Glaucoma in benin-city, Nigeria

Aim: To determine the contribution of glaucoma to ocular morbidity and the different types of glaucoma seen. Method: Medical records of all new patients attending the consultant outpatient clinics of the University of Benin Teaching Hospital, Benin city, Nigeria, over a 2-year period were reviewed. Those with a diagnosis of glaucoma were analysed. Results: Of 1,698 new patients, 147 (8.7%) had glaucoma diagnosed. One hundred and thirteen patients (76.9%) had primary open angle glaucoma, 4 patients (2.7%) had primary angle closure glaucoma, one patient (0.7%) had congenital glaucoma, 5 patients (3.4%) had juvenile glaucoma and 24 patients (16.3%) had secondary glaucoma. Among the patients with primary open-angle glaucoma, 19 patients (16.8%) and 47 patients (41.6%) were blind using visual acuity estimation and visual field criteria respectively. Conclusion: Glaucoma remains a common cause of ocular morbidity worldwide as in our centre. Primary open-angle glaucoma is the most common type while primary angle-closure glaucoma remains relatively rare. Key words: glaucoma, morbidity, types, Benin City.     

海德堡视网膜断层扫描仪在青光眼诊断中的价值

目的：评价海德堡视网膜断层扫描仪Ⅱ型（Heidelberg retina tomograph-Ⅱ,HRT-Ⅱ）在青光眼诊断中的应用价值。方法：对对照组98例（98只眼）和闭角型青光眼（Primary angle closure glaucoma,PACG）59例（59眼）,开角型青光眼（primaryopen angle glaucoma,POAG）36例（36眼）分别行HRT-Ⅱ检查,比较各组间视盘结构参数的差异,并用Roc曲线下面积分析不同参数的诊断灵敏度和特异度。结果：正常组与开角型青光眼组间杯盘面积比、视杯容积、盘沿容积、杯型测量及平均神经纤维层厚均有显著性差异。正常组与闭角型青光眼间只有杯形测量及平均神经纤维层厚有显著性差异。结论：HRT-Ⅱ对青光眼的诊断有很大帮助。     

孔源性视网膜脱离合并非继发性青光眼治疗的初步探讨

目的:探讨孔源性视网膜脱离合并非继发性青光眼的发病原因、治疗方法及疗效.方法:回顾性分析28例孔源性视网膜脱离合并原发性或先天性青光眼患者的临床资料.结果:视网膜复位手术28例,一次性成功者25例(89.3%),失败3例(均为行外加压手术者);术后第1天眼压为10～46(28.1士6.5)mmHg,术后1周眼压为(18.9士7.2)mmHg,最后复诊时眼压为(17.6士6.2)mmHg;再行抗青光眼手术者10例(35.7%);术后脉络膜出血2例,渗出性脉络膜脱离2例.结论:此类病人开角型青光眼比例较高,外伤及手术是重要原因;手术治疗成功率与普通孔源性视网膜脱离无明显差异;提倡玻璃体切割 硅油填充或放液 注气 冷冻 加压(DACE)的手术方法;脉络膜易受累,即术前脉络膜脱离,术后脉络膜出血及渗出较易发生;术中术后应密切注意眼压;术后视力恢复较差,可能与原发青光眼/眼压有关.     

彩色多普勒血流显像对中晚期青光眼患者的眼血流动力学研究

为探讨血管因素在中晚期青光眼患者视功能损害机制中的作用,选择中晚期青光眼患者 ２７例、５２ 眼,用彩色多普勒超声检查仪测定每眼的眼动脉、睫状后短动脉及视网膜中央动脉的血流速度,并选择年龄、性别与患者相匹配的正常人 ２５ 例、５０ 眼为对照组。结果显示,青光眼组的眼动脉、视网膜中央动脉及睫状后短动脉的血流速度明显降低,阻力指数明显增高,而慢性闭角型青光眼及开角型青光眼之间则无明显差异。证明中晚期青光眼视功能损害与视神经的血供不足密切相关。     

Long-term intraocular pressure fluctuation of primary angle closure disease following laser peripheral iridotomy/iridoplasty

Background  Many studies indicated that short-term and long-term intraocular pressure (IOP) fluctuations in primary open angle glaucoma patients might lead to glaucomatous progression. However, seldom study has evaluated the long-term fluctuation of IOP in primary chronic angle closure diseases. The objective of this study was to investigate the long-term IOP fluctuation of primary angle closure diseases and its associations following laser peripheral iridotomy (LPI) with or without laser peripheral iridoplasty.

Methods  A total of 158 patients with primary angle closure suspect (PACS, n=21), primary angle closure (PAC, n=81) and primary angle closure glaucoma (PACG, n=55) had been treated by LPI with or without laser peripheral iridoplasty and followed up for more than 12 months. IOP was measured with Goldman applanation tonometer. Multivariate linear regression with generalized estimating equation (GEE) regression models was used to evaluate the association of long-term IOP fluctuation (maximum IOP minus minimum IOP) with gender, age, baseline IOP, baseline peripheral anterior synechia (PAS), baseline vertical cup/disc ratio (VCDR), baseline mean deviation (MD), need for IOP-lowering medications.

Results  IOP fluctuation during follow-up in PACS, PAC and PACG groups were (4.83±2.90), (5.67±3.35), and (9.40±7.14) mmHg, respectively. IOP fluctuation was strongly correlated with baseline IOP (r=0.356, P <0.001), PAS (r=0.374, P <0.001). IOP fluctuation was higher in patients with higher baseline IOP (0.18 mmHg per unit increase, 95% CI: 0.05–0.31 mmHg).

Conclusions  Long-term IOP fluctuation in PACG group was larger than that in PACS or PAC group. Eyes with higher baseline IOP were observed to have larger long-term IOP fluctuation.

     

海德堡视网膜断层扫描仪在青光眼诊断中的价值

目的评价海德堡视网膜断层扫描仪Ⅱ型（HRT-Ⅱ）在青光眼诊断中的应用价值。方法对正常组98例（98只眼）和闭角型青光眼（PACG）组59例（59只眼）、开角型青光眼（POAG）组36例（36只眼）分别行HRT-Ⅱ检查,比较各组间视盘结构参数的差异,并用ROC曲线下面积分析不同参数的诊断灵敏度和特异度。结果正常组与开角型青光眼组间杯盘面积比、视杯容积、盘沿容积、杯型测量及平均神经纤维层厚均有显著性差异。正常组与闭角型青光眼组只有杯形测量及平均神经纤维层厚有显著性差异。结论 HRT-Ⅱ对青光眼的诊断有很大帮助。     

虹膜周切术与前房深度

描述解除瞳孔阻滞前后前房加深的特点，进一步说明不同类型青光眼的发病机理。方法：对133例224眼接受了激光虹膜周切术的闭角型青光眼病人测量中轴部及虹膜6点子午线1／2处的分中心前房。结果：前房深度术后中轴部较术前无变化，旁中心部较术前平均加深0．33mm（P＜0．001），aACG组与cACG组均显示与总体同样趋势。aACG组青光眼术前中轴部及分中心部均明显浅于cACG组，术后前房加深程度更大，使前房深度接近cACG组。结论：激光虹膜周切术可以明显缓解瞳孔阻滞，使虹膜平复，旁中心前房加深。旁中心前房的测量可以很好反映虹膜与瞳孔阻滞力间的作用结果。aACG组虹膜受瞳孔阻滞力作用变形更显著，这种解剖特点可能为其发病急剧的原因。     

双层羊膜植入联合小梁切除术治疗青光眼的疗效观察

目的:观察双层羊膜植入联合小梁切除术治疗原发性青光眼的临床疗效.方法:对35例40只眼原发性青光眼,其中22眼为闭角型青光眼、18眼为开角型青光眼,进行常规小梁切除术,并在巩膜瓣下植入双层羊膜.观察术后眼压、视野、视力等情况,进行了术前术后对比,并随访6～18个月,观察术后疗效.结果:术前术后眼压对比,术后眼压均有降低,视野及视力保持不变或改善,随访期间视力、眼压、视野维持良好.未出现不良反应.结论:双层羊膜植入联合小梁切除术可防止术后组织瘢痕形成,使滤过通道保持畅通,是安全、经济、有效的治疗青光眼的改良方法.     

激光周边虹膜切除术后急慢性闭角型青光眼患者和正常人24h眼压波动的比较

目的对激光周边虹膜切除术后急慢性闭角型青光眼和正常人昼夜眼压波动进行比较。方法收集闭角型青光眼患者44例(急性闭角型青光眼25例,慢性闭角型青光眼19例)以及年龄和性别相匹配的正常人20例。临床前期或先兆期或早期闭角型青光眼患者均进行Nd:YAG激光周边虹膜切除术,采用Goldmann压平式眼压计由一名医师对所有入选病例均进行24h眼压波动的检测,6个时间点分别为2pm、6pm、10pm、5am、7am、10am,同时依据眼压高峰值出现的时间点和波动的幅度对昼夜眼压波动规律进行分类。结果三组间昼夜眼压波动幅度差异有显著性(P=0.000),急性闭角型青光眼患者(0.92±0.27kPa)和慢性闭角型青光眼患者(1.11±0.36kPa)昼夜波动幅度明显高于正常对照组(0.44±0.11kPa),在2pm、6pm,慢性闭角型青光眼比急性闭角型青光眼眼压高峰值出现的频率更多,慢性闭角型青光眼和正常对照组有相似的昼夜波动类型,正常对照组眼压波动为平坦形。高峰值出现的时点与原发性青光眼的类型高度相关。结论激光周边虹膜切除术后急慢性闭角型青光眼患者眼压昼夜波动幅度仍明显大于正常对照组。慢性闭角型青光眼患者眼压高峰值多出现于2pm、6pm;而急性闭角型青光眼眼压高峰值多出现于5am、7am、10am。眼压高于2.79kPa且昼夜波动幅度>0.80kPa未出现于正常对照组。     

氩激光超全视网膜光凝术治疗新生血管性青光眼

目的：评估氩激光超全视网膜光凝术对视网膜中央静脉阻塞所致的新生血管性青光眼的疗效。方法：用氩蓝绿激光对12眼视网膜中央静脉阻塞所致的新生血管性青光眼行超全视网膜光凝术,每眼平均光凝点达2050点。结果：术后8例虹膜和前房角新生血管全部萎缩,4例术后眼压控制至正常水平,8例术后眼压仍高,但较术前明显下降,虽需药物或其他手术辅助降压,但全部患者的眼痛、头痛症状均有减轻或消失。结论：超全视网膜光凝术应为视网膜中央静脉阻塞所致的新生血管性青光眼的首选治疗方法,光凝越早,范围越广,效果越好。     

Primary angle closure glaucoma in Chinese and Western populations

目的：原发性闭角型青光眼的研究进展。方法：对近年来中国眼科学以及国外学在这方面的这方面的研究工作特别是对超声生物显微镜用于原发性闭角型青光眼研究后的研究工作及有关献进行了归纳和复习。结果：根据房角关闭,中国人的原发性闭角型青光眼可分为三种类型：1.多种机制共存型。2.单纯瞳孔阻滞型。3.非瞳孔阻滞型。由于多种机制共存型闭青的临床特点及对治疗的反应不同于其它类型闭青,除了要解除其瞳孔阻滞因素外,同时要针对性地处理共同存在的非瞳孔阻滞因素。结论：超声生物显微镜在闭青的研究、诊断以及对治疗效果的评价方面的应用促进了闭青的认识,随着这一技术的普及,将大大提高闭青的诊治水平。     

Prevalence of glaucoma in Sunsari district of eastern Nepal

Aims: To determine prevalence of glaucoma and glaucoma suspect in subjects 40 years and above in Sunsari district of eastern Nepal. Methods: A community based cross sectional study examining 1600 selected subjects was carried out. In all subjects best corrected visual acuity was determined. Oblique torch light test was used for anterior chamber depth evaluation. Intraocular pressure (IOP) measurements with Perkins tonometer and fundus examination were carried out in the community. Subjects diagnosed as glaucoma suspect were further evaluated in the hospital using slit lamp examination, gonioscopy and Goldmann perimetry. Glaucoma was defined by characteristic disc and visual field changes irrespective of the level of IOP. Results: Of 1600 subjects examined, the prevalence of glaucoma was found to be 0.938%. The prevalences of primary open angle glaucoma, primary angle closure glaucoma, secondary glaucoma and ocular hypertension were 0.562%, 0.125%, 0.250% and 0.500% respectively. Lens induced glaucoma accounted for all the cases of secondary glaucoma. Conclusion: The prevalence of glaucoma in the Sunsari District of Nepal is 0.938%, which is lower than that reported in the neighboring regions. Lens induced glaucoma is highly prevalent as a cause of secondary glaucoma. Key words: Glaucoma, prevalence, Eastern Nepal, secondary glaucoma.     

An analysis of glaucoma patients seen at the General Hospital Kuala Lumpur over a five year period: 1986 to 1990

The records of all the glaucoma patients seen at the General Hospital Kuala Lumpur over a five year period were analysed. The racial, age and sex distribution of patients with primary open angle glaucoma and primary angle closure glaucoma was determined. The causes of secondary glaucoma were analysed. As no previous records of glaucoma statistics are available in Malaysia, it is hoped that these findings will form an initial mosaic to build on in the future.     

原发性开角型青光眼患者眼血流动力学的改变及与中医证型关系的研究

目的：探讨原发性开角型青光眼患者眼血流动力学的改变及其与中医辨证分型之间的关系。方法采用彩色超声多普勒成像(CDI)对102例原发性开角型青光眼患者眼血流动力学的改变进行了检测。结果开角型青光眼及其中医证型（分为肝郁气滞证、痰湿犯目证、肝肾阴虚证）在眼动脉（OA）血流参数中,与正常组相比,PSV、EDV、AV差异均有统计学意义(P＜0.05或P＜0.01);在视网膜中央动脉（CRA）血流参数中,与正常组相比,PSV、EDV 和AV差异均有统计学意义(P＜0.05或P＜0.01),其变异程度依次为肝郁气滞证组＞痰湿犯目证组＞肝肾阴虚证组。结论原发性开角型青光眼患者OA和CRA的血流速度下降明显,血流阻力增加,眼局部血液循环障碍,OA和CRA的血流参数可作为反映开角型青光眼及其中医证型间局部血瘀程度的一项重要指标。     

817例原发性青光眼各型的构成比

7年中,817例原发性青光眼患者的各型构成比为:开角型136例、闭角型681例;二者之比为1:5;闭角型中急性256例、慢性425例,二者之比为1∶1.7。40岁以下患者开角型多于闭角型,41岁及以上者闭角型多于开角型。男性开角型多于闭角型,女性则相反。     

四种常见病所致视力下降患者眼底动脉血流动力学探讨

目的：四种常见病所致视力下降患者眼底动脉血流动力学探讨及分析。方法：使用新型的彩色多普勒超声仪检测糖尿病视网膜病变、静光眼、视网膜静脉栓塞及老年性黄斑病等四种常见病所致视力下降患者眼动脉、睫状后动脉、视网膜中央动、静脉的收缩期最大血流速度、平均血流速度、血流阻力指数等。结果：经t检验,各指标变化有显著意义。结论：彩色多普勒超声对视力下降患者眼底动脉检测有明显的临床意义。     

超声乳化晶状体摘除术对不同阶段原发性闭角型青光眼的疗效分析

目的 比较分析超声乳化晶状体摘除术对不同阶段的原发性闭角型青光眼的治疗效果,为临床上闭角型青光眼行 晶状体摘除术治疗的手术时机选择提供依据。方法 收集2008 年7 月至2013 年12 月行超声乳化晶状体囊外摘除术联合人工晶状体植入术的闭角型青光眼患者70 例（共113 眼）,分为临床前期组（40 眼）、急性发作组（48 眼）和慢性进展组（25 眼）3 组,平均随访（19.47±10.10）个月。比较各组患者术前、术后的视力、眼压、视野、房角粘连等参数,以及术后随访过程中青光眼继续进展的情况。结果 临床前期组患者术后均无青光眼进展;急性发作组10.4%患者术后继续进展,继续进展和术前病程相关（r=0.462,P＝0.003）;慢性进展组40.0%患者术后继续进展,继续进展和房角粘连程度相关（r=0.698,P＝0.000）。结论 原发性闭角型青光眼临床前期患者进行晶状体摘除可良好地预防青光眼进展;房角关闭急性发作时尽早行晶状体摘除;慢性进展期在早期,房角粘连未达1/2周之前行晶状体摘除均可有效控制病情发展。     

Ocular Surface Changes in Primary Open Angle Glaucoma with Long Term Topical Anti Glaucoma Medication

Background

Topical life long anti glaucoma medication forms the mainstay of treatment of primary open angle glaucoma. Their long term usage can cause changes in conjunctival epithelium.

Methods

Hundred cases of primary open angle glaucoma were divided into four groups of 25 patients each. Each group was put on Timolol, Pilocarpine, Brimonidine and Latanoprost respectively. Ocular surface changes were monitored using Schirmer''s test, tear film break up time (BUT) and conjunctival impression cytology.

Result

Altered Schirmer''s test value was seen in 40% of patients and reduced tear film BUT values in 26%, at the end of one year. These changes were more in patients treated with timolol. Changes in conjunctival cytology such as decrease in goblet cell density, squamous metaplasia and presence of inflammatory cells were seen in significant number of patients at the end of one year treatment. There was direct relation of duration of treatment to various ocular surface changes.

Conclusion

Ocular surface changes are seen in significant number of patients of primary open angle glaucoma at the end of one year follow up with topical anti glaucoma therapy. Conjunctival impression cytology is a non invasive technique to monitor these changes.Key Words: Primary open angle glaucoma, Ocular surface changes, Goblet cell density, Squamous metaplasia     

闭角型青光眼凝血指标的变化

目的:探讨闭角型青光眼患者凝血指标变化与临床的关系。方法:对50例闭角型青光眼患者及43例正常对照组进行了凝血指标(PT、TT、Fbg、APTT)检测。结果:闭角型青光眼患者与对照组比较PT、TT无显著变化(P<0.05),Fbg含量升高有极显著性差异(P<0.01),APTT时间缩短有极显著性差异(P<0.01)。结论:闭角型青年眼患者体内血液是高凝状态,而这种高凝状态在闭角青光眼病的发生、发展中起着重要的作用。     

高频超声对原发性开角型青光眼眼底动脉与指动脉血流动力学相关性研究

目的：用高频超声对原发性开角型青光眼（POAG）患者眼底动脉和指动脉血流动力学进行研究，找出二者血流动力学的相互关系。方法：对临床确诊的36例POAG患者进行彩色多普勒检查。检测视网膜中央动脉（CRA）、睫状后动脉（PSA）和指动脉（FA）血流动力学变化。用相同的条件检测对照组72例的CRA、PSA、FA的血流动力学变化。结果：POAG组的CRA、PSA和FA的阻力指数（RI）、搏动指数（PI）高于对照组；POAG组与对照组的FA—RI／CRA-RI、FA-RI／SPA-RI、FA-PI／CRA-PI、FA．PL／SPA-PI比较，无显著差异。POAG组FA-RI与CRA-RI、SPA-RI的相关系数分别为0．491，0．510。结论：POAG组眼底动脉与指动脉血流动力学的变化趋势一致，POAG眼底动脉血流动力参数RI与指动脉血流动力学参数RI呈正相关．表明眼底血流动力学异常只是全身小动脉血流动力学异常的一部分。