24小时眼压测量在疑似正常眼压性青光眼患者诊断的临床应用

目的:评价24h眼压测量在正常眼压性青光眼疑似患者诊断中的意义。方法:选择正常眼压性青光眼疑似患者51人(51只眼),进行24h眼压测量。结果:进入研究的51只眼中,只有18只眼(35.3%)的眼压在正常范围内且昼夜眼压波动小于6mmHg(1mmHg=0.133kPa),33只眼(64.7%)出现昼夜眼压波动过大或峰值眼压高于21mmHg。24h眼压的昼夜波动值、均值及峰值分别比门诊多次眼压高4.65mmHg、1.64mmHg及3.96mmHg,差异均具有统计学意义(P<0.001)。结论:24h眼压测量与门诊多次眼压相比,能更好地发现高眼压和昼夜眼压波动异常。     

疑似青光眼患者24小时眼压变动规律的临床研究

目的研究疑似青光眼患者的24h眼压变动规律。方法选择疑似青光眼患者158例（316只眼）,进行24h眼压测量,测量自清晨9：00开始至第2天清晨7：00,每2h测1次眼压。结果进入研究的316只眼中,只有113只眼（35.8%）的眼压在正常范围内且昼夜眼压波动小于8mmHg（1mmHg=0.133kPa）,80只眼（26.1%）出现昼夜眼压波动过大或峰值眼压高于21mmHg,123只眼（39.1%）出现昼夜眼压波动过大且峰值眼压高于21mmHg。眼压高峰最常出现在11AM和11PM到次日5AM,眼压低谷最常见于5PM和9PM。结论24h眼压波动个体差异较大,但其仍是发现夜间异常眼压和昼夜眼压波动异常的一种好方法。     

正常眼压性青光眼的24小时眼压测量临床价值

目的 评估24h眼压测量在正常眼压性青光眼中的意义,以更好地指导临床应用.方法 于2008年1月至2011年2月正常眼压性青光眼(NTG)患者共86例(86只眼)入选本研究,应用非接触眼压计自清晨8:00开始至第二天清晨8:00,每两小时测量一次,共12次;采用A型超声波角膜测厚仪对中央角膜厚度进行测定.结果 所有86只眼的24h眼压测量值中,29只眼(33.7％)在正常范围内且昼夜眼压波动小于5 mm Hg,而57只眼(66.3％)出现异常.所有患者昼夜眼压曲线中眼压低谷值为(13.78±1.39) mm Hg眼压高峰值为(18.52±1.81) mm Hg,分别出现于18:00～20:00和夜间2:00.根据24 h最高眼压是否高于21 mm Hg分为高眼压组和低眼压组,两组年龄差异显著有统计学意义,而中央角膜厚度无明显差异.结论 24 h眼压测量应作为正常眼压性青光眼患者诊断的常规检查,能提高夜间眼压高峰及昼夜波动过大的检出率,避免漏诊误诊的发生.     

高眼压症及原发性开角型青光眼患者的24 h眼压波动规律

目的 通过24 h眼压测量来深入分析对比高眼压症与原发性开角型青光眼(POAG)患者的眼压曲线特征。方法 收集2016年1月~2019年3月在我科门诊诊断为高眼压症的患者52例(104眼)及POAG尚未接受降眼压治疗的患者38例(76眼)。入院后行24 h眼压检查,用非接触性眼压计从早9时起每隔2 h测量眼压1次,至次日7时结束。分析2组患者的平均眼压,峰值眼压及时间点,谷值眼压及时间点,昼夜眼压波动及双眼眼压压差值及其分布情况,比较2组眼压波动的异同点。结果 104眼高眼压症患者的平均眼压为(18.73±1.71)mmHg(1 mmHg=0.133 kPa),平均峰值眼压为(22.36±2.40) mmHg,平均谷值眼压为(15.63±2.09) mmHg,平均昼夜眼压波动为(6.72±2.24) mmHg。76眼POAG患者的平均眼压为(20.65±2.53) mmHg,平均峰值眼压为(25.78±2.81) mmHg,平均谷值眼压为(17.45±2.54) mmHg,平均昼夜眼压波动为(8.34±2.37) mmHg。2组的峰值及谷值眼压值分布最多的时间点均为凌晨3时及夜晚21时,大部分患者的峰值眼压时间点在门诊时间之外。高眼压症组中昼夜眼压波动位于5~8 mmHg的占比最大,为54.81%(57/104),POAG组中昼夜眼压波动>8 mmHg的占比最大,为53.95%(41/76)。高眼压症组中,16例患者经24 h眼压检查后监测到眼压波动异常,占比为30.77%(16/52);POAG组中经24 h眼压检查后有29例患者可以监测到眼压波动异常,占比为76.32%(29/38)。结论 24 h眼压监测中,POAG患者较高眼压症患者的平均眼压、峰值眼压、谷值眼压、昼夜眼压波动及双眼压差均有增加。对于24 h眼压发现眼压波动较大的高眼压症患者应在后续加强密切随访,而对于POAG患者24 h眼压监测可在治疗前提供眼压的基线水平,为后续治疗提供参考及评估依据,因此建议将24 h眼压作为高眼压症及POAG的常规检查手段。     

测量间隔时间对24 h眼压波动的影响

目的 观察青光眼和疑似青光眼患者24 h眼压波动规律及不同测量间隔时间对其的影响.方法 选择疑似及确诊青光眼患者60例(120眼),进行24 h眼压测量.所有患者上午8:00至晚上23:00,每1h测量一次眼压,晚上23:00至第2天早上7:00每2 h测量一次,共20次.结果 68眼(56.7%)眼压异常.眼压低谷出现在晚上19:00至23:00(52眼,43.3%),平均眼压为(16.17±5.56)mmHg(1 kPa=7.5 mmHg);高峰出现在上午9:00至11:00(41眼,34.2%)和第2天凌晨1:00至5:00(42眼,35.O%),平均眼压分别为(18.28±5.27)mmHg和(17.95 4±6.40)mmHg.按间隔时间1 h、2 h、3 h、4 h对测量数据统计,其阳性率分别为45.8%、35.8%、27.5%、21.7%;而阴性率分别为5.8%、16.7%、25.8%、49.4%.结论 青光眼及疑似青光眼患者的眼压高峰不但出现在上午也出现在凌晨睡眠时间.为更好地观察患者眼压的波动情况,应尽量缩短24 h眼压测量的间隔时间.     

日间与昼夜眼压曲线对异常眼压测量能力的比较

目的评价日间眼压曲线与昼夜眼压曲线对异常眼压测量的能力。方法对就诊于北京同仁眼科中心的21例原发性开角型青光眼（POAG）、11例可疑正常眼压性青光眼（SNTG）及24例可疑青光眼患者进行昼夜眼压曲线测量。间隔2 h后,先使用手持式压平眼压计测量24 h的卧位眼压得到昼夜卧位眼压曲线。在9：30、11：30、13：30、15：30,患者完成卧位眼压测量5 min后测量坐位眼压,5 min后再使用非接触眼压计测量眼压,分别得到日间卧位眼压曲线、日间坐位眼压曲线和日间非接触眼压曲线。定义眼压峰值〉21 mmHg时为峰值异常,眼压波动〉5 mmHg时为波动异常。分析日间眼压曲线与昼夜眼压曲线均值、峰值及波动值间是否存在差异。结果不同组别昼夜眼压均值为（20.24±2.45）～（22.32±6.02）mmHg,较日间眼压均值高-0.19～6.37 mmHg;昼夜眼压峰值在（24.17±3.42）～（26.43±6.23）mmHg,较日间眼压峰值高1.75～8.76 mmHg;昼夜眼压波动在（8.00±3.47）～（9.09±3.83）mmHg,较日间眼压波动高3.59～6.00 mmHg。眼压峰值多出现于夜间睡眠时,POAG、SNTG和可疑青光眼患者眼压峰值出现于23：30～5：30的概率分别为57.14%、72.73%和66.67%。日间眼压曲线无法确定昼夜眼压波动的异常,若以昼夜眼压曲线作为金标准,各组的敏感性为10.00%～36.84%。结论56例患者的峰值眼压多发生在夜间睡眠时,日间和昼夜眼压曲线测得的眼压均值、峰值、波动及发现异常眼压的能力存在差异,依靠日间眼压曲线很难对昼夜眼压的情况做出准确判断。     

正常眼压性青光眼24小时眼压波动的研究进展

正常眼压性青光眼(normal-tension glaucoma, NTG)是一种慢性进行性视神经病变, 发病时眼压在正常范围内。NTG在开角型青光眼中的占比较高。在NTG的诊断中, 24 h眼压测量尤其重要, 是与原发性开角型青光眼相鉴别的主要体征。NTG患者24 h眼压监测通常表现为夜间出现眼压峰值, 且其眼压的昼夜波动幅度往往比正常人大。且24 h眼压的平均眼压、短期和长期眼压波动幅度、最小眼压值都显示为NTG疾病进展中的预测参数。这使得NTG患者24 h眼压监测及根据其24 h眼压波动特点进行个体化治疗变得尤为重要。(国际眼科纵览, 2023, 47:24-29)     

可疑青光眼48小时眼压变动规律的临床研究

目的探讨可疑青光眼患者48 h眼压变动规律。方法选择临床上疑似青光眼患者180例(360只眼),进行48 h眼压测量。测量自入院时10AM开始至第3天清晨8AM,取偶数时间点,每2 h测量1次眼压。结果进入研究的360只眼中,130只眼(36.11%)的眼压昼夜波动小于8 mm Hg,230只眼(63.89%)出现昼夜波动过大。眼压高峰通常出现在2AM、4AM、6AM和8AM几个时间点,最少出现在6PM、8PM、10PM时间点。结论 48 h眼压的波动存在个体差异,对于可疑青光眼的临床诊断和治疗具有一定的参考价值。     

青光眼昼夜眼压波动

病理性高眼压和较大的昼夜眼压波动是青光眼视神经损害进展的重要危险因素.眼压具有波动性,正常人眼压波动的峰值多出现于凌晨,这种波动与体位、眼灌注压、眼轴等有关.正常眼压性青光眼患者眼压波动是视野进展的重要危险因素,且经24小时眼压监测发现大部分眼压是存在异常的,因此需根据其昼夜眼压曲线明确诊断和针对性治疗;原发性开角型青光眼患者昼夜眼压波动规律与正常人相似,眼压高峰多在夜间,但波动范围可能比正常人大,且双眼的波动呈明显的一致性;激光周边虹膜切开术后的慢性闭角型青光眼患者的昼夜眼压波动较大,其眼压波动与基线眼压和房角粘连程度呈正相关.与激光和药物相比,小梁切除术更有利于控制长期和昼夜的眼压波动.抗青光眼药物中前列腺素类药物是控制昼夜眼压波动效果最好的滴眼剂.     

YAG激光虹膜周切术治疗药物难控制性急性闭角型青光眼

目的:探讨YAG激光周边虹膜切除术在药物难控制急性闭角型青光眼治疗中的作用。方法:回顾分析我院住院患者共124例124眼,其中男51例,女73例,入院诊断符合急性闭角型青光眼发作期临床特征,且药物治疗24h后眼压仍>21mmHg的急性闭角型青光眼患者,其中控制眼压为21~35mmHg者51眼(41.1%),眼压36~50mmHg者37眼(29.8%),50mmHg以上者36眼(29.1%)。视力范围为光感~0.3。所有患者均在表面麻醉下行YAG激光周边虹膜切除术治疗,术后继续观察眼压、视力、前房深度变化,眼压控制稳定后分别进行小梁切除术、青光眼白内障联合人工晶状体植入术,或单纯白内障超声乳化吸出联合人工晶状体植入术。结果:患者124例124眼急性闭角性青光眼患者行YAG激光虹膜周切术后,第2d检测眼压≤21mmHg者28眼(22.6%),眼压为22~35mmHg者60眼(48.4%),眼压36~50mmHg者25眼(20.2%),眼压>50mmHg者11眼(8.9%);激光术后视力增加3行者33眼（26.6%）,2行者31眼(25.0%),视力增加1行者44眼(35.5%),视力不增加者16眼(12.9%);119眼前房深度增加(96.0%); YAG激光虹膜周切术后并发前房出血98眼(79.0%)。眼压控制稳定后分别进行小梁切除术37眼,青光眼白内障联合人工晶状体植入术43眼,白内障超声乳化吸出联合人工晶状体植入术44眼。观察随访3~9mo,眼压控制≤18mmHg者95眼,眼压≤25mmHg者24眼,眼压为26~35mmHg者5眼,未见前房积血、黄斑囊样水肿等并发症。结论:YAG激光虹膜周切术在药物难控制性急性闭角型青光眼治疗中能明显降低眼压,为各种青光眼手术的治疗提供安全可靠的条件,有助于视功能保护和恢复,提高疗效。     

疑似青光眼患者24h眼压变化规律

目的：分析疑似青光眼患者24h眼压的变化规律。

方法：收集疑似青光眼患者48例96眼,使用Accupen手持眼压计(24-3000)和NCT非接触眼压计(CT-80)测量24h眼压,自7：30开始,每2h测一次眼压,共12次,其中7：30～21：30测量坐位眼压,23：30～5：30测量坐位及卧位眼压。

结果：两种眼压计测量的传统体位下24h眼压峰值均出现在7：30,非接触眼压计测得的结果为22.05±3.608mmHg,手持式眼压计测得的结果为19.79±4.147mmHg。手持眼压计测得习惯性体位下眼内压峰值出现在5：30,平均21.64±4.814mmHg,且两种体位24h眼内压谷值均出现在21：30,谷值眼内压平均值为15.73±3.649mmHg。两种体位均呈夜间眼压逐渐升高,白天眼压逐渐下降的趋势。

结论：疑似青光眼患者眼内压峰值多出现在清晨,夜间卧位眼压值较坐位眼压值高。     

Relationship of the office intraocular pressure (IOP) to diurnal fluctuation of IOP in low-tension glaucoma: a multivariate analysis]

In 288 eyes of 114 low-tension glaucoma (LTG) patients, the mean, peak, trough and magnitude of the diurnal fluctuation of the intraocular pressure (IOP) determined over a period of 24 hours (diurnal IOP) were correlated with the IOPs recorded at the daytime office (office IOP), refraction, extent of visual field loss, age, sex, blood pressure and obesity index by the method of multivariate analysis. Only the mean office IOP was found to have a statistically significant contribution for estimating the mean, peak and trough of the diurnal IOP with the proportion (R) of 0.71 0.67 and 0.68 respectively. Furthermore, an analysis of the IOP data obtained from 118 LTG suspects using the receiver operating characteristics (ROC) curve showed that a patient whose peak diurnal IOP exceeds 21 mmHg could be detected with a sensitivity of 100% and a specificity of 46% if around-the-clock IOP measurements were carried out in patients whose mean office IOP are above 16 mmHg at least in one eye. In view of high prevalence of LTG in Japanese, estimation of mean diurnal IOP from mean office IOP and exclusion of primary open angle glaucoma using the mean office IOP of 16 mmHg as a cutoff IOP level are thought to be clinically useful.     

Ocuton-S self tonometry vs. Goldmann tonometry; a diurnal comparison study

PURPOSE: To compare 24-hour diurnal intraocular pressure (IOP) measurements obtained using the Ocuton-S applanation self tonometer and the Goldmann tonometer. METHODS: 24-hour diurnal IOP curves were obtained on 14 eyes of 7 trained patients suffering from medically controlled primary open angle glaucoma. IOP was measured every third hour starting at 9 a.m. with a calibrated Goldmann tonometer; one week later, a similar set of measurements was obtained with Ocuton-S self tonometry by the patients. One week later still, ultrasound corneal pachymetry was performed at the same hours. RESULTS: Overall IOP (24-hour mean) did not differ significantly between the different measuring techniques (ANOVA, p = 0.74), but the IOP differed in a statistically significant manner around the clock (ANOVA, p = 0.00006). The mean Goldmann tonometric readings were up to 2.8 mmHg lower than the Ocuton-S values during the daytime (9 a.m. to 9 p.m.), however, during the night (12 midnight to 6 a.m.) mean IOP measured with Goldmann tonometry was 2.2 to 3.3 mmHg higher than the corresponding average of the self tonometry readings. There was a statistically significant interaction between the type of tonometry and the time of the measurement (p = 0.0007). Central corneal thickness (CCT) showed a significant change during the 24-hour period (p = 0.000001). CONCLUSION: IOP shows a different diurnal curve when measured with the Goldmann tonometer and with the Ocuton-S applanation self tonometer. The instruments' readings might be influenced in different ways by the diurnal changes of the corneal thickness. Since Ocuton-S self tonometry underestimates the IOP in the early morning period, a careful evaluation is necessary when nocturnal and early morning IOP elevation is investigated with this technique.     

可疑青光眼患者清晨起床前后的体位变化和日常活动对眼压的影响

目的：观察可疑青光眼患者清晨起床前后的体位变化和日常活动对眼压的影响。 方法：使用Icare回弹式眼压计对51例100眼可疑青光眼患者进行清晨起床前后的卧、坐位和日常活动前后的眼压测量,对比分析卧、坐位眼压和日常活动前后的眼压测量结果。 结果：起床前卧、坐位测量的眼压均值分别为19.14±5.51和17.12±4.53mmHg,两者差别显著。清晨日常活动前后测量的眼压均值分别为17.12±4.53和14.44±3.90mmHg,两者有显著差别。 结论：起床前后的体位变化和日常活动可以导致显著的眼压变化。     

白内障小切口囊外摘除联合小梁切除治疗PACG合并白内障

目的：观察白内障小切口囊外摘除联合小梁切除术治疗原发性急性、慢性闭角型青光眼的疗效。

方法：急性闭角型青光眼合并白内障23例24眼,慢性闭角型青光眼合并白内障11例12眼,进行白内障小切口囊外摘除联合小梁切除术,均一期植入人工晶状体。

结果：术后随访1mo,急性闭角型青光眼组术前平均眼压30.68±7.60mmHg,术后17.83±5.95mmHg,差异有统计学意义(P<0.05); 慢性闭角型青光眼组术前平均眼压29.27±5.55mmHg,术后18.12±1.88mmHg,差异有统计学意义(P<0.05)。术前、术后两组间平均眼压差异无统计学意义。术后眼压控制良好者(6～21mmHg)者26眼(72%),局部使用抗青光眼药物后眼压控制良好者8眼(22%),总体有效控制率94%,眼压不能控制者(22～30mmHg)2眼(6%); 术后视力提高者32眼(89%),没有发生严重并发症。

结论：白内障小切口囊外摘除联合小梁切除术对于原发性闭角型青光眼(PACG)合并白内障的治疗可以有效控制眼压、提高视力,并发症少; 其在控制眼压方面对于原发性急/慢性闭角型青光眼无差异。     

POAG患者习惯性体位眼压及眼灌注压昼夜波动趋势的研究

目的：探讨初诊未行治疗的原发性开角型青光眼( prilary open angle glaucola,POAG)患者习惯性体位眼压及眼灌注压(ocular perfusion pressure,OPP)波动趋势,并验证由日间平均坐位及卧位眼压推导夜间峰值眼压的可行性。
　　方法：选取POAG患者19例19眼及正常对照组18例18眼,分别于10：00,14：00,18：00及22：00时行坐位眼压及血压监测,为验证由日间卧位眼压推导夜间峰值眼压的可行性,另对POAG组于卧位5 lin后再行监测。2：00,5：00及7：00行卧位监测,计算出OPP并行数据分析。由已知公式通过日间眼压计算夜间峰值眼压,并与实际值对比。
　　结果：24h习惯性体位下,POAG患者平均眼压及眼压波动均高于正常对照组(P<0.05),POAG组平均眼压峰值出现于凌晨5：00,对照组则为7：00。两组夜间眼压均值均大于日间,差异有统计学意义(P<0.05)。两组内习惯性体位平均眼灌注压( MOPP )均表现为夜间低于日间( P<0.05),而两组间 MOPP 无明显统计学差异( P>0.05)。POAG患者MOPP波动较对照组大,差异有统计学意义( P<0.05)。由两公式推导所得夜间眼压峰值均与所测值无明显统计学差异(P>0.05)。
　　结论：习惯性体位下POAG组及正常人的眼压峰值多出现在凌晨至上午,POAG患者的习惯性体位平均眼压及眼压波动均高于对照组。两组内夜间灌注压均较日间低,且POAG患者有更大的MOPP波动。由日间眼压推导夜间峰值眼压具有一定的可行性。     

Twenty-four-hour intraocular pressure pattern associated with early glaucomatous changes

PURPOSE: To characterize the 24-hour pattern of intraocular pressure (IOP) in untreated patients with newly diagnosed early glaucomatous changes. METHODS: Measurements of IOP, blood pressure, and heart rate were taken every 2 hours during a 24-hour period from a group of 24 untreated patients (ages 40-78 years) with newly diagnosed abnormal optic discs and/or abnormal visual fields. In the 16-hour diurnal awake period, IOP was measured sitting and supine, and blood pressure and heart rate were measured supine. In the 8-hour nocturnal sleep period, all measurements were taken in the supine position. Mean diurnal and nocturnal IOP, blood pressure, and heart rate in the glaucoma group were compared with data obtained from an age-matched control group of 24 individuals with healthy eyes. RESULTS: Mean diurnal IOP, either sitting or supine, was significantly higher in the glaucoma group than in the control group. For both subject groups, nocturnal supine IOP was higher than diurnal sitting IOP. However, this diurnal-to-nocturnal increase in IOP was significantly smaller in the glaucoma group. When compared with the diurnal supine IOP, the nocturnal supine IOP was lower in the glaucoma group but higher in the control group. Around normal awakening time, the supine IOP increased in the glaucoma group and did not change in the control group. There was a diurnal-to-nocturnal decrease in mean blood pressure only in the glaucoma group. CONCLUSIONS: Compared with healthy eyes, the diurnal IOP is higher, the diurnal-to-nocturnal change of habitual IOP is less, and the posture-independent IOP pattern around normal awakening time is different in eyes with early glaucomatous changes.