青光眼患者小梁切除术后生存质量的评价

目的:评价青光眼患者小梁切除术后的生存质量及其影响因素。方法:采用视功能损害患者生存质量量表对123例青光眼患者小梁切除术后的生存质量进行评价。结果:青光眼患者小梁切除术后的生活质量得分较低,视力损害严重影响着患者的生存质量得分,多因素逐步直线回归显示:影响总分的主要因素是视力损伤程度(β=-10.139,P=0.000)、健康教育(β=2.576,P=0.000)、手术次数(β=-3.598,P=0.002)及性别(β=3.807,P=0.013)。结论:青光眼患者小梁切除术后的生存质量得分较低,因此不仅要重视患者的临床治疗,在保护青光眼患者视功能的同时,根据患者的职业、经济状况等进行综合治疗,给予必要的健康教育和心理治疗,解除患者的心理问题,对提高患者的生存质量有重要的意义。     

白内障患者超声乳化术后视功能和生存质量的调查研究

目的评价白内障超声乳化术后患者的视力、视功能(visual function,VF)和生存质量(quality of life,QOL)。方法随访检查172例(205眼)白内障超声乳化术后6~36个月患者的日常生活视力。用尼泊尔眼病调查视力分级标准进行日常生活视力检查分级,同时由调查员采用美国眼科研究所开发的VF和QOL调查表进行现场问卷调查。结果本组病例平均VF得分为79.00±15.46,与视力等级的相关系数为-0.4,与远视力等级回归系数为-7.769,经t检验(t=-7.12,P=0.000)有统计学意义;与术前眼疾手术史的回归系数为-6.5059,经t检验(t=-2.92,P=0.004)有统计学意义。平均QOL得分为89.35±13.97,与视力等级的相关系数为-0.59。QOL与远视力等级的回归系数为-8.2867,经t检验(t=-9.27,P=0.000)有统计学意义。经方差分析术后不同时间组平均VF得分(F=1.09,P=0.3398)和QOL得分(F=0.62,P=0.5407)差别无统计学意义。结论白内障超声乳化术后6~36个月患者的VF和QOL状况稳定。     

农村短期集中白内障防盲手术后患者视功能和生存质量的调查

目的评价农村短期集中白内障防盲手术后患者的视力、视功能、生存质量和存在的问题。方法检查接受白内障防盲手术的患者术后6个月时日常生活视力并分级,调查员进行视功能和生存质量现场问卷调查。结果251例接受手术的患者中131例(53.9%)接受调查,术后视功能平均得分为83.21±16.40,生存质量平均得分为86.53±16.33,与视力的等级相关系数分别为-0.48和-0.68。视功能得分与视力状况(t=-7.51,P=0.000)和居住地(t=-2.01,P=0.047)相关,生存质量得分与视力状况(t=-10.27,P=0.000)和性别(t=-2.59,P=0.011)相关。结论白内障术后患者平均视功能和生存质量有明显提高,在农村短期集中开展白内障手术具有重要意义。     

原发性青光眼患者术前术后心理特征变化

目的:探讨原发性青光眼患者术前术后心理特征的变化。方法:原发性青光眼患者62例,其中原发性开角型青光眼患者8例,原发性闭角型青光眼患者54例,术前、术后2d及术后1mo,分别用汉米尔顿(Hamilton)焦虑量表(HAMA)(同时附自评量表STAI)、汉米尔顿抑郁量表(HRSD)(同时设抑郁自评量表SDS)、燥狂评定量表(MRS)进行测评。结果:术前与术后2d比较:汉米尔顿焦虑量表(HAMA)中的躯体性焦虑因子(A2)得分结果(t=1.576,P>0.05)、汉米尔顿抑郁量表(HRSD)中的认识障碍因子(B3)得分结果(t=1.788,P>0.05)、汉米尔顿抑郁量表(HRSD)中的迟缓因子(B4)得分结果(t=1.880,P>0.05)、汉米尔顿抑郁量表(HRSD)中的睡眠障碍因子(B5)得分结果(t=1.727,P>0.05)无显著性差异,其余各项均有显著性差异(P<0.05);术前与术后1mo比较:汉米尔顿焦虑量表(HAMA)中的躯体性焦虑因子(A2)得分结果(t=1.972,P>0.05)、汉米尔顿抑郁量表(HRSD)中的认识障碍因子(B3)得分结果(t=0.382)无显著性差异,其余各项均有显著性差异(P<0.05),显示了青光眼患者术前与术后的心理特征有较明显的变化;术后2d与术后1mo组比较:汉米尔顿抑郁量表(HRSD)中的总分(B)(t=2.499,P<0.05)、汉米尔顿抑郁量表(HRSD)中的体重因子(B2)得分结果(t=2.257,P<0.05)、汉米尔顿抑郁量表(HRSD)中的睡眠障碍因子(B5)得分结果(t=3.131,P<0.05)、燥狂评定量表(MRS)总分(C)(t=5.515,P<0.05)、抑郁自评量表SDS总分(E)(t=3.788,P<0.05)有显著性差异,其余各项均无显著性差异。结论:原发性青光眼患者术前、术后的心理特征会发生较大的变化,术后随病情好转,其情绪也将趋于稳定。     

不同手术方式对POAG患者情绪及生存质量影响的比较

目的 比较不同手术方式对原发性开角型青光眼(primary open-angle glaucoma,POAG)患者情绪及生存质量产生的影响.方法 收集POAG患者72例(72眼),其中接受小梁切除术(penetrating trabeculectomy surgery,PTS)患者36例,接受非穿透性小梁切除术(non-penetrating trabecularectomy surgery,NPTS)患者36例.所有患者术前采用家庭支持量表、Hamilton抑郁量表(HAMD)、Hamilton焦虑量表(HAMA)及低视力者生活质量量表(LVQOL)进行测试,术后3d采用HAMD、HAMA进行测试,术后1个月采用HAMD、HAMA及LVQOL进行测试.结果 PTS和NPTS组患者家庭支持量表总分、术前以及术后3d HAMA和HAMD总分差异均无统计学意义(均为P＞0.05);术后1个月,PTS组患者HAMA总分高于NPTS组,差异有统计学意义(P=0.048).术后3d两组患者HAMA总分、HAMD总分均较术前下降,差异均有统计学意义(均为P＜0.05);术后1个月NPTS组患者HAMD总分较术后3d下降,差异有统计学意义(P=0.030),而PTS组患者HAMD总分与术后3d相似,差异无统计学意义(P=0.090).术后1个月,PTS组患者LVQOL中远视力、移动、光感维度得分较术前降低,差异有统计学意义(P =0.002),调节维度得分较术前增高,差异有统计学意义(P =0.000),LVQOL总分及其余维度得分与术前相似,差异无统计学意义(均为P＞0.05);NPTS组患者调节维度得分较术前增高,差异有统计学意义(P=0.000),LVQOL总分及其余维度得分与术前相似,差异均无统计学意义(均为P ＞0.05).结论 与PTS相比,NPTS治疗POAG术后患者情绪及生活质量有更明显的改善.     

激光虹膜成形联合白内障超声乳化吸除术治疗急性闭角型青光眼

目的 分析激光虹膜成形术联合白内障超声乳化吸除术,对药物治疗不能迅速缓解的合并白内障的原发性闭角型青光眼急性发作的治疗效果.方法 对药物治疗不能迅速缓解的合并不同程度白内障的原发性闭角型青光眼急性发作患者12例(14只眼)行激光虹膜成形术以开放房角、控制眼压,而后行白内障超声乳化吸除联合人工晶状体植人术,随访(3～12)月,观察房角、眼压、视力变化及并发症情况.结果 激光虹膜成形术后超声生物显微镜检查示所有术眼房角开放;激光虹膜成形术前眼压(44.5±6.3)mmHg,术后2h、4h的眼压分别为(20.5 4±3.5)mmHg、(11.9 4±2.9)mmHg,与光凝前眼压的差异均有统计学意义(t=21.4956,P=0.000;t=241.5631,P=0.000);白内障超声乳化术后2周、3月的眼压均低于21mmHg,平均分别为(16.54±2.7)mmHg、(15.84±2.6)mmHg;激光虹膜成形术后和白内障超声乳化吸除术后视力不同程度提高;无严重并发症.结论 激光虹膜成形术能有效缓解药物治疗无效的原发性闭角型青光眼急性发作,并可作为白内障超声乳化吸除术治疗急性闭角型青光眼的前期治疗.     

中国和印度原发性先天性青光眼患者临床特点的对比研究

目的:总结中国原发性先天性青光眼患者的临床特点,与印度原发性先天性青光眼患者进行比较,研究二者临床特点的差异。方法:对中国和印度的原发性先天性青光眼患者进行回顾性分析。复习40例中国先天性青光眼患者的病历记录,将临床特点总结为几个可定量临床参数,评价疾病的严重程度。将中国患者的量化临床特点以及病情严重度分级和文献中的印度患者比较,进行统计分析。结果:中国患者40例和印度患者43例纳入了研究。中国患者的性别比例约为2∶1,3例(7.5%)患者有家族史,1例(2.5%)患者的亲代为近亲婚配。中国患者的主要症状和体征较多,初诊时最常见的症状是眼球长大(42.5%)、视力下降(35.0%)。与印度患者比较,中国先天性青光眼患者发病较晚,诊断较迟,角膜增大和视神经损害更严重(P<0.01)。两国的眼科医生都倾向于采用小梁切开联合小梁切除术。印度患者接受联合手术的比例更高(P<0.01)。两国患者的病情严重程度分布不同,大部分中国患者的病情严重,而大部分印度患者的病情非常严重(P<0.01)。结论:中国原发性先天性青光眼患者为散发病例,非近亲婚配型。与印度原发性先天性青光眼患者比较,中国患者的发病较晚,诊断治疗相对滞后。中国先天性青光眼的防治工作尚待加强。     

屈光手术后新兵生活质量评价

目的:评价屈光手术后新兵生活质量.方法:采用以人群为基础的横断面调查.应用屈光矫正生活质量影响量表(QIRC)对615例屈光手术后新兵的生活质量进行评价.对不同组间QIRC量表总得分进行比较,包括术前屈光不正程度、术后时间、手术方式和术后恢复时间等.结果:屈光手术后新兵平均QIRC量表总得分为49.15±7.89.术前屈光不正程度不同有显著差异(F=4.16,P＜0.05),其中低度近视组得分(50.67±7.59)明显好于高度近视组(47.57±7.52).而术后6mo以内得分(49.18±7.86)和术后6mo以上得分(49.18±8.03)没有统计学差异.行表层切削得分(46.68±6.09)最低,但并没有统计学差异(t=1.99,P＞0.05),行MK-LASIK,SBK,FS-LASIK,ReLEx flex或SMILE等其他手术方式得分也无统计学差异.屈光手术后有不良主诉的新兵得分(45.85±6.66)较低,和全部相比有统计学差异(t=5.28,P＜0.01).结论:除去有术后并发症的,屈光手术后新兵生活质量较好,术前低度近视新兵术后生活质量好于高度近视新兵.     

视功能指数量表(VF-14)的修订及评价

目的:对视功能指数量表(VF-14)进行修订并对中文修订本进行信效度评价,为探索国内适宜的视功能评价工具提供依据。方法:选取眼科专家及年龄相关性白内障患者为研究对象,收集量表的修订资料形成修订本;选取年龄相关性白内障患者作为研究对象,收集其一般情况及量表资料。采用t检验、相关分析等统计方法对量表的信度效度进行分析。结果:VF-14量表中文修订本的信度:(1)重测信度:量表各条目和总分的ICC范围值在0.814～0.976;(2)内部一致性:量表的Cronbachα系数为0.916;(3)评定者间信度:量表各条目和总分的ICC范围值在0.854～0.996;(4)分半信度:量表的分半信度系数为0.817。VF-14量表中文修订本的效度:量表的条目包括了所要测量视功能的各个方面;采用术前及术后视功能生存质量量表(VRQOL)得分与VF-14中文修订本得分做相关分析,相关系数分别为0.67和0.46;采用50例患者术前术后VF-14中文修订本得分进行t检验得t=17.18,P<0.05;采用患者主观视功能改善程度与量表分值变化做相关分析,显示量表的相关系数在0.35～0.62之间。结论:视功能指数量表(VF-14)中文修订本的信度效度较好。     

SQOL-DV1对甲状腺相关眼病患者生活质量的评估

目的:对视功能损害眼病患者生存质量量表(The quality oflife scale which measures the quality of life for Chinese patients with visual impairment,SQOL-DV1)应用于甲状腺相关眼病(thyroid associated ophthalmopathy,TAO)患者生活质量评价进行效度、信度和反应度检验。方法:应用SQOL-DV1量表对39例TAO患者和31例正常对照组进行调查。分析该量表能否准确有效评估TAO患者的生活质量。结果:效度分析:(1)内容效度检验各个分项得分之间的相关系数0.62～0.80(P=0.00),各个分项得分与量表总得分的相关系数0.88～0.89(P=0.00)。(2)区分效度检验TAO患者组在症状与视功能、身体机能、社会活动、精神心理各分项得分及量表总分上均低于正常对照组(P=0.00),治疗后TAO患者量表各分项得分及总得分提高(P<0.05)。信度分析:(1)重测信度。量表重复测量相关系数达到0.913(P=0.00)。(2)克朗巴赫系数为0.944。反应度分析:效应大小统计量(ES)为0.88。结论:SQOL-DV1量表是评估TAO患者生活质量的一种有效、可信的工具,可用于临床上TAO患者生活质量的测量和相关研究。     

视功能损害眼病患者生存质量量表的研究

目的研究一个适合测量我国视功能损害眼病患者的生存质量量表。方法通过指标筛选，最终选择２０个指标形成生存质量量表。应用该量表测量了５７例单纯视力损害的白内障患者和６０例有不同程度视力及视野损害的青光眼患者，并对该量表进行效度、信度和反应性的评价。结果该量表２０个指标，包括症状、视功能、身体机能、社会活动及精神心理等四个方面。（１）准则关联效度：ｒ＝０．６８６５，Ｐ＝０．０００。（２）重测信度：ｒ＝０．８９５９，Ｐ＝０．０００；克朗巴赫系数：α＝０．９３５８；方差比＝０．０５５１；分半信度：Ｒ＝０．９５５３。（３）反应度：ｔ检验＝５．９５（Ｐ＝０．０００），效应大小统计量为１．５３３。结论该量表具有满意的效度、信度和反应度。可试用于临床试验评价     

Visual acuity outcomes following vitreous loss in glaucoma and diabetic patients

PURPOSE: To analyze the visual acuity (VA) of patients with and without vitreous loss, while concurrently analyzing the effects of the pre-existing pathologies of glaucoma and diabetes on VA. METHODS: A retrospective study on 1013 cataract extractions from 1995 to 1999 was performed. Patients included in this study had intraocular lens implantation during phacoemulsification surgery, no intraoperative complications besides vitreous loss, had no other prior ophthalmic condition other than glaucoma or diabetes, and had a postoperative follow-up interval between one and 4 months. When indicated, vitrectomy was performed concurrently with phacoemulsification following vitreous loss. Patients diagnosed with both glaucoma and diabetes were excluded. The identified subjects were then placed into six groups: (1) patients with uncomplicated surgery; (2) patients with surgery complicated by vitreous loss; (3) glaucoma patients with uncomplicated surgery; (4) glaucoma patients with surgery complicated by vitreous loss; (5) diabetic patients with uncomplicated surgery; and (6) diabetic patients with surgery complicated by vitreous loss. A two-tailed, heteroscedastic t-test and power calculation were performed on the preoperative and postoperative visual acuities of the groups. RESULTS: There were statistically significant differences (P < 0.05) in the postoperative VA between patients with and without vitreous loss at the time of surgery. Patients with the pre-surgical conditions of diabetes or glaucoma did not display a statistically significant difference in postoperative VA when compared to controls. However, the pre-surgical condition of glaucoma displayed a trend, which showed it may contribute to a poorer postoperative VA (P = 0.072, power = 0.430). CONCLUSIONS: Vitreous loss is a risk factor for a decreased postoperative VA. Also while the pre-surgical condition of glaucoma may play a role in decreasing postoperative VA, diabetes does not.     

蓝光滤过型人工晶状体对青光眼白内障患者白内障术后睡眠质量的影响

目的　观察青光眼合并白内障患者行白内障超声乳化吸出联合蓝光滤过型人工晶状体植入术后睡眠质量的情况。方法　本研究为前瞻性研究,选取2017年1月至2018年1月于北京市回民医院眼科就诊的分别行双眼白内障超声乳化吸出联合蓝光滤过型人工晶状体植入术治疗的患者99例198眼,将所有患者分为两组:青光眼合并白内障组49例98眼,单纯白内障组50例100眼。使用匹兹堡睡眠质量指数（PSQI）量表对入组患者进行白内障术前及术后1个月、3个月的调查评分,并对结果进行统计学分析。结果　青光眼合并白内障组PSQI总分值术前为（7.00±1.09）分,术后1个月为（5.00±1.04）分,术后3个月为（5.00±1.03）分,术后1个月、3个月较术前均有改善,差异均有统计学意义(F=12.35、12.36,均为P=0.02)。单纯白内障组PSQI总分值术前为（7.00±1.02）分,术后1个月为（4.00±1.09）分,术后3个月为（4.00±1.06）分,术后1个月、3个月较术前均有改善,差异均有统计学意义(F=15.46、15.47,均为P=0.01)。青光眼合并白内障组与单纯白内障组术前PSQI 总分差异无统计学意义(t=0.09、P=0.80),术后1个月、3个月青光眼合并白内障组PSQI总分值高于单纯白内障组,差异均有统计学意义 (t=0.08、0.21,P=0.02、0.01)。结论　蓝光滤过型人工晶状体对青光眼白内障患者术后睡眠质量无负面影响,单纯白内障患者较青光眼合并白内障患者行白内障术后睡眠质量改善幅度更大。     

激光周边虹膜成形术治疗闭角青光眼的中远期结果

目的 探讨激光周边虹膜成形术治疗闭角青光眼的中远期效果.方法 对UBM显示虹膜根贴靠小梁网的早期闭角青光眼55只眼,实施倍频Nd:YAG(532nm)激光周边虹膜成形术.激光治疗参数:功率300～500mW,暴光时间0.2～0.3s,光斑直径500μm,距虹膜根部500μm在360°范围做24～30个光凝点.术后定期复查视力、眼压、前房角,记录用药指数,并做UBM.结果 激光术后随访(11-39)月(18.6±6.2)月.与术前相比,术后眼压下降均非常显著(F=45.454,P=0.000),用药次数显著减少(F=48.715,P=0.000),AOD500增大亦非常显著(F=46.567,P=0.000).术后1、2、3年房角开放度回退到术前情况的眼数分别约为12%,26%,55%(X2=11.772,P=0.003).结论 LPI术后随时间的推移,闭角青光跟前房角开放度逐渐回缩,降眼压效果也逐渐减弱.     

New Management of Angle—closure Glaucoma by Phacoemulsification with Foldable Posterior Chamber Intraocular Lens Implantation

Objective: To investigate the management oi angle-closure glaucoma byphacoemulsification with foldable posterior chamber intraocular lens (PC-IOL)implantation.Design: Retrospective, noncontrolled interventional case series.Participants: In 36 eyes with angle-closure glaucoma (ACG) , there were 18 eyes withprimary acute angle-closure glaucoma (PACG) , 14 eyes with primary chronicangle-closure glaucoma (PCCG) , 3 eyes with secondary acute angle-closure glaucoma(SACG) and 1 eye with secondary chronic angle-closure glaucoma (SCCG).Intervention: Phacoemulsification with posterior chamber intraocular lens implantation.Main Outcome Measures: Postoperative visual acuity, IOP, axial anterior chamberdepth.Results: After a mean postoperative follow-up time of 8. 81±7. 45 months, intraocularpressure was reduced from a preoperative mean of 23. 81 ±17. 84 mmHg to apostoperative mean of 12. 54 4. 73 mmHg ( P =0. 001). Mean anterior chamber depthwas 1. 75 ± 0. 48 mm preoperatively and 2. 29 ?0. 38 mm postoperatively     

Childhood glaucoma profile in Dakahelia, Egypt: a retrospective study

AIM: To analyze childhood glaucoma regarding its demographics, presentations, different causes and surgical modalities used among patients in Dakahelia and to apply the Childhood Glaucoma Research Network (CGRN) classification retrospectively to evaluate its convenience. METHODS: A retrospective study in which the medical files of all glaucoma patients <16 years old presented to Mansoura Ophthalmic Center, Mansoura University from 2014 to 2017, were retrieved and analyzed. Collected data included: age, gender, laterality, visual acuity (VA), refraction, intraocular pressure (IOP), corneal diameter, cup-disc ratio, types and number of surgeries and antiglaucomatous drugs (AGD) at the first and last visit. Prevalence of different subtypes was calculated and means of clinical features were compared. RESULTS: A total of 305 eyes of 207 patients were included classified into 6 groups: primary congenital glaucoma (PCG), juvenile open angle glaucoma (JOAG), glaucoma associated with systemic disease, glaucoma associated with ocular anomalies, acquired glaucoma and glaucoma following cataract surgery. PCG was the predominant type (55.1%) followed by acquired glaucoma (29.5%). Males represented 63.8% of the whole studied patients. Glaucoma associated with ocular anomaly group showed the youngest age at diagnosis (21.9±30.0mo). The shortest corneal diameter was recorded in post cataract group (10.4±0.5 mm). Highest cup-disc ratio was found in the PCG group (P<0.0005). Glaucoma associated with systemic disease presented with the highest baseline IOP (34.5±5.0 mm Hg). All the cases with PCG were treated surgically with 21.8% required more than one surgery. The majority of the patients (74.2%) in the acquired group were treated medically. Combined trabeculotomy-trabeculectomy was the most frequent operation done, accounting for 34.5% of all primary surgeries. Ahmed valve implantation comprised 87% of the secondary surgeries. Acquired glaucoma group had the highest percent of eyes with good final Snellen''s VA (69.4%), while glaucoma associated with ocular anomaly group had poorest final VA. CONCLUSION: PCG is the most prevalent type of childhood glaucoma, followed by acquired glaucoma especially traumatic hyphema. Combined trabeculotomy-trabeculectomy and Ahmed valve implantation are the most common surgical interventions. CGRN classification is found to provide a consensus skeleton and is recommended to be integrated in our routine ongoing clinical practice.     

A comparison study of the clinical features between Chinese and Indian primary congenital glaucoma patients

To summarize the clinical features of Chinese primary congenital glaucoma(PCG) and to investigate the discrepancies of the clinical features between the Chinese and Indian patients. · METHODS: Clinical records of 40 Chinese PCG patients were reviewed. The clinical features were summarized as several quantifiable clinical parameters and the severity of the disease was evaluated. Both the quantified clinical features and severity were statistically compared with those of the Indian patients, which were cited from the previously published articles. · RESULTS: Forty Chinese and 43 Indian patients were included in the study. In Chinese patients, sex ratio (male to female )was about 2:1, family history was presented in 3 patients(7.5%) and consanguinity was found in one patient (2.5%). The main symptoms and signs observed in Chinese patients spanned a wide spectrum of manifestations. The most frequent signs noted in the initial examination were enlarged eyeball (42.5%) and decreased visual acuity(VA)(35.0%). Compared with Indian patients, Chinese patients had a later onset, a delayed diagnosis , more severe corneal changes and more severe optic nerve damages(P <0.01). The combined trabeculectomy and trabeculotomy operation was preferred by both Chinese and Indian doctors whereas a higher proportion of Indian patients received the combined operation (P <0.01). The proportions of the severity grade were different between Chinese and Indian patients. Most Chinese patients were in the severe grade while most Indian patients were in the very severe grade (P <0.01). · CONCLUSION: Chinese PCG patients were sporadic and non-consanguineous. Compared with Indian patients, Chinese patients had a relative later onset, a delayed diagnosis and treatment. More attempts are needed in Chinese PCG prevention and treatment.     

原发性先天性青光眼临床特征的相关性

目的 分析原发性先天性青光眼的临床特征及其相关关系.方法 收集2006～2007年于北京同仁医院诊治三岁内原发性先天性青光眼患者临床资料,应用SPSS软件进行相关分析和回归分析.结果 共收集144例(259只眼),79.9%为双眼患病,男性明显多于女性(男女比=2.51:1),一岁内发病者占71.53%.有先天性青光眼家族史者占2.78%.最常见的症状为角膜混浊(41.0%)和畏光流泪(38.9%),多元回归分析发现发病时间与此相关(β=-0.191,P=0.027;β=-0.235,P=0.008).多元线性回归分析发现眼压与角膜直径(β=-0.244,P=0.038)、视乳头C/D比(β=0.293,P=0.005)之间显著相关.Logistic回归分析显示角膜直径(OR=0.403,P=0.000)与Haab纹显著相关.Pearson相关分析发现角膜直径与发病时间和病程无关.结论 角膜混浊与畏光流泪同是原发性先天性青光眼最常见的症状.检查角膜是否清亮,患儿是否怕光可作为先天性青光眼初步筛查的检查项目.眼压、角膜直径、Haab纹及视乳头C/D比均可以作为判断病情严重程度的指标.角膜直径仅与眼压相关,与发病时间和病程无关,是很好的判断疾病是否进展的指标.     

原发性闭角型青光眼合并白内障患者眼前节生物测量

目的采用眼前节光学相干断层扫描（SL-OCT）、超声生物显微镜（UBM）及传统的A型超声3种不同的检测方法观察原发性闭角型青光眼（PACG）合并白内障患者的眼前节解剖结构,评价3种检测方法的临床应用价值。方法研究设计为诊断试验。对PACG合并白内障的患者30例42眼行白内障超声乳化联合人工晶状体（IOL）植入术,于术前、术后1个月分别用SL-OCT、UBM及A型超声对眼前节进行测量,分析手术前后SL-OCT、UBM及A型超声测量的眼前节参数的变化,并比较3种不同的检查方法对眼前节测量参数间的差异,同时监测手术前后视力及眼压的情况。结果 SL-OCT、UBM、A型超声检测显示所有患者术后1个月中央前房深度（ACD）明显增加,与术前比较差异均有统计学意义（t=-15.695、t=-15.367、t=-6.981,P〈0.01）;术后1个月SL-OCT和UBM检测500μm房角开放距离（AOD500）、小梁虹膜夹角与术前比较差异均有统计学意义（P〈0.01）;术后1个月周边部、中周部、瞳孔缘区虹膜厚度（IT）与术前比较差异均无统计学意义（P〉0.05）。术前和术后1个月SL-OCT、UBM和A型超声3种检测方法测得的ACD差异均有统计学意义（F=21.060,P〈0.01;F=21.012,P〈0.01）,术前和术后1个月SL-OCT和UBM检测的AOD500、小梁虹膜夹角差异均有统计学意义（P〈0.01）,而IT差异无统计学意义（P〉0.05）。术前及术后3d、7d、1个月眼压逐渐下降,视力逐渐改善,差异均有统计学意义（F=35.792,P=0.000;F=124.891,P=0.000）。结论 SL-OCT、UBM和A型超声可以客观、准确地提供PACG合并白内障患者眼前节的解剖参数,为选择白内障超声乳化联合IOL植入术的手术时机提供参考依据。     

Correlation between surgical success rate and severity of congenital glaucoma

AIM: To study the correlation between severity of primary congenital glaucoma (PCG) and success of three types of surgery. METHODS: This was a retrospective review of all records of patients diagnosed with PCG up to age 1 year who underwent goniotomy, trabeculotomy, or combined trabeculotomy-trabeculectomy with mitomycin C as initial procedure between 1982 and 2002 at the King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. 532 paediatric glaucoma patients below age 1 year (820 eyes) with a minimum 1 year follow up were identified. The main outcome measures used for the surgeries were postoperative intraocular pressure, stability of the corneal diameter, and maintenance of corneal clarity. Surgical success was defined as a postoperative intraocular pressure of < or = 21 mm Hg without additional medical or surgical therapy, and with decreased corneal oedema, stabilised corneal diameter, and no additional optic nerve damage for at least 1 year after surgery. Complications, time of surgical failure, and follow up were recorded. RESULTS: The eyes were grouped into mild (249), moderate (342), and severe (229) PCG, based on intraocular pressure, corneal diameter, and clarity. All three surgical procedures resulted in high success rates of 81-100% for the mild form of PCG. Eyes classified with moderate glaucoma had a 13%, 40%, and 80% success rate respectively for goniotomy, trabeculotomy, and combined trabeculotomy-trabeculectomy with mitomycin C. The success rate for severe PCG was 10% and 70% for trabeculotomy and combined surgery respectively. Goniotomy was never done for eyes with this condition. CONCLUSION: Clinical classification of PCG is helpful for surgical decision making. The mild form has a high surgical success regardless of the procedure chosen. Combined trabeculotomy-trabeculectomy with mitomycin C gave the best results for moderate and severe cases of PCG.