高度近视合并原发性开角型青光眼的临床特点研究进展

许多研究显示高度近视与青光眼密切相关,高度近视因患者眼轴长、前房深、房角宽的特点,并发青光眼的类型常为原发性开角型青光眼.然而,由于高度近视可导致一系列的眼底病变,使青光眼的早期眼底改变易被高度近视造成的眼底病变所掩盖,所以,认识高度近视合并原发性开角型青光眼的临床特点及诊断要点,有利于疾病的早期诊断和减少漏诊、误诊.本文对高度近视合并原发性开角型青光眼的临床特点进行总结归纳,提高对疾病的认识,为疾病的早期诊断提供依据.     

高度近视合并原发性开角型青光眼的临床诊断研究进展

临床和试验研究均发现,高度近视患者并发原发性开角型青光眼的概率高于非高度近视患者,特别是当高度近视与原发性开角型青光眼并存时,病情变得尤其复杂。对于个体而言,近视和青光眼之间的关系在很多情况下仍然很不明确,高度近视是造成青光眼的风险因素之一,多数情况下从青光眼的眼底变化中也很难分辨出是近视导致还是功能异常,因此高度近视合并原发性开角型青光眼的早期诊断非常困难但意义重大。本文从流行病学特征、视盘结构、视野改变、眼压测量等方面对高度近视与原发性开角型青光眼的关系及诊断进行综述。     

高度近视合并原发性开角型青光眼的眼底改变

高度近视是原发性开角型青光眼(POAG)的高危因素.受高度近视因素的干扰,早期轻度的青光眼症状,常被误认为视疲劳或近视加重而被忽略.由于原发性开角型青光眼症状不明显,就诊时通常已是晚期.本文对高度近视合并POAG的眼底改变,从视神经纤维层厚度、视盘改变、视盘周围脉络膜损伤及早期检查方法进展四方面作一综述,为提高高度近视中POAG的早期诊断提供依据.     

高度近视与原发性开角型青光眼关系的研究进展

近年来,在青光眼及近视发病机制研究中发现,高度近视与原发性开角型青光眼的发病有明显相关性.高度近视眼底病理改变是开角型青光眼的高危因素,且高度近视眼底改变与早期开角型青光眼眼底改变容易混淆,造成青光眼早期诊断困难.如何从高度近视患者中早期发现青光眼,并进行早期干预治疗成为难点.本文回顾分析近年文献,对高度近视与原发性开角型青光眼的关系做一综述.     

原发性开角型青光眼合并高度近视一家系

原发性开角型青光眼与高度近视的关系早被许多学者注意 ,二者均为遗传性和家族性的疾病。现将遗传性原发性开角型青光眼合并高度近视一家系 ,报告如下。彼此有亲缘关系的原发性开角型青光眼患者 6例 ,男性 3例 ,女性 3例 ,平均年龄 3 2 5岁。原发性开角型青光眼的诊断标准参见《原发性青光眼早期诊断的初步建议》〔1〕。常规测视力及矫正视力 ,裂隙灯检查眼前节 ,房角镜检查以及直接检眼镜查眼后节 ,并测眼压及视野。先证者男　 5 0岁　 1980年因双眼虹视而来眼科就诊 ,确诊为双眼原发性开角型青光眼合并高度近视。于 1981年分别行双眼小梁…     

高度近视与原发性开角型青光眼

临床上发现高度近视与原发性开角型青光眼密切相关 ,其可能的机制有 :( 1 )升压基因学说 ;( 2 )胶原基因学说。高度近视眼与原发性开角型青光眼对糖皮质激素反应增高表明 ,二者的基因在糖皮质激素诱导下最易表达特异性蛋白 ,这可能与高度近视、原发性开角型青光眼的TIGR基因突变有关。本文从流行病学、临床特征及诊断、遗传学说及机制等方面对高度近视与原发性开角型青光眼的关系及研究进展进行综述。     

高度近视合并原发性开角型青光眼眼底结构改变的研究进展

高度近视是原发性开角型青光眼(POAG)发生发展的重要危险因素，如何在高度近视人群中发现POAG患者一直是国内外学者研究的热点和难点。高度近视患者并发POAG的概率明显高于非高度近视患者。高度近视本身就可能发生眼部一系列结构和功能的改变，当高度近视合并POAG时，复杂的眼底改变造成近视与早期开角型青光眼相互混淆，使早期青光眼的诊断具有一定的难度。本文将回顾高度近视合并POAG的相关文献，从流行病学、视盘、视神经节细胞层、视网膜神经纤维层、血管密度等眼底结构特点做一综述。     

高度近视与原发性开角型青光眼

目的:从流行病学、临床特征及诊断、遗传学说及机制等方面对高度近视与原发性开角型青光眼的关系及研究进展进行综述。方法:仔细分析了28篇原文,总结出高度近视与原发性开角型青光眼的可能机理。结果:高度近视与原发性开角型青光眼密切相关,其可能的机制有:①升压基因学说。②胶原基因学说。结论:高度近视与原发性开角型青光眼密切相关,根据TIGR基因理论和胶原基因理论,高度近视与原发性开角型青光眼都与TIGR基因突变和胶原疾病有关。     

高度近视与原发性开角型青光眼

临床上发现高度近视与原发性开角型青光眼密切相关，其可能的机制有：（1）升压基因学说；（2）胶原基因学说。高度近视眼与原发性开角型青光眼对糖皮质激素反应增高表明，二的基因在糖皮质激素诱导下最易表达特异性蛋白，这可能与高度近视，原发性开角型青光眼的TIGR基因突变有关。本从流行病学、临床特征及诊断，遗传学说及机制等方面对高度近视与原发性开角型青光眼的关系及研究进展进行综述。     

重视高度近视合并闭角型青光眼

目前,国内外不同人种、不同地区的流行病学调查和临床研究均显示近视(尤其是高度近视)是青光眼独立于眼压之外的危险因素.虽然开角型青光眼是高度近视合并青光眼的主要类型,但是近些年却不断有高度近视合并闭角型青光眼的报道.本文对高度近视合并青光眼的类型以及高度近视合并闭角型青光眼的发病机制进行讨论分析,目的是提醒眼科医师在临床工作中重视高度近视合并闭角型青光眼,以免误诊漏诊.     

青少年型开角型青光眼48例临床分析

目的 :探讨青少年型青光眼的临床特点、治疗效果及并发症。方法 :对 1996年 7月至 1999年 7月收治的 48例 ( 92眼 )青少年开角型青光眼的临床表现、治疗情况进行分析。结果 :80眼合并近视 ,44眼合并高度近视 ,手术后视力恢复差。结论 :青少年近视度数加深者或高度近视患者应注意警惕是否伴有青光眼 ,主张及早手术     

Progress in understanding the association between high myopia and primary open‐angle glaucoma

Many clinical and fundamental studies have shown that high myopia (HM) and glaucoma are closely associated. In particular, the occurrence and progression of primary open‐angle glaucoma interact with the progression of HM. Two hypotheses have been proposed to explain the association between the two disorders: the hypertension gene theory and the collagen‐related gene theory. HM and primary open‐angle glaucoma patients show similar collagen changes and hypersensitive responses to glucocorticoids. Consequently, these common features may hold key information regarding their underlying mechanisms. Advances in life sciences, such as molecular genetics, provide opportunities for clarifying their association at the molecular level. This article reviews available research on the association between these two disorders from the perspectives of epidemiology, clinical manifestation, diagnosis and pathogenic mechanisms.     

Anterior axial lens subluxation, progressive myopia, and angle-closure glaucoma: recognition and treatment of atypical presentation of ectopia lentis.

PURPOSE: To describe the clinical features of an atypical presentation of ectopia lentis consisting of primary anterior axial lens subluxation in childhood, associated progressive myopia, and complicating angle-closure glaucoma; to facilitate early diagnosis of this triad; and to report the results of lensectomy for treatment. METHODS: A retrospective case review of eight patients. Clinical course, visual acuity, gonioscopy, axial length, refraction, fundus examination, associated systemic features, and results of treatment are provided. RESULTS: This subgroup of patients with ectopia lentis is at risk for progressive, synechial, angle-closure glaucoma. Identification of a clinical triad consisting of rapidly increasing myopia, normal axial length, and progressive axial subluxation leads to earlier diagnosis. Prophylactic lensectomy provides a safe and sight-saving treatment that arrests and, at times, reverses the progression of angle-closure glaucoma. CONCLUSIONS: Ectopia lentis with anterior axial subluxation and progressive myopia can be a sight-threatening condition when significant forward mobilization of the lens results in synechial angle-closure glaucoma. Recognition of this clinical entity can expedite diagnosis and prevent irreversible loss of vision secondary to glaucoma. Because the primary mechanism of angle closure is angle crowding, peripheral iridotomy does little to control the rise in intraocular pressure. Prophylactic lensectomy has proven to be the most reliable treatment in our experience.     

图形视觉诱发电位振幅与峰潜伏时比值对开角型青光眼早期诊断价值

目的 探讨图形视觉诱发电位(PVEP)的振幅/峰潜伏时(A/LT)比值在开角型青光眼(POAG)早期诊断中的应用.方法 检测可疑开角型青光眼56例(84只眼)、早期POAG患者62例(90只眼)及上正常对照组40例(80只眼)PVEP及A/LT比值.结果 可疑POAG及早期POAG患者PVEP检测阳性率均高于正常对照组,可疑POAG及早期POAG患者PVEP检测阳性率之间差异无统计学意义.可疑POAG及早期POAG患者A/LT比值分别为1.16和1.29,两者差异有统计学意义.结论 PVEP的A/LT比值分析在POAG早期诊断中有较好地临床应用前景.

Abstract：

Objective To study the primary open angle glaucoma by relative value of amplitude/latency through pattern visual evoked potential examination (PVEP) for early diagnosis.Methods Fifty-six cases (84 eyes) doubtful primary open angle glaucoma,62 cases (90 eyes) of early primary open angle glaucoma and 40 cases (80 eyes) of normal controls were tested for relative value of amplitude/latency.Results The abnormal ratio of doubtful and early primary open angle glaucoma was higher than that in normal controls.The abnormal ratio of doubtful and early primary open angle glaucoma was different,which was insignificant.Relative value of amplitude/latency in doubtful and early primary open angle glaucoma were 1.16 and 1.29,the difference was statistically significant (P＜0.05).Conclusion Relative value of amplitude/latency has a better perspective of clinical application in early diagnosing open angle glaucoma.     

高度近视合并原发性开角型青光眼的临床分析

目的 探讨高度近视合并原发性开角型青光眼（primary open-angle glaucoma,POAG)的早期诊断依据。方法 （1）将存档的21例（40只眼）高度近视合并POAG患者资料（A组）与随机抽取的21例（40只眼）中度近视合并POAG患者的资料（B组）及21例（42只眼）低度近视合并POAG患者的资料（C组）进行对照,比较初次就诊时3组患者间视野缺损,视网膜神经纤维层缺损（retinal nerve fibre layer defect,RNFLD),最高眼压值及最佳矫正视力等指标的差异;（2）观察A组患者的三维眼底照片,分析其临床特点。结果 （1）初诊时,A组患者中,重度视野缺损和RNFLD的比例明显高于B,C组,矫正视力低于B,C组;（2）高度近视患者视乳头,视网膜的特异性变化及视乳头周围病变等,直接干扰对青光眼的早期诊断;（3）散瞳检查或立体眼底拍片是提高青光眼检出率的重要手段。结论 认识高度近视本身及合并POAG时的临床特点,有利于提高临床医师对该病的警觉性及早期诊断水平。     

高度近视合并POAG的临床特征研究进展

高度近视常常同时合并POAG,由于其眼底视盘和视网膜脉络膜等改变使其很难在早期发现POAG的合并存在。早期诊断和及时治疗高度近视合并POAG对提高患者的视觉和生存质量具有重要意义。现就高度近视与POAG的联系,高度近视合并POAG时相关的视功能改变做一综述,期望为临床诊断提供有益线索。     

Normal tension glaucoma: diagnostic features and comparisons with primary open angle glaucoma

Background : A significant proportion of patients diagnosed under the broad classification of open angle glaucoma actually has normal tension glaucoma (NTG). It has many clinical features that overlap with primary open angle glaucoma (POAG), yet there is a question of whether it has a different aetiology in which intraocular pressure plays less of a role. Methods : The epidemiology and clinical features of normal tension glaucoma are reviewed with particular reference to possible differences from primary open angle glaucoma, which might permit differentiation. The pathophysiology is discussed, outlining recent research in cell death (apoptosis), axonal damage and neuroprotection. Discussion and Conclusion : There is considerable evidence that NTG develops with little contribution from the effect of intraocular pressure. However, the clinical diagnosis of NTG is often one of exclusion and the differentiation of NTG from POAG remains difficult because many clinical signs are suggestive but not definitive of NTG. More accurate diagnosis may be possible when individual patients exhibit a greater number of signs. Some evidence suggests that NTG with relatively high pressures (greater than 15 mmHg) is more likely to progress than NTG with relatively low pressures. Clinicians must be particularly alert to the possibility of NTG because IOP, a clinical marker for some glaucomas, is absent.