干扰素在青光眼滤过性手术上应用的研究

滤过道的瘢痕化是青光眼滤过性手术失败的主要原因,严重影响了青光眼患者的预后.与抗代谢药不同,干扰素作为伤口愈合的调节物质,也被尝试用于抗青光眼手术.本文综述了干扰素的基本特性及其在青光眼滤过性手术上应用的研究进展.     

抗青光眼滤过手术后患者的出院指导

青光眼患者术后往往需要继续进行院外治疗及护理 ,特别是滤过性手术后的患者更是如此。我院从 1999年 1月～ 12月用滤过性手术加早期眼球按摩治疗青光眼 3 1例 ,每例均给予有针对性的出院指导 ,有效地预防并发症 ,确保手术效果 ,并大大提高了整体护理的质量和病人的满意度。(一 )临床资料1 一般资料 1999年 1月～ 12月以滤过性手术治疗青光眼加术后早期眼球按摩 ,共 3 1例患者。其中慢性闭角型青光眼 13例 ,急性闭角型 10例 ,继发性青光眼 4例 ,发育性青光眼 2例 ,激素性青光眼 1例 ,开角型青光眼 1例。2 手术方式　小梁切除术 2 2例 ,巩膜…     

周边虹膜切除术后继发恶性青光眼

周边虹膜切除术后继发恶性青光眼哈尔滨市眼科医院王雪梅，孟繁纯恶性青光眼常常发生于抗青光眼滤过性手术之后，而周边虹膜切除术后导致恶性青光眼确很少见，现将我院１例报告如下：于××女５０岁住院号５０２７因双眼原发性慢性闭角型青光眼，于１９９４年５月１０日局...     

丝裂霉素C在青光眼滤过性手术中的临床效果

青光眼滤过性手术失败的主要原因是滤过泡的瘢痕形成。自报道丝裂霉素C（以下简称MMC）在滤过性手术中能有效防止滤过泡癫痕增生［1］以来，许多人相继应用于临床。观察34眼小梁切除术中的MMC应用的临床观察，报告如下：一般资料：本组28例对眼，男10例12眼，女18例R眼，年龄刀一78岁，平均46岁。慢性闭角型青光眼力例兀眼；急性闭角型青光眼5例6眼；开角型青光眼2例2眼。再次滤过性手术者8例8眼。方法：SInl注射用水溶解ZIng／支的MMC，配成浓度为0．ot％的MMC溶液待用。常现做以穹窿部为基底的结膜瓣，把浸有MMC溶液的硅胶海棉（…     

玻璃体腔注射Avastin治疗新生血管性青光眼

目的：评价玻璃体腔注射Avastin治疗新生血管性青光眼的临床疗效。 方法：我院自2007-01/2011-10收治的视力>指数的新生血管性青光眼23例23眼,玻璃体腔注射Avastin后,观察虹膜新生血管的变化,3~7d新生血管消退,再行抗青光眼手术,术后观察患者的眼压、视力、新生血管的变化、眼部的炎症反应、并发症,并随访12~24mo。 结果：注射后,23眼中21眼于3~5d虹膜新生血管消退,有效率91.30%;2眼于5d变细,7d萎缩,至2wk时消退。注射前后眼压差值<2mmHg。23眼注射后均未出现并发症和不良反应,随后行复合小梁切除术。术后随访12~24mo,23眼中18眼无需加用抗青光眼药物,眼压位于正常范围;3眼加用2种抗青光眼药物,眼压<21mmHg;2眼加用3种抗青光眼药物,眼压<21mmHg。 结论：玻璃体腔注射Avastin可使新生血管性青光眼的新生血管迅速消退或萎缩,再行滤过性手术,避免术中或术后出血,无需选择破坏性手术,保留了较好的视力,且控制了眼压。术后进一步治疗并发症,保护残留的视功能。     

Bevacizumab在青光眼治疗中的研究进展

Bevacizumab是一种合成的抗血管内皮生长因子抗体片段,通过前房或玻璃体腔注射Bevacizumab,能促进虹膜和前房角新生血管的消退,显著降低眼压,可单独或联合手术治疗新生血管性青光眼;同时在青光眼滤过性手术中或在失败的滤过泡中应用,能显著提高手术的成功率,为青光眼的治疗开辟了新的途径,本文综述了这方面的进展。     

新生血管性青光眼分期综合治疗的效果

目的探讨新生血管性青光眼按不同分期综合治疗的效果。设计回顾性病例系列。研究对象63例（69眼）新生血管性青光眼患者分为虹膜红变组（15例16眼）、开角型青光眼组（20例22眼）和闭角型青光眼组（28例31眼）。方法虹膜红变组行全视网膜光凝术治疗,其中3眼行白内障手术,1眼玻璃体内注射bevacizumab。开角型青光眼组在全视网膜光凝术基础上应用抗青光眼药物,其中8眼行小梁切除术,4眼行白内障手术,2眼白内障联合玻璃体切除,5眼玻璃体内注射bevacizumab。闭角型青光眼组在全视网膜光凝术、抗青光眼药物、小梁切除术或睫状体光凝术基础上,联合玻璃体内注射bevacizumab,其中21眼玻璃体切除联合白内障手术,12眼填充硅油。平均随访（18.6±15.3）个月。主要指标视力、眼压、虹膜红变、前房角及并发症。结果虹膜红变组、开角型青光眼组和闭角型青光眼组治疗后视力不变或提高分别为15眼（93.8%）、17眼（77.3%）和16眼（51.6%）（χ2=9.76,P﹤0.01）。治疗前眼压分别为（14.6±3.8）mmHg、（31.6±9.1）mmHg和（44.8±12.2）mmHg,治疗后眼压为（14.1±3.86）mmHg、（17.9±3.7）mmHg和（18.9±10.8）mmHg（F=185.8,P﹤0.001）。治疗后虹膜红变在虹膜红变组16/16眼消退,开角型青光眼组20/22眼消退及闭角型青光眼组28/31眼消退。治疗后前房角在虹膜红变组16眼仍为宽角,开角型青光眼组18/22眼前房角中的纤维血管膜萎缩,房角开放范围较治疗前扩大,闭角型青光眼组31眼房角中的纤维血管膜不同程度萎缩,但房角开放范围无扩大。三组患者治疗后并发症的发生率分别为6.3%、22.7%和48.4%（χ2=9.75,P﹤0.01）。结论新生血管性青光眼按临床分期差异化综合治疗对虹膜红变期及开角型青光眼期效果较好。     

5—氟尿嘧啶在原发性青光眼滤过术中及术后的应用

5—氟尿嘧啶（5－FU）作为一种有效的抗代谢类药物，在抗青光眼术后应用，可抑制滤过道处的瘢痕形成，提高青光眼滤过性手术的成功率。但因其剂量大，给药次数多，疗程长，眼部并发症相对高，在一定程度上限制了临床上的广泛应用[1]。因此，有必要探讨其最适剂量及最佳给药途径。我们自1991年6月至1992年12月，对16例16眼原发性青光眼行小梁切除手术局部应用5－FU，并且手术后低剂量球结膜下注射5—FU，取得了满意的疗效，现报告于下。临床资料1．一般情况：本组病例中，男6人，女10人。年龄最小29岁，最大78岁，平均56岁。其中急性闭角…     

新生血管性青光眼睫状体冷凝术联合球后无水酒精注射疗效观察

目的 观察睫状体冷凝术联合球后无水酒精注射治疗新生血管性青光眼患者眼痛等临床症状的疗效.方法 对视力光感或光感消失伴药物不能控制眼压、且不宜施行滤过性手术的新生血管性青光眼32例（32只眼）,施行睫状体冷凝联合球后无水酒精注射术,并辅助降眼压药物治疗.结果 所有患者眼压均得到控制,症状缓解,虹膜新生血管消失.结论 睫状体冷凝术联合球后无水酒精注射对缓解视功能丧失的新生血管性青光眼患者的眼痛等临床症状是一种有效的治疗方法.     

新生血管性青光眼的治疗进展

新生血管性青光眼治疗困难、预后不佳.随着血管内皮生长因子等细胞因子在本病的发生发展中作用的研究深入,全视网膜光凝和抗新生血管生成药物在抑制新生血管形成预防青光眼发生方面取得较好疗效.新型房水引流装置、改良滤过性手术、睫状体光凝及光动力疗法的尝试也在降低眼压、解除患者痛苦等方面成为重要手段.另外多种治疗措施的联合进一步提高了新生血管性青光眼的治疗成功率.围绕上述研究热点,本文将近年来的有关进展做一介绍.     

大鼠房水外引流手术后前房抗原引流变化的实验研究

目的建立大鼠房水外引流手术模型,通过前房注射荧光标记抗原,观察房水外引流手术对前房内抗原引流的影响。方法 SD大鼠右眼行房水外引流手术后前房内注入荧光标记抗原FITC-dextran,对照组大鼠不行房水外引流手术,仅前房注射FITC-dex-tran。于注射后24h取出颈部淋巴结,一半组织制作冰冻切片荧光显微镜下观察,另一半组织制备单细胞悬液,流式细胞仪检测各组织FITC阳性细胞百分数。结果大鼠前房注射后24h,手术及非手术大鼠在颈部淋巴结均可见到荧光标记抗原分布。手术组大鼠颈部淋巴结FITC阳性细胞百分数为(2.96±0.67)%,明显多于正常大鼠的FITC阳性细胞百分数(1.57±0.48)%,二者比较差异有显著统计学意义(P=0.001)。结论房水外引流手术影响了前房内抗原的引流,使其与局部淋巴结接触增多,可能对眼部的结构和功能产生一定的影响。     

结膜下注射CTGF抗体对兔青光眼滤过手术后眼压和滤过泡面积的影响

目的:探讨结缔组织生长因子(connective tissue growth factor,CTGF)抗体对兔青光眼滤过手术后滤过泡瘢痕化的抑制作用。方法:家兔5只双眼制作青光眼滤过手术模型。随机选取家兔一眼作为抗体组,分别于手术完成当时和术后5d结膜下注射0.1mL浓度为50mg/L的CTGF抗体;另一眼作为对照组在相同时间点结膜下注射0.1mL磷酸盐缓冲液。术后1,3,5,7,10,14d分别观察滤过泡形态并测量其面积和眼压值。结果:术后7,10和14d抗体组滤过泡面积均大于对照组(P<0.05),眼压均小于对照组(P<0.05)。结论:结膜下注射CTGF抗体可维持兔眼滤过手术后较大的滤过泡面积和较低的眼压。     

Comparison of delayed-onset glaucoma and early-onset glaucoma after infantile cataract surgery

PURPOSE: To investigate the causes and characteristics of glaucoma in children following cataract surgery. METHODS: Twenty-four patients (37 eyes) with uncomplicated congenital cataracts who developed glaucoma after cataract surgery were studied retrospectively. Variables included cataract morphology, surgical techniques, post-operative complications, time to the onset of glaucoma, gonioscopic findings, presence of microcornea and the histopathologic characteristics of the filtration angle (in one case). RESULTS: There was a bimodal onset of glaucoma after cataract surgery. Early-onset glaucoma occurred at a mean age of 6 months in 15 eyes and delayed-onset glaucoma at a mean age of 12 years in 22 eyes. Early-onset glaucoma was significantly (p = 0.018) more likely to be due to angle closure than delayed-onset glaucoma. With delayed-onset glaucoma, the filtration angle was open in 86% of eyes and significantly (p = 0.006) more eyes in the delayed-onset group had microcornea. Medical treatment was sufficient to control intraocular pressure in the delayed-onset group while the early-onset group required surgical treatment (P < 0.001). CONCLUSIONS: The onset of glaucoma after cataract surgery during infancy follows a bimodal pattern that is correlated with the configuration of the filtration angle. The early-onset glaucoma group had high incidence of angle closure requiring surgical treatment, while in the delayed-onset group non-surgical treatment was sufficient to control intraocular pressure. Prophylactic iridectomy in eyes at risk for pupillary block is recommended. Eyes with delayed-onset glaucoma have open filtration angles yet also have findings of incomplete development of filtration structures. Microcornea is a risk factor for delayed-onset glaucoma.     

巩膜瓣下应用黏弹剂对青光眼白内障联合术后前房的影响

目的：研究闭角型青光眼急性发作的白内障患者行青光眼白内障联合术中巩膜瓣下应用黏弹剂对术后前房的影响。

方法：前瞻性研究。选取我院2016-08/2018-08采用青光眼白内障联合术治疗青光眼急性发作的白内障患者，随机分为应用黏弹剂组和常规手术组，分别于术后1、3、7d应用眼前节OCT测量前房深度(ACD)、巩膜突前500μm房角开放距离(AOD₅₀₀)、虹膜小梁网夹角(TIA)和眼压。

结果：术后1、3、7d，前房结构参数应用黏弹剂组为：ACD：3.82±0.51，3.71±0.63，3.78±0.33mm； AOD_500：0.25±0.04，0.24±0.04，0.25±0.05mm； TIA：32.01°±7.71°，31.36°±5.61°，31.82°±7.53°； 常规手术组为：ACD：2.71±0.29，3.21±0.43，3.60±0.57mm； AOD_500：0.20±0.08，0.21±0.05，0.24±0.07； TIA：25.13°±8.06°，26.18°±8.06°，29.25°±6.22°。其中术后1、3d ACD、AOD_500、TIA，两组患者有差异(P<0.05)； 而术后7d无差异(P>0.05)。两组患者术后眼压均显著降低至20mmHg以下，术后1d应用黏弹剂组眼压高于常规手术组(P<0.05)； 术后7d两组患者眼压无差异(P>0.05)。

结论：青光眼白内障联合手术中巩膜瓣下应用黏弹剂，能有效加深术后早期前房，术后眼压稳定，具有避免术后早期浅前房发生，维持房角开放的作用。     

原发性闭角型青光眼术后恶性青光眼发生的危险因素分析

目的：探讨原发性闭角型青光眼术后恶性青光眼发生的危险因素,为恶性青光眼的防治提供理论依据。

方法：回顾性分析2012-06/2016-06于我院眼科治疗的原发性闭角型青光眼患者767例965眼的临床资料,调查术后是否出现恶性青光眼,将术后1a出现恶性青光眼的患眼设为观察组,随机选取未出现恶性青光眼患者50眼设为对照组。调查两组患者性别、年龄、术前高眼压情况、房角结构、眼轴长度、晶状体厚度、前房深度、是否合并糖尿病、高血压等,单因素分析其危险因素,通过多因素Logistic回归分析探讨其独立危险因素。

结果：选取的965眼原发性闭角型青光眼患者中术后1a出现恶性青光眼30眼,恶性青光眼发生率为3.1%; 单因素分析结果显示：年龄、术前持续高眼压、眼轴长度、前房深度、晶状体厚度、房角完全关闭是原发性闭角型青光眼术后出现恶性青光眼的危险因素,组间比较差异具有统计学意义(P<0.05); 多因素Logistic回归分析结果显示年龄(OR=2.521,95%CI为1.434～8.876)、术前持续高眼压(OR=2.483,95%CI为2.123～11.543)、眼轴长度(OR=2.654,95%CI为1.547～12.678)、房角完全关闭(OR=3.212,95%CI为1.543～8.675)是原发性闭角型青光眼术后恶性青光眼的独立危险因素。

结论：我院原发性闭角型青光眼术后恶性青光眼发生率为3.1%,年龄、术前持续高眼压、眼轴长度、房角完全关闭均可增加恶性青光眼的发生风险,对于有该类危险因素的患者术中需特别注意。     

难治性青光眼的治疗现状

难治性青光眼是眼科常见病,常见病因包括多次滤过手术失败、新生血管性青光眼、角膜移植术后继发性青光眼等。因其病因复杂,病情多变,治疗手段虽较多,但疗效较差,常因药物耐受、滤过术后瘢痕阻塞通道等导致手术失败。针对难治性青光眼的特征,一些改良术式及联合术式逐渐应用,如复合式小梁切除术、脉络膜上腔引流术、房角金环植入术及全视网膜光凝联合avastin球内注射等。就难治性青光眼的各种治疗方法、临床疗效及术后并发症等进行综述。     

A modified model of glaucoma filtering surgery in Sprague-Dawley rats

Animal models are useful in glaucoma research to study tissue response to wound healing. Smaller animals such as rats offer additional advantages in terms of availability of detection antibodies and microarrays with cheaper maintenance costs. In this study, we describe a glaucoma filtering surgery (GFS) model in adult Sprague–Dawley rats by performing a sclerostomy using a 26-G needle and additionally placing a silicone tube (27 G) connecting the anterior chamber to the subconjunctival space to maintain a patent fistula for the flow of aqueous humor, thus providing a more definitive bleb. This technique will be useful in identifying and modifying newer targets in the wound healing process in order to improve surgical outcomes following GFS.     

Timolol maleate 0.5% versus timolol maleate in gel forming solution 0.5% (Timolol GFS) in open angle glaucoma in India. Preliminary safety and efficacy study

PURPOSE: To compare the efficacy and safety profile of Timolol maleate 0.5% versus Timolol gel forming solution (GFS) 0.5% in open angle glaucoma in Indian eyes. METHODS: In a prospective crossover study 52 patients of open angle glaucoma, well controlled intraocular pressure (IOP) on 0.5% timolol maleate solution were switched over to timolol GFS once a day, after a washout period of one month. A diurnal IOP measurement was done after 6 weeks and compared with patients on timolol maleate 0.5% twice a day. In addition, side effects reported or observed were compared. RESULTS: Statistically significant difference was not observed in ocular hypotensive effect of the two treatment. The side-effects in both the treatment groups were similar except for higher incidence of blurring of vision in patients on timolol GFS. The compliance was better with timolol GFS, but was not statistically significant. CONCLUSION: The results of this study suggest that the more convenient 0.5% timolol in gel forming solution can be offered as an equally efficacious and well-tolerated alternative to twice daily 0.5% timolol solution in open angle glaucoma.     

硅油填充术后继发青光眼的临床分析

目的:探讨硅油填充术后早期继发青光眼的常见原因及处理方法。方法:回顾2007-01/2008-12我院128眼玻璃体切割联合硅油填充术后出现继发青光眼的原因、类型及处理方法。结果:术后128眼中发生继发青光眼26眼(20%)。常见的原因是术后眼部炎症反应、硅油入前房、全视网膜激光光凝以及巩膜环扎术。术后发现有继发性青光眼者,局部或联合全身降眼压治疗,并积极寻找病因并针对病因治疗。结论:硅油充填术后继发青光眼发生率较高,药物和手术治疗可以有效控制眼压。     

Regression of Iris Neovascularization after Subconjunctival Injection of Bevacizumab

To describe three cases of neovascular glaucoma (NVG) where iris or angle neovascularization regressed remarkably after subconjunctival bevacizumab injections used as the initial treatment before pan retinal photocoagulation (PRP) and/or filtering surgery. Three consecutive NVG patients whose intraocular pressure (IOP) was not controlled with maximal medication were offered an off-label subconjunctival injection of bevacizumab (2.5-3.75 mg/0.1-0.15 mL, Avastin). Bevacizumab was injected into the subconjunctival space close to the corneal limbus in two or three quadrants using a 26-gauge needle. Serial anterior segment photographs were taken before and after the injection. Following subconjunctival injection of bevacizumab, iris or angle neovascularization regressed rapidly within several days. Such regression was accompanied by lowering of IOP in all three cases. The patients underwent subsequent PRP and/or filtering surgery, and the IOP was further stabilized. Our cases demonstrate that subconjunctival bevacizumab injection can be potentially useful as an initial treatment in NVG patients before laser or surgical treatment.