近视与原发性开角型青光眼的相关性研究

目的探讨近视尤其是高度近视与原发性开角型青光眼的关系及眼压变化对高度近视合并原发性开角型青光眼诊断的影响。方法回顾性分析早期原发性开角型青光眼患者和正常人群中近视情况,并比较它们与眼压的关系。结果原发性开角型青光眼患者中近视率达78.72%,远高于正常对照组的62.22%(P=0.0140),近视率差异只要由高度近视引起(P=0.0056),中低度近视和正常视力在两组间的分布并无差异。高度近视合并原发性开角型青光眼25眼中有5眼眼压未增高。结论高度近视可能为原发性开角型青光眼的高危因素,对于眼压正常的高度近视者不能忽视对其可能并发POAG的相关检测。     

近视人群角膜厚度与眼轴长度和非接触眼压计值的关系

近年来，在近视人群中发现的原发性开角性青光眼(POAG)患者不断增加，已引起眼科界的高度重视。为此，我们对一组早期原发性开角性青光眼患者和正常对照组进行眼轴长度、中央角膜厚度和眼压的测量，比较他们在两组人群中的差异，分析其与眼压的关系，从而为近视人群原发性开角性青光眼的诊治和研究提     

原发性青光眼患者屈光状态的研究

目的:探讨原发性青光眼患者的屈光状态对其发病机制的影响.方法:对原发性青光眼患者50例(100眼),分别进行裸眼视力、矫正视力、主觉和他觉验光检查,以及眼轴的测量.结果:原发性青光眼患者50例(100眼)中,屈光不正患病率为71.00%.原发性开角型青光眼患者的近视率为76.09%,平均屈光度为-3.61D;原发性闭角型青光眼患者的远视率为50.00%,平均屈光度为 0.57D(P＜0.01).原发性开角型和闭角型青光眼平均眼轴长度为24.81 mm和22.30 mm(P＜0.01).结论:原发性青光眼的发病与患者的屈光状态存在一定内在联系,原发性开角型青光眼以近视性屈光不正为主,原发性闭角型青光眼以远视性屈光不正为主.     

近视与开角型青光眼(OAG)临床相关研究进展

 开角型青光眼(open-angle glaucoma,OAG)包括高眼压性原发性开角型青光眼(primary open-angle glaucoma,POAG)和正常眼压性青光眼(normal-tension glaucoma,NTG)。不少研究表明近视,特别是高度近视是OAG发生的危险因素,但近视对青光眼性损害形式及进展的影响尚不明确。近视本身也可能发生一系列器质性改变,使得近视与OAG并存时病情尤为复杂。NTG与POAG在临床表现和发病机制上有所不同,近视对两者的影响也有所不同。而不同程度的近视对OAG影响亦不同,表现在其流行病学、视神经和视野损害形式、视野进展速率上有所差异。明确近视与OAG发生、发展的关系,对OAG的诊断、治疗、预后及发病机制的研究有重要作用。     

近视与眼内压相关关系的研究

目的 :通过对近视眼与眼内压相关关系的分析 ,进一步探讨近视眼与原发性开角性青光眼的内在联系。方法 :随机选取非青光眼性近视眼病人 148例 (2 70眼 ) ,除给予常规的裸眼视力、矫正视力、裂隙灯显微镜、眼底、视野等检查外 ,还均给予非接触眼压计眼压测量、自动验光仪散瞳验光、A型超声波眼轴测量检查 ,并对上述病人的屈光状态、眼轴长度、眼内压的相关关系进行统计分析。结果 :近视患者的眼内压与患者性别、眼别、年龄、视力无关 ;近视眼病人眼内压与眼轴长度呈正相关 (r =0 .18,P<0 .0 1,Y^ =4.85 +0 .44X ) ;中、低度近视组眼压均值无显著性差异 (t =1.5 6,P >0 .0 5 ) ,高度近视组眼压均值 (16.6± 2 .42 )mmHg高于中度近视组 (15 .3 3± 2 .77)mmHg。两组差异显著 (t =2 .75 ,P <0 .0 1) ;随眼内压增高 ,眼轴长度≥ 2 6mm者所占百分比有逐渐增高趋势。结论 :在非青光眼性近视眼 ,其屈光状态、眼轴长度与眼内压存在一定内在联系 ,尤其是随着近视程度、眼轴长度和眼内压的增加 ,这种联系更为密切。因此对眼压值偏高的近视眼或高度近视眼要给予高度重视     

小梁切除联合超声乳化术治疗原发性闭角型及开角型青光眼并发白内障43例

目的:探讨原发性闭角型青光眼(PACG)及开角型青光眼(POAG)并发白内障患者采用小梁切除术联合超声乳化术治疗的临床疗效。方法:将原发性青光眼并发白内障患者86例86眼按原发疾病类型的不同分为PACG组(43例,43眼)和POAG组(43例,43眼),均行小梁切除术联合超声乳化术治疗,术后对两组患者的临床效果进行分析比较。结果:PACG组术后视力恢复及眼压改善情况优于对照组(P<0.05);PACG组并发症发生率为9.30%,POAG组并发症发生率为16.28%,但两组无统计学差异(P>0.05)。结论:采取小梁切除术联合超声乳化术治疗原发性开角型青光眼及闭角型青光眼并发白内障患者临床效果显著,可改善患者的视力,且安全性好,但闭角型青光眼患者的眼压控制优于开角型青光眼患者。     

新疆乌鲁木齐市50岁及以上体检人群青光眼构成情况

目的:探讨青光眼在50岁及以上体检人群类型构成、性别、年龄分布特点,为青光眼防治提供流行病资料.方法:2008年3月～2008年8月,对50岁及以上眼科体检人群,总计1 743人进行青光眼调查.检查项目包括常规视力、裂隙灯显微镜、周边前房深度、眼压及直接眼底镜检查.对可疑青光眼患者进一步详细检查眼压、前房角镜、视野检查及眼底检查.结果:1 743人中确诊为青光眼者36人,占体检人群的2.07%,其中原发性闭角型青光眼、原发性开角型青光眼、继发性青光眼各占整个体检人群的1.55%、0.40%和0.11%,男性青光眼患者的构成比为1.51%,女性为2.53%,女性青光眼患者明显高于男性,原发性闭角型青光眼明显高于原发性开角型青光眼,且各型青光眼构成比随年龄增长而增高.结论:50岁及以上体检人群青光眼构成比与既往青光眼流行病调查的患病率接近,且原发性闭角型青光眼构成比高于原发性开角型青光眼构成比,女性原发性闭角型青光眼构成比高于男性.     

原发性开角型青光眼的遗传学研究

原发性开角型青光眼（Primary open-angle glaucoma，POAG）为常见的青光眼类型，是主要致盲性眼病之一。至上世纪末，全世界患青光眼的人数超过6600万。我国青光眼的患病率为1．68％。根据此资料的推算，我国有青光眼患者520万，因青光眼失明者48万。POAG是由于病理性高眼压引起视神经乳头损害和视野缺损，而且眼压升高时前房角开放的一种青光眼。POAG患者早、中期可无症状或症状不明显，晚期视功能的损害是不可逆的，目前治疗主要是控制眼压等方面。因此，有必要从遗传学上来探讨POAG的发病机制，以达到早期诊断、早期治疗POAG。     

前列腺素类药物对原发性开角型青光眼患者眼血流的影响

原发性开角型青光眼（primary open-angle glaucoma,POAG）视功能损害的多因素学说[1]认为眼压升高是青光眼视功能损害的基本因素,但并不是唯一因素。如糖尿病、高血压、血管痉挛、眼动脉低灌注压、血液流变学异常等,这些因素可以单独引起视功能损害,也可以与眼压共同作用。     

青光眼滤过术后眼轴改变及人工晶体度数计算

目的:探讨不同类型青光眼滤过术后的眼轴改变及青光眼滤过术后白内障患者的人工晶体度数计算。方法:分析40例青光眼滤过术后成功控制眼压的原发开角型、闭角型青光眼的眼轴改变,以及分析20例青光眼滤过术后白内障超声乳化折叠式人工晶体植入术后和常规白内障超声乳化折叠式人工晶体植入术后屈光状态对比情况。结果:开角型青光眼、闭角型青光眼滤过术后眼轴均变短,开角型青光眼平均为0.35mm,闭角型青光眼平均为0.32mm,与术前相比差异均有显著性(配对T检验,P<0.001),但开角型青光眼和闭角型青光眼眼轴变化二者之间无差异(T检验,P>0.05),青光眼滤过术后白内障超声乳化人工晶体植入术后屈光度为-1.72±0.22D,常规白内障超声乳化人工晶体植入术后屈光度为-0.98±0.24D,二者差异有显著性(T检验,P<0.001)。(凡白内障术前常规给予-1.00D屈光状态)。结论:青光眼滤过术后眼压控制良好患者眼轴缩短,青光眼滤过术后白内障患者术后人工晶体度数偏高,青光眼滤过术后白内障人工晶体度数应以青光眼滤过术前眼轴为准,眼轴测量应列为青光眼滤过术前常规检查。     

Juvenile glaucoma, race, and refraction

Of 68 patients who presented between the ages of 10 and 35 years with elevated intraocular pressure, 25 were classified as juvenile ocular hypertension and 43 as juvenile primary open-angle glaucoma. Blacks constituted a greater proportion of the primary open-angle glaucoma patients (47%) than of the ocular hypertensives (20%) and in both groups presented at younger ages than did whites. Myopia was present in 59% of the ocular hypertensives and 73% of the primary open-angle glaucoma patients, of whom 39% had more than 6 diopters of myopia. All eyes of black patients with more than 3 diopters of myopia had glaucomatous defects compared with 52% of such eyes of white patients. Our data suggest that myopia is strongly associated with juvenile open-angle glaucoma and that young black patients with elevated intraocular pressure, especially when myopic, are more susceptible to glaucomatous damage than are whites.     

高度近视伴原发性开角型青光眼视乳头及视网膜神经纤维层改变的分析

目的分析伴有高度近视的开角型青光眼(primary open angle glaucoma,POAG)的视乳头形态及视网膜神经纤维层改变,探讨其早期诊断方法。方法(1)收集20例(38只眼)高度近视合并POAG患者资料(A组),与随机抽取的20例(36只眼)中度近视合并POAG患者的资料(B组),以及20例(40只眼)低度近视合并POAG患者的资料(C组)进行对照,比较初次就诊时3组患者间视野缺损、视网膜神经纤维层缺损(retinal nerve fibre layer de-fect,RNFLD)、最高眼压值及矫正视力等指标的差异;(2)观察3组患者的眼底照片并分析各组的临床特点。结果(1)A组患者中、重度视野缺损和RNFLD的比例明显高于B、C组,矫正视力低于B、C组;(2)高度近视患者视乳头、视网膜的特异性变化及视乳头周围的特征性改变等,干扰了对青光眼的早期诊断;(3)高度近视患者常规进行散瞳检查或眼底照相是诊断早期青光眼的重要手段及方法。结论在合并高度近视的POAG临床检查及诊断时,应注意其视野的缺损、RNFLD,并避免与高度近视视乳头、视网膜的特异性变化及视乳头周围的特征性改变相混淆,正确认识高度近视本身及合并POAG时的临床特点,有助于POAG的早期诊断。     

原发性开角型青光眼与正常眼24小时眼压波动规律

目的 分析其眼压昼夜变化规律,以期为青光眼的个性化治疗提供参考依据.方法 收集2006年4月至2009年4月上海市北站医院和复旦大学附属眼耳鼻喉科医院门诊的原发性开角型青光眼患者102例及正常志愿者83名,进行24 h眼压测量,用非接触性眼压计从8 am起每隔2 h测1次眼压,零点至6 am为唤醒后即刻坐位眼压.结果 二组之间峰值眼压[正常组右眼(16.0±2.7)mm Hg,左眼(16.2±2.7)mm Hg;POAG组右眼(25.3±5.6)mm Hg,左眼(24.8±5.1)mm Hg]、谷值眼压[正常组右眼(11.1±2.5)mm Hg,左眼(11.0±2.3)mm Hg;POAG组右眼(16.3±3.7)mm Hg,左眼(16.2±3.3)mm Hg]、平均眼压[正常组右眼(13.4±2.5)mm Hg,左眼(13.4±2.5)mm Hg;POAG组右眼(19.9±4.3)mm Hg,左眼(19.8±3.8)mm Hg]及眼压波动值[正常组右眼(5.0±1.6)mm Hg,左眼(5.2±1.7)mm Hg;POAG组右眼(9.1±3.6)mm Hg,左眼(8.6±3.8)mm Hg]的差异均具有统计学意义(均P＜0.01),正常组59.6%,POAG组73.5%的峰值眼压位于门诊工作时间以外;尤其是在零点至早上6点这一时间段,正常组50%,POAG组64.7%的峰值位于凌晨0:00至06:00.结论 通过对比分析,24 h眼压可以为我们提供治疗前的基础状态,从而为个性化治疗提供详实的资料.建议有条件的话,应该将24 h昼夜眼压监测作为开角型青光眼的检查常规.

Abstract：

Objective To analyze the discipline of intraocular pressure (IOP) variation, through circadian intraocular pressure monitoring in primary open-angle glaucoma (POAG) patients and normal controls, with a view to provide basis for individualized treatment of glaucoma. Methods Subjects were enrolled from the outpatients of Shanghai Beizhan Hospital and Eye and ENT Hospital of Fudan University,which were diagnosed as primary open angle glaucoma, from April 2006 to April 2009. Totally there were 102 cases of patients and 83 cases of normal volunteers. All the subjects accepted 24-hour IOP measurements using non-contact tonometer every two hours starting from 8:00 am. And the IOP between O0:00 to 06:00 am was measured in sitting position immediately after wake up. Results The differences of peak IOP[ (16.0±2.7)mm Hg of right eye and ( 16.2±2.7)mm Hg of left eye in normal group; (25.3±5.6) mm Hg of right eye and (24.8±5.1) mm Hg of left eye in POAG group], valley IOP ( 11.1±2.5) mm Hg of right eye and (11.0±2.3) mm Hg of left eye in normal group; ( 16. 3 ±3.7) mm Hg of right eye and ( 16.2 ±3. 3 ) mm Hg of left eye in POAG group, average IOP (13.4±2.5) mm Hg of right eye and ( 13.4 ± 2.5)mm Hg of left eye in normal group; ( 19.9 ±4.3) mm Hg of right eye and ( 19. 8 ±3. 8) mm Hg of left eye in POAG group), and IOP fluctuations (5.0 ± 1.6) mm Hg of right eye and (5. 2 ± 1.7) mm Hg of left eye in normal group; (9.1 ±3.6) mm Hg of right eye and (8.6±3.8 ) mm Hg of left eye in POAG group between two groups were all of statistically significance (P ＜ 0. 01 ). Notably, the peak IOP of 59. 6% in normal control group and 73.5% in POAG group were outside working hours, especially in the time period from 00:00 to 06:00 am. The peak value of 50% in normal group and 64.7% in POAG group located between 00:00 to 06:00 in the morning. Conclusions By comparison and analysis, 24-hour intraocular pressure measurement could provide us pre-treatment basic state, so as to provide detailed information for individualized treatment. If possible, it is suggested that 24-hour IOP monitoring should be added as a routine examination of primary open angle glaucoma.     

后巩膜增强术对眼内压的影响

本病通过对２９例４８眼高度近视患者手术前后眼压、巩膜硬度、屈光度、视力的检查，分析施行后巩膜增强术对眼内压的影响，经观察患者术后大部分视功能获得改善，眼压得以降低，４８眼术后降低眼压达３０眼，占６２．５％，平均每眼术后比术前眼压降低０．３９９ｋＰａ，统计学处理差异有显著性（Ｐ＜０．０５），说明手术可以改善降低眼内压，同时亦说明高度近视患者多伴有低巩膜硬度及眼压偏高现象，因此，开展后巩膜增强术对防治高度近视有重要意义。     

Analysis of MYOC gene mutation in a Chinese glaucoma family with primary open-angle glaucoma and primary congenital glaucoma

Background Glaucoma is one of the leading causes of blindness in the world. Primary open-angle glaucoma （POAG） and primary congenital glaucoma （PCG） are subtypes of glaucoma. Myocillin is the first gene identified to be involved in POAG. Recently, myocillin mutation has been found in PCG. In this context, we reported a special glaucoma pedigree, which was composed of both PCG and POAG patients, and analyzed the mutation of myocillin in this pedigree. Methods The family was composed of the parents, a son and a daughter. All members of the family underwent the complete ophthalmologic examinations. All coding exons 1-3 and flanking introns of myocilin gene were screened for sequence alterations by polymerase chain reaction and direct DNA sequencing. Results The son was the proband, who was diagnosed as PCG in both eyes. The father was diagnosed as POAG in the right eye, the left eye was still normal. Both the sister and the mother of the proband had normal intraocular pressure without glaucomatous optic disc changes. The mutations in intron 2 of myocilin gene were detected in the family. While the proband and the father were homozygous, the mother and the sister were heterozygous for the mutation. Conclusions Homozygous mutation in intron 2 of myocilin gene is involved in both POAG and PCG. It is suggested that the pathogenesis might be overlapping in POAG and PCG.     

抗青光眼药物对眼表不良反应的评估与预防

 抗青光眼药物是治疗开角型青光眼（primary oper-angle glancoma,POAG）的一线药物。此类药物在降低眼压的同时会对眼表结构(泪膜、结膜、角膜)产生一定的不良反应。药物中所含的防腐剂(如氯化苯甲烃铵)可能是引起不良反应的原因。无防腐剂药物、维生素A棕榈酸酯眼用凝胶及多种新型药物制剂如纳米乳化剂、阳离子乳化剂及抗代谢药物等都可以在一定程度上预防此类不良反应的发生。     

尼莫地平对原发性开角型青光眼的疗效观察

目的 观察尼莫地平对原发性开角型青光眼的治疗效果.方法 原发性开角型青光眼患者22例(36眼),分为两组,两组患者的眼压均控制在18mmHg以下,其中一组予口服尼莫地平,治疗前后分别检测视力、眼压和视野(用视网膜平均光敏感度代表),采用t检验和x2检验比较两组之间的差异.结果 治疗6、12个月时,尼莫地平组的视网膜平均光敏感度分别为(16.48±3.05)dB和(16.05±2.47)dB,对照组分别为(12.36±2.64)dB和(10.49±2.58)dB,两组比较有显著性差异(t=4.43,6.54,P<0.01).治疗12个月时,尼莫地平组有2眼出现视野进行性损害,对照组有7眼出现视野进行性损害,两组比较有显著性差异(x2=5.40,P<0.05).治疗前后各时间段两组的眼压和视力无显著性差异.应用尼莫地平的患者未出现明显的药物不良反应.结论 尼莫地平可能有利于保护或改善青光眼患者的视野.     

糖尿病与高眼压及原发性开角型青光眼的相关性探讨

目的探讨糖尿病与高眼压及原发性开角型青光眼的相关性。方法回顾性分析我院2008年10月-2010年10月收治的120例眼科患者,其中正常眼压患者60例（对照组）、高眼压患者及原发性开角型青光眼患者60例（A组）;分别测定对照组、A组的空腹血糖、2h餐后血糖及糖化血红蛋白以诊断糖尿病的发生率,并进行调查分析。结果对照组的糖尿病发生率3.3%,A组糖尿病发生率13.3%,其发生率随患者年龄增长而增高,但与患者性别无关,A组与对照组比较差异有统计学意义（P〈0.01）。结论糖尿病与高眼压及原发性开角型青光眼有着密切的关系。