. The monkey laser-induced high intraocular pressure (IOP) model is a common model for ophthalmologic research, especially into glaucoma. Although several studies using this model have focused on changes in visual field, retinal ganglion cells (RGC), and lateral geniculate nucleus (LGN), clear relationships among these changes in one and the same monkey have not been established. We therefore examined visual field changes, RGC and LGN numbers, and glial fibrous acidic protein (GFAP) immunohistochemistry in the LGN in each of two monkeys. Visual field sensitivity, RGC number, and neuronal density of LGN were all decreased by high IOP. The relationship between loss of RGC and decrease in visual field sensitivity depended on the eccentricity from the fovea. Moreover, LGN immunohistochemistry revealed greater increases in GFAP expression in the layers receiving a neuronal input from the high IOP eye than in those receiving a neuronal input from the contralateral untreated eye. From these results, we suggest that glaucoma may lead to changes in glial function not only in the retina, but also in the visual pathway, and that such central nervous system changes may be a hallmark of neuropathy in glaucoma, as in other neurodegenerative diseases.     

Population-based glaucoma prevalence studies in Asians

Glaucoma-related population-based studies from Japan, Mongolia, India, Singapore, Thailand, China, Bangladesh, Myanmar, Sri Lanka, and South Korea show a higher glaucoma prevalence in Asian patients, including a higher incidence of primary angle-closure glaucoma, than in white patients, although primary open-angle glaucoma (POAG) is still the most commonly reported. Among POAG, normal tension glaucoma predominates over high tension glaucoma, a distinctive finding. Risk factors for glaucoma in population-based studies in both Asian and white patients are similar, except that myopia is a greater risk factor in Asian patients. Diagnostic criteria differ among studies, some using the International Society of Geographic and Epidemiologic Ophthalmology (ISGEO) classification and others not. The devices used to observe the optic disk and test the visual field are also not uniform across studies. Moreover, the ages of patients, and whether rural or urban, were different. To allow reliable comparison of the results of epidemiologic studies, efforts to standardize the diagnostic criteria, devices, and the age range of the study population are required.     

Comparison of delayed-onset glaucoma and early-onset glaucoma after infantile cataract surgery

PURPOSE: To investigate the causes and characteristics of glaucoma in children following cataract surgery. METHODS: Twenty-four patients (37 eyes) with uncomplicated congenital cataracts who developed glaucoma after cataract surgery were studied retrospectively. Variables included cataract morphology, surgical techniques, post-operative complications, time to the onset of glaucoma, gonioscopic findings, presence of microcornea and the histopathologic characteristics of the filtration angle (in one case). RESULTS: There was a bimodal onset of glaucoma after cataract surgery. Early-onset glaucoma occurred at a mean age of 6 months in 15 eyes and delayed-onset glaucoma at a mean age of 12 years in 22 eyes. Early-onset glaucoma was significantly (p = 0.018) more likely to be due to angle closure than delayed-onset glaucoma. With delayed-onset glaucoma, the filtration angle was open in 86% of eyes and significantly (p = 0.006) more eyes in the delayed-onset group had microcornea. Medical treatment was sufficient to control intraocular pressure in the delayed-onset group while the early-onset group required surgical treatment (P < 0.001). CONCLUSIONS: The onset of glaucoma after cataract surgery during infancy follows a bimodal pattern that is correlated with the configuration of the filtration angle. The early-onset glaucoma group had high incidence of angle closure requiring surgical treatment, while in the delayed-onset group non-surgical treatment was sufficient to control intraocular pressure. Prophylactic iridectomy in eyes at risk for pupillary block is recommended. Eyes with delayed-onset glaucoma have open filtration angles yet also have findings of incomplete development of filtration structures. Microcornea is a risk factor for delayed-onset glaucoma.     

Current concepts on primary open-angle glaucoma genetics: a contribution to disease pathophysiology and future treatment

Glaucoma is a common, complex, heterogenous disease and it constitutes the major cause of irreversible blindness worldwide. Primary open-angle glaucoma (POAG) is the most common type of glaucoma in all populations. Most of the molecular mechanisms leading to POAG development are still unknown. Gene mutations in various populations have been identified by genetic studies and a genetic basis for glaucoma pathogenesis has been established. Linkage analysis and association studies are genetic approaches in the investigation of the genetic basis of POAG. Genome-wide association studies (GWAS) are more powerful compared with linkage analysis in discovering genes of small effect that might contribute to the development of the disease. POAG links to at least 20 genetic loci, but only 2 genes identified in these loci, myocilin and optineurin, are considered as well-established glaucoma-causing genes, whereas the role of other loci, genes, and variants implicated in the development of POAG remains controversial. Gene mutations associated with POAG result in retinal ganglion cell death, which is the common outcome of pathogenetic mechanisms in glaucoma. In future, if the sensitivity and specificity of genotyping increases, it may be possible to screen individuals routinely for disease susceptibility. This review is an update on the latest progress of genetic studies associated with POAG. It emphasizes the correlation of recent achievements in genetics with glaucoma pathophysiology, glaucoma treatment perspectives, and the possibility of future prevention of irreversible visual loss caused by the disease.     

Loss of retinal capillary vasoconstrictor response to Endothelin-1 following pressure increments in living isolated rat retinas

Increased intraocular pressure (IOP) is a major risk factor for glaucoma, and its contribution to neuronal damage appears multi-factorial. An open issue is whether pressure effects on blood vessels contribute to neuronal damage. In particular, little is known about pressure effects on capillaries, which are the site of most metabolic exchange in the retina, but cannot be easily visualized in vivo. To address this issue, here we have imaged retinal capillaries in acutely isolated living rat retinas, and measured alterations in capillary viability, caliber and response to vasoactive stimuli after controlled pressure stimuli. We found that capillary viability, diameter and response to vasodilator stimulation are not affected after pressure increments; yet, a prolonged lack of capillary response to the vasoconstrictor Endothelin-1 (Et-1) is observed. Considering that Et-1 is a major component of the endogenous control of retinal blood flow the present data lead to the hypothesis that prolonged or repeated IOP elevation could induce capillary disregulation contributing to neuronal damage over time.     

The cellular mechanism underlying neuronal degeneration in glaucoma: Parallels with Alzheimer's disease

Evidence is presented that the characteristic pattern of neuronal degeneration associated with glaucoma is due to a combination of the persistent physical damage to axons at the level of the lamina cribrosa and the associated neuronal reaction to this kind of trauma. The class of neuronal cytoskeletal proteins known as the neurofilament triplet are crucially involved in the reaction to physical damage and the selective localization of these proteins to larger retinal ganglion cells may underlie their susceptibility to eventual degeneration. The appearance of glaucoma-like neuronal pathology in Alzheimer's disease may follow the reaction of neurofilament-containing retinal ganglion neurons to persistent damage to their axons by β-amyloid plaque formation in subcortical visual centres.     

Ex-PRESS引流器植入术治疗青光眼研究进展

Ｅｘ-ＰＲＥＳＳ青光眼引流器是一种无阀门设计的新型房水引流装置,临床上主要用于前房较深的青光眼患者的手术治疗。本文将从Ｅｘ-ＰＲＥＳＳ引流器的设计与生物特征、手术方式的发展和现行的标准术式、手术适应证和禁忌证、并对比分析该手术与小梁切除术及Ａｈｍｅｄ青光眼引流阀植入术的临床特性、适应证及疗效５个方面进行综述。     

Possible role of excitotoxicity in the pathogenesis of glaucoma

Excitotoxicity describes the process of neuronal injury by excess stimulation of amino acid receptors. This form of insult was first described in the retina, and subsequently has been shown to be an important component of the pathogenesis of ischaemic and traumatic injury in the central nervous system. Furthermore, there is increasing evidence that excitotoxicity is involved in several chronic neurological conditions, and anti-excitotoxic treatment has already been approved for some of these conditions. A large-scale trial is currently underway that will determine the efficacy of an anti-excitotoxic drug (memantine) in the management of glaucoma. This review provides an overview of neurotransmission and the mechanisms of excitotoxicity. The evidence for excitotoxicity as a component of certain neurological diseases, including glaucoma, is discussed.     

抗VEGF抗体贝伐单抗在青光眼滤过性手术的应用

新生血管化发生于青光眼滤过性手术的伤口愈合阶段,是对青光眼治疗的挑战.为提高手术成功率,近年来抗VEGF抗体贝伐单抗(bevacizumab,BVZ)应用于青光眼滤过性手术,如原发性开角型青光眼、色素性青光眼、剥脱性青光眼、慢性闭角型青光眼、新生血管性青光眼以及抗青光眼手术失败的再次青光眼滤过性手术.给药方式包括局部给药、结膜下注射、前房内注射、玻璃体内注射、联合给药等.     

Glaucoma among Saudi Arabian population: a scoping review

Despite its high risk of leading to permanent visual dysfunction, glaucoma remains underdiagnosed in primary care settings. About 11% of glaucoma patients in Saudi Arabia end up with bilateral blindness. This scoping review investigates and presents results on the glaucoma profile, including its prevalence, knowledge, attitude, and practice of Saudi Arabians towards the disease. An online search using four databases through online software (www.rayyan.ai) was performed to extract the relevant articles. Out of 76 records, 21 articles were eligible for the analysis. All included studies were published between the years 2014 and 2022. Most studies were in Riyadh city, followed by Jeddah. All participants (n=11 388) were adults >18 years old, and male participants were generally higher than females. The findings showed poor knowledge of glaucoma among the general population, while the knowledge among glaucoma patients was acceptable. The attitude was positive, while the compliance and practice were fair. More educational programs about glaucoma, its risk to the eyes, and the overall quality of life are highly recommended.     

Overcoming diagnostic and treatment challenges in uveitic glaucoma

Uveitic glaucoma is a range of disorders that results in optic nerve damage from elevated intraocular pressure secondary to intraocular inflammation. As compared to primary open angle glaucoma, uveitic glaucoma is associated with a more aggressive disease course caused by very high intraocular pressure levels that wax and wane. Diagnosis is often based on clinical presentation, disease course, and associated systemic manifestations. Diagnostic imaging plays an important role in both diagnosis and management. While the mechanisms of uveitic glaucoma vary, treatment requires strict control of the inflammation and may involve additional intraocular pressure lowering techniques. Management often dictates an interdisciplinary approach as systemic association and treatment is common. When topical management does not slow the progression of optic nerve damage and vision loss, surgical intervention is required. A significant portion of patients with uveitic glaucoma will eventually require surgical intervention and the appropriate referrals should be made. By nature, success rates of surgical intervention in uveitic glaucoma patients are lower than non‐inflammatory causes of elevated intraocular pressure and glaucomatous damage. Chronic inflammation, multiple mechanisms, systemic associations, and unpredictable response to treatment make uveitic glaucoma challenging to manage. This review will discuss the pathophysiology, diagnosis, and management of uveitic glaucoma to provide a guide for eye‐care providers.     

青光眼引流器植入术在新生血管性青光眼治疗中的疗效观察

目的观察青光眼引流器植入术对新生血管性青光眼的治疗作用。方法回顾性总结33例新生血管性青光眼行青光眼引流器植入术的治疗结果。结果术后眼压控制较好,视力损伤小,并发症少。结论青光眼引流器植入术恢复快,对视力损伤小,对新生血管性青光眼是一种疗效较好的治疗方法。     

青光眼患者心理因素的探讨

青光眼是一种常见的眼科心身疾病,因患者发病前经历的负性生活事件产生情绪应激是导致原发性青光眼患者发病重要原因之一,青光眼的发病及复发与精神、情绪等有关,反过来心理因素的变化又影响了青光眼的治疗。我们就青光眼患者的心理因素作一综述。     

Spontaneous malignant glaucoma: Case report and review of the literature

Malignant glaucoma usually occurs after anterior segment surgery (typically after glaucoma surgery). The aim of this article is to report a case of spontaneous malignant glaucoma (SpMG), which required phacovitrectomy for resolution and to review the cases of SpMG reported in modern literature. Only nine cases were identified. SpMG has no gender predilection and age at onset seems to be lower (mean age 47 years) than in secondary malignant glaucoma (SeMG). Nearly in half of the reported patients (4 out of 9) the condition had a bilateral presentation. The risk factors that have been identified for SeMG (nanophthalmos, shallow anterior chamber, iris plateau, zonular laxity) are underrepresented in SpMG.