高眼压症患者的随访观察

目的:探讨高眼压症的危险因素、随访指标。方法:对29例高眼压症患者进行3～4(平均3.5)a的随访,随访内容包括眼压、视野、视盘及视神经纤维层等方面的检查。结果:随访过程中25例患者眼压无明显变化,2例眼压呈下降趋势,眼压增高2例。结论:高眼压症与多种致病因素有关,应密切随访观察,出现可疑青光眼改变,积极行抗青光眼的治疗。     

高眼压症患者的临床随访观察

目的 探讨高眼压症的致病因素、随访指标、治疗等。方法 对22例高眼压症患者进行3年～10年(平均4年)的随访。随访包括眼压、视乳头杯／盘、视野等方面。并对其中2例存在高危因素的病例进行药物治疗。结果 22例患者随访过程中眼底无变化，其中2例眼压呈下降趋势，2例视野出现可疑青光眼改变，并且伴有高危因素，予降眼压药物治疗。结论 高眼压症患者的致病因素与年龄、屈光、内分泌系统疾病、视乳头慢性缺血、心血管疾病等有关。     

高眼压症

在确定患者是否为高眼压症时,必须考虑到检查者眼压测量误差、中央角膜厚度、眼压昼夜波动等多因素的影响。对具有发展为青光眼高危因素的患者、眼压高于28mmHg者应进行治疗,并进行密切随访。本文系统复习了高眼压症的定义、病理生理学、患病率、诊断、治疗及随访等的原则与规范。     

儿童高眼压症与成人高眼压症患者长期随访后的临床特点与转归

目的　探讨儿童高眼压症和成人高眼压症患者长期随访后的临床特点与转归。方法　收集2014年3月至2015年3月就诊于胜利油田中心医院眼科门诊及病房且符合入选标准的57例高眼压症患者为研究对象。按照年龄分为儿童组和成人组:儿童组患者24例（48眼），年龄9~18岁；成人组患者30例（60眼），年龄21~66岁。对两组患者进行3~4 a的随访，按照每个季度（4月为春节、7月为夏季、10月为秋季、1月为冬季）复诊监测患者不同季节下的视力、眼压、视盘C/D比值、视野变化及视神经纤维层厚度变化。结果　儿童组患者眼压水平与眼压波动幅度均大于成人组（均为P<0.05）。儿童组首诊门诊连续3次检测眼压≥21 mmHg（1 kPa=7.5 mmHg）者48眼、≥30 mmHg者17眼；成人组≥21 mmHg者54眼（4例均单眼高眼压）、≥30 mmHg者11眼。儿童组24 h眼压高峰为早晨8∶00~10∶00，低谷为晚上22∶00~2∶00，眼压差为2.9~22.0（8.95±3.38）mmHg；成人组眼压高峰为夜间2∶00~4∶00，低谷为晚上18∶00~20∶00，眼压差为1.0~8.5（5.75±1.46）mmHg。儿童组患者的24 h眼压峰值与谷值均明显受季节影响，冬天显著高于夏天（P<0.05）；与成人组患者相比差异均有统计学意义（均为P<0.05）。儿童组患者四季眼压波动有差异，冬天显著高于夏天（P<0.05）。儿童组中男孩与女孩性别之间四季眼压波动差异无统计学意义（P>0.05）。成人组中四季眼压波动差异有统计学意义（均为P<0.05），性别之间差异无统计学意义（P>0.05）；与儿童组相比眼压差均减小，差异均有统计学意义（均为P<0.05）。随访3~4 a，儿童组患者有1例发展为青光眼，其神经纤维层厚度变薄，视野出现鼻侧阶梯，且患者近视进展比较快；有12例眼压趋于下降，神经纤维层厚度未见明显变化，视野未见明显异常；成人组患者有2例发展为青光眼，其神经纤维层厚度变薄，视野出现鼻侧阶梯，有1例伴发视网膜分支静脉阻塞。结论　儿童高眼压症患者眼压常呈波动性，眼压高峰值多数超过30 mmHg，其明显受季节影响；成人高眼压症患者眼压受季节影响小。     

高眼压症

在确定患是否为高眼压症时，必须考虑到检查眼压测量误差、中央角膜厚度、眼压昼夜波动等多因素的影响。对具有发展为青光眼高危因素的患、眼压高于28mmHg应进行治疗，并进行密切随访。本系统复习了高眼压症的定义、病理生理学、患病率、诊断、治疗及随访等的原则与规范。     

高眼压症中央角膜厚度与眼压关系的临床观察

目的 评价高眼压症患者中央角膜厚度(CCT)与眼压(IOP)的关系,并探讨CCT在判断高眼压症患者是否给予降眼压药物干预治疗中的临床意义.方法 对54例(108只眼)高眼压症患者进行非接触眼压计检测和超声角膜厚度测量,并对校正眼压＜21 mmHg的患者31例62只眼(占57.4%)不予降眼压治疗,追踪观察其眼压、视野、视乳头以及视网膜神经纤维层的情况.结果 IOP随CCT增加而增高,并呈正相关(CCT每增加100μm,IOP将随之增加2.1mmHg).对校正眼压＜21mmHg的患者不予降眼压治疗,随访24～36个月,平均30个月,其中1例2只眼出现视野改变,发生率为1.85%.结论 中央角膜厚度测量可以作为高眼压症与青光眼进行鉴别诊断,以及判断高眼压症能否发展为青光眼的重要依据,常规测量高眼压症患者的CCT并校正其眼压,对高眼压症患者的合理处置非常重要,对校正眼压＜21mmHg的患者可以不需降压药物干预治疗,仅需密切随访.     

高眼压症与角膜厚度

目的评价角膜厚度在高眼压症眼压测量中的作用影响.方法选取34例(68眼)高眼压症患者(眼压≥21mmHg,≤35mmHg,正常视野,正常视神经乳头,无角膜水肿等病变)均为复旦大学医学院眼耳鼻喉科医院眼科门诊患者.年龄6～65岁(19.70±13.52),平均20岁,男性18例,女性20例.由专人应用Goldmann压平眼压计测量眼压,由专人应用Sonoscan     

角膜厚度与高眼压症及青光眼的眼压

目的 探讨高眼压症、正常眼压性青光眼、原发性开角型青光眼患者及正常人的角膜厚度差异,分析角膜厚度与眼压间的关系,以及角膜厚度的测定对各型青光眼的诊断意见。方法 用超声波角膜测厚仪检测７３例（７３只眼）高眼压症、７９例（７９只眼）正常人的中央角膜厚度,并将其测定结果进行比较。回顾性分析每只青光眼治疗前的最高眼压（Ｇｏｌｄｍａｎｎ）,包括２４ｈ眼压曲线,用Ｅｈｌｅｒ法通过中央角膜厚度对眼压进行校正。结     

高眼压症的相关特殊检查研究

高眼压症又称为疑似青光眼或早期青光眼,随着临床研究的深入,眼科检测技术不断提高,对高眼压症的诊断、治疗评估、判断预后等有重要指导意义。我们仅对近年来高眼压症的相关特殊检查研究进展作一总结。     

The natural course of ocular pressure in ocular hypertension

The intraocular pressures of ocular hypertensives may undergo diurnal variation and/or slow cyclic variations over years. Studies of both types of variations are reviewed. Pressure tends to decrease cyclicly in some ocular hypertensives and to increase in others. It is possible that an increasing pressure trend may be an important symptom indicating a higher risk of development of glaucomatous damage.     

Erroneous assumption of ocular hypertension in patients with elevated intraocular pressure

Purpose:To determine the proportion of erroneously assumed ocular hypertension (OHT) among referred patients of elevated intraocular pressure (IOP) seen in glaucoma clinic of a teaching hospital in Northern India.Methods:Retrospective review of case records of referred, diagnosed patients of OHT or unspecified glaucoma seen between January 2019 and March 2020. Using an algorithmic clinical approach, including gonioscopy, Goldmann applanation tonometry (GAT), and pachymetry, underlying cause for elevated-IOP was amended and proportion of erroneously assumed OHT was calculated.Results:Of 276 patients diagnosed either as OHT or unspecified glaucoma before being seen at our glaucoma clinic, 44 (16%) had IOP within normal range (10–21 mmHg) on GAT. In 97 (35%) cases elevated-IOP was associated with angle closure. The central corneal thickness (CCT) was >550 μm in 39 (14%) patients with elevated-IOP. The proportion of erroneously assumed OHT was 70% in this study.Conclusion:The elevated-IOP does not imply with OHT unless evident through comprehensive clinical examination and appropriate investigations.     

选择性激光小梁成形术对高眼压症的临床疗效观察

目的:评价选择性激光小梁成形术(selective laser trabeculoplasty,SLT)治疗高眼压症(ocular hypertention,OH)的治疗效果。方法:诊断为OH患者28例(28眼,男15例,女13例),平均年龄31.4±11.0岁;术前眼压29.11±4.94mmHg。所有患者上方房角180°范围内进行治疗,能量0.85～1.56mJ,点数80～120点。测量术后1,2,3,4h眼压,术后1d;1wk;1,3,6mo;1a随访,监测术后眼压、视力、视野、杯盘比变化。结果:患者术前平均眼压29.33±4.17mmHg,术后1d为18.73±5.70mmHg、于术后1d停用药物治疗,其后随访的眼压结果:1wk为22.39±4.36mmHg,1mo为20.92±3.74mmHg,3mo为23.05±3.06mmHg,6mo为23.54±3.12mmHg,1a为24.68±2.57mmHg。术前患者杯盘比为0.50±0.19,术后1a为0.51±0.17;术前视力0.82±0.30,术后1a视力0.84±0.43;视野术后无变化。结论:SLT可以有效的降低高眼压症患者的眼内压。     

Effect of IOP on the visual field in ocular hypertension and glaucoma

The traditional opinion that increased intraocular pressure is the cause of glaucoma is controversial, probably mainly because of the fact that firm evidence for the value of pressure reduction is largely lacking. The present article reviews results from short term studies of visual fields before and after pressure reduction. It also reviews published and unpublished preliminary results from studies addressing the problem of whether the long term visual field prognosis, in glaucoma and inocular hypertension, is affected by pressure lowering therapy.There is no convincing agreement among results from modern studies using computerized perimetry indicating that acute lowering of the ocular tension results in an improvement of the glaucomatous visual field. Long-term result are equally conflicting, and often negative. We have noted from a preliminary analysis of our own masked, prospective study of patients with high risk ocular hypertension, that the same results may be interpreted in quite different ways.The results of available studies certainly indicate that pressure reduction does not automatically lead to clear and positive effects on the visual field. The studies have often been small, however, and have usually not had the power of detecting small effects of treatment. Also, pressure reduction has usually not been dramatic and many treated patients have maintained elevated pressure levels. Patients with very high pressures have not been included, and the effect of pressure reduction in this situation has therefore not been investigated at all. More controlled, prospective therapeutic studies are necessary and ethical. It seems particularly important to study the long-term effects of non-pharmacologically induced pressure reduction in patients with manifest field loss. It is necessary to make every effort to avoid bias not only in the design of such studies, but also in the interpretation of their results.     

国产与进口拉坦前列素滴眼液降眼压作用的短期效果比较

目的 比较国产与进口拉坦前列素滴眼液的短期降眼压效果。设计 随机、开放、平行对照的临床研究。 研究对象  原发性开角型青光眼患者和高眼压症患者42例。方法 对上述患者按所用药物的不同依随机表法分为A、B两组。A组28例（28眼）,滴用国产拉坦前列素滴眼液（特力洁）,B组14例（14眼）,滴用进口拉坦前列素滴眼液（适利达）,均为每日1次,每次1滴,共28天。受试者于入组当日及用药后第28天8:00、11:00、14:00、16:00测眼压,第7、14、21天则于8:00测眼压。眼压测量采用Goldmann压平眼压计,测量3次取平均值。裂隙灯显微镜观察角膜、虹膜、晶状体情况。主要指标  眼压值。结果 A组用药前眼压为（23.99±1.51）mm Hg, 用药后1～4周眼压分别为（18.04±1.27）mm Hg、（17.75±1.43）mm Hg、（17.63±1.50）mm Hg、（17.49±1.47）mm Hg,用药后眼压明显下降,与用药前相比差异有统计学意义（F=105.72,P=0.000）。B组用药前眼压为（24.37±1.55）mm Hg,用药后1～4周眼压分别为（17.91±1.35）mm Hg、（17.71±1.39）mm Hg、（17.55±1.34）mm Hg、（17.44±1.17）mm Hg,与用药前相比,用药后眼压明显下降,差异有统计学意义（F=67.85 P=0.000）。A、B两组用药前眼压比较无显著性差异（P=0.43）,用药后1～4周两组眼压比较无显著性差异（P值分别为0.76、0.93、0.86、0.89）。入组当日8:00、11:00、14:00、16:00  A、B两组眼压之间的比较无显著性差异（P值分别为0.46、0.44、0.50、0.31）,用药后28天8:00、11:00、14:00、16:00  A、B两组眼压之间的比较无显著性差异（P值分别为0.89、0.85、0.94、0.98）。用药28天时两组患者角膜、虹膜、晶状体均无异常改变。结论  本文的小样本、短期研究显示,国产拉坦前列素与进口拉坦前列素均能有效降低原发性开角型青光眼及高眼压症患者的眼压,两者之间的降眼压效果无显著差异。（眼科, 2012, 21: 111-114）     

The effect of phacoemulsification surgery on intraocular pressure and anterior segment anatomy of the patients with cataract and ocular hypertension

We evaluated the effect of phacoemulsification surgery on intraocular pressure (IOP), anterior chamber depth (ACD), iridocorneal angle (ICA), and central corneal thickness (CCT) of the patients with cataract and ocular hypertension. The decrease in IOP values of the 1^st week, 1^st month, 3^rd month, 6^th month, and 1^st year was statistically significant, but that of the 2^nd year was not significant. The increase in ACD and ICA values of the 1^st week, 1^st month, 3^rd month, 6^th month, and 1^st year was statistically significant, but that of the 2^nd year was not significant. The increase in CCT values of 1^st week and 1^st month was statistically significant, but those of 3^rd month, 6^th month, 1^st year, and 2^nd year were not significant. In conclusion, phacoemulsification surgery decreases IOP and increases ACD and ICA in the short-term. However, in the long-term it does not cause any significant changes.     

真空小梁成形术对原发性开角型青光眼及高眼压症的降眼压作用的初步研究

目的观察真空小梁成形术（PNT）对国人原发性开角型青光眼（POAG）及高眼压症患者的降眼压效果。设计前瞻性病例系列。研究对象北京同仁医院2008年11月至2009年2月就诊的POAG及高眼压症患者30例（30眼）。方法人选患者进行眼科一般检查、前房角镜及Humphrey视野检查,测量眼压（压平眼压计）。患者单眼或双眼进行PNT1000型治疗仪（Ophthalmic International公司产）治疗。治疗后1小时、1天、1周、2周、1个月、2个月复查。首次治疗后第7天重复治疗一次。单眼治疗者选治疗眼,双眼者随机选1眼,进行重复测量的方差分析。主要指标眼压。结果30例患者治疗前眼压（23．2±5．3）mmHg,平均应用局部降眼压药物1．47种（0—5种）,治疗后1天、1周、2周、1个月、2个月各时间点眼压分别为（20．0±5．0）mmHg、（19．8±3．8）mmHg、（19．7±4．0）mmHg、（19．3±3．9）mmHg、（19．8±4．0）mmHg,眼压下降幅度分别为3．2mmHg、3．4mmHg、3．5mmHg、3．9mmHg、3．4mmHg,各时间点较治疗前眼压差异有统计学意义（P均〈0．001）.23例（83％）治疗后眼压下降≥15％。结论本文的短期小样本研究显示,真空小梁成形术可安全有效地降低POAG及高眼压症患者的眼压。     

近视伴高眼压症的眼压与中央角膜厚度的关系

目的 :探讨近视眼患者中高眼压症的眼压与中央角膜厚度的关系及其临床意义。方法 :用超声角膜测厚仪及非接触眼压计对 14例 2 8眼近视伴高眼压症患者的中央角膜厚度和眼压进行测定 ,并采用SPSS 10 .0作统计分析。结果 :14例 2 8眼的眼压范围为 2 0～ 2 9mmHg,平均 (2 3.88± 2 .2 6 )mmHg ;中央角膜厚度为 5 33～ 6 70 μm ,平均 (5 86 .5 0± 31.91) μm ;屈光度为 - 0 .75～ - 3.5 0D ,平均 - (1.5 0± 0 .6 9)D。应用SPSS(10 .0 )软件进行相关分析 :眼压与厚度经回归分析 ,直线方程式为 :Y(中央角膜厚度 ) =4 4 5 .15 1+5 .92 0X(眼压 ) ;眼压与屈光度的相关系数r =0 .35 5 ,P >0 .0 5。结论 :眼压与中央角膜厚度成正相关 ,与屈光度无相关性。近视眼中高眼压症的眼压升高与中央角膜厚度增加有关 ,提示近视眼伴高眼压症患者的真实眼压可能是正常的 ,只是由于中央角膜厚度的增加而使眼压的测量值升高。检测中央角膜厚度有助于更正确地估计实际的眼压值。     

The “no treatment” approach to ocular hypertension

Should patients with ocular hypertension be treated to prevent glaucomatous visual field loss? Three considerations suggest that for most patients the answer is no. First, the average risk of visual field loss in untreated ocular hypertension is small. Population surveys and prospective studies indicate that no more than about one of every nine persons with intraocular pressures higher than 20 mm Hg will develop a visual field defect. Secondly, treatment of ocular hypertension to lower intraocular pressure is of unproven efficacy in preventing visual field defects. Thirdly, adverse reactions to glaucoma therapy occur frequently and are sometimes serious. Although pressure reduction may be indicated for some patients who possess certain risk factors which make them especially susceptible to glaucomatous damage, for most patients “no treatment” is the best management. Untreated patients must be observed carefully with periodic visual field and optic disc examinations.