青光眼住院病人流行病学调查--疾病构成及其变化特点

目的：了解青光眼住院病人的病型构成、性别、年龄分布及其变化特点，尤其是原发性青光眼内部构成的变化，为制定青光眼防治的新策略提供依据。方法：对眼科1978年1月～1981年12月以及2001年1月～2002年12月所有青光眼住院病人进行统计分析。结果：原发性青光眼患者占所有青光眼住院病人的81．35％。原发性开角型青光眼(plqmary open angle glaucoma，POAG)在原发性青光眼的比例于1978．1～1981．12为11．3％，2001．1～2002．12为23．9％。经检验POAG构成比增大有统计学意义。先天性青光眼(Congenital Glaucoma，CG)和继发性青光眼(Secondary Glaucoma，SG)分别占整个青光眼住院病人的5．05％和13．59％．其构成比均无显著性变化。PACG中位数年龄在1978．1～1981．12为54岁，在2001．1～2002．12为63岁；POAG则分别为47．5及47岁。女性患者在PACG与POAG分别占64．8％与25．8％。结论：原发性青光眼在青光眼住院病人中占绝大多数，其中原发性闭角型青光眼(Primary angle closure glaucoma，PACG)仍占主要部分，但POAG的构成有增多的趋势，分析可能有诊断，屈光不正，全身情况，环境，遗传以及社会因素等方面的原因。     

穿刺巩膜隧道植入Ahmed青光眼阀治疗难治性青光眼的疗效

目的:观察用23G针头直接穿刺制作巩膜隧道的方式植入Ahmed青光眼阀(Ahmed glaucoma valve,AGV)治疗难治性青光眼的临床疗效及并发症。方法:观察44例44眼难治性青光眼患者,应用23G针头直接穿刺制作巩膜隧道,行青光眼阀植入术进行治疗。观察患者术后眼压、视力、并发症,并与术前进行对比。结果:本组患者成功率84.1%。术前眼压:52.1±10.1mm Hg,最后一次随访眼压15.6±6.9mm Hg。视力提高者11眼,视力无改变者27眼,视力降低者6眼。并发症包括:浅前房4例,脉络膜脱离3例,引流管移位1例,前房积血6例,引流管阻塞1例,脉络膜驱逐性出血1例,引流盘包裹5例。结论:直接穿刺巩膜隧道的方法植入青光眼阀,手术操作简单可行,避免了制瓣及异体巩膜移植,并简化了手术操作,防止术后房水管周渗漏,术后浅前房发生率低,为切实可行的手术方法。     

难治性青光眼治疗的研究进展

难治性青光眼(Intractable Glaucoma)系指常规的滤过手术成功率低,手术预后较差的青光眼,又称为"顽固性青光眼"或"复杂性青光眼",包括新生血管性青光眼、多次滤过手术失败者、复杂眼外伤后青光眼、无晶体性或人工晶体性青光眼、视网     

色素性青光眼和囊性青光眼：临床和组织病理学报告

本文报告色素性青光眼7例(13眼),囊性青光眼9例(12眼)。眼前段色素播散和剥脱物质沉着分别是色素性青光眼和囊性青光眼的特征性改变,而囊性青光眼也可见非典型眼前段色素播散。小梁标本的组织病理学研究表明色素性青光眼中色素颗粒,囊性青光眼中剥脱物质和色素颗粒在阻塞房水排出通道中起重要作用。本文还讨论了这二型青光眼的诊断和鉴别诊断。     

原发性开角型青光眼

原发性开角型青光眼李美玉青光眼是由于眼压升高引起的视乳头损害和视野缺损的一种眼病。个体眼球对眼压的耐受力不同，有些眼球眼压高于２．８ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）可产生视乳头和视野损害，形成真正的青光眼；有些眼压虽高出正常值，却不产生视乳头和视野...     

恶性青光眼的临床新观点

恶性青光眼或称睫状环阻滞性青光眼，是一种比较难治的眼疾，若处理不当可造成严重的后果。在1995年里我院共收治了24例恶性青光眼病人，在保守治疗无效时，采取不同的手术方式进行治疗并取得了成功。现对其具体分析，并就其发病机理提出一些新的见解。1对象与方法1．1对象病人     

Ahmed青光眼阀植入术治疗难治性青光眼

目的评价Ａｈｍｅｄ青光眼阀植入术治疗难治性青光眼的近期和中期疗效，探讨术中、术后并发症及预防。方法对２０例难治性青光眼施行颞上象限前房到赤道部区域的Ａｈｍｅｄ青光眼阀植入术。其中新生血管性青光眼９例，无晶体或人工晶体植入术后青光眼７例，先天性青光眼３例，原发性慢性闭角型青光眼１例。结果术后１个月，眼压≤２．８ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）者１５例，总成功率为７５．０％；其中新生血管性青光眼成功率为５５．６％，其它类型青光眼成功率为９０．９％。８５．０％的患者视力提高或不变；随访６个月以上者１２例，总成功率为５８．３％；其中新生血管性青光眼成功率为４０．０％，而其它类型青光眼成功率为７１．４％。并发症包括短暂性前房出血，术后早期低眼压，引流管内、外口阻塞，引流管接触晶体或角膜，引流管外露，渗出性脉络膜脱离，植入盘脱出。结论尽管Ａｈｍｅｄ青光眼阀植入术存在一些不容忽视的并发症，但仍不失为治疗难治性青光眼的一种有效方法。     

青光眼房水引流装置的研究现状

青光眼房水引流装置(GDD)植入术是治疗难治性青光眼的有效方法之一.但滤过泡的纤维化一直是导致GDD植入术失败的主要原因,近年来有多数学者致力于从病理组织学角度解释纤维化形成的原因及纤维化对GDD植入术临床疗效的影响.抗代谢药物曾被认为可以抑制滤过泡的纤维化,但近年来的临床试验却对此观点提出了挑战.尽管GDD植入术能够有效地降低难治性青光眼的高眼压,但这种手术也存在较多严重的并发症,如眼内炎、角膜内皮失代偿、低眼压等.针对现有房水引流装置存在的问题,近年来出现了许多新型的引流物和手术方式.眼前节相干光断层扫描技术可以显示GDD植入术后引流管的形态和位置,对术后的治疗有指导意义.另外,新型材料和纳米技术在GDD植入术中的应用,将可能开创引流物植入手术的新时代.     

Ahmed青光眼阀植入治疗难治性青光眼的临床观察

目的:探讨Ahmed青光眼阀植入治疗难治性青光眼的临床效果。方法:采用Ahmed青光眼阀植入术治疗难治性青光眼18例,观察手术前后视力和眼压的变化及术后并发症的情况,术后平均随访3～12mo。结果:术后1mo时眼压由术前51.53±6.57mmHg降至16.82±5.63mmHg,总成功率为95%;随访3mo时,眼压由术前51.53±6.57mmHg降至17.14±6.38mmHg,总成功率为89%;随访≥12mo者15眼,眼压由术前50.36±7.92mmHg降至18.35±7.24mmHg,总成功率为73%。结论:采用Ahmed青光眼阀植入术治疗难治性青光眼,操作简便、术后恢复快、并发症少、眼压控制较理想,保存患者残存视力,是治疗难治性青光眼的有效方法。     

Ocular surface injury resulted from topical anti-glaucoma medications: prevention and cure

The accumulating evidences from experimental and clinical studies suggested that the ocular surface could be injured by topical anti-glaucoma medications. The ocular surface injury not only caused dry eyes, red eye, eye itching, photophobia and other discomforts, but also increased the risk of failure of glaucoma surgery in patients. The commonly used preservative Benzalkonium Chloride (BAK) plays an important role in ocular surface damage and its side effects are dose- and time-dependent, particularly, in the combined medications. Topical application of preservative BAK could result in the damage of epithelial cells and endothelial cells, and also affect the central corneal thickness. Prevention of ocular injury should be seriously taken into consideration in the anti-glaucoma medical treatment. Development of complex preparations, preservative-free and/or novel preservative preparations for glaucoma therapy may provide a promising approach in the prevention of ocular surface injury.     

Ocular factors relevant to keratoepitheliopathy in glaucoma patients with and without diabetes mellitus

PURPOSE: To examine the effect of diabetes mellitus on the keratoepitheliopathy in glaucoma patients with and without diabetes mellitus who were treated with anti-glaucoma eye drops. METHODS: The presence and severity of keratoepitheliopathy was investigated in the eyes of 36 glaucoma patients with diabetes mellitus and 47 nondiabetic patients who had glaucoma. All the patients had used anti-glaucoma eye drops. The ocular factors examined were the status of the lipid layer of the tear fluid assessed by a specular reflection video recording system, the tear volume assessed by the Schirmer test, and the tear film stability assessed by tear break-up time (BUT). RESULTS: The incidence of superficial punctate keratitis (SPK) was 36.1% in the diabetic patients with glaucoma and 27.7% in the nondiabetic patients with glaucoma. Serious cases of SPK were seen only in the diabetic patients with glaucoma. The uniformity of the tear lipid layer, results of the Schirmer test, and the tear BUT in the diabetic patients with glaucoma were similar to those in the nondiabetic patients with glaucoma. CONCLUSION: In glaucoma patients who use anti-glaucoma eye drops, the effects of diabetes mellitus on the keratoepitheliopathy and other ocular factors are not significant. However, we must consider the serious cases of keratoepitheliopathy in these patients.     

Exploring topical anti-glaucoma medication effects on the ocular surface in the context of the current understanding of dry eye

Purpose

To assess tear film parameters, ocular surface characteristics, and dry eye symptomology in patients receiving topical anti-glaucoma medications.

不含苯扎氯铵的曲伏前列素滴眼液对患者干眼症状及泪膜质量的影响

目的 观察使用含苯扎氯铵的曲伏前列素滴眼液的患者改用不含苯扎氯铵的曲伏前列素滴眼液后的干眼症状及泪膜质量的变化。设计 前瞻性病例系列。研究对象 仅需局部使用0.004%曲伏前列素眼水控制眼压的患者22例（44眼）。方法 入选患者先行泪液分泌试验、泪膜破裂时间检测及干眼症问卷调查,然后换用不含苯扎氯铵的0.004%曲伏前列素滴眼液,换药后7天、1、3个月重复上述检查。并对换药前后数据进行比较分析。主要指标 泪液分泌试验、泪膜破裂时间、干眼症问卷调查评分。结果 更换药物后1、3个月泪膜破裂时间（分别为7.69±1.17 s和9.47±1.01 s）较换药前（6.95±1.24 s)明显延长（P均=0.0000）,基础泪液分泌量（分别为10.80±1.58 mm和12.36±1.54mm）较换药前（8.43±1.73mm）明显增加（P均=0.0000）,干眼症状评分（分别为24.73±7.27和21.45±6.88）较换药前（29.68±11.58）明显降低（P=0.0003和0.0000）。结论 更换为不含苯扎氯铵的0.004%曲伏前列素滴眼液后,患者的干眼症状减轻,泪膜功能状态改善。     

Effect of chronic anti-glaucoma medications and trabeculectomy on tear osmolarity

Purpose

To evaluate the tear film osmolarity (TFO) and ocular surface clinical signs and symptoms in chronically medicated glaucoma patients and post-trabeculectomy patients.

Methods

This is a single-center, prospective case-controlled study. One-hundred and thirty eyes of 130 participants aged ≥45 years were included (49 normal controls, 50 glaucoma patients on chronic preserved anti-glaucoma medication ≥6 months, and 31 post-trabeculectomy patients not on medication ≥6 months). TFO, tear break-up time (TBUT), Schirmer''s test I and dry eye symptoms were evaluated. Data from both groups of glaucoma patients were compared with age and sex-matched controls. Logistic regression was performed to calculate the odds ratios.

Results

Mean TFO in the three groups were 301.4±7.7, 307.0±9.3, and 307.4±11.6 mOsm/l, respectively. Compared with normal controls, chronically medicated glaucoma patients and post-trabeculectomy patients were more likely to have a raised TFO, with odds ratios (95% CI) of 4.43 (1.74–11.32) and 2.76 (1.02–7.94), respectively. Both groups of glaucoma patients were also more likely to experience dry eye symptoms, with ORs of 4.72 (1.92–11.59) and 4.24 (1.54–11.72). There was no significant difference in TFO and symptoms between both groups of glaucoma patients, and in TBUT and Schirmer''s test across all three groups.

Conclusions

Patients on chronic topical anti-glaucoma medication and post-trabeculectomy patients were more likely to have raised TFO and dry eye symptoms, suggesting significant ocular surface disease. Glaucoma practitioners should be aware that dry eye symptoms and raised TFO may occur in the absence of TBUT and Schirmer''s test abnormality.     

重视长期局部应用抗青光眼药物对眼表组织的损伤

长期应用抗青光眼药物能引起结膜慢性炎症、浅层点状角膜炎及干眼症等眼表疾病。病理研究发现该类患者结膜杯状细胞数量减少、眼表上皮鳞状化生及角膜上皮细胞凋亡。已有证据表明滴眼液中的防腐剂苯扎氯胺有毒性作用,是眼表组织损伤的重要原因。药物性眼表损伤患者临床表现无特异性,症状轻微,病变发生滞后,常与眼表疾病共存或混淆,可严重影响患者的生活质量和青光眼的治疗。因此,要十分重视长期局部应用抗青光眼药物对眼表组织的损伤问题,选用降眼压效果好、作用时间长的抗青光眼药物,必要时使用联合固定配方制剂,减少药物使用的种类和次数。对需要使用多种药物才能达到靶眼压或出现眼表组织损伤的患者,应及时采取手术或激光等其他治疗措施。注意对眼表组织损伤的预防及共存眼表疾病的治疗。研制无防腐剂或含有新型防腐剂的抗青光眼药物,改进或研制长效药物和药物赋形剂是今后新型抗青光眼药物剂型发展的方向。     

周边虹膜切除术对泪液膜影响的研究

目的 研究周边虹膜切除术对泪膜的影响。方法 急性闭角型青光眼126例，一只眼接受周边虹膜切除术，另一只眼点1％匹罗卡品。治疗后观察受检者的症状和体征，包括畏光、眼痒、异物感、烧灼感、干涩感、视疲劳、结膜充血、角膜丝状物、Schirme I试验、泪膜破裂时间(BUT)、角膜荧光素染色情况。用TMS-1角膜地形图对其中的82人角膜表面规则指数和角膜表面不对称指数进行测定。以t检验比较手术组和药物组症状、体征和干眼症诊断性试验结果的差异性，以χ^2检验比较手术组和药物组干眼症发生率的差异性。结果 手术组与药物组在青光眼的类型、病程、年龄、性别等方面差异无显著性，手术组干眼的症状及体征比药物组明显，手术组Schirmer I试验及BUT测定明显低于药物组，角膜染色试验手术组比药物组严重，手术组干眼症的发生率明显高于药物组，所有这些差异均有统计学意义。结论 周边虹膜切除术能引起泪膜功能受损，使泪膜稳定性受到破坏。应用人工泪液可以改善手术组的于眼症状。     

药源性干眼症

药源性干眼症是近年来逐渐被认识的一类药源性眼病,引起此病的药物有十余类上百种,其中常见的有抗胆碱能受体药、抗组胺药、抗抑郁症类药、抗精神病类药、激素类药、抗青光眼类药等。主要机制是药物影响副交感或交感神经系统,支配腺体分泌的通路受到阻断;或药物局部使用引起泪膜不稳定及眼表面异常。防治此类干眼症主要采用停药或换药,对因治疗以及对症处理。     

睑板腺脂质在干眼症发病机制中的作用

干眼症是眼科常见病,根据病因可分为泪液分泌不足和泪液蒸发过强两种类型。位于泪膜最外层的脂质层由睑板腺分泌,具有维持泪膜稳定和防止泪液蒸发的作用。脂质层的组成成分以及组织结构对它的稳定性有很大影响,睑板腺功能障碍患者由于脂质层功能紊乱,造成泪膜稳定性下降及眼表的破坏,引起蒸发过强型干眼症。（国际眼科纵览,2014, 38：316-319）     

干眼的免疫机制研究进展

干眼是一种由多因素所致,发病机制众多的常见眼表疾病。随着我国干眼发病率逐年升高,干眼逐渐引起人们的重视。干眼的发病机制较为复杂,其中炎症、角结膜上皮细胞改变、泪膜成分改变、角膜神经改变、睑板腺功能异常改变等均为重要因素。泪膜高渗导致眼表上皮细胞高渗,刺激炎症发生级联反应,眼表炎症反应为干眼发病机制中最为关键的环节。该过程中有多种炎症介质和免疫细胞参与,越来越多的人认为干眼是一种抗原特异性自身免疫性炎症疾病且二者存在联系。临床治疗中,各类抗炎药物及促进泪液分泌药物在一定程度上标志着干眼药物治疗的快速发展,但干眼治疗并非仅仅为了改善症状,而要根据具体病因展开治疗。近年关于干眼免疫机制的研究日益增多,据此本文就干眼的免疫机制研究进展进行综述,希望系统性了解免疫在干眼发生发展过程中的作用及临床意义。