原发性开角型青光眼与高血压的关系

目的探讨原发性开角型青光眼与高血压病的关系.方法随机选择确诊原发性开角型青光眼50例,高血压病50例,观察眼压、血压、视乳头C/D比,视野,归纳总结.结果 50例原发性开角型青光眼中,血压高者25例(50%).50例高血压病中,眼压高者38例(76%),视野损害40例(80%),光敏度下降35例(70%),中心暗点25例(50%),周边视野缩小17例(34%),生理盲点扩大17例(34%).结论原发性开角型青光眼与高血压病有极大关联.     

原发性开角型青光眼术后筛板血流改变及其临床意义

研究原发性开角型青光眼术后的血流改变情况 ,探讨其机理。方法25例(40眼)经临床证实为原发性开角型青光眼并接受小梁切除术的患者用HRF共焦激光多普勒眼底视网膜血流仪行筛板血流检查。根据术前视野损害程度分组 ,其中早期组15例(15眼) ,中晚期组25例(25眼)。SPSS统计软件分析两组血流速度改变情况。结果术后血流速度改变与青光眼所处的阶段有关。在早期组血流速度无明显改善 ,而中晚期组血流速度明显改善 ,并且与术后眼压下降的幅度有关(P<0.05)。结论中晚期青光眼术后血流改善明显 ,与眼压下降幅度有关 ,预示着中晚期青光眼患者存在筛板血管自身调节异常     

小梁切除术后影响功能性滤过泡的相关因素

目的 探讨抗青光眼小梁切除术后影响功能性滤过泡的相关因素。方法 分别对48例50眼青光眼小梁切除术后滤过泡失败患者的年龄、青光眼粪型、术前眼部情况（视力、视野、杯／盘及眼压）、术前用药情况以及所采取的手术方式和术后处理等做一回顾性分析。结果小梁切除术35眼。小梁切除术联合术中丝裂霉素应用15眼。术后无功能滤过泡发生在30～45岁者30眼（60％）；慢性开角性青光眼者26眼（52％）；34眼（68％）为晚期青光眼；16眼长期局部应用抗青光眼药物；8眼为高眼压下实施手术；11眼术后出现不同程度的葡萄膜炎症反应；24例未得到正确护理；结论 青光眼小梁切除术后功能性滤过泡的维持与手术方式、术前眼压状况、术前用药及术后处理等有关，与手术年龄、膏光眼类型、手术时机是否有直接关系有待进一步研究。     

原发性急性闭角型青光眼高眼压持续状态下的手术治疗

目的探讨闭角型青光眼高眼压持续状态下手术的特点，并评价其临床疗效。方法对52例54只眼，使用局部和全身药物治疗，眼压不能良好控制的原发性闭角型青光眼进行改良小梁切除术治疗。结果54只眼顺利完成手术，术后其中2眼出现前房出血，2眼出现脉络膜脱离，6眼出现浅前房经过相应的处理后稳定。术后1月随访时，视力提高或保持不变的有47只眼占87％，眼压≤21mmHg者有44只眼占81．5％。结论原发性急性闭角型青光眼高眼压持续状态下施行改良小梁切除术是必要、可行，安全有效的。     

原发性开角型青光眼微循环改变及临床意义

目的：探讨原发性开角型青光眼与微循环的关系。方法：采用国产WX－9A型微循环仪及图像自动分析系统，观察46例原发性开角型青光眼患者甲皱微循环变化。结果：患者组甲皱微循环管襻形态，襻周状态，血流状态等项指标与对照组比较均有显著性差异（P＜0．05），表现不同程度的微循环障碍。结论：原发性开角型青光眼的发生与微循环障碍有关。     

抗青光眼滤过手术后前房延缓形成分析

1　资料与方法1.1　临床资料　 6 0例 (85只眼 )男 2 6例 ,女 34例。年龄 6～81岁 ,平均年龄 5 6 .7岁。右眼 15例 ,左眼 2 0例 ,双眼 2 5例。其中原发性青光眼 79只眼 (闭角型青光眼 77只眼 ,开角型青光眼 2只眼 ) ,继发性青光眼 5只眼 ,先天性青光眼 1只眼。1.2　方法1.2 .1　术前准备　一般眼压控制在 3.73k Pa以下 ,对晚期青光眼控制在 1.99～ 2 .6 6 k Pa左右 ;术前 3d停用缩瞳剂 ,常规作血尿粪、心电图 ,胸透检查 ,血压 ,血糖维持在正常范围。1.2 .2　手术　 1巩膜瓣下小梁切除联合丝裂霉素 C术。 2巩膜瓣下咬切术。 3巩膜瓣下咬切 …     

是否合并有糖尿病的开角型青光眼小梁切除术后脉络膜厚度的改变

目的：观察开角型青光眼(primary open angle glaucoma,POAG)与开角型青光眼合并糖尿病患者小梁切除术后脉络膜厚度的变化。方法：选择在我院眼科住院治疗的开角型青光眼患者120例(130只眼)为研究对象,根据是否合并有糖尿病分为青光眼组69例(76只眼)和合并糖尿病组51例(54只眼),应用光学相干断层扫描技术(optical coherence tomography,OCT)于小梁切除术前后对视网膜色素上皮层到内巩膜层的垂直距离(即脉络膜厚度)进行测量。通过软件计算自动获得脉络膜平均厚度,观察并与术前比较是否有改变。结果：术前,两组视力、眼压和脉络膜厚度均无统计学差异(P>0.05)。小梁切除术后2周,合并糖尿病组脉络膜厚度比青光眼组厚,两组比较,差异具有统计学意义(P<0.05);但两组视力与眼压均无统计学差异(P>0.05)。组内治疗前后情况,两组视力与脉络膜厚度无统计学差异(P>0.05),但眼压在术后明显降低,差异具有统计学意义(t=10.76,P=0.00)。结论：开角型青光眼是否合并有糖尿病于小梁切除术后对脉络膜厚度无影响。     

青光眼与心理社会因素的关系及相关研究

青光眼是一种公认的最重要的眼科心身疾病。大多数学者认为 ,青光眼是具有病理性高眼压或正常眼压合并视乳头、视网膜神经纤维层损害及青光眼性视野改变的一种复杂而又顽固的常见眼病 ,为致盲的主要原因之一 ,可分为原发性、继发性、混合型和先天性四种[1] 。原发性青光眼是眼心身疾病的主要研究对象 ,又分为开角型和闭角型二类 ,低压性青光眼也属于它的范畴[2 ] 。根据ＤＳＭ—Ⅲ的定义 ,可将原发性青光眼归为“心理因素影响的躯体情况”或“心理生理疾病”或“心身疾病”。近年来 ,青光眼的发病率、致盲率在逐年增高 ,因此全面了解青光眼…     

吉安县农村50岁以上人群原发性闭角型青光眼流行病学调查

目的调查50岁以上的中老年人群的原发性闭角型青光眼患病率并讨论其相关影响因素。方法于2006年11～12月在江西省吉安县以自然村为单位,通过重组随机整群抽样确定50岁以上人群为检查对象,对5013人进行青光眼筛查。采用Van Herick法检测周边前房深度,常规检测视力、屈光状态,直接眼底镜检查视乳头C/D大小,询问病史和家族史,对可疑青光眼和青光眼患者进行青光眼标准检查,其中包括便携式Goldmann压平式眼压检查、Glodmann房角镜前房角检查、视野检查、HRTⅡ、SL-OCT等检查。结果本次调查50岁以上农村特定人群的应答率93.1%(5031/5402),人群中PACG患病率1.5%(76/5013),95%可信区间(CI)0.9%～2.0%,男性和女性患病率分别为1.0%(95%CI0.6%～1.2%)、1.9%(95%CI1.4%～2.1%),在50～59、60～69和70～87岁年龄组中分别为0.5%、2.3%和2.4%。60岁以上年龄段为患病率骤升年龄段,前房角<20°者中有40.6%(76/187)为原发性闭角型青光眼,HRTⅡ对原发性闭角型青光眼的检出率为89.5%(68/76)。回归校正混杂作用后,PACG患病率与前房角解剖、性别、年龄相关。结论原发性闭角型青光眼是重要致盲性眼病,年龄、性别和前房角度数大小为其发病的高危因素。     

原发性开角型青光眼术后筛板血液改变及其临床意义

目的 研究原发性开角型青光眼术后的血流改变情况，探讨其机理。方法 ２５例（４０眼）经临床证实为原发性开角型青光眼并接受小梁切除术的患者用ＨＲＦ共焦激光多普勒眼底视网膜血流仪行筛板血流检查。根据术前视野损害程度分组，其中早期组１５例（１５眼），中晚期组２５例（２５眼）。ＳＰＳＳ统计软件分析两组血流速度改变情况。结果 术后血流速度改变与青光眼所处的阶段有关。在早期组血流速度无明显改善，而中晚期组血流速     

Whole-mitochondrial genome sequencing in primary open-angle glaucoma using massively parallel sequencing identifies novel and known pathogenic variants

PurposeThe aim of this study was to determine whether mutations in mitochondrial DNA play a role in high-pressure primary open-angle glaucoma (OMIM 137760) by analyzing new data from massively parallel sequencing of mitochondrial DNA.MethodsGlaucoma patients with high-tension primary open-angle glaucoma and ethnically matched and age-matched control subjects without glaucoma were recruited. The entire human mitochondrial genome was amplified in two overlapping fragments by long-range polymerase chain reaction and used as a template for massively parallel sequencing on an Ion Torrent Personal Genome Machine. All variants were confirmed by conventional Sanger sequencing.ResultsWhole-mitochondrial genome sequencing was performed in 32 patients with primary open-angle glaucoma from India (n = 16) and Ireland (n = 16). In 16 of the 32 patients with primary open-angle glaucoma (50% of cases), there were 22 mitochondrial DNA mutations consisting of 7 novel mutations and 8 previously reported disease-associated sequence variants. Eight of 22 (36.4%) of the mitochondrial DNA mutations were in complex I mitochondrial genes.ConclusionMassively parallel sequencing using the Ion Torrent Personal Genome Machine with confirmation by Sanger sequencing detected a pathogenic mitochondrial DNA mutation in 50% of the primary open-angle glaucoma cohort. Our findings support the emerging concept that mitochondrial dysfunction results in the development of glaucoma and, more specifically, that complex I defects play a significant role in primary open-angle glaucoma pathogenesis.Genet Med 17 4, 279–284.     

Relative afferent pupillary defects in primary open-angle glaucoma--five years' experience

Afferent pupillary defects may accompany asymmetric primary open-angle glaucoma, though the exact incidence has not been reported. Charts were reviewed on 89 patients attending the Glaucoma/Uveitis Clinic at the North Carolina Memorial Hospital in Chapel Hill, North Carolina over a five-year period. All patients had primary open-angle glaucoma diagnosed by: (1) increased ocular tensions (22 mmHg) in the presence of open-anterior-chamber angles and (2) optic-nerve cupping and atrophy compatible with (3) pressure-dependent, visual-field loss. No subjects with secondary glaucomas, primary-angle-closure glaucoma, or ocular hypertension are included.     

高眼压状态下青光眼手术的临床观察

目的探讨高眼压状态下青光眼手术方法的安全性和效果。方法对32例药物降压无效的青光眼患者进行青光眼手术,术后观察出血、滤过泡、前房、眼压及视力的变化。结果术后1月视力提高的21只眼(65.63%);保持不变的11只眼(34.38%);眼压术后≤21mmHg者28只眼(87.5%);用药物控制的4只眼(12.5%)。结论高眼压状态采取手术治疗是安全有效的。     

Ocular telehealth screenings in an urban community

The current U.S. economic recession has resulted in a loss of income, housing, and healthcare coverage. Our major goal in this socioeconomic setting was to provide ophthalmic remote health screenings for urban soup kitchen and homeless populations in order to identify and refer undetected vision-threatening disease (VTD). We assessed visual acuity, blood pressure, pulse/oxygen saturation, body mass index, and intraocular pressure for 341 participants at soup kitchens as part of the homeless outreach program in Newark, NJ. History of diabetes, hypertension, and smoking, last ocular examination, and ocular history were noted. Imaging was performed with an 8.2 megapixel non-mydriatic retinal camera with high-speed Internet ready for off-site second opinion image evaluation. Positive VTD findings were identified in 105 participants (31%) (mean age, 53.6 years), of whom 78% were African American, 73% males, and 62% smokers. We detected glaucoma in 34 participants (32%), significant cataract in 22 (21%), diabetic retinopathy in 5 (5%), optic atrophy in 1 (1%), age-related macular degeneration in 1 (1%), and other retinal findings in 43 (41%). The incidence of VTDs was higher among this cohort than among study groups in previous screenings (31% vs. 12%). This finding shows an increase in ocular morbidity in a younger, at-risk population with elevated rates of hypertension, diabetes, and smoking. Functional visual impairment was 2.5 times higher than the national average (16% vs. 6.4%). Comprehensive, community-based screenings can provide more sensitive detection of VTDs in high-risk groups with low access to ophthalmic care and can be an integral part of recession solutions for improving healthcare.     

单基因青光眼的临床实践指南

青光眼(glaucoma)是一组视网膜神经节细胞及其轴突变性的进行性视神经病,其典型临床特征为视乳头凹陷性萎缩和特征性视野缺损,遗传因素在其发病过程中起着重要作用。本指南主要介绍单基因变异相关的青光眼,包括原发性先天性青光眼(primary congenital glaucom a,PCG)和原发性开角型青光眼(primary open-angle glaucoma,POAG)的致病基因、疾病诊断以及临床咨询等方面,旨在规范单基因青光眼临床分子遗传诊疗,为临床医生对单基因青光眼诊治和遗传咨询服务提供参考。     

Pattern of presentation and outcome of surgical management of primary open angle glaucoma in Kano, Northern Nigeria

BACKGROUND: Primary open angle glaucoma (POAG) is one of the leading causes of avoidable blindness. Unlike blindness from cataracts, glaucomatous optic nerve damage is irreversible, and prevention of glaucoma is one of the priorities of World Health Organization (WHO) Vision 2020 program. POAG is the commonest type of glaucoma and affects about 33.1 million people worldwide. This study is a five year review of 71 eyes of 63 patients who had trabeculectomy. The study evaluates the pattern of presentation and modality of surgical treatment in our environment. METHODS: Records of all patients with primary open angle glaucoma operated over a five year period was retrieved. Information extracted included patients bio data, visual acuity, gonioscopic findings, intra ocular pressure as measured with applanation tonometer before and after surgery, and recorded in mmHg. Perimetry was done with 2 m tangent screen and recorded in a perimetry chart. All the patients had trabeculectomy with application of antimetabolite (5-fluorouracil). Extra capsular cataract extraction with or, without posterior chamber intra ocular lens implantation was done on 13 patients. Biometry was not done on patients with cataract. Surgery was done on better eye first in all patients. RESULTS: There were 71 eyes of 63 patients. The male to female ratio was 3:1. The age ranged between 18 to 75 years. 8 patients were below the age of 30 years. One third of the patients were between the ages of 50 to 59 years. At presentation 12 patients (19%) had normal vision (WHO vision category O), 26 patients (41%) were visually impaired, 12 patients (19%) were severely visually impaired and 13 patients (21%) were blind (from co existing cataracts). The cup disc(c: d) ratio assessed before surgery was 0.5 in 9 eyes (13%), 31 eyes (53%) had c: d ratio 0.6 to 0.8 and 18 eyes had c: d ratio of 0.9. All the patients had open anterior chamber angles (Schafer grade 3 and 4). Perimetric changes were; mild peripheral constriction in 5 eyes (8%), peripheral constriction with arcuate scotoma in 19 eyes (26%), constricted fields of 300 or less in 34 eyes (48%), and in 13 eyes there was inability to fixate on target. IOP before surgery was 21 to 30 mm Hg in 12 eyes (17%), and above 31 mm Hg in 69 eyes (83%). Post operative IOP of 10 to 15 mm Hg was obtained in 58 eyes (82%) and 11 eyes (15%) had IOP of 16 to 20 mm Hg. Only 2 eyes (3%) had IOP in the lower twenties. CONCLUSION: Primary open angle glaucoma is characterized by late presentation. Trabeculectomy with application of 5FU is the surgical treatment of choice in our environment and give good intra ocular pressure control. There is need to increase public awareness on glaucoma to limit this type of avoidable blindness.     

Twenty-four-hour repeatability of diurnal intraocular pressure patterns in glaucomatous and ocular hypertensive individuals

OBJECTIVE:

To verify the 24-hour repeatability of diurnal intraocular pressure patterns in glaucomatous and ocular hypertensive individuals.

METHODS:

A prospective analysis of 88 eyes from 88 ocular hypertensive or open-angle glaucoma patients was conducted on diurnal tension curves obtained by the same examiner on two consecutive days. The intraclass correlation coefficient test was used for statistical analysis.

RESULTS:

Eighty-eight eyes from 88 patients were analyzed. Fifty-seven patients (64.8%) were female. The mean age of all participants was 68.7 (SD 10.8, range 51–79) years. The intraclass correlation coefficient values for measurements at 8 AM, 11 AM, 2 PM, and 4 PM were 0.80, 0.82, 0.83, and 0.86, respectively (all intraclass correlation coefficient values, p<0.001).

CONCLUSION:

Diurnal intraocular pressure data collected on a single day characterize the diurnal intraocular pressure variability over 24 hours in primary open-angle glaucoma and ocular hypertensive patients.     

Role of cerebrospinal fluid in glaucoma: Pressure and beyond

Glaucoma is the second leading cause of blindness worldwide. Primary open-angle glaucoma (POAG) is characterized by optic disc cupping and visual field impairment. Though the elevated intraocular pressure (IOP) is thought to be the major risk factor for POAG, about 50% of the POAG patients have normal IOP, called ‘normal-tension’ glaucoma. Besides, many POAG patients still experience visual field loss and/or optic disc cupping even though the IOP has been well controlled. The mechanisms underlying the pathogenesis of POAG remain unclear. Extensive studies have shed lights on the mechanisms that may be involved in the etiopathology and/or the optic neuropathic manifestations of POAG. In this article, we noticed that the changes in the cerebrospinal fluid, particularly that existing in the subarachnoid space of the optic nerve, appear to be actively involved in the pathogenesis of POAG.     

Identification of a new GLC1A mutation in a sporadic,primary open-angle glaucoma in Japan

Glaucoma is a major cause of blindness characterized by progressive degeneration of the optic nerve and elevated intraocular pressure. Recent studies have revealed a genetic basis for a substantial proportion of cases of familial primary open-angle glaucoma (POAG) and the gene causing the abnormality has been identified. Sequence variations that meet the criteria for a probable disease-causing mutation have been found in the American and European populations. In this study, we examined 58 cases of sporadic glaucoma from Japan to clarify the relationship between the mutations of the GLC1A gene and sporadic glaucoma in Japan. We have examined 33 POAG, 17 primary closed-angle glaucomas, 6 normal-tension glaucomas and 2 steroid-induced glaucomas for mutation of the GLC1A gene using polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) analysis and direct DNA sequencing studies. We identified a previously unreported GGT right curved arrow GAT transition at codon 451 in exon 3, resulting in a glycine to asparagine substitution in one POAG patient. No other mutations of the GLC1A gene were found in other types of glaucoma. These findings further emphasize the importance of GLC1A mutation in the development of POAG.