剥脱综合征性青光眼的发病机制

剥脱综合征是一种常见的年龄相关性眼病,是导致青光眼的常见原因.剥脱综合征性青光眼较慢性单纯性青光眼更严重、预后更差.在此文中对近年来,剥脱综合征性青光眼发病机制的有关论著作一综述.     

假性囊膜剥脱综合征发病机制研究进展

假性囊膜剥脱综合征（PEX）是一种以纤维状剥脱物广泛沉积于眼部及全身其他组织为特征的年龄相关性疾病,在发病过程中可加速白内障的进展,部分患者可继发青光眼。目前研究表明,PEX的发病与基底膜损伤、自身免疫功能紊乱以及遗传因素相关,但确切的发生机制至今尚未明确。就PEX的组织病理学特点及发病机制的研究进展进行综述,以期有助于PEX的预防与治疗。     

剥脱性青光眼患者视网膜神经纤维层厚度变化分析

目的：比较维吾尔族假性剥脱综合征(PEX)患者、剥脱性青光眼(PEXG)患者视网膜神经纤维层(RNFL)厚度,为早期诊断剥脱性青光眼提供理论依据。

方法：回顾性病例对照研究。选取2018-04/ 2020-06在我院就诊治疗的维吾尔族假性剥脱综合征患者70例70 眼,剥脱性青光眼患者 80例80 眼,按照视野缺损分期分为早中期剥脱性青光眼患者56眼、晚期剥脱性青光眼患者24眼,选取同期本院收治的维吾尔族年龄相关性白内障病例60例60 眼作为对照组。比较四组患者视盘不同位置RNFL厚度。

结果：对照组、假性剥脱综合征组及剥脱性青光眼组患者视野缺损(MD)逐渐加重且剥脱性青光眼组患者MD显著高于假性剥脱综合征组(P<0.01); 假性剥脱综合征组、早中期剥脱性青光眼组及晚期剥脱性青光眼组视盘不同位置RNFL厚度较对照组均变薄(均P<0.01); 假性剥脱综合征组患者视盘平均RNFL、下方、上方RNFL厚度均低于对照组(均P<0.01)); 晚期剥脱性青光眼组患者视盘各个位置RNFL厚度明显低于早中期剥脱性青光眼患者(均P<0.01)。

结论：维吾尔族假性剥脱综合征患者早期RNFL厚度较未患有剥脱综合征人群开始变薄,早期对于假性剥脱综合征患者RNFL进行检测有助于剥脱性青光眼疾病诊断并进行治疗。     

原发性开角型青光眼发病机制的研究进展

原发性开角型青光眼作为全球第二大致盲性眼病,其发病机制的研究一直备受关注。本文对传统的机械学说和血管学说,以及近年来发展的跨筛板压力学说、基因研究、免疫机制、线粒体动力学等研究结果和各种危险因素进行综述,为眼科工作者提供参考资料。     

剥脱综合征性青光眼临床分析

目的:探讨剥脱综合征性青光眼(peseudo exfoliation glaucoma,PEG)的临床表现及其特点,寻求有效的治疗途径。方法:对13例17眼剥脱综合征性青光眼患者的临床资料进行分析。结果:药物控制眼压理想3眼,行小梁切除术后眼压正常但视力降至光感1眼,小梁切除术后眼压视功能良好者4眼,白内障超声乳化术后眼压下降明显7眼,白内障超声乳化摘除联合小梁切除术2眼,其中1眼术后并发睫状环阻滞性青光眼,1眼眼压虽明显下降,但视力降至光感。结论:剥脱综合征青光眼是一种房水流出阻力增加的高眼压性开角型青光眼,其临床表现较为复杂。提高对本病的认识,能够选择正确治疗方法,减少手术并发症,最大程度减少视功能的进一步损害。     

剥脱性青光眼2例

剥脱性青光眼是剥脱综合征继发的一类青光眼,临床上少见。本文报告2例患者,患眼瞳孔缘可见灰白色碎屑样物质沉积,散大瞳孔后可见晶状体前囊周边部混浊带,房角镜下可见Sampaolesi线。认识其临床特征,将有助于提高其诊治率。     

剥脱性青光眼的研究进展

剥脱性青光眼是继发于剥脱综合征的一种青光眼类型,剥脱综合征目前是继发性开角型青光眼最常见的原因之一。近年来,剥脱综合征和剥脱性青光眼受到越来越多的研究者关注,开展了大量的相关性研究,获得了较多的研究资料。因此,有必要就剥脱性青光眼的患病率、遗传特性、剥脱物质的形成机制、基因和治疗研究进展进行综述。     

剥脱综合征与青光眼

剥脱综合征是一种以纤维样细胞外物质在眼球组织及全身多种器官组织中产生与沉积为特征的年龄相关性疾病。本文就该病的流行病学、临床表现、发病机制及其与青光眼的关系予以综述。     

假性剥脱性青光眼的生物标志物研究进展

假性剥脱性青光眼(PEXG)是一种严重危害视力的眼部疾病,较原发性开角型青光眼(POAG)更具侵袭性,对视神经的损害更严重,预后更差,且对治疗有较高的耐药性。早期诊断PEXG有助于及时治疗,并延缓疾病进展,因此确定适当的生物标志物至关重要。近几年来,越来越多的人开始研究PEXG的生物标志物,希望通过基因组学、转录组学、蛋白组学、代谢组学以及脂质组学标志物的研究,了解该病的发病机制,寻找PEXG潜在的早期诊断和治疗靶点,对该疾病提供一定帮助。本文将对近几年PEXG的生物标志物研究进展进行阐述,其中一些生物标志物可能在未来对PEXG的早期诊断提供新思路。     

剥脱综合征与青光眼

患者男性，76岁，左眼视力差6年，于2002年6月11日来我院就诊，在外院诊断为“左眼视神经萎缩”，无其它眼部及垒身病史。眼科检查：视力：右眼0．6，左眼光感，眼压日曲线(Schioetz)；右眼18～23mmHg(23.38，22．38，18．86，20．55mmHg，平均21．20mmHg)，左眼37～54mmHg(54．66，45．12，40．18，37．19mmHg，平均44．29mmHg)。双角膜透明，周边前房深度为1／4CT。右眼虹膜色素正常,瞳孔直径约3mm，对光反应存在，散瞳后晶状体前囊表面中央见盘状灰白色物质；左眼虹膜基质硫松，瞳孔直径约6mm，对光反应迟钝，瞳孔缘可见头屑状灰白色物质，晶状体表面见灰白色混浊物。     

Vascular risk factors in glaucoma: the results of a national survey

Background The role of vascular risk factors in glaucoma is still being debated. To assess the importance of vascular risk factors in patients with primary open-angle glaucoma (POAG), data from the medical history of 2,879 POAG patients and 973 age-matched controls were collected and analyzed. Methods Design: observational survey. Setting: 35 Italian academic centers. Study population: POAG patients and age-matched controls. In order to reduce bias consecutive patients were included. Observation procedures: data concerning vascular risk factors were collected for all patients with a detailed questionnaire. A complete ophthalmological examination with assessment of intraocular pressure (IOP), visual field, optic disc, and systemic blood pressure was performed. Main outcome measures: the ESH-ESC (European Society of Hypertension-European Society of Cardiology) guidelines were used to calculate the level of cardiovascular risk. Crude and adjusted estimates of the odds ratios (OR) were calculated for all cardiovascular risk factors in POAG and controls. Results The study included 2,879 POAG patients and 973 controls. POAG cases had a significantly higher systolic and diastolic blood pressure (p = 0.001) and systolic perfusion pressure (p = 0.02) as compared with controls. Also mean IOP was significantly higher in the POAG group (p = 0.01), while diastolic perfusion pressure was not significantly different in the two groups. Myopia was more prevalent in the POAG group (23 vs 18%, p = 0.005) as well as a positive family history for glaucoma (26 vs 12%, p = 0.004). POAG patients tended to have a higher cardiovascular risk than controls: 63% of glaucoma cases vs 55% of controls (OR: 1.38, p = 0.005) had a “high” or “very high” cardiovascular risk. Conclusions The level of cardiovascular risk was significantly higher in glaucoma patients than in controls. The study was supported by an unrestricted grant from MSD. No proprietary interest.     

原发性开角型青光眼进展的危险因素研究概况

原发性开角型青光眼(POAG)进展的危险因素包括全身性及眼部因素,眼部因素包括眼压及非眼压因素.在以往的多中心研究中,眼压对于由高眼压症发展为POAG及其在POAG进展中的作用已经明确,而目前降低眼压也是临床惟一有效地延缓、控制青光眼视神经损害进展的主要因素.制定目标眼压,进行降眼压治疗尤其是控制昼夜眼压波动对于阻止青光眼进展非常重要.非眼压危险因素包括高龄、中央角膜厚度增厚、视乳头出血、晶状体囊膜剥脱征、初始的青光眼严重程度及双眼罹患青光眼等.其他因素包括近视、青光眼家族史、眼部低灌注压、低血压、心血管疾病、高血压、高血脂等血管或血液性因素.POAG进展的危险因素研究在一定程度上揭示了POAG的发病机制及临床发病规律,对于指导临床医师决定随诊频率、选择治疗方案及提高治疗效率意义重大.     

Combined true and pseudoexfoliation in a Saudi patient with co-existing cataract and glaucoma

True exfoliation and pseudoexfoliation of the anterior lens capsule are different conditions, their coexistence is rare. We report a case with clinical findings of unilateral combined true exfoliation and pseudoexfoliation in a Saudi Bedouin that was confirmed histologically. We suggest that high levels of infrared radiation in the desert may have contributed to the capsular delamination.     

Retrobulbar hemodynamic parameters in pseudoexfoliation syndrome and pseudoexfoliative glaucoma

OBJECTIVE: To compare the hemodynamic parameters in the retrobulbar vessels in pseudoexfoliative syndrome (PXS), pseudoexfoliative glaucoma (PXG), and age-matched healthy subjects by using color Doppler imaging (CDI). SUBJECTS AND METHODS: 72 eyes from 72 patients with PXS, 70 eyes from 70 patients with PXG, and 66 eyes from 66 age-matched healthy subjects who met the inclusion/exclusion criteria were included in this prospective cross-sectional study. Peak systolic velocity (PSV), end-diastolic velocity (EDV), and Pourcelot resistance index (RI) were assessed in the ophthalmic artery (OA), central retinal artery (CRA), and temporal short-posterior ciliary arteries (SPCA). Visual function was assessed using the 24-2 Swedish Interactive Threshold Algorithm (SITA). The main outcomes of the study were PSV, EDV and RI in the OA, SPCA, and CRA. RESULTS: The EDV in the OA, SPCA and the CRA was decreased significantly (p < 0.001, <0.001, and 0.003 respectively) in the eyes of PXG patients compared with controls and PSX respectively. The RI in the OA, SPCA, and the CRA was significantly higher (p = 0.022, 0.005, and 0.007 respectively) in the eyes of PXG patients compared with healthy controls and PSX patients respectively. The mean difference in mean EDV in the OA between the control group and the PXS was 0.18 cm/s, 95% confidence interval (CI) -0.60 to 0.95, p = 0.661. The mean difference in mean EDV in the SPCA between the control healthy subjects and the pseudoexfoliative subjects was -0.18 cm/s, 95% CI -0.45 to 0.08, p = 0.176. Multivariate regression analysis showed that in the PXG patients the PSV and EDV in the CRA were significantly positively correlated with the mean defect (p = 0.006 and 0.002 respectively). The RI in the CRA was significantly negatively correlated with the mean defect in PXG patients, p = 0.009. CONCLUSION: The results of this study showed that the retrobulbar hemodynamics might be disturbed in patients with PXG, especially in the central retinal artery. Our results have found no significant differences in the retrobulbar hemodynamic parameters between pseudoexfoliative syndrome patients and age-matched healthy subjects.     

蠕形螨睑缘炎的危险因素及发病机制研究进展北大核心CSCD

Demodex is a common small parasite in the human body, with a body length of about 150-350 μm and mainly found in human sebaceous glands and skin hair follicles. In recent years, numerous studies in dermatology and ophthalmology have shown that Demodex is related to the occurrence and development of rosacea, blepharitis and other diseases. Demodex blepharitis has become one of the clinical concerns. Demodex blepharitis is an inflammation in the skin of the eyelid margin caused by Demodex infection. In severe cases, cornea and conjunctiva can be involved, and vision can be affected. Demodex blepharitis is a widespread and easily overlooked disease. Up to 90% of patients with blepharitis are infected with Demodex, and the main pathogenic diagnostic methods are light microscopy and in vivo confocal microscopy. At present, the treatment of Demodex blepharitis is mainly to remove mites by metronidazole and tea tree oil etc. Its risk factors and pathogenesis are not fully understood yet. This article mainly summarized and analyzed the research progress on the risk factors for Demodex blepharitis and its possible pathogenesis at home and abroad in order to provide references for further research and clinical treatment. © 2023 Henan Institute of Ophthalmology. All rights reserved.     

The pathogenesis of glaucoma in Sturge-Weber syndrome

What is the cause of glaucoma in Sturge-Weber syndrome? Looking for the answer to this puzzling question, we examined 21 patients with the disease. Sixteen patients had gglaucoma: three bilateral and 13 unilateral. Episcleral hemangiomas were visible in all glaucomatous eyes. In general, the more extensive the hemangioma, the more severe was the glaucoma. During gonioscopy, blood could easily be made to reflux into Schlemm's canal of glaucomatous eyes. Often the canal separated into multiple fine channels. Episcleral venous pressure, which we measured in 11 patients, was high in all glaucomatous eyes. These observations suggest that glaucoma in Sturge-Weber syndrome is caused by elevated episcleral venous pressure. Most likely, veins draining aqueous from the canal of Schlemm are part of an intrascleral or episcleral hemangioma. The canal of Schlemm itself may be part of the hemangioma. Arteriovenous shunts in the hemangioma raise episcleral venous pressure, which in turn elevates intraocular pressure.     

剥脱综合征与青光眼

目的分析13例20只剥脱综合征眼的青光眼发生情况及其临床特点和治疗效果。方法回顾总结了13例20只剥脱综合征眼的青光眼发生率及其临床特点、治疗方法及疗效。结果13例20只剥脱综合征眼中合并青光眼10例13只，占65％，全部为开角型。眼压15．5～43．38mmHg．平均26．13mmHg。眼底视盘C／D0．3～1．0，其中≥0．6者8眼，占40％，0．8～1．0者6只眼，占30％。4只眼行单纯超声乳化白内障摘除术后眼压下降。1眼行小梁切除术，术后眼压控制良好。2眼曾行小梁切除术，但术后眼压仍高，视神经进行性损害最终失明。1眼白内障术后眼压仍高，需应用药物。结论剥脱综合征具有较高的青光眼发生率，其眼压难于控制、视野进行性损害迅速、对药物治疗反应差，应及早手术干预。对于处在较早期、较轻微的、视神经尚未严重损害者，单纯超声乳化白内障手术有效，对于已发生严重视神经损害者须行青光眼手术。     

原发性闭角型青光眼相关因素的病例对照研究

目的 探讨原发性闭角型青光眼(PACG)的危险因素.方法 采用1:1配对病例对照研究设计.收集2004年2月至2005年6月在南通大学附属医院眼科诊治的192例原发性闭角型青光眼患者,以年龄、性别作为匹配条件,选择有其他眼部疾患的192例患者作为对照组,通过χ2检验比较PACG病例组与对照组在人群特征、生活行为习惯、既往病史、青光眼家族史及眼底、屈光、眼压、A超等方面的差异.结果 单因素分析提示,居住农村(OR=2.40,P=0.000)、高文化程度(OR=0.21,P=0.000)、高经济收入(OR=0.34,P=0.000)、高血压(OR=3.05,P=0.000)、青光眼阳性家族史(OR=5.59,P=0.001)、浅前房(OR=11.25,P:0.000)、大杯盘比(OR:8.81,P=0.000)、近视眼(OR=0.31,P=0.000)、近距离看电视(OR=0.47,P=0.001)是PACG的独立相关冈素.多因素条件Logistic回归分析显示,高血压(DR=2.004,P=0.009)、青光眼家族史(OR=6.726,P=0.003)、远视眼(OR=3.192,P=0.031)、浅前房(OR=12.804,P=0.000)、大杯盘比(OR=9.401,P=0.007)等因素与PACG存在关联性.未发现吸烟、饮酒、近视眼、糖尿病、血型等因素与PACG存在统计学关联.结论 高血压可能与PACG存在关联性,眼科医师应定期随访具有青光眼家族史、浅前房及大杯盘比等特征的青光眼高危人群.     

原发性青光眼晚期患者视野缺损的相关因素分析

目的探讨原发性青光眼晚期患者视野缺损的相关因素。方法回顾性病例对照研究。收集2014年1月至2019年12月在复旦大学附属眼耳鼻喉科医院眼科诊治的仅残留中心管状视野≤10°或颞侧视岛(生理盲点颞侧)的原发性青光眼晚期患者, 并按视野缺损类型分为管状视野组(对照)和颞侧视岛组。分析年龄、性别、眼别、青光眼类型、初诊青光眼分期、随访眼压、手术次数、疾病史等临床特征与晚期视野缺损类型的关系, 单因素分析采用χ2检验或独立样本t检验, 多因素分析采用logistic回归分析法。结果共纳入287例(287只眼)患者, 其中管状视野组101例, 男性48例, 女性53例, 年龄(61±15)岁;颞侧视岛组186例, 男性107例, 女性79例, 年龄(59±17)岁;两组间年龄、性别、眼别、初诊年龄、手术次数、青光眼家族史、合并全身疾病史等因素差异均无统计学意义(均P>0.05)。原发性开角型青光眼、慢性原发性闭角型青光眼(CPACG)、急性原发性闭角型青光眼在管状视野组分别有26、34、41例, 在颞侧视岛组分别有61、78、47例;初诊青光眼分期为中期、晚期者在管状视野组分别有30、71...