非穿透小梁切除术治疗开角型青光眼

目的：观察非穿透小梁切除术治疗开角型青光眼的疗效。方法：对40例（45眼）开角型青光眼施行非穿透性小梁切除术，术中应用丝裂霉素防止瘢痕形成，并对手术前后视力，眼压及手术并发症进行观察。结果：45眼术后眼压均得到控制。手术前后眼压对比有非常显著性差异（P＜0．01）。术后6个月，有5眼眼压升高，加用一种抗青光眼药物治疗后眼压即恢复正常。与术前需用1－3种降眼压药物相比，有非常显著性差异（P＜0．01）。视力同术前或有提高，患者术后均无明显的前房炎症反应，浅前房以及脉络膜脱等并发症，结论：非穿透小梁切除术是治疗开角型青光眼的有效方法，其最大特点是手术不穿透前房，术后视力迅速恢复，手术并发症极少。     

高眼压持续状态急性闭角型青光眼手术治疗分析

目的观察改良小梁切除术治疗高眼压持续状态急性闭角型青光眼的疗效及安全性。方法对药物无法控制眼压的52例(56眼)急性原发性闭角型青光眼患者,均行改良小梁切除术治疗,比较手术前后患者视力、眼压等变化,观察术后并发症,随访评估疗效及安全性。结果本组手术均顺利完成,术后房角均较术前增宽视野范围扩大;术后视力提高36眼,视力未改变18眼,视力下降2眼;术后眼压在正常范围50眼,6眼需局部降眼压治疗;术中无严重并发症发生。结论小梁切除术是治疗持续高眼压状态急性闭角型青光眼的一种安全、有效的方法。     

原发性闭角型青光眼合并白内障31例分析

目的：白内障超声乳化人工晶体植入联合小梁切除术治疗原发性闭角型青光眼合并白内障的疗效。方法：对31例原发性闭角型青光眼合并白内障患者行白内障超声乳化人工晶体植入联合小梁切除术,术后随访6个月。结果：术后视力较术前视力明显提高,术后眼压较术前眼压有统计学差异,术后闭角型青光眼患者巩膜突可见不同程度的增宽〉180°范围,术后5眼周边前房深度〉1CT,17眼周边前房深度1～1／2CT,18眼1／z～1／3CT,1眼1／3～1／4CT。结论：白内障超声乳化人工晶体植入联合小梁切除术治疗原发性闭角型青光眼合并白内障可有效控制眼压,迅速恢复和改善视力,减少手术并发症,是一种良好的手术方法。     

前房穿刺与调节缝线联合丝裂霉素在青光眼小梁切除术中的应用

目的 探讨前房穿刺与调节缝线在青光眼小梁切除术中的应用及疗效。方法采用前房穿刺与调节缝线小梁切除术对26例急性闭角型青光眼、18例慢性闭角型青光眼、6例开角型青光眼、7例难治性青光眼共57例77眼进行了6个月至18个月的随访观察。结果术后视力较术前提高1～2行者4眼，术后视力不变67眼，下降1～2行6眼；出院时眼压平均在12．26mmHg左右，两周平均眼压为13．26mmHg左右，6～18个月眼压平均为15．69mmHg左右。无一例术后出现持续性浅前房。结论前房穿刺与调节缝线联合丝裂霉素行小梁切除术能有效地降低眼压，控制术后浅前房，提高了手术成功率，是一种安全有效的青光眼滤过手术方法。     

非穿透性小梁切除手术的临床研究及护理

目的 分析非穿透性小梁切除术（NPT）对开角型青光眼的手术效果、手术并发症及护理特点。方法 开角型青光眼患76例（82眼）,分为实验组和对照组,均为38例（41只眼）。实验组患行非穿透性小梁切除手术,对照组行传统的小梁切除术。术后观察丁达尔征、视力、结膜滤泡、并发症发生率,并随访3－12月术后平均眼压。结果 实验组比对照组术后降眼压幅度降低14．9％;术后并发症下降8．3％。结论 NPT是一种治疗开角型青光眼较有效 的滤过性手术,且并发症少,可获得较稳定的眼压,远期疗效显。加强非穿透性切除术治疗开角型青光眼患的心理护理和疾病宣教,帮助患培养良好的生活习惯,有助于患达到最佳康复状态。     

复合式小梁切除术治疗闭角型青光眼50例分析

目的:探讨复合式小梁切除术治疗闭角型青光眼的疗效。方法:采用复合式小梁切除术对50例(55眼)闭角型青光眼进行治疗。结果:术后第1天前房全部形成。术后5眼发生浅前房,术眼经加压包扎,散瞳处理后前房恢复正常。术后视力提高者12眼,保持不变者38眼。出院时,55眼眼压均控制在正常范围。术后随访1个月,仍在正常范围。结论:复合式小梁切除术治疗闭角型青光眼疗效满意。     

非穿透小梁切除术联合白内障超声乳化吸除术治疗青光眼合并白内障的临床研究

目的评价非穿透小梁切除术联合超声乳化吸除术治疗青光眼合并白内障的手术疗效。方法对18例(24眼)青光眼合并白内障的患者采用经上方巩膜瓣下非穿透小梁切除结合白内障超声乳化吸除人工晶体一期植入术治疗,观察眼压、视力、滤过泡状态及并发症。随机选用同时期小梁切除术联合白内障超声乳化吸除人工晶体一期植入术患者29例(29眼)做对照。术后随访6个月,观察平均眼压、手术并发症、术后视力、滤过泡形成情况。结果术后观察组平均眼压、手术并发症明显低于对照组,术后视力、滤过泡形成情况同对照组相比无统计学差异。结论非穿透小梁切除术联合超声乳化吸除术治疗青光眼合并白内障疗效满意,手术后反应轻,是较为理想的治疗青光眼合并白内障的术式。     

非传统性小梁切除术治疗开角型青光眼的护理

小梁切除术是治疗青光眼，特别是开角型青光眼的经典手术，但可出现前房出血、前房炎症反应、术后浅前房、脉络膜脱离、滤过过强型低眼压、低眼压黄斑病变及眼内炎等并发症，且有部分因滤过泡瘢痕化而导致手术失败。为减少上述并发症及术后滤过泡瘢痕，2000年4月始，我院采用非传统性小梁切除＋羊膜植入治疗开角型青光眼31例（42眼），减少了手术并发症及滤过泡瘢痕的发生，本文就护理特点做一些介绍。     

超声乳化人工晶状体植入联合青光眼小梁切除的临床观察

目的探讨闭角型青光眼合并白内障行超声乳化人工晶状体植入联合小梁切除术的临床效果。方法对62例闭角型青光眼合并白内障行白内障超声乳化人工晶状体植入联合小梁切除术,观察术后视力、眼压、眼底改变。随访时间为术后12月。结果术后视力、眼压、房角均较术前改善。并发症包括:术后一过性浅前房、角膜水肿、后发障。结论白内障超声乳化人工晶状体植入联合小梁切除术是治疗闭角型青光眼合并白内障的有效方法。     

急性闭角型青光眼行小梁切除术53例围术期护理

目的:探讨小梁切除术治疗急性闭角型青光眼围术期的护理方法.方法:对53例(57眼)急性闭角型青光眼患者实施穿透性小梁切除术,围术期及出院时给予患者整体护理和临床指导,观察术后眼压、视力、滤过泡形态、并发症的发生情况,并及时处理,随诊1个月.结果:术前所有患者药物治疗眼压降至正常值或联合3～4类降眼压药物治疗72～96 h,术中配合严密,术后并发症少.随访期间观察眼压均在正常值范围,22例(23眼)国际标准对数视力表检查视力较术后1周提高2～3行.结论:小梁切除术治疗急性闭角型青光眼效果较好,加强围术期管理,优化术前、术中、术后护理流程,可为手术成功提供必要保障.     

非穿透性小梁显微手术的远期疗效观察

目的探讨非穿透性小梁显微手术治疗青光眼的远期疗效。方法对原发性开角型青光眼患者共46例（46眼），随机选择施行非穿透性小梁手术（A组22例，22眼）或穿透性小梁手术（B组24例，24眼），比较两组患者术后的眼压、滤过泡和视野等情况。结果①术后观察近50个月，A组眼压有较明显升高的趋势，眼压控制完全成功仅为5眼（22．73％），失败7眼（31．82％）；B组完全成功11眼（45．83％），失败4眼（16．67％），但两组的差异无统计学意义（P〉0．05）；②术后所有B组患者均形成明显的功能性滤过泡；A组患者只有15眼（68．18％）形成明显滤过泡，3眼（13．64％）仅见滤床轻度隆起；随着时间的推移，两组患者滤过泡消失的例数显示出明显差异（P〈0．05）；③术后50个月的视野改变情况，A组视野缩小者例数为9眼（40．90％），B组为4眼（16．67％），但差异无统计学意义（P=0．068〉0．05）。结论施行非穿透性小梁手术的部分病例远期疗效欠佳，须谨慎选择适应患者，以提高手术成功率。     

Biomarkers in primary open angle glaucoma

Abstract Glaucoma, a leading cause of blindness worldwide, is currently defined as a disturbance of the structural or functional integrity of the optic nerve that causes characteristic atrophic changes in the optic nerve, which may lead to specific visual field defects over time. This disturbance usually can be arrested or diminished by adequate lowering of intraocular pressure (IOP). Glaucoma can be divided roughly into two main categories, 'open angle' and 'closed angle' glaucoma. Open angle, chronic glaucoma tends to progress at a slower rate and patients may not notice loss of vision until the disease has progressed significantly. Primary open angle glaucoma (POAG) is described distinctly as a multifactorial optic neuropathy that is chronic and progressive with a characteristic acquired loss of optic nerve fibers. Such loss develops in the presence of open anterior chamber angles, characteristic visual field abnormalities, and IOP that is too high for the healthy eye. It manifests by cupping and atrophy of the optic disc, in the absence of other known causes of glaucomatous disease. Several biological markers have been implicated with the disease. The purpose of this study was to summarize the current knowledge regarding the non-genetic molecular markers which have been predicted to have an association with POAG but have not yet been validated.     

Effects of travoprost 0.004% ophthalmic solution, six weeks after its laminated packaging had been removed, in primary open-angle glaucoma: a randomized, controlled, investigator-blinded study

BACKGROUND: Primary open-angle glaucoma (POAG) is a chronic and progressive optic nerve and retinal nerve fiber layer neuropathy, with characteristic visual field damage. The intraocular pressure (IOP) is typically higher than the level considered statistically normal. Although there is no known cure, appropriate reduction of IOP with hypotensive drugs (eg, the topical prostaglandin analogue travoprost) delays the progression of POAG. Chemical-stability studies of travoprost performed by the manufacturer suggest that the stability of travoprost is maintained beyond the expiration date, which is 6 weeks after the laminated packaging has been opened. OBJECTIVE: The goal of this study was to assess the efficacy and tolerability of travoprost 0.004% ophthalmic solution, 6 to 12 weeks after its expiration date, in patients with POAG. METHODS: This randomized, controlled, investigator-blinded study was conducted at 2 centers in Brazil: the Ophthalmology Department, Federal University of Goiás, Goiania, and the Ophthalmology Department, Santa Casa de Misericordia Hospital in S?o José do Rio Preto, Sao Paulo. Patients with POAG (in 1 or both eyes) were randomly assigned to receive travoprost, either from a bottle from which the laminated packaging had been removed and that had been stored at room light and temperature for 6 weeks (ie, after the expiration date; opened group), or from a bottle that had been sealed until first use by the patient (control group). Drug was to be administered, 1 drop in the lower conjunctival sac (in the affected eye[s]), QD between 7 pm and 9 pm, for 6 weeks. IOP was measured at study weeks 0 (baseline), 4, and 6. The 2 treatment groups were compared with regard to hypotensor effect and incidence of adverse events (AEs). RESULTS:: Thirty-one patients completed the study (55 eyes; 28 right and 27 left eyes; 35 eyes of women, 20 eyes of men). The mean (SD) ages of the opened and control groups were 61.8 (13.5) and 62.8 (14.1) years, respectively. Twenty-four patients were included in both treatment groups (ie, 1 eye per group). The baseline IOP was similar between the 2 treatment groups. There was a significant reduction in IOP in both groups at 4 and 6 weeks (both, P < 0.001 vs baseline). However, no significant differences in IOP were found between the 2 treatment groups at any time during the study. Conjunctive hyperemia and a burning sensation in the eye immediately after application were the only AEs reported; the incidence of these was similar between the 2 treatment groups. CONCLUSIONS: In this study of patients with POAG, IOPs and AEs were similar in eyes receiving 6 weeks of treatment with travoprost 0.004% ophthalmic solution, either from bottles from which the laminated packaging had been opened and that had been stored at room light and temperature for 6 weeks (ie, after the expiration date), or from bottles that had been sealed until first use by the patient. These results suggest that travoprost remains effective for at least 12 weeks after the laminated packaging has been opened.     

超声乳化白内障吸出术和小切口非超声乳化囊外摘除术治疗高龄白内障的临床疗效观察

目的观察超声乳化白内障吸出术和小切口非超声乳化囊外摘除术治疗高龄白内障的临床疗效。方法选择114例高龄白内障患者,随机平均分为两组,A组(57例)采用超声乳化白内障吸出术,B组(57例)采用小切口非超声乳化囊外摘除术,对比术后视力、术后散光度数,同时观察术后并发症发生情况。结果 B组术后3 d的视力显著高于A组(P0.05);A组患者术后1个月及3个月视力均高于B组,但差异无统计学意义(P0.05)。两组患者术后1个月及3个月的散光度数对比差异无统计学意义(P0.05),两组患者术后1个月散光度数均显著高于术前(P0.05)。核硬度≤Ⅲ级时,两组患者术后并发症发生率对比差异无统计学意义(P0.05);核硬度≥Ⅳ级时,B组患者术后并发症发生率显著低于A组(P0.05)。结论超声乳化白内障吸出术和小切口非超声乳化囊外摘除术在治疗高龄白内障方面临床疗效确切,但核硬度≥Ⅳ级时,采用小切口非超声乳化囊外摘除术有助于术后视力恢复,并发症较少,值得临床推广应用。     

Acute and chronic effects of brimonidine 0.2% on intraocular pressure and pulsatile ocular blood flow in patients with primary open-angle glaucoma: an open-label, uncontrolled, prospective study

BACKGROUND: Brimonidine has been reported to decrease aqueous production and increase uveoscleral outflow; however, the hemodynamic effects of brimonidine are still under investigation. OBJECTIVE: The purpose of this study was to report the acute and chronic effects of brimonidine 0.2% on intraocular pressure (IOP) and pulsatile ocular blood flow (pOBF) in patients with primary open-angle glaucoma (POAG). METHODS: Nonsmoking patients aged 45 to 67 years with POAG and normal blood pressure, heart rate, body mass index, and hemorheologic parameters were enrolled in the study. Brimonidine 0.2% was self-administered twice daily for 180 days. IOP and pOBF were determined using Goldmann applanation tonometry and the Langham system. All measurements were taken at baseline and 4, 8, and 12 hours after treatment and were repeated on days 7, 15, 30, 60, 90, 120, 150, and 180 of treatment. RESULTS: Of the 18 eligible patients, 10 (6 men and 4 women) were enrolled (mean age, 51.5 +/- 4.39; range, 47-64 years). When measured 12 hours after instillation, mean IOP was significantly reduced by 21.5% (P < 0.001) compared with the baseline value. The greatest decrease in IOP (-23.5%) was observed at 8 hours. After 12 hours, a significant increase (P < 0.001) in pOBF was measured. A stable IOP reduction (P < 0.001 vs baseline), as well as an increase in pOBF (P = 0.015), was recorded at the subsequent time points. The pOBF increases ranged from 22.5% at day 30 to 9.2% at day 180 of treatment. No evidence of adverse events was found at any time point. CONCLUSIONS: In this sample of patients with open-angle glaucoma, brimonidine induced a rapid reduction in IOP that was significant even after 6 months. Moreover, an increase in pOBF was observed from the first day of treatment, and remained consistent throughout the study.     

内镜下激光睫状体光凝术治疗白内障合并青光眼患者的护理

目的探讨内镜下激光睫状体光凝术(endoscopic cyclophotocoagulation,ECP)治疗白内障合并难治性青光眼患者的护理方法。方法回顾性分析2011年12月至2012年2月在中国医科大学眼科医院治疗的白内障合并难治性青光眼患者24例(共24只眼)的临床资料。所有患者均行白内障超声乳化摘除及折叠人工晶状体植入术联合内镜下激光睫状体光凝术。结果患者术后眼压较术前明显下降,主要并发症是前房炎症反应,给予局部及全身抗炎对症治疗,炎症在10～15d消退。结论 ECP在治疗白内障合并难治性青光眼方面可以获得满意的疗效。     

Criteria for choosing clinically effective glaucoma treatment: A discussion panel consensus

Abstract

Background:

In the clinical management of patients at risk for or diagnosed with primary open-angle glaucoma (POAG), the aim of medical treatment is to reduce intraocular pressure (IOP) and then maintain it over time at a level that preserves both the structure and function of the optic nerve.

Objective:

The objective of this report was to establish a consensus on the criteria that should be used to determine the characteristics of IOP-lowering medication.

Methods:

Discussion was held among a panel of 12 physicians considered to be experts in glaucoma to develop a consensus on the criteria used by them to determine the characteristics of the IOP-lowering medication chosen for initial monotherapy and adjunctive treatment of ocular hypertension (OHT) or POAG. Consensus development combined available evidence and the impressions of these physicians regarding the clinical effectiveness of IOP-lowering medication for OHT and POAG. Once the panel identified the criteria, the order of priority and the relative importance of these criteria were then established in the setting of 3 risk categories (low, medium, and high) for a patient to experience significant visual disability from glaucoma over their expected life span.

Results:

The panel identified 5 criteria to determine the characteristics of IOP-lowering medication for OHT and POAG: IOP-lowering effect, systemic adverse events (AEs), ocular tolerability, compliance/administration, and cost of treatment. IOP-lowering effect was consistently ranked as the highest priority and cost as the lowest. The priority of compliance/administration did not vary by clinical situation. Systemic AEs and ocular tolerability were ranked as higher priorities in initial monotherapy than in adjunctive treatment and ranked lower as the risk for visual disability increased. The priority given to the criteria used to determine clinical effectiveness varied both with the risk for functional vision loss from glaucoma and whether initial monotherapy or adjunctive treatment was being considered.

Conclusion:

Glaucoma treatment should be assessed with regard to the need not only to lower IOP but also to minimize systemic and ocular AEs, promote patient compliance, and minimize cost. The order of priority and relative importance given to these treatment criteria will vary as part of individualizing patient care.Key Words: consensus, criteria, intraocular pressure, glaucoma     

Gold standard medical therapy for glaucoma: defining the criteria identifying measures for an evidence-based analysis

BACKGROUND: Over the past decade, several new medical therapies have become available for the treatment of primary open-angle glaucoma (POAG). A systematic evidence-based approach for identifying an optimal therapeutic agent is lacking. OBJECTIVES: The aims of this review were to critically evaluate published treatment recommendations for POAG and, based on a systematic review of the literature, to develop criteria that would define a "gold standard" medical therapy that reflects new treatment advances and established therapeutic goals. METHODS: A MEDLINE search spanning the years 1966 to 2002 and using the search terms gold standard, drug of choice, agent of choice, benchmark, ophthalmology, eye, and glaucoma was conducted and the results reviewed by a panel of 15 experts in the field of glaucoma. Published treatment recommendations for POAG were discussed. Criteria, anchored to medical evidence, for distinguishing a standard of medical therapy for POAG were defined. RESULTS: The terms connoting a gold standard therapy were found in only 258 of approximately 368,000 ophthalmology-related citations and 53 of almost 23,000 glaucoma citations, validating the need to define therapeutic standards. The lack of recommendations for the use of new classes of ocular hypotensive agents was acknowledged. Criteria identified to evaluate intraocular pressure (IOP)-lowering agents as gold standards included the following: efficacy in reducing IOP consistently over a 24-hour period to a level that will preserve the visual field and protect the optic nerve without inducing tachyphylaxis and tolerance, paucity of local and systemic adverse effects, promotion of patient compliance, and applicability in diverse patient populations. CONCLUSIONS: These criteria should be employed as measures for evidence-based analyses to evaluate available and future IOP-lowering medical therapies for POAG. The conceptual framework presented may be applicable to other therapeutic areas.     

Reduction of ER stress via a chemical chaperone prevents disease phenotypes in a mouse model of primary open angle glaucoma

Mutations in myocilin (MYOC) are the most common genetic cause of primary open angle glaucoma (POAG), but the mechanisms underlying MYOC-associated glaucoma are not fully understood. Here, we report the development of a transgenic mouse model of POAG caused by the Y437H MYOC mutation; the mice are referred to herein as Tg-MYOC(Y437H) mice. Analysis of adult Tg-MYOC(Y437H) mice, which we showed express human MYOC containing the Y437H mutation within relevant eye tissues, revealed that they display glaucoma phenotypes (i.e., elevated intraocular pressure [IOP], retinal ganglion cell death, and axonal degeneration) closely resembling those seen in patients with POAG caused by the Y437H MYOC mutation. Mutant myocilin was not secreted into the aqueous humor but accumulated in the ER of the trabecular meshwork (TM), thereby inducing ER stress in the TM of Tg-MYOC(Y437H) mice. Furthermore, chronic and persistent ER stress was found to be associated with TM cell death and elevation of IOP in Tg-MYOC(Y437H) mice. Reduction of ER stress with a chemical chaperone, phenylbutyric acid (PBA), prevented glaucoma phenotypes in Tg-MYOC(Y437H) mice by promoting the secretion of mutant myocilin in the aqueous humor and by decreasing intracellular accumulation of myocilin in the ER, thus preventing TM cell death. These results demonstrate that ER stress is linked to the pathogenesis of POAG and may be a target for treatment in human patients.     

青光眼滤过术后硬核性白内障手术的改良研究

目的观察青光眼滤过术后硬核性白内障改良手术方式的临床效果。方法对青光眼小梁切除术后半年以上的硬核性白内障患者共82例（114眼）行颞侧角膜缘反眉弓板层巩膜隧道切口,开罐式破囊,水分离,用注水晶状体圈匙缓慢娩出晶体核,对有虹膜后粘连者进行分离,对瞳孔变形和散大者用0／10线进行瞳孔缝合成形。术中不做直肌牵引缝线和烧灼止血,避开滤过泡,整个手术过程均在密闭状态下完成。术后随访6～12个月,观察术后视力、眼压、滤过泡和并发症等。结果①110眼术后视力均有不同程度的提高,视力≥0．6者34眼（占29．82％）;0．4～0．6者47眼（占41．23％）;0．2．0．4者27眼（占23．68％）;≤0．2者6眼（占5．26％）;②术眼滤过泡保存完好,未出现滤过泡破损及粘连等情况;③术后瞳孔成形效果好,41眼的瞳孔上移、散大和变形得到改善;④术后眼压保持稳定,所有患者眼压均在8～20mmHg（平均为15．15±2．78mmHg）范围内,与术前眼压（平均15．23±2．87mmHg）比较,差异无统计学意义（t=0．21,P〉0．05）;⑤术后有38眼出现不同程度的角膜水肿,3眼出现较为严重的葡萄膜炎性反应,经治疗后均逐渐消退。结论采用本法改良的术式对青光眼滤过术后硬核性白内障施行摘除手术的疗效较好且操作简单、便于推广。