动态轮廓眼压计在正常眼压性青光眼及原发性开角型青光眼的应用研究

目的:应用动态轮廓眼压计(dynamic contour tonometer,DCT)测量正常眼压性青光眼(normal tension glaucoma,NTG)及原发性开角型青光眼(primary open angle glaucoma,POAG)患者的眼压(intraocular pressure,IOP)及眼脉动幅度值(ocular pulse amplitude,OPA),并探讨影响OPA测量值的相关因素。方法:选取NTG患者20例,POAG患者21例及正常对照组各20例,应用Goldmann压平眼压(Goldmann applanation tonometer,GAT)及DCT测量IOP,同时测量了中央角膜厚度(central corneal thickness,CCT)、眼轴(axial length,AL)、心率(heart rate,HR)、收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)等指标,并探讨GAT,DCT两种眼压计测量的相关性,进而分析OPA测量值的影响因素。结果:三组被检者的IOP,OPA,SBP及DBP差异均有统计学意义(P<0.05),而CCT,AL及HR差异无统计学意义(P>0.05)。其中OPA值NTG组为(1.7±0.9)mmHg,POAG组为(2.8±0.7)mmHg,正常对照组为(2.4±0.6)mmHg;NTG组与POAG组比较(P=0.001),与正常对照组比较(P=0.005)差异均有统计学意义,POAG组与正常对照组比较(P=0.502)差异无统计学意义;OPA值与IOP,HR及CCT无相关性(P>0.05),与AL,SBP及DBP具有一定的相关性(P<0.05)。结论:NTG患者与POAG患者及正常人的OPA值存在差异,同时OPA值受AL及SBP及DBP影响。     

动态轮廓眼压计的临床应用

目的 探讨动态轮廓眼压计(OCT)在原发性开角型青光眼(POAG)、高眼压症(OHT)、正常眼压性青光眼(NTG)及正常对照人群眼压和眼压脉动振幅(OPA)测量中的临床应用价值及影响因素.方法 选取POAG、OHT、NTG及正常对照组各30例,分别采用Goldmann压平眼压计(GAT)测量眼压,DCT测量眼压及OPA,并测量中央角膜厚度(CCT)、中央角膜曲率(CCV)以及心率、收缩压、舒张压等指标,以了解这些指标对OPA的影响.各组统计量两两比较采用q检验.各统计量之间的相关分析采用Pearson相关分析,对于多个变量之间的线性关系采用多重线性回归分析.结果 DCT测量POAG、OHT、NTG及对照组的眼压值分别为(21.68±2.02)、(23.37±2.65)、(18.43±3.08)、(17.04±2.07)lnln Hg(1 mm Hg=0.133 kPa);GAT测最的眼压值分别为(21.18±2.95)、(23.28±5.95)、(16.39±3.60)、(14.66±2.27)mm Hg.两者测量结果的差异无统计学意义(t=1.338,1.445,1.682,1.803;P=0.197,0.151,0.136,0.081).POAG、OHT、NTG及对照组的OPA值分别为3.03±1.13,3.53±1.43,2.21±0.55,2.87±0.60,组间比较差异有统计学意义(F=21.311,P=0.000);OPA值与心率、收缩压、舒张压、GAT测量值、CCT均相关,与年龄无明显相关性.结论 DCT测量结果与GAT有良好的一致性,受干扰因素少,可信度高;POAG、NTG、OHT患者和正常人的OPA存在差异,其中NCT患者OPA值明显较低,提示各组间眼内血液动力学状况的差异,OPA可能对青光眼的诊断及治疗具有一定的潜在价值.     

动态轮廓眼压计在正常人群中的应用及其影响因素分析

目的评价动态轮廓眼压计（DCT）与Goldmann压平眼压计（GAT）测量值之间的关系,寻找DCT眼压测量值的影响因素;分析DCT所测眼压脉动振幅（OPA）与DCT眼压值、中央角膜厚度（CCT）、角膜屈光力（CCV）、眼轴长度（AL）、前房深度（ACD）、收缩压（SBP）、舒张压（DBP）和心率（HR）的关系。方法分别测量正常人60例60眼的DCT眼压、GAT眼压、CCT、CCV、AL、ACD以及HR、SBP、DBP等指标,比较GAT、DCT2种眼压计测量的相关性及DCT测量值的影响因素。结果 DCT与GAT所测眼压平均值分别为（16.04±2.57）mmHg和（14.20±2.93）mmHg。DCT眼压值较GAT眼压值高,差异有统计学意义（t=6.454,P〈0.01）。DCT眼压值与GAT眼压值呈正相关（r=0.684,P〈0.01）。DCT眼压值与CCT不相关（r=0.212,P=0.105）,GAT眼压值与CCT呈正相关（r=0.291,P=0.024）。60例正常人的OPA均值为（2.50±0.89）mmHg,OPA与年龄、DCT眼压值、CCT、SBP、DBP、HR均不相关（P〉0.05）,与CCV呈正相关（r=0.343,P=0.007）。结论在正常人群中DCT眼压值与GAT眼压值有较好的相关性,DCT的眼压测量值不受CCT、CCV等因素的影响。DCT眼压值、CCT、SBP、DBP、HR等对OPA无明显影响。     

正常眼压性青光眼与原发性开角型青光眼24小时眼压曲线的比较

目的 通过24 h眼压的测量来深入分析比较正常眼压性青光眼(NTG)与原发性开角型青光眼(POAG)的眼压曲线特征.方法 前瞻性病例对照研究.收集2006年4月至2009年4月在上海市闸北区北站医院和复旦大学附属眼耳鼻喉科医院门诊就诊的NTG患者131例及POAG患者102例,测量24 h眼压,用非接触性眼压计从8 am起每隔2 h测一次眼压,0 am至6 am之间测得的为唤醒后即刻坐位眼压.主要观察指标为眼压波动曲线、平均眼压、峰值时间及眼压、谷值时间及眼压和眼压波动值.采用独立样本t检验和卡方检验比较各指标在两组之间的差异.结果 NTG组双眼平均眼压为(14.2±2.1)mmHg,低于POAG组[(19.9±3.5)mmHg];NTG组双眼峰值眼压为(17.0±2.4)mmHg,低于POAG组[(24.7±4.3)mmHg];NTG组双眼谷值眼压为(11.8±2.2)mmHg,低于POAG组[(16.5±3.1)mmHg];NTG组双眼眼压波动值为(5.2±1.8)mmHg低于POAG组(8.2±3.1)mmHg];两组的平均眼压、峰值、谷值及眼压波动值的差异均有统计学意义(t=-14.52、-16.44、-13.16、-8.90,P均＜0.01).NTG组63.3%患者、POAG组73.5%患者的峰值眼压位于门诊工作时间以外;尤其是NTG组有51.5%患者、POAG组有64.7%患者的峰值位于0 am至6 am时间段,两组差异有统计学意义(X2=8.150,P=0.017).结论 NTG及POAG患者24 h眼压曲线的变化规律具有相似性,是诊断和个体化治疗方案制订的依据,并可用作治疗随访中评价疗效和调整方案的重要参考指标.     

青光眼的眼压及眼脉动幅度比较分析

目的:观察比较慢性闭角型青光眼、原发性开角型青光眼、正常眼压性青光眼以及正常人的眼压,眼脉动幅度特征及其相关性。方法:收集临床确诊为慢性闭角型青光眼患者19例,原发性开角型青光眼18例,正常眼压性青光眼15例,正常人20例,用动态轮廓眼压计测量其眼压及眼脉动幅度,同时测量患者的血压及心率。运用SPSS14.0进行统计学分析。结果:慢性闭角型青光眼组的平均眼压为25.42±9.95mmHg,OPA为3.84±0.88mmHg;原发性开角型青光眼组的平均眼压为23.12±5.47mmHg,OPA为3.29±0.90mmHg;正常眼压性青光眼组的平均眼压为16.52±2.23mmHg,OPA为1.85±0.47mmHg;正常人组的平均眼压为16.31±2.67mmHg,OPA为2.47±0.80mmHg。前两组与后两组之间的眼压存在着显著性差异,四组之间的OPA均存在统计学差异。四组患者的眼压及眼脉动幅度之间存在着弱相关性,但无统计学意义。结论:慢性闭角型青光眼、原发性开角型青光眼及正常眼压性青光眼的OPA之间存在统计学差异,眼压与OPA之间存在弱相关性,但无统计学意义。     

Goldmann眼压计与非接触眼压计测量青光眼患者眼压的对比分析

目的：：对比分析 Goldmann 压平式眼压计( Goldmann applanation tonometer, GAT)和非接触眼压计( non-contact tonometer,NCT)测量青光眼患者眼压的结果,寻找其规律性。方法：分别使用GAT和NCT测量108例206眼青光眼患者的眼压。结果：青光眼患者108例206眼的平均眼压：GAT测量为29.77±10.27mmHg,NCT测量为24.59±8.58mmHg,两者比较存在显著性差异(P<0.01),而且眼压越高,差异性越显著。结论：NCT 测量值较 GAT 测量值低,眼压越高,差值越大。建议使用GAT检查青光眼患者的眼压,以免漏诊和贻误治疗。     

PASCAL动态轮廓眼压计临床应用的初步报告

目的:验证动态轮廓眼压计(DCT)的临床性能。方法:对81例143眼青光眼及可疑病例青光眼患者用DCT测量眼内压(IOP);132眼同时用Goldmann压平眼压计(GAT)测量眼压,部分病例同时用NIDEKUP-1000型角膜测厚仪测量中央角膜厚度(CCT)。GAT与DCT测量结果采用配对t检验,GAT、DCT测量值与CCT的关系及DCT测量值与眼脉动振幅(OPA)的相关关系采用Spearman双变量相关分析。结果:①DCT和GAT测得的眼压均数分别为(18.6±3.9)mmHg和(17.4±4.1)mmHg;DCT测得的眼压值高于GAT,其差值均数为(1.1±2.3)mmHg;两种眼压计测得的眼压值呈正相关(r=0.83,P<0.01)。②116眼同时完成了DCT眼压测量及CCT测量,两者相关系数r=0.03,P=0.77;113眼同时完成了GAT眼压测量及CCT测量,两者相关系数r=0.28,P=0.003。③143眼同时记录了DCT眼压值和眼脉动振幅(OPA),其均数分别为(18.6±3.9)mmHg和(2.6±1.1)mmHg,两者的相关系数r=0.32,P<0.01。结论:以上结果初步证实:①DCT眼压计测量值与GAT眼压测量值高度相关,但DCT测量值略高于GAT测量值,提示DCT可用于临床诊断。②DCT测量值与CCT不相关,GAT测量值与CCT显著相关,提示DCT在青光眼诊断中有独特优势。③DCT测量的OPA与IOP值显著相关,相关的机制及临床意义有待探讨。     

双眼之间PASCAL动态轮廓眼压计眼压测量值的比较及OPA与眼压的关系

目的分析双眼之间PASCAL动态轮廓眼压计(dynamic contour tonometer,DCT)眼压(intraocular pressure,IOP)测量值的差异及眼脉动振幅(ocular pulse amplitude,OPA)与IOP的关系,探讨双眼DCT IOP差异形成的可能影响因素。方法 2007年4月至2008年2月就诊于我院的非青光眼患者147例(293眼)分别用DCT与GAT进行双眼IOP测量,同时记录OPA值,两种仪器的测量顺序随机确定,同一种眼压计均先测右眼,再测左眼。双眼之间IOP值及OPA的比较采用配对t检验,OPA值与DCT所测IOP值的相关性采用Spearman双变量相关分析。结果 129例(258眼)完成DCT测量,其左眼、右眼IOP值分别为(17.3±3.1)mmHg(1kPa=7.5mmHg)、(17.6±3.1)mmHg,差值(0.4±1.7)mmHg;左右眼OPA值分别为(2.2±0.9)mmHg、(2.4±0.9)mmHg,左眼均低于右眼,双眼之间DCT所测IOP值及OPA值差异均具有显著统计学意义(t=2.399,P=0.018;t=3.49,P=0.001);147例GAT测量中排除5例(9眼)双眼IOP差值大于4mmHg,其余284眼其左眼、右眼GAT所测IOP值分别为(16.2±3.5)mmHg、(16.1±3.4)mmHg,二者之间差异无统计学意义(t=-1.45,P=0.149)。PASCAL DCT所测得的左右眼OPA值与IOP值均呈弱相关(r=0.262,P=0.002;r=0.259,P=0.002)。结论 DCT所测得的IOP值及OPA值其右眼均高于左眼,且OPA与IOP呈弱相关关系,而GAT无这种表现。     

三种不同眼压计眼压测量值的比较

目的:比较分析Icare回弹式眼压计、GAT和DCT的眼压测量结果,探讨Icare回弹式眼压计的临床性能。方法:78例152眼分别用Icare,GAT,DCT3种眼压计进行眼压测量,然后根据测得的眼压高低分为高眼压、中眼压、低眼压3个组,对比分析3种眼压计的测量结果。结果:在全部受测者中Icare,GAT,DCT测得的眼压均值分别为19.16±5.03mmHg,18.41±4.52mmHg和17.23±3.69mmHg,每两种眼压计相比均有显著差别,但是彼此之间密切相关。高、中、低3个眼压组两种眼压计之间的差值均随着眼压的增高而增大。结论:使用Icare测量的眼压值准确可信,Icare,GAT和DCT的眼压值彼此之间具有良好的相关性。     

中央角膜厚度对3种眼压计眼压测量值的影响

目的比较分析不同中央角膜厚度(central corneal thickness,CCT)下Icare回弹式眼压计、Goldmann压平式眼压计(Goldmann applanation tonometer,GAT)和动态轮廓眼压计(dynamic contour tonometry,DCT)的眼压测量结果,探讨CCT对3种眼压计测量值的影响。方法 对78例患者152眼分别用Icare、GAT、DCT3种眼压计进行眼压测量,并进行CCT的测量,对比不同CCT下3种眼压计的测量结果,分析眼压测量值与CCT的关系。结果 在全部受测者中Icare、GAT、DCT测得的眼压均值分别为(19.16±5.03)mmHg(1 kPa=7.5 mmHg)、(18.41±4.52)mmHg和(17.23±3.69)mmHg,三者之间有显著差异(F=7.256,P=0.001)。Icare和GAT的眼压测量值均与CCT显著相关(r=0.341,P<0.001;r=0.333,P<0.001),CCT每改变10μm,Icare的眼压值改变0.47 mmHg,GAT的眼压值改变0.41 mmHg;而DCT的眼压测量值与CCT无显著相关(r=0.032,P=0.699)。结论 Icare、GAT的眼压测量值均明显受CCT的影响,而Icare受CCT影响的程度较GAT的稍大,DCT的眼压测量值基本不受CCT的影响。     

Modern diagnostic methods for suspected glaucoma and glaucoma

BACKGROUND: Diagnosis of early glaucomatous damage as well as the detection of glaucomatous change are still difficult tasks. During the last years numerous new diagnostic techniques have been investigated and some of them have been introduced to the market. METHODS: This paper reviews the different aims of diagnostic technologies in the field of glaucoma. Methods appearing suitable for a large-scale use by ophthalmologists will be judged according to their suitability to meet the goals of early diagnosis, objective diagnosis, progression analysis and screening. CONCLUSIONS: The new diagnostic techniques have not yet greatly influenced our diagnostic procedure. This is mainly due to the fact that, for the most difficult borderline cases of glaucoma, these methods are of limited value, or have not yet been sufficiently investigated. Nevertheless, the Heidelberg retina tomograph (HRT), the nerve fiber analyzer GDX, short wavelength perimetry (SWAP), and the frequency doubling test (FDT) may play a role in these cases. For follow-up, HRT and GDx have proven valuable, especially in early stages of the disease. The very short testing time of FDT together with good specificity qualifies this test for glaucoma screening.     

Retinal venous pulsation in glaucoma and glaucoma suspects

PURPOSE: To determine whether changes in central retinal vein pulsation characteristics occur in glaucoma, and how these are related to indices of glaucoma severity. DESIGN: A large, consecutive, prospective, case-controlled study. PARTICIPANTS: Ninety-four consecutive glaucoma patients and 105 glaucoma suspects seen in a tertiary referral clinic were examined. Forty-one age-matched normal subjects also were examined. METHODS: The presence or absence of spontaneous venous pulsation was observed in these 3 groups. The ophthalmodynamometric force (ODF) required to induce venous pulsation at the optic disc was measured in those without spontaneous pulsation. Optic disc photographs were obtained and visual field testing was performed for all subjects. MAIN OUTCOME MEASURES: The prevalence of spontaneous venous pulsation between these 3 groups was compared. The relationship between ODF and visual field mean deviation, neuroretinal rim area, age, intraocular pressure (IOP), gender, and diagnosis of glaucoma was investigated using linear mixed models fitted by Gibb's sampling. RESULTS: Significantly fewer (chi-square, 27.7; P<0.001) glaucoma patients (54%) were observed to have spontaneous venous pulsation than suspects (75%) or normals (98%). A worse visual field mean deviation was shown to be the most significant predictor of a higher ODF (P<0.000), with younger age (P<0.000) also predictive of a higher ODF. A strong relationship between ODF and mean deviation was found in the glaucoma patients (r = 0.59; n = 52; P<0.001). CONCLUSIONS: Spontaneous venous pulsation is less common in glaucoma. The ODF required to induce venous pulsation is increased in glaucoma, and this ODF is greater in those with more severe field loss.     

免疫与青光眼

青光眼是不可逆盲的主要原因之一,是视神经的慢性退行性病变.视网膜神经节细胞（RGCs）凋亡和视神经纤维进行性丢失可导致青光眼患者视神经结构和视功能的损害.越来越多的临床和实验研究表明,免疫系统参与青光眼的神经变性过程.青光眼患者视神经变性中涉及免疫机制及免疫系统相关细胞的相互作用,包括眼免疫赦免环境的破坏、胶质细胞的异常激活、T细胞免疫的异常、Th1/Th2免疫失衡、自身抗原的产生、补体通路的激活、氧化应激反应、衰老等免疫因素及氧化应激放大的初始压力损伤,这些因素均可使青光眼视神经进一步损害.就眼的保护性免疫和免疫异常与青光眼的研究进展进行综述.     

Pregnancy and glaucoma

Glaucoma, primarily a disease of the older population, may affect women of childbearing age. Pregnancy affects the intraocular pressure (IOP) of women with pre-existing glaucoma. Both elevations and reductions of IOP have been reported during pregnancy. Additionally, visual field test results may fluctuate during pregnancy. In managing the pregnant glaucoma patient with medical therapy, one must consider not only the systemic side effects on the mother, but also any potentially harmful effects on the developing fetus. All anti-glaucoma medications are categorized as class C by the Food and Drug Administration, except brimonidine and nonspecific adrenergic agonists, which belong to class B. In general, the lowest effective dosage of medication should be used. Systemic absorption can be reduced by punctal occlusion, eyelid closure, and blotting the excess drops away during administration. In those patients who need surgery, most local anesthetics may be used safely because they have not been shown to be teratogenic in humans. Antifibrotic agents commonly used adjunctively in trabeculectomy, however, should be avoided. Glaucoma laser procedures, such as laser peripheral iridotomy and laser trabeculoplasty, have been employed without identifiable teratogenic effects or increased risk of side effects for pregnant women.     

Infections and glaucoma

Glaucoma is an intraocular pressure-related ophthalmic disease with multiple causes that results in an optic neuropathy and vision loss. Intraocular pressure elevation is among its strongest risk factors. While glaucoma is mostly primary in etiology, secondary glaucoma is not infrequent. Recognizing its cause is imperative, since treatment is often different depending on the pathophysiologic mechanism. Numerous clinically relevant ophthalmic infections can result in robust inflammatory responses that may result in pressure elevation or intraocular anatomic configurations that predispose to pressure elevation. Knowing the mechanisms by which these infections can lead to glaucoma is critical in treating, and we consolidate what is currently known in regards to how infectious diseases lead to glaucoma.     

Iridoschisis and glaucoma

Three patients with unilateral iridoschisis and glaucoma (1 with bilateral open-angle glaucoma, 1 with unilateral glaucoma) were observed for 3 to 15 years. In none of these patients did iridoschisis progress and a good control of the glaucoma was achieved. The mechanism of this rare condition is yet not clear.     

Autoimmunity and glaucoma

Elevated intraocular pressure does not explain glaucoma in all patients, but there is information that autoimmune mechanisms may be involved in this disorder. This review attempts to reveal the findings about specific changes in autoantibody profiles in glaucoma patients and their possible role in glaucoma. Considering that these changes in natural autoimmunity can be found consistently among different study populations, it might be a promising new tool for glaucoma detection.