慢性青光眼的视诱发电位

对51例96只慢性青光眼和51例102只正常眼进行了视诱发电位试验,发现青光眼组的VEP波幅(amplitude)较正常组显著降低(P<0.001),青光眼的VEP潜伏期(Latency)和波幅与垂直杯盘比(C/D)的大小有关,显示VEP对慢性青光眼的早期诊断有一定价值。     

闭角青光眼眼阻抗式血流图的改变

报道了使用直接式血流图仪检查34例(54眼)正常人,55例(71眼)闭角青光眼病人及大于45岁单眼闭角青光眼对侧眼(26眼)的眼血流图结果。分析了眼压对眼血流图的影响及相关性。提示眼血流图检查可作为判断眼后部各组织供血情况的一客观依据。并发现正常限血流图波型可以出现转折波和平顶波。     

Biomechanical Glaucoma Factor and Corneal Hysteresis in Treated Primary Open-Angle Glaucoma and Their Associations With Visual Field Progression

PurposeTo investigate the relationship between biomechanical glaucoma factor (BGF) measured with Corvis ST and glaucomatous visual field (VF) progression, compared to corneal hysteresis (CH) measured with ocular response analyzer using a longitudinal dataset of primary open-angle glaucoma (POAG). The discriminative powers of BGF and CH were also compared using a cross-sectional dataset.MethodsThe longitudinal dataset included 166 POAG eyes. The rate of VF change during the follow-up period was evaluated using the mean of 52 pointwise total deviations in the Humphrey 24-2 field test. Variables associated with the VF progression rate were identified from BGF, CH, age, baseline VF severity, and intraocular pressure during the VF follow-up period by identifying the optimal model. The cross-sectional dataset included 68 POAG eyes and 68 healthy eyes. Using this dataset, the area under the curve (AUC) values of the receiver-operating curve were compared between CH and BGF.ResultsThe optimal multivariate linear mixed model to describe the VF rate included age and CH, but not BGF. Between POAG and healthy eyes, CH was statistically different (P < 0.001), although this was not the case with BGF. The AUC values were 0.61 and 0.71 for BGF and CH, respectively (P = 0.027).ConclusionsCH, but not BGF, was associated with VF progression in POAG patients under treatment. BGF was not useful to discriminate POAG between treated and normal eyes.     

Glaucoma in China

The motivation for this paper is that, having come from China, a country which had closed herself to the outside world for three decades, I thought it might be interesting to compare glaucoma in the two countries. Since I am from only a municipal hospital of a small city Hangzhow (a sister city of Boston), whatever I say can only be accepted as personal view points. Presently I have this wonderful opportunity to be a research fellow at the world wide famous Massachusetts Eye & Ear Infirmary, which is affiliated with Harvard Medical School. The comparison therefore may not be exactly appropriate but may help to see where my country stands, what we have, what we lack and what goals to strive for to better the health of China. There may be some confusing terms in this paper such as Liberation, Cultural Revolution, etc. Table 1 may help give a clearer conception.     

Phacotrabeculectomy in Treatment of Primary Angle-closure Glaucoma and Primary Open-angle Glaucoma

Purpose To evaluate the surgical outcome of combined phacoemulsification, posterior chamber intraocular lens implantation, and trabeculectomy (phacotrabeculectomy) in patients with primary angle-closure glaucoma (PACG) or primary open-angle glaucoma (POAG).Methods The records of 57 consecutive patients (65 eyes) with PACG or POAG that were treated with phacotrabeculectomy were reviewed retrospectively. There were 31 eyes with PACG and 34 with POAG. The mean follow-up period was 21.0 ± 8.3 months. The visual acuity, intraocular pressure (IOP), number of medications, and complications were evaluated.Results The mean IOP and the number of glaucoma medications decreased significantly after phacotrabeculectomy in both groups. The mean IOP reduction was significantly greater in eyes with PACG (P < 0.05). The absolute success rates were 87.1% and 70.6% in PACG and POAG, respectively. The difference in the success rates was not significant (P = 0.297). The early postoperative complication rates were similar in both groups.Conclusions Phacotrabeculectomy results in greater IOP reduction in eyes with PACG than in those with POAG, but the overall success rates were not significantly different. Jpn J Ophthalmol 2004;48:408–411 © Japanese Ophthalmological Society 2004     

A deep dive into the latest European Glaucoma Society and Asia-Pacific Glaucoma Society guidelines and their relevance to India

Glaucoma is the second leading cause of blindness in India. Despite advances in diagnosing and managing glaucoma, there is a lack of India-specific clinical guidelines on glaucoma. Ophthalmologists often refer to the European Glaucoma Society (EGS) and Asia-Pacific Glaucoma Society (APGS) guidelines. A group of glaucoma experts was convened to review the recently released EGS guideline (fifth edition) and the APGS guideline and explore their relevance to the Indian context. This review provides the salient features of EGS and APGS guidelines and their utility in Indian scenario. Glaucoma diagnosis should be based on visual acuity and refractive errors, slit-lamp examination, gonioscopy, tonometry, visual field (VF) testing, and clinical assessment of optic nerve head, retinal nerve fiber layer (RNFL), and macula. The intraocular pressure target must be individualized to the eye and revised at every visit. Prostaglandin analogues are the most effective medications and are recommended as the first choice in open-angle glaucoma (OAG). In patients with cataract and primary angle-closure glaucoma (PACG), phacoemulsification alone or combined phacoemulsification and glaucoma surgery are recommended. Trabeculectomy augmented with antifibrotic agents is recommended as the initial surgical treatment for OAG. Laser peripheral iridotomy and surgery in combination with medical treatment should be considered in high-risk individuals aged <50 years. In patients with phakic and PACG, phacoemulsification alone or combined phacoemulsification and glaucoma surgery are recommended. Visual acuity, VF testing, clinical assessment of the optic disc and RNFL, and tonometry are strongly recommended for monitoring glaucoma progression.     

Prevalence of Glaucoma in the Wroclaw Population. The Wroclaw Epidemiological Study

Purpose: Primarily to determine the prevalence of various types of glaucoma and ocular hypertension in Wroclaw inhabitants aged 40–79 years. The second aim of the study was to determine the number of undiagnosed glaucoma cases in this population. Methods: A representative group of the Wroclaw population (4853 people aged from 40 to 79 years) was recruited by a proportional simple random sampling selection with stratification. All participants underwent the first, screening-stage examination, which included a medical history interview, intraocular pressure (IOP) measurement, anterior chamber depth assessment by the Van Herrick technique, and optic nerve head (ONH) assessment by means of indirect ophthalmoscopy (Volk's lens), confocal scanning laser ophthalmoscopy with a Heidelberg Retinal Tomograph (HRT) and scanning laser polarimetry by the GDx Nerve Fiber Analyzer (GDx). The second stage, in glaucoma-suspect patients only, included best corrected visual acuity, static perimetry, 24-hour monitoring of IOP, gonioscopy, and full eye examination with mydriasis. Glaucoma was diagnosed by the presence of any two of the following: characteristic morphological changes in the optic disc, glaucomatous visual field abnormalities, and intraocular pressure greater than 21 mmHg. Results: The overall prevalence of glaucoma was 1.6% (79 subjects). The prevalence increased with age from 0.4% in subjects belonging to the age group 40–49 years to 4.6% in people aged between 70 and 79 years. The prevalence of definite primary open-angle glaucoma was 1.0% (49 subjects). Normal-pressure glaucoma was diagnosed in 13 subjects (0.3%). Ocular hypertension was diagnosed in 92 subjects (1.9%). Conclusion: The prevalence of the different types of glaucoma was similar to that found in other white populations. Among the subjects examined, 79 had various forms of glaucoma and 71% of them had not previously been diagnosed. Undiagnosed glaucoma is a serious public health problem in Poland.     

小瓣小梁切除术治疗青光眼

目的探讨小瓣小梁切除术治疗青光眼的方法及效果.方法治疗组各型青光眼40例40眼,行小瓣小梁切除术,巩膜瓣2 mm×2 mm,小梁切除1 mm×1 mm.对照组各型青光眼40例40眼,行复合式小梁切除术,巩膜瓣4 mm×3 mm,小梁切除1.0mm×3.0 mm.观察术后眼压及浅前房等并发症,并进行比较.结果治疗组术前眼压44.11±14.86 mmHg(1 mmHg=0.133 kPa),对照组术前眼压为46.45±11.27.随访12～18月,术后最后随访眼压治疗组为12.94±4.13 mmHg,对照组为13.51±3.56mmHg,两组差异无显著意义(t=0.66,P＞0.05).浅前房发生率治疗组为16%(6/40),对照组2.6%(1/40),两组差异无显著意义(X2=1.59＜3.84,P＞0.05).结论小瓣小梁切除术是一种安全、有效的抗青光眼滤过手术.眼科学报2001;17239～240.     

Glaucoma in Retinoblastoma

The association between retinoblastoma and secondary glaucoma is well known. The most common cause of secondary glaucoma in retinoblastoma is iris neovascularization (NVI) followed by pupillary block and tumor seeding of the anterior chamber. Although glaucoma is a secondary clinical issue in retinoblastoma (RB) management and care, awareness of its presence, revealed by a thorough ocular exam of the anterior segment, can guide the clinician in assessing the overall condition of the affected eye.     

Complications of Uveitis: The Northern California Epidemiology of Uveitis Study

Purpose: To describe the uveitis complications in a large, community-based cohort.

Methods: Retrospective, community-based, cross-sectional cohort study analyzing complications and associations with complications.

Results: A total of 844 cases of uveitis were found; 342 were new-onset, and 462 were prior-onset. In total, 29.5% of patients were affected by one or more complications associated with age, gender, course, and anatomic location of uveitis. Visual loss was experienced by 19.1% of patients and was associated with age, course of disease, and anatomic location of uveitis. Of the patients who developed glaucoma or elevated intraocular pressure over 30 mmHg, 3.9% (n = 33) were related solely to uveitis; 5.2% (n = 44) had an unclear or combined mechanism; and 1.8% (n = 15) were related solely to steroid response. Cystoid macular edema was associated with course of disease and anatomic location of uveitis.

Conclusions: Complications affect a significant portion of uveitis patients, and are often associated with demographic and clinical factors.     

青光眼阀植入物治疗难治性青光眼

目的观察Ahmed青光眼引流植入物治疗难治性青光眼的疗效.方法采用Ahmed青光眼引流植入物,共治疗28例(29只眼)难治性青光眼,其中新生血管性青光眼10例(10只眼),青少年型青光眼5例(6只眼),其它青光眼13例(13只眼).结果术后随访3～12个月,新生血管性青光眼的眼压由术前40.9±7.32 mmHg降至20.63±2.75 mmHg(1mmHg=0.133kPa);人工晶体联合玻璃体手术后青光眼的眼压由术前41±5.66mmHg降至术后18.00±2.12 mmHg;青少年型青光眼的眼压由术前33.65±5.28 mmHg降至术后16.45±1.48 mmHg;常规滤过性手术失败的青光眼的眼压由术前31.43±4.13 mmHg降至18.13±1.25 mmHg.术后常见并发症有浅前房、前房积血、前葡萄膜炎等.结论Ahmed青光眼引流植入物是治疗难治性青光眼的一种较为有效的降眼压方法.眼科学报2000;16259～261.     

福建地区真菌性角膜炎的流行病学研究

目的:研究福建地区真菌性角膜炎的流行病学特征。方法:回顾性分析2006-07/2008-07住院确诊的真菌性角膜炎患者176例176眼,分析其发病高峰、人群特征、发病诱因、病原学特征。结果:每年10～12月份发病率最高,农村居民106例(60.2%),男女患病率比为1.5∶1,41～60岁为发病集中年龄,仅70例(39.8%)有明确外伤史,菌属鉴定结果:前两位病原菌为镰刀菌属(60.4%)和曲霉菌属(25.4%)。结论:福建地区真菌性角膜炎在10～12月份为高发季节,多发于中老年的农村居民,多数无明显诱因发病,致病菌属以镰刀菌属和曲霉菌属为主。     

Glaucoma Disparities in the Hispanic Population

ABSTRACT

The Hispanic population is the United States’ largest minority and one of the fastest growing as well. In the next 30 to 40 years, the proportion of open-angle glaucoma patients represented by Hispanics is expected to dramatically rise. Here we examine the unique considerations and challenges of glaucoma care in this population, from demographics to risk factors to treatments and outcomes. Currently, access to care and the under-diagnosis of glaucoma in this population are significant issues that look only to grow in significance as the glaucoma burden continues to grow. Additionally, utilization of medical and surgical therapy remains lower in Hispanics than in many other ethnic groups. Understanding and proactively addressing the unique challenges in the screening and treatment of Hispanics will be of utmost importance to providing effective care to this population.     

Epidemiology of myopia

Myopia is one of the most prevalent disorders of the eye. Higher myopia is associated with comorbidities that increase risks of severe and irreversible loss of vision, such as retinal detachment, subretinal neovascularization, dense cataract, and glaucoma. In recent years, reports from population-based prevalence studies carried out in various geographical areas now give a clear picture of the current distribution of refractive error. The scarcity of data from well-designed longitudinal cohort studies is still yet to be addressed. These studies have confirmed the previous data indicating that prevalence of refractive error varies according to ethnicity and geographic regions, and also point to an increase in myopia prevalence over the past half-century. The problem is particularly pronounced in affluent, industrialised areas of East Asia. Environmental risk factors for myopia related to socioeconomic status and lifestyle have been identified. The past decade has seen a greater understanding of the molecular biological mechanisms that determine refractive error, giving further support to the belief that myopia is the result of a complex interaction between genetic predisposition and environmental exposures. This review summarizes data on the prevalence, incidence, progression, associations, risk factors, and impact from recent epidemiological studies on myopia.     

Prevalence of Primary Glaucoma as Diagnosed by Study Optometrists of L. V. Prasad eye Institute – Glaucoma Epidemiology and Molecular Genetics Study

Purpose: To report the prevalence of primary glaucoma as identified by study optometrists of the L. V. Prasad Eye Institute – Glaucoma Epidemiology and Molecular Genetics Study (LVPEI-GLEAMS).

Methods: Two study optometrists and a total number of 3833 individuals participated in the LVPEI-GLEAMS. All subjects underwent a complete medical history and comprehensive eye examination including slit lamp photography, imaging of anterior and posterior segment, frequency doubling technology and standard automated perimetry including gonioscopy with a Sussman 4 mirror goniolens, post dilated evaluation of the optic disc and fundus was done with a 90 D lens by the study optometrist. A diagnosis of primary open angle glaucoma (POAG), primary angle closure suspect (PACS), primary angle closure (PAC), primary angle closure glaucoma (PACG), normal tension glaucoma (NTG), glaucoma/disc suspect or no glaucoma was made based on the clinical examination.

Results: Estimated prevalence of OAG (POAG and NTG) was 1.07% (0.74–1.39), PACS 2.03% (1.58–2.48), PAC 1.77% (1.35–2.19), PACG 0.21% (0.06–0.35) as identified by the study optometrists on site.

Conclusions: Prevalence of all the categories of primary glaucoma, as reported by the study optometrists of LVPEI-GLEAMS was comparable to previous findings of other regions in South India.     

Recent Advances in the Management of Neovascular Glaucoma

ABSTRACT

The development of anti-vascular endothelial growth factor (VEGF) molecules has expanded the range of available treatment options for many ocular diseases, including neovascular glaucoma (NVG). A number of studies have explored the use of anti-VEGF agents as stand-alone or adjunctive treatment for NVG. Although no large, prospective, randomized trials have been performed to date, the growing body of knowledge suggests that anti-VEGF agents are effective at reversing iris and angle neovascularization and lowering intraocular pressure in patients with NVG. Response to a single injection is typically temporary; therefore, laser or incisional surgery is still necessary in most cases. Future research is needed to determine the optimal agent, dose, route of administration, and timing of treatment either as monotherapy or coupled with other medical and/or surgical interventions.     

亚在地区青光眼的流行病学

Primary open angle glaucoma is the second most important cause of permanent blindness in the Asia-Pacific region. Thus it is very important to identify epidemiological and other risk factors which are associated with open angle glaucoma. The risk for glaucoma optic nerve damage increases with the age and with the level of the intraocular pressure. In this paper, I will highlight our study of several risk factors for development of the open angle glaucoma like (1) elevated intraocular pressure, (2) myopia, (3) suspicious large optic disc cup, (4) cupping with disc haemorrhages and (5) nerve fibre defect. The general and systemic conditions which are implicated as risk factors are (1) family history of glaucoma. (2) increase in age, (3) diabetes mellitus, (4) cardiovascular conditions like central retinal vein occlusion etc. (5) the endocrine disorders with increased thyroid and increased corticosteroids responsiveness in patients with glaucoma will be discussed.     

我国原发性青光眼流行病学研究进展

青光眼是不可逆盲的主要病因。随着社会、经济、环境的变化以及诊疗手段的进步,青光眼的流行病学特点也在不断的变化。由于不同的青光眼诊断标准和分类系统可以导致不同的流行病学调查结果,而流行病学的特征又指导着临床的干预措施。因此青光眼流行病学状况对青光眼的防治有着重要的意义。本文就我国原发性青光眼流行病学相关研究进展作一综述。     

Rationale, methods and baseline demographics of the Bhaktapur Glaucoma Study

Background: To describe the methodology and baseline data of a population‐based study designed to determine the prevalence of glaucoma and to study the risk factors for glaucoma development in a Nepali population. Design: Population‐based cross‐sectional study Participants: Subjects 40 years and above residing in Bhaktapur District. Patients and Methods: Power calculations suggest that a sample size of 4758 is required. Thirty clusters were randomly selected from the 2 municipalities and 16 Village Development Committees of Bhaktapur District in Nepal. A door‐to‐door census was conducted in the selected clusters to identify citizens 40 years of age and older. Demographic details were collected and a structured interview, regarding awareness for cataract and glaucoma was taken. All individuals fulfilling the eligibility criteria were recruited and referred to the Tilganga Institute of Ophthalmology in Kathmandu for a detailed clinical examination including glaucoma diagnostic procedures. Peripheral blood samples were taken to facilitate future genetic analysis. Main Outcome Measures: Prevalence of glaucoma, risk factors and genetic screening. Results: A total of 4800 people were selected. The mean age of participants was 55.4 ± 12.3 years (range: 40–99) and 51.8% were female. In total, 64.8% of our cohort was aged less than 59 years and 60.5% were illiterate. Among the various ethnic races, 69.7% belonged to the Newar ethnic group. Conclusion: This study will determine the prevalence of glaucoma and allow for an increased understanding of the risk factors for glaucoma development in this region.     

前房注气对青光眼术后前房形成的影响

１００例青光眼病人，随机分成实验和对照组，实验组在滤过术毕行前房注气，观察两组病人滤过术后前房形成情况。认为前房注气可、维持一定的眼内压防止和防止虹膜晶体膈前移、防止脉络脱离发生；前房注气促使前房形成、抑制房水水分泌，减少房水滤出，利于结膜瓣愈合，减少了滤过口漏的发生。认为此方法简单、完全、可靠，是有效地防止滤过术后前房延缓形成的方法。