原发性闭角型青光眼研究进展

本文对原发性闭角型青光眼(PACG)新的定义及分类方法进行简单的介绍,其着重于“终末器官损害”,特别是青光眼性视神经损害,小梁组织的阻塞或损害。根据此定义,我们对PACG的诊断方法的研究进展进行综述,希望能够得到筛查和早期诊断PACG的较好方法,从而可以进行早期治疗并追踪随访,防止青光眼盲目和低视力的发生。     

双眼慢性原发性闭角型青光眼术前房水中炎症因子的表达及其对预后的影响

目的:探讨慢性原发性闭角型青光眼(CPACG)双眼先后行小梁切除术前房水中炎症因子的表达水平及其与术后滤过泡和眼压的相关性。方法:选取2021-09/12在南京医科大学附属眼科医院就诊并行小梁切除术的双眼CPACG患者15例30眼,双眼手术间隔7d,利用酶联免疫吸附试验(ELISA)分别检测双眼术前房水中单核细胞趋化蛋白-1(MCP-1)、白细胞介素-17(IL-17)、转化生长因子-β(TGF-β)和干扰素-γ(IFN-γ)的表达水平,并于术后1mo评估眼压及滤过泡形态。结果:纳入患者第一眼术前房水中MCP-1、IL-17、TGF-β和IFN-γ的含量分别为330.4±46.2、357.3±46.9、2347.5±363.8、527.7±101.6pg/mL,第二眼术前房水中MCP-1、IL-17、TGF-β和IFN-γ的含量分别为298.2±40.7、309.1±53.5、1938.3±426.0、628.2±104.9pg/mL,双眼术前房水中炎症因子表达水平均有差异(P≤0.05)。纳入患者双眼术前房水中IL-17、TGF-β表达水平与术后1mo眼压、滤过泡高度均具有相关性(P...     

原发性慢性闭角型青光眼

原发性闭角型青光眼是我国青光眼防治工作的重点。长期以来对急性闭角型青光眼作了大量深入的系统研究，有了较统一的认识，但至于缺乏症状、病程隐匿的慢性闭角型青光眼尚缺乏足够认识，对其诊断标准、发病机制、治疗原则及其与急性闭角型青光眼的异同等一系列问题尚无统一意见。我们认为慢性闭角型青光眼是不同于急性闭角型青光眼的原发性闭角型青光眼，有必要对其作出完整的认识。本就慢性闭角型青光眼的定义、临床表现、发病机理和治疗原则等方面作了详细综述。     

原发性闭角型青光眼流行病学研究进展

青光眼是全球第二大致盲眼病、不可逆性盲最主要的原因。原发性闭角型青光眼(PACG)是亚洲、特别是东亚、中国人中最常见的青光眼类型。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不断变化;不同的青光眼诊断标准和分类系统也会导致不同的流行病学调查结果;流行病学的特征又指导着临床干预措施;这一切都密切相关,因此,PACG流行病学状况对青光眼的防治有着重要的意义。本文就国内外PACG流行病学相关研究进展作一综述。     

原发性闭角型青光眼发病机制的研究进展

原发性闭角型青光眼是主要的不可逆致肓眼病.随着影像技术在眼科应用的进展,人们对前房角关闭机制的了解越来越深入.目前认为它的发病机制主要包括瞳孔阻滞机制、高褶虹膜机制、晶状体诱发性机制、恶性青光眼、脉络膜膨胀机制及混合机制.因各种发病机制的影响因素和治疗原则有所差异,要求针对前房角关闭患者的病因治疗不能千篇一律.动态生理性改变将是前房角关闭的重要研究方向之一.     

我国原发性闭角型青光眼的研究进展

近年来 ,随着超声生物显微镜 (ｕｌｔｒａｓｏｕｎｄｂｉｏｍｉｃｒｏｓｃｏｐｙ,ＵＢＭ)用于原发性闭角型青光眼 (ｐｒｉｍａｒｙａｎｇｌｅｃｌｏｓｕｒｅｇｌａｕｃｏｍａ,ＰＡＣＧ)的诊断和研究后 ,对ＰＡＣＧ特别是慢性ＰＡＣＧ发生的解剖学基础和病理生理学机制的研究更加深入。笔者复习了国内外有关ＰＡＣＧ研究方面的文献 ,提出了一个以房角关闭机制为基础的ＰＡＣＧ分型系统 ,并提出对多种机制共存型ＰＡＣＧ的诊断和处理原则。一、人种和ＰＡＣＧ的关系1 不同人种ＰＡＣＧ患病率的差异 :原发性闭角型青光眼是亚洲人群最常见的青光…     

原发性闭角型青光眼发病机制的研究进展

原发性闭角型青光眼是主要的不可逆致肓眼病.随着影像技术在眼科应用的进展,人们对前房角关闭机制的了解越来越深入.目前认为它的发病机制主要包括瞳孔阻滞机制、高褶虹膜机制、晶状体诱发性机制、恶性青光眼、脉络膜膨胀机制及混合机制.因各种发病机制的影响因素和治疗原则有所差异,要求针对前房角关闭患者的病因治疗不能千篇一律.动态生理性改变将是前房角关闭的重要研究方向之一.     

原发性闭角型青光眼发病机制的研究进展

原发性闭角型青光眼是主要的不可逆致肓眼病.随着影像技术在眼科应用的进展,人们对前房角关闭机制的了解越来越深入.目前认为它的发病机制主要包括瞳孔阻滞机制、高褶虹膜机制、晶状体诱发性机制、恶性青光眼、脉络膜膨胀机制及混合机制.因各种发病机制的影响因素和治疗原则有所差异,要求针对前房角关闭患者的病因治疗不能千篇一律.动态生理性改变将是前房角关闭的重要研究方向之一.     

晶状体与原发性闭角型青光眼

原发性闭角型青光眼(primaryangle-closureglaucoma,PACG)是我国主要的致盲眼病之一,其中部分患者亦同时患有白内障。不少学者观察到有患者在白内障手术后部分或完全阻止了青光眼的发展,现综述如下。     

青光眼患者房水中细胞因子的研究进展

房水由睫状突上皮细胞产生,是前房的重要组成部分,为角膜、晶状体、小梁网等无血管组织提供营养.相较于血液,房水能更好地反映眼内的环境,因此近几年房水中细胞因子检测成为眼科研究的热点之一.研究者已经在多种眼部疾病中发现了房水细胞因子的改变,包括青光眼.一些研究认为,房水中细胞因子的改变可能与青光眼的发病机制有关,甚至可能影响青光眼滤过术的预后.本文总结了几类细胞因子在青光眼房水中的变化,并分析它们与青光眼的关系.     

Aqueous proinflammatory cytokines in acute primary angle-closure eyes

AIM: To evaluate changes of proinflammatory cytokines in aqueous humor of patients with acute primary angle-closure (APAC) and age-related cataracts. METHODS: Twenty eyes of 20 APAC patients and 15 eyes of 15 age-related cataract patients were included in this cross-sectional study. Aqueous humor samples were collected prospectively. The levels of 20 proinflammatory cytokines were evaluated in the aqueous humor of the APAC and cataract patients using the multiplex bead immunoassay technique. Clinical data were collected for correlation analysis. RESULTS: Seven of the 20 proinflammatory cytokines included in the magnetic bead panel were detectable in both APAC eyes and cataract eyes: interleukin (IL)-10, IL-12, IL-15, IL-21, IL-6, chemokine (C-C motif) ligand 20, and tumor necrosis factor alpha (TNF-α). IL-27 was only detectable in APAC eyes. Compared with the cataract eyes, the APAC eyes had significantly elevated concentrations of IL-12 (P=0.036), IL-15 (P=0.001), IL-6 (P=0.012), and IL-27 (only detectable in APAC eyes). Age was positively correlated with IL-12 (P=0.022) and IL-6 (P=0.037), and time elapsed between APAC onset and aqueous humor samples collection was positively correlated with IL-15 (P=0.037), IL-27 (P=0.040), and TNF-α (P=0.042). CONCLUSION: Several proinflammatory cytokines including IL-12,IL-15, IL-6 and IL-27, were elevated in the APAC eyes and may be implicated in its pathologic mechanism.     

Sustained elevation of extracellular ATP in aqueous humor from humans with primary chronic angle-closure glaucoma

While the death of retinal ganglion cells in glaucoma is frequently associated with an elevation of intraocular pressure (IOP), the mechanisms connecting the two processes remain unclear. Extracellular ATP is released throughout the body in response to mechanical deformations. We have previously shown that patients with an acute rise in IOP have an elevated concentration of ATP in the anterior chamber. In the present study we ask whether ATP levels remain increased in patients with chronic elevations of IOP. The concentration of ATP in samples of aqueous humor obtained from patients with primary chronic angle-closure glaucoma (PCACG) was compared with that from control cataract patients whose IOP was normal. The mean ATP concentration in aqueous humor was 14-fold higher for PCACG samples than for control. ATP levels were correlated with IOP and the cup-to-disk ratio (C/D ratio). Brief treatment of Timolol, Alphagan, Pilocarpine and/or Azopt did not affect the rise in ATP concentration. In conclusion, sustained elevations in extracellular ATP levels accompany the chronic elevation of IOP in chronic glaucoma. As numerous ocular tissues express purinergic receptors, an increased extracellular ATP may have diverse physiological and pathophysiological effects.     

急性闭角型青光眼患者血清及房水一氧化氮水平的研究

目的探讨急性闭角型青光眼(AACG)患者血清和房水中一氧化氮(NO)浓度的变化及它们与眼压的关系,并分析这些变化对青光眼发生发展可能产生的影响。方法用硝酸还原酶法测定AACG患者28例及正常人20例血清中一氧化氮的浓度,AACC;患者22例和老年性白内障患者13例房水中一氧化氮的浓度,分别对血清和房水中一氧化氮的浓度进行统计学分析。结果青光眼组的房水平均NO浓度为(61.46±4.89)μm/L,白内障组的房水平均NO浓度为(30,60±2,81)μm/l,两组均数之间的差异有显著性(P<0.01)。青光眼组血清NO平均浓度为(68.49±15.37)μm/L,正常对照组血清NO平均浓度为(72.19±10.82)μm/L,两组均数之间的差异无统计学意义(P>0.05)。结论μAACG患者房水NO浓度较白内障组明显增高,高眼压可能是导致房水NO浓度改变的关键因素。过度升高的NO对视网膜神经节细胞的毒性作用可能参与了青光眼性视神经损害的发展过程。     

Concentration of hyaluronic acid in primary open-angle glaucoma aqueous humor

We compared the concentration of hyaluronic acid in the aqueous humor of primary open-angle glaucoma (POAG) patients and non-glaucomatous patients. Aqueous humor samples were obtained from 22 patients just before trabeculectomy for clinically uncontrolled POAG (POAG group). Aqueous humor (0.1 mL) was aspirated by inserting a 26-gauge needle into the anterior chamber. The same procedure was performed for 22 non-glaucomatous patients just before cataract surgery (control group). Immediately after collection, the aqueous humor was stored at -20 degrees C. The concentration of hyaluronic acid was determined by a sensitive, noncompetitive and nonisotopic fluoroassay. The median (range) concentrations of hyaluronic acid of the POAG and control groups were 298.4 microg L(-1) (99.0-743.7 microg L(-1)) and 545.1 microg L(-1) (145.0-2366.0 microg L(-1)), respectively. The difference in concentrations of hyaluronic acid between the groups was statistically significant (P<0.001). In conclusion, the concentration of hyaluronic acid in the aqueous humor in POAG patients is lower than in non-glaucomatous patients. Further studies are necessary to determine the role of hyaluronic acid in the pathophysiology of POAG.     

原发性急性闭角型青光眼患者房水中CXCR2和bFGF表达与小梁切除术后预后的关系

目的：探讨原发性急性闭角型青光眼(APACG)患者的房水中趋化因子受体2(CXCR2)、碱性成纤维细胞生长因子(bFGF)水平与小梁切除术后预后的关系。方法：收集2020-06/2022-01期间本院收治的80例80眼行小梁切除术的APACG患者纳入病例组,依据术后疗效分为成功组60例60眼和失败组20例20眼; 收集同期本院行白内障超声乳化术且眼压正常的白内障患者86例86眼纳入对照组。采用酶联免疫吸附法检测房水中CXCR2、bFGF水平; 采用ROC曲线分析房水中CXCR2、bFGF水平预测APACG患者小梁切除术失败的价值; APACG患者小梁切除术失败的影响因素采用多因素Logistic回归分析。结果：病例组房水中CXCR2、bFGF水平显著高于对照组(P&#x003C;0.05)。失败组房水中CXCR2、bFGF水平及术后浅前房发生患者比例显著高于成功组(P&#x003C;0.05)。房水中CXCR2、bFGF水平单独及联合预测APACG患者小梁切除术后失败的AUC分别为0.885、0.883、0.953。CXCR2、bFGF是APACG患者小梁切除术后失败的危险因素(P&#x003C;0.05)。结论：APACG患者房水中CXCR2、bFGF水平显著升高,且二者均是小梁切除术后失败的危险因素。     

原发性急性闭角型青光眼患者房水中IL-8和IL-12p70的表达及其临床意义

目的:对原发性急性闭角型青光眼(AACG)和年龄相关性白内障(ARC)患者房水中IL-8及IL-12p70浓度进行检测,并探讨其临床意义.方法:选取2019-10/2020-12于我院治疗的原发性AACG急性发作期患者29例29眼作为研究组,同期于我院行手术治疗的ARC患者17例17眼作为对照组,通过流式液相蛋白定量技...     

Identification of differentially expressed proteins in the aqueous humor of primary congenital glaucoma

Primary Congenital Glaucoma (PCG) is an autosomal recessive disease caused by an abnormal development of the anterior chamber angle. Although, PCG has been linked to several genetic loci, the role that the genes at these loci or their encoded proteins play in the pathophysiology of PCG and development of the anterior chamber is not known. To identify proteins that may be altered in PCG and that may help in understanding the underlying pathophysiology of the disease, we took a global proteomics approach. Tryptic digests of the complex mixtures of proteins in aqueous humor were analyzed using Liquid Chromatography/Mass Spectrometry (LC-MS/MS). Proteins were identified by searching the data against the human subset of the UniProt database. The proteomes of aqueous humor in PCG (n = 7) and patients undergoing cataract surgery as control (n = 4) were compared based on the scan counts of comparable proteins. Using stringent filtering criteria, Apolipoprotein A-IV (APOA-IV), Albumin and Antithrombin 3 (ANT3) were detected at significantly higher levels in PCG AH compared to control, whereas Transthyretin (TTR), Prostaglandin-H2 D-isomerase (PTGDS), Opticin (OPT) and Interphotoreceptor Retinoid Binding Protein (IRBP) were detected at significantly lower levels. Many of these proteins play a role in retinoic acid (RA) binding/transport and have been implicated in the pathogenesis of neurodegenerative diseases such as Alzheimer’s (AD). It is possible that similar to AD, the pathologic changes in PCG during development could be influenced by the availability of RA in the anterior chamber.     

闭角型青光眼的筛查方法

简单、快速、高效、非接触、易操作及能够量化前房角结构是闭角型青光眼筛查追求的主要目标。手电筒斜照法、眼球生物学测量法、van Herick检查法、前房角镜检查、超声生物显微镜、眼前段相干光断层扫描、前房角扫描分析仪、Scheimpflug照相技术均有各自的优缺点,临床医生可根据自身情况,选择适合自己的方法,同时也可联合两种或两种以上的方法,提高筛查的敏感性和特异性。（眼科,2012,21：7-10）