EFFECTS OF OPIATES AND OPIOIDS ON INTRAOCULAR PRESSURE OF RABBITS AND HUMANS

Acute intraocular injection of morphine or D-Ala-met-enkephalinamide (D-Ala-E) in rabbits caused a sustained decrease in intraocular pressure. Conjunctival instillation of naloxone solution prevented the lowering effect of morphine or D-Ala-E on intraocular pressure. Aqueous outflow facility appeared to be significantly higher in patients addicted to morphine or heroin than in healthy volunteers. Intraocular pressure was significantly lower in addicted patients than in control subjects. Conjunctival instillation of naloxone solution decreased aqueous outflow facility and increased intraocular pressure in addicted patients. Patients with chronic open angle glaucoma showed a significant decrease in intraocular pressure after conjunctival instillation of morphine solution. It is concluded that intraocular opiate receptors are involved in the regulation of intraocular pressure in animals and humans.     

分级眼压管理在原发性闭角型青光眼术后眼压管理中的效果

目的　探讨分级眼压管理在原发性闭角型青光眼（PACG）术后眼压管理中的效果。方法　研究类型为前瞻性对照研究，将济南市第二人民医院2020年1月至2021年10月手术治疗PACG患者96例，按随机数字表法分为对照组与研究组，每组48例。对照组男19例、女29例，年龄（58.95±7.54）岁；研究组男22例、女26例，年龄（59.40±7.82）岁。对照组实施常规眼压管理；研究组在非药物控制眼压策略基础上实施分级眼压管理，设定眼压管理目标为与出院前基线值比较上升幅度<20.0%或眼压绝对值<18 mmHg（1 mmHg=0.133 kPa），且未出现视野缺损进展；通过随访确定其眼压变化及视野缺损进展，经药物实现分级眼压管理目标。对比两组患者基线及术后1个月、3个月、6个月眼压、视力及视野缺损程度，分析眼压、视力及视野缺损程度是否受到管理方式的影响。计量资料采用独立样本t检验或重复测量方差分析，计数资料采用χ²检验。结果　研究组术后6个月眼压、视野缺损程度分别为（15.04±2.97）mmHg、（-4.32±0.66）dB，均低于对照组的（16.48±3.39）mmHg、（-4.69±0.72）dB，差异均有统计学意义（t=2.214、2.625，P=0.029、0.010）。研究组术后6个月视力为（0.59±0.14），高于对照组的（0.51±0.16），差异有统计学意义（t=2.607，P=0.011）。结论　分级眼压管理可有效降低PACG患者术后眼压水平，减轻视力下降与视野缺损程度。     

超声乳化治疗合并自内障的闭角型青光眼临床观察

目的观察超声乳化白内障吸除人工晶体植入术治疗合并白内障的闭角型青光眼的疗效。方法对本院2009年1月一2011年1月收治的急慢性闭角型青光眼合并白内障的患者36例（40眼）行超声乳化白内障吸除人工晶体植入术,观察手术前后眼压、视力及房角变化。随访6个月～2年。结果术后眼压[（12．62±4．23）mmHg]比术前药物控制眼压[（24．83±8．62）mmHg]明显降低,差异有统计学意义（P〈0．01）。前房深度增加,房角加宽。视力均有不同程度提高。结论超声乳化白内障吸除人工晶体植人术可有效降低眼压。可作为合并有白内障的闭角型青光眼的有效选择手段之一,具有降压、增视双重作用。     

Latanoprost: new preparation. Antiglaucoma eye drops that can change the colour of the iris

(1) Latanoprost, a prostaglandin F2 alpha analogue, is an antiglaucoma drug. (2) The clinical file is fairly thorough. (3) Dose-finding studies show that the optimal daily dose is a single drop of 0.005% solution, preferably in the evening. Two drops a day are less effective than one drop a day. (4) The local hypotensive action of latanoprost persists in the long term (current follow-up one year). (5) Four double-blind trials have compared 0.005% latanoprost eye drops and 0.5% timolol eye drops. In three trials the effect of latanoprost on intraocular pressure was statistically stronger than that of timolol. However, the difference in mean intraocular pressure was less than 2 mm Hg between the two treatments, and the clinical relevance of such a difference is not known. (6) Latanoprost has not been compared with the other available antiglaucoma eye drops. (7) Various trials have shown that intraocular pressure is statistically lower when latanoprost is combined with another antiglaucoma eye drop preparation (timolol, pilocarpine or dipivefrine) than during monotherapy. The additive action of latanoprost eye drops when combined with oral acetazolamide has been established more soundly in a comparative double-blind trial. (8) In approximately 30% of cases (especially patients with non homogeneous eye colour), latanoprost eye drops can cause permanent darkening of the iris. Patients must be warned of this risk before beginning treatment.     

Ex-PRESS青光眼引流钉植入对原发性开角型青光眼患者眼压的影响

目的 分析Ex-PRESS青光眼引流钉植入对原发性开角型青光眼患者眼压的影响.方法 选取2014年2月至2015年10月本院收治的70例(98眼)原发性开角型青光眼患者,将所有患者随机分为两组,各35例(49眼).对照组采用传统小梁切除术,观察组则采用Ex-PRESS青光眼引流钉植入术,对比两组手术成功率、手术前后眼压变化及术后并发症发生率.结果 观察组患者手术成功率为83.67％,明显高于对照组的65.31％,差异有统计学意义(P＜0.05);术前两组眼压变化比较差异无统计学意义(P＞0.05),术后1周、1个月、3个月,对照组患者眼压值均高于观察组,差异均有统计学意义(均P＜ 0.05);观察组术后并发症发生率为8.16％,低于对照组的22.45％,差异有统计学意义(P＜0.05).结论 Ex-PRESS青光眼引流钉植入可有效控制原发性开角型青光眼患者的眼压,手术成功率及安全性均较高,并发症少,在临床应用中值得推广.     

不同时机采用糖皮质激素治疗流行性角结膜炎的临床效果

目的分析不同时期应用糖皮质激素对流行性角膜炎进行治疗的临床效果。方法120例流行性角膜炎患者,随机分为A组、B组、C组,每组40例。A组患者治疗初期应用糖皮质激素;B组患者出现伪膜、角膜上皮点状浸润时应用糖皮质激素;C组患者角膜表层炎症消失,上皮下出现灰白色圆形浸润时应用糖皮质激素。比较三组患者遗留病灶率及治疗前、治疗3个月后的眼压水平。结果A组患者遗留病灶率为0,明显低于B组的20.00%和C组的42.50%,差异有统计学意义(P<0.05)。治疗3个月后,B组、C组患者眼压水平高于本组治疗前,差异具有统计学意义(P<0.05);A组患者眼压水平于本组治疗前比较差异无统计学意义(P>0.05)。治疗3个月后,A组患者的眼压水平为(15.04±3.32)mm Hg(1 mm Hg=0.133 kPa),低于B组的(16.78±1.62)mm Hg和C组的(16.97±1.34)mm Hg,差异有统计学意义(P<0.05)。结论流行性角膜炎患者要尽早应用糖皮质激素进行治疗,可以有效提升治疗效果,降低患者的眼压,值得临床推广应用。     

高眼压状态下复合式小梁切除术临床观察

目的探讨在高眼压状态下青光眼手术的必要性、可行性及治疗效果。方法60例（65眼）术前眼压控制不佳的青光眼患者在显微镜下施行了复合式小梁切除术,术中采用前房穿刺的方法缓慢降低眼压,并联合应用抗代谢药物丝裂霉素。结果术后随访6～15个月,术后视力有不同程度提高43眼,视力不变19眼,视力下降3眼。眼压稳定60眼,辅助用药后控制5眼;功能性滤泡占84．6％（55／65）,无严重并发症发生。结论对部分眼压控制不佳的青光眼患者应及时实施手术,只要手术前后处理得当,可以取得满意疗效。     

不同手术方式治疗青光眼合并白内障患者的疗效比较

目的 对比分析不同手术方式治疗青光眼合并白内障患者的疗效。方法 回顾性分析60例(65眼)青光眼合并白内障且分别行单切口(白内障小切口摘除+人工晶体植入+小梁切除术)和双切口(白内障超声乳化吸出+人工晶体植入+小梁切除术)治疗的患者临床资料,比较两种手术方式对患者术后的眼压、视力和并发症的影响。结果 所有患者术后眼压较术前明显降低(P<0.05),视力明显改善(P<0.05);两种手术方式对视力、眼压的影响差异无统计学意义(P>0.05),单切口组术后前房炎性反应高于双切口组。结论 单切口与双切口两种手术方式均能良好的控制眼压和改善视力,对患者术后的视力和眼压没有影响,但双切口术后并发症较单切口少。     

改良青光眼合并白内障的联合术式临床分析

目的探讨改良白内障超声乳化人工晶体植入联合隧道内小梁切除术、手法小切口白内障摘除人工晶体植入联合隧道内小梁切除术,治疗原发性闭角型青光眼合并白内障的两种术式效果。方法原发性闭角型青光眼合并白内障共62例,分为甲乙两组。甲组37例,采用手法小切口白内障摘除后房型人工晶体植入联合隧道内小梁切除术。乙组25例,采用白内障超声乳化后房型人工晶体植入联合隧道内小梁切除术。两种术式均不做巩膜瓣及虹膜周切孔。结果术后随访12个月,视力(0.3占72.95%,眼压62只眼(18.2±1.76mmHg。结论两种术式在术后眼压控制、视力改善、并发症方面均无明显差异。     

青光眼引流阀植入术后白内障的治疗

目的探讨青光眼引流阀植入术后白内障的治疗。方法对7例7眼青光眼引流阀植入术后白内障需手术治疗的患者,根据眼压、前节OCT等情况分别采用白内障囊外摘除（ECCE）、白内障超声乳化（Phaco）、联合或不联合前段玻璃体切除,结合视功能情况植入或不植入人工晶体（IOL）,部分患者行房角分离术。结果术后患者眼压均得以控制,视力提高4眼,不变3眼。结论对青光眼引流阀植入术后白内障需手术治疗的患者,根据眼压、前节OCT等情况作相应处理,术后患者眼压仍可控制,部分患者视力可改善。     

超声乳化手术治疗高龄青光眼合并白内障患者的有效性与安全性分析

目的 探讨超声乳化手术治疗高龄青光眼合并白内障患者时对于角膜内皮细胞和眼内压的影响.方法 选取海南医学院附属医院自2013年8月至2014年8月间收治的高龄青光眼合并白内障患者70例(患眼70只)作为研究对象,所有患者均行超声乳化手术进行治疗,观察治疗前后患者的眼内压、角膜内皮细胞的完整性、并发症发生等情况,分析并发症发生的原因.结果 手术治疗后30 d内,患者的眼内压与术前比较差异有统计学意义(P<0.05),30 d后差异不具有统计学意义(P>0.05);细胞密度(CD)指标在术后持续降低(P<0.05),细胞体积(AVE)和内皮细胞变异系数(CV)两项指标持续升高(P<0.05),角膜中央平均厚度(CCT)指标术后30 d与术前比较差异不具有统计学意义(P>0.05).出现并发症15例,均为术后角膜水肿,并发症发生率为21.43%,影响因素为晶体核硬度、眼部手术史、基础性疾病等.结论 使用超声乳化术治疗高龄青光眼合并白内障患者在短期内会影响患者的眼内压和角膜细胞的密度等,长远期来看影响较小.     

Estimation of intraocular pressure in rabbits using noncontact tonometer: a comparative evaluation with Schiotz tonometer

Estimation of intraocular pressure in rabbits is often done by indentation tonometry using Schiotz tonometer. The use of Schiotz tonometer for estimation of intraocular pressure requires the use of topical anesthesia, poses risk of infection and injury to cornea and puts the animal under stress. Therefore, in this study noncontact tonometer was used to estimate intraocular pressure in rabbits and the technique is described for the first time. Twenty-five rabbits were subjected to intraocular pressure estimation using Schiotz as well as noncontact tonometer by two independent observers. All intraobserver and interobserver differences were within two standard deviation from the mean, indicating good repeatability and reproducibility of the two methods. A good linear correlation was observed between measurements done by Schiotz and noncontact tonometers with the correlation coefficient (r(2)) of 0.9122 and regression equation y = 1.632x + 4.8684. No significant difference was observed in percent change in intraocular pressure in timolol-treated, water-loaded rabbits using noncontact tonometer and Schiotz tonometer. Noncontact tonometer provides an easy, quick and safe method for intraocular pressure estimation, which is comparable to the conventional method of Schiotz tonometry. Therefore, despite the cost, noncontact tonometry seems to have a greater scope in experimental studies.     

Medical backgrounders: glaucoma

Glaucoma is a leading cause of irreversible blindness in the world. Currently, glaucoma is diagnosed as a progressive optic neuropathy with characteristic optic disc and nerve fiber layer damage, usually associated with loss of visual function. The intraocular pressure (IOP) is the most important risk factor for the disease, although a significant proportion of patients do not have elevated IOP. Other risk factors include older age, African descent, myopia and family history of the disease. The ophthalmoscopic examination of the optic disc is essential to identify the signs of glaucomatous optic neuropathy, such as increased cupping, neuroretinal rim thinning or optic disc hemorrhages. Glaucomatous visual field loss usually starts in the periphery, and loss of central vision does not occur until late in the course of the disease. Visual function is most commonly assessed by standard automated perimetry; however, as many as 50% of nerve fibers can be lost before the appearance of visual field defects in this test. Newer technologies have been developed to find more sensitive ways to detect early glaucoma using both functional (short-wavelength automated perimetry and frequency-doubling perimetry) and structural (scanning laser topography, optical coherence tomography and scanning laser polarimetry) measurements. The management of glaucoma is based on lowering the intraocular pressure to prevent further optic nerve damage. Currently, there are five major classes of medications that are used to lower the intraocular pressure: Beta-adrenergic antagonists, adrenergic agonists, parasympathomimetics, prostaglandin-like analogues and carbonic anhydrase inhibitors. The goal of therapy is to maintain adequate vision for patients during their lifetime, keeping in mind the possible adverse effects of the drugs. If additional lowering of IOP is indicated or if medication fails to sufficiently lower the IOP, laser trabeculoplasty is usually the next step. If IOP is still not adequately controlled, incisional glaucoma surgery is indicated. Neuroprotective agents, which directly protect the optic nerve in glaucoma, are being evaluated in clinical trials.     

高眼压状态下手术治疗青光眼40例临床分析

目的 分析高眼压状态下手术治疗青光眼的效果.方法 对40例（41眼）青光眼患者高眼压状态下行小梁切除术.结果 40例患者手术经过顺利,视力有不同程度的提高,全部患者无严重并发症.结论 处于高眼压状态下的青光眼患者,为了避免高眼压对其视神经造成损害,应尽快行青光眼手术,可以取得与正常眼压下青光眼手术相同的疗效.     

青光眼药物治疗的新进展

青光眼是一种多元性的视神经和视网膜病变。全世界大约有 70 0万病人因青光眼而失明。眼压升高是青光眼发病过程中的主要危险因素。本文简要地回顾目前常用的药物疗法 ,并介绍正在研发中的新降眼压药的药效和药理机制。     

丝裂霉素C联合可调整缝线在小梁切除术中的应用

目的 观察丝裂霉素C联合可调整缝线在青光眼小梁切除术中的效果。方法 对68例(75眼)青光眼患者进行丝裂霉素联合可调整缝线的小梁切除术,术后随诊观察视力、眼压和滤过泡状况。结果 手术后第1周眼压为12.28±2.12mmHg,第1月眼压为13.34±2.51mmHg,第1年眼压为17.26±3.16mmHg;术后1年功能型滤过泡65眼(86.66%)。     

Photodynamic therapy combined with intravitreal injection of triamcinolone acetonide for choroidal neovascularization

The aim of this research was to evaluate the efficacy and safety of photodynamic therapy (PDT) combined with intravitreal injection of triamcinolone acetonide (TA) in the treatment of choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) and pathological myopia. PDT combined with intravitreal injection of TA was performed on 16 eyes of 16 patients with CNV diagnosed by visual acuity, fluorescein fundus angiography (FFA) and optical coherent tomography (OCT), including 14 eyes secondary to age-related macular degeneration and two eyes secondary to pathological myopia. TA was injected intravitreally 72 h post PDT on 12 eyes and from three months to one year (mean nine months) post PDT on four eyes respectively. All the patients were followed up for 3 to 18 months (mean 18.6 months). Best-corrected visual acuity, intraocular pressure, retinal thickness and FFA were observed. The visual acuity was improved in seven eyes (43.8%) of all the 16 eyes and stable in nine eyes (56.2%), respectively. FFA revealed complete or partial closure of CNV in all patients. OCT showed that the macular edema disappeared or was alleviated. Transient intraocular pressure elevation occurred in one patient (6.25%) of all the 16 eyes and intraocular pressure returned to the normal after a transient treatment with antiglaucoma medication. The mean number of PDTs during the first year was 1.1. PDT combined with intravitreal injection of TA for CNV is safe and effective. It can reduce the risk of visual loss and the treatment frequency. __________ Translated from Chinese Journal of Ocular Fundus Diseases, 2007, 23(1): 13–16 [译自: 中华眼底病杂志]     

氩激光周边虹膜成形术治疗急性闭角型青光眼急性发作期临床疗效观察

目的 分析氩激光周边虹膜成形术治疗急性闭角型青光眼急性发作期的临床效果.方法 88例急性闭角型青光眼急性发作期患者,按照奇偶法分为对照组和观察组,每组44例(44只眼).对照组患者接受常规药物治疗,观察组患者接受氩激光周边虹膜成形术治疗.比较两组患者治疗前后患眼和对侧眼角膜内皮细胞数量变化情况及视力、眼压变化情况.结果...     

前房重建在小梁切除术中应用

目的探讨青光眼小梁切除术中前房重建的疗效。方法对126例（144只眼）青光眼患者进行小梁切除术,术中常规进行前房重建,术后观察前房深度、眼压、结膜滤泡与并发症。结果术后浅前房发生率为5．6％,术后随访眼压3～6个月,144只眼中137只眼压控制在10—21mmHg之间,手术成功率为95．8％。结论青光眼小梁切除术中前房重建,方法简单,可有效控制术后浅前房,低眼压发生,提高手术成功率。     

小切口白内障摘除联合房角分离术治疗闭角型青光眼合并白内障疗效分析

目的探讨小切口白内障摘除联合房角分离术治疗闭角型青光眼合并白内障的临床疗效。方法闭角型青光眼合并白内障56例(56眼),术前房角开放超过180°,均行小切口白内障摘除人工晶体植入联合房角分离术,术后随访8～12个月。观察手术前后视力、眼压、房角的变化。结果术前平均眼压(19.45±5.01)mmHg,术后平均眼压(10.11±2.94)mmHg,差异有统计学意义(P<0.05)。术前周边前房深度<1/2CT者36例,术后周边前房深度≥1CT者43例,所有眼术后房角加宽,大部分开放,术前视力≤0.05者18眼,占32.14%,术后视力≥0.3者35眼,占62.5%,患者满意度较高。结论房角开放超过180°的闭角型青光眼合并白内障患者单纯行小切口白内障摘除联合房角分离术可以较好地控制眼压,并提高视力。