青光眼滤过术中应用丝裂霉素C加可调整缝线的临床研究

目的 评价丝裂霉素C联合可调整缝线在青光眼滤过术中的作用。方法 对原发性开角型青光眼(POAG)或原发性闭角型青光眼(PACG)64例(66只眼)，随机分为观察组26例(27只眼)．对照组38例(39只眼)。观察组采用丝裂霉素C联合小梁切除术．对照组采用单纯小粱切除术，66只眼均使用可调整缝线。并对手术疗效、手术并发症进行对照分析。结果 64例66只眼术后1～12个月的随访观察，眼压均有效控制。结论 对POAG或PACG采用丝裂霉素C小梁切除术的方法．可减少巩膜瓣瘢痕及主动调节房水滤过量，促进功能性滤过泡形成，减少并发症，提高手术成功率。     

复合式小梁切除术48例临床分析

目的 观察应用复合式小梁切除术病历的临床效果。方法 对48例原发性开角型青光眼(POAG)或原发性闭角型青光眼(PACG)的手术疗效、手术并发症进行观察分析，随访6个月～1年。结果 术眼眼压控制理想，术后浅前房、低眼压、脉络膜脱离发生率较低。结论 复合式小梁切除术的疗效更确切，并可增加手术安全性。减少术后早期并发症。     

倍诺喜表面麻醉在青光眼小梁切除术中的应用

1 临床资料 1.1 一般资料 我院2004年12月～2006年6月间收治的青光眼共44例(68眼).男15例,女29例.年龄40～79岁,平均56.78岁.单眼手术20例,双眼手术24例.急性闭角型青光眼18例(28眼),慢性闭角型青光眼14例(22眼),原发性开角型青光眼10例(16眼) ,继发性青光眼2例(2眼).     

小梁切除联合超声乳化术治疗原发性闭角型及开角型青光眼并发白内障43例

目的:探讨原发性闭角型青光眼(PACG)及开角型青光眼(POAG)并发白内障患者采用小梁切除术联合超声乳化术治疗的临床疗效。方法:将原发性青光眼并发白内障患者86例86眼按原发疾病类型的不同分为PACG组(43例,43眼)和POAG组(43例,43眼),均行小梁切除术联合超声乳化术治疗,术后对两组患者的临床效果进行分析比较。结果:PACG组术后视力恢复及眼压改善情况优于对照组(P<0.05);PACG组并发症发生率为9.30%,POAG组并发症发生率为16.28%,但两组无统计学差异(P>0.05)。结论:采取小梁切除术联合超声乳化术治疗原发性开角型青光眼及闭角型青光眼并发白内障患者临床效果显著,可改善患者的视力,且安全性好,但闭角型青光眼患者的眼压控制优于开角型青光眼患者。     

原发性闭角型青光眼合并青睫综合征1例

青光眼-睫状体炎综合征(glaucomatocyclitic crisis)首先由Posner-Schlossmann于1948年提出,故又名Posner-Schlossmann综合征(简称青睫综合征),属继发性开角型青光眼,临床常见.本病可同时合并双眼原发性开角型青光眼(POAG),而合并原发性闭角型青光眼(PACG)的病例,国内外文献仅见1篇报道[1].我们遇到1例右眼青睫综合征合并双眼原发性慢性闭角型青光眼的病人,现报告如下.     

黏弹物质小管切开术治疗原发性开角型青光眼的临床研究

目的观察黏弹物质小管切开术(VCO)治疗原发性开角型青光眼(POAG)的临床效果。方法对原发性开角型青光眼30眼采用黏弹物质小管切开术治疗,30眼行传统小梁切除术(TE)治疗。观察两组患眼手术前后的眼压、视力及术中、术后并发症。结果术后随访2～12个月,黏弹物质小管切开术组视力无1例下降,平均眼压由术前43.15 mmHg改善为出院时11.20 mmHg,无任何严重并发症发生。传统小梁切除术组视力下降5例,平均眼压由术前42.77 mmHg改善为出院时11.50 mmHg。术中前房出血4例;术后浅前房5例,脉络膜脱离1例,两组术中、术后并发症比较有显著性意义(P<0.01)。结论黏弹物质小管切开术能很好地降低原发性开角型青光眼病人的眼压,术中、术后并发症少,是治疗原发性开角型青光眼安全而有效的手术方法,可推广应用。     

小梁切除术和小梁切除联合可拆除缝线术治疗原发性青光眼

我们于 1995年 1月～ 1998年 5月采用小梁切除术和小梁切除联合可拆除缝线术治疗了 58例 ( 74眼 )原发性青光眼 ,对其疗效进行了比较 ,现将结果报告如下。1　临床资料1 1　一般资料　本院确诊为原发性青光眼而行滤过性手术的住院患者 58例 ( 74眼 ) ,男 2 2例 ( 2 8眼 ) ,女36例 ( 4 6眼 ) ,年龄 35～ 72岁。急性闭角型青光眼32眼 ,慢性闭角型青光眼 16眼 ,开角型青光眼 2 6眼 ;3眼为第 2次小梁切除术。 2 4例施行了单纯小梁切除术 ,34例应用小梁切除联合可拆除缝线术。1 2　检查　术前及术后 1天 ,1月及 1年所有患者均在裂隙灯下仔细检查滤…     

复合式小梁切除术76例临床分析

目的：观察应用复合式小梁切除术病例的临床效果。方法：将76例原发性开角型青光眼(POAG)或原发性闭角型青光眼(PACG)的患者随机分成两组，对手术疗效、手术并发症进行观察分析，随访6个月～1年。结果：研究组术眼眼压控制理想，术后浅前房、低眼压、脉络膜脱离发生率降低。结论：复合式小梁切除术的疗效更确切，并可增加手术安全性，减少术后早期并发症。     

青光眼小梁切除术138例疗效分析

我科 1995年 1月至 1999年 12月对 138例 15 9只眼施行了小梁切除术 ,经 8ｍｏｎ～ 3ａ的随访 ,疗效满意 ,现报告如下 :1　对象与方法1 1　一般资料 :本组 138例 15 9眼 ,男 5 4例 6 9眼 ,女 84例90眼 ,年龄 2 2岁～ 81岁 ,平均 5 6岁。急性闭角型青光眼 6 6只 ,慢性闭角型青光眼 44只 ,开角型青光眼 15只 ,发育性青光眼 3只 ,继发性青光眼 10只 ,经临床控制眼压、炎症后施行手术。1 2　方法 :常规术前准备 ,显微镜下局部麻醉 ,11点～ 1点方位以穹隆为基底做结膜瓣 ,以角巩膜缘为基底做 (4× 3)ｍｍ2 或 (4× 4)ｍｍ2 的梯形巩膜瓣或三角形…     

390例原发性青光眼手术分析

于1980～1990年10年间,对原发性青光眼390例,484眼中463眼进行手术分析,其中闭角型青光眼403眼、开角型青光眼31眼、绝对期青光眼29眼.治疗效果:控制眼压为闭角型青光眼91.81%、开角型青光眼87.1%;视力提高为闭角型青光眼42.43%、开角型青光眼29.03%.     

Analysis of MYOC gene mutation in a Chinese glaucoma family with primary open-angle glaucoma and primary congenital glaucoma

Background Glaucoma is one of the leading causes of blindness in the world. Primary open-angle glaucoma （POAG） and primary congenital glaucoma （PCG） are subtypes of glaucoma. Myocillin is the first gene identified to be involved in POAG. Recently, myocillin mutation has been found in PCG. In this context, we reported a special glaucoma pedigree, which was composed of both PCG and POAG patients, and analyzed the mutation of myocillin in this pedigree. Methods The family was composed of the parents, a son and a daughter. All members of the family underwent the complete ophthalmologic examinations. All coding exons 1-3 and flanking introns of myocilin gene were screened for sequence alterations by polymerase chain reaction and direct DNA sequencing. Results The son was the proband, who was diagnosed as PCG in both eyes. The father was diagnosed as POAG in the right eye, the left eye was still normal. Both the sister and the mother of the proband had normal intraocular pressure without glaucomatous optic disc changes. The mutations in intron 2 of myocilin gene were detected in the family. While the proband and the father were homozygous, the mother and the sister were heterozygous for the mutation. Conclusions Homozygous mutation in intron 2 of myocilin gene is involved in both POAG and PCG. It is suggested that the pathogenesis might be overlapping in POAG and PCG.     

蓝-黄视野结合视觉电生理检查在原发性开角型青光眼早期诊断中的意义

目的 探讨蓝—黄视野结合视觉电生理检查对原发性开角型青光眼早期诊断的临床应用价值,为临床青光眼早期诊断提供较为客观敏感的检测方法.方法 选择53例53眼标准自动视野检查正常的可疑开角型青光眼患者及30例60眼正常人进行蓝—黄视野检查结合图形视网膜电图及多焦视网膜电图,并对其结果进行对比研究.结果 在可疑青光眼患者中,B/Y视野检查31眼视野出现异常,与正常人比较差异有显著性.P-ERG检查眼的N95波潜伏期延长有明显差异,mf-ERG检查眼的N1P1N2波潜伏期有明显差异.结论 对于原发性青光眼早期发生,在眼底及普通视野未出现明显异常的患者,B/Y视野检查联合P-ERG,mf-ERG检查无疑是一种敏感性较高的检查手段.     

Rehabilitation of vision disorder and improved quality of life in patients with primary open angle glaucoma

Background  Primary open angle glaucoma (POAG) is a common cause of irreversible blindness. The variable etiology of POAG poses significant challenges for treatment and rehabilitation. We analyzed a large POAG patient cohort during treatment to reveal possible causes of vision disorder, assess vision-related quality of life (VRQL), and to evaluate the efficacy of rehabilitative treatments.

Methods  We analyzed the visional disturbances in 500 POAG patients (890 eyes) by regular ophthalmic examination and visual field examination using Humphrey 30º perimetry. Appropriate rehabilitative treatments for POAG were prescribed based on results of clinical examination and included correction of ametropia, health education, counseling, and the fitting of typoscopes. VRQL was assessed before and after treatment by a VRQL self-assessment questionnaire.

Results  Scores on the VRQL self-assessment were significantly lower compared to healthy controls. The primary cause of the vision disturbances was ametropia (97.99%), and 51.61% of the ametropia eyes had not received appropriate correction. The secondary causes of visual impairment were glaucomatous neurodegeneration (26.29%), complicated cataract, or other accompanying eye diseases. The causes of the clinical low vision (44 patients) were glaucomatous neurodegeneration (32 eyes), fundus diseases (23 eyes), keratopathy (11 eyes), and other eye diseases (10 eyes). The VRQL scores of patients improved significantly after rehabilitation and the correction of ametropia (P <0.01). Twenty-five patients with low vision were provided with typoscopes, and 21 (84%) experienced significant functional recovery, while the remaining low vision patients could see letter lines two or more levels lower (smaller) on visual charts in a near vision test.

Conclusions  Vision disorders in POAG patients are common and severe. Appropriate rehabilitation, especially the correction of ametropia, can significantly improve VRQL as revealed by the self-assessment of POAG patients.

     

青光眼合并高血压患者的眼部血流动力学观察

目的　了解青光眼合并高血压患者的眼部血流动力学。方法　应用彩色多普勒成像技术对 15例合并高血压的原发性开角型青光眼 (POAG )患者的眼动脉 (OA )、视网膜中央动脉(CRA)和睫状后短动脉 (SPCA)的血流动力学指标进行检测 ,并取无高血压的 POAG患者 2 0例作为对照组。结果　观察组视网膜中央动脉及睫状后短动脉的收缩期峰值流速、舒张期血流速度及平均流速均高于对照组 (P<0 .0 5 )。结论　高血压可能有利于青光眼患者视神经乳头的血供 ,临床应用降血压药物时应防止血压过低而导致或加重青光眼视神经损害。     

原发性开角型青光眼与正常眼24小时眼压波动规律

目的 分析其眼压昼夜变化规律,以期为青光眼的个性化治疗提供参考依据.方法 收集2006年4月至2009年4月上海市北站医院和复旦大学附属眼耳鼻喉科医院门诊的原发性开角型青光眼患者102例及正常志愿者83名,进行24 h眼压测量,用非接触性眼压计从8 am起每隔2 h测1次眼压,零点至6 am为唤醒后即刻坐位眼压.结果 二组之间峰值眼压[正常组右眼(16.0±2.7)mm Hg,左眼(16.2±2.7)mm Hg;POAG组右眼(25.3±5.6)mm Hg,左眼(24.8±5.1)mm Hg]、谷值眼压[正常组右眼(11.1±2.5)mm Hg,左眼(11.0±2.3)mm Hg;POAG组右眼(16.3±3.7)mm Hg,左眼(16.2±3.3)mm Hg]、平均眼压[正常组右眼(13.4±2.5)mm Hg,左眼(13.4±2.5)mm Hg;POAG组右眼(19.9±4.3)mm Hg,左眼(19.8±3.8)mm Hg]及眼压波动值[正常组右眼(5.0±1.6)mm Hg,左眼(5.2±1.7)mm Hg;POAG组右眼(9.1±3.6)mm Hg,左眼(8.6±3.8)mm Hg]的差异均具有统计学意义(均P＜0.01),正常组59.6%,POAG组73.5%的峰值眼压位于门诊工作时间以外;尤其是在零点至早上6点这一时间段,正常组50%,POAG组64.7%的峰值位于凌晨0:00至06:00.结论 通过对比分析,24 h眼压可以为我们提供治疗前的基础状态,从而为个性化治疗提供详实的资料.建议有条件的话,应该将24 h昼夜眼压监测作为开角型青光眼的检查常规.

Abstract：

Objective To analyze the discipline of intraocular pressure (IOP) variation, through circadian intraocular pressure monitoring in primary open-angle glaucoma (POAG) patients and normal controls, with a view to provide basis for individualized treatment of glaucoma. Methods Subjects were enrolled from the outpatients of Shanghai Beizhan Hospital and Eye and ENT Hospital of Fudan University,which were diagnosed as primary open angle glaucoma, from April 2006 to April 2009. Totally there were 102 cases of patients and 83 cases of normal volunteers. All the subjects accepted 24-hour IOP measurements using non-contact tonometer every two hours starting from 8:00 am. And the IOP between O0:00 to 06:00 am was measured in sitting position immediately after wake up. Results The differences of peak IOP[ (16.0±2.7)mm Hg of right eye and ( 16.2±2.7)mm Hg of left eye in normal group; (25.3±5.6) mm Hg of right eye and (24.8±5.1) mm Hg of left eye in POAG group], valley IOP ( 11.1±2.5) mm Hg of right eye and (11.0±2.3) mm Hg of left eye in normal group; ( 16. 3 ±3.7) mm Hg of right eye and ( 16.2 ±3. 3 ) mm Hg of left eye in POAG group, average IOP (13.4±2.5) mm Hg of right eye and ( 13.4 ± 2.5)mm Hg of left eye in normal group; ( 19.9 ±4.3) mm Hg of right eye and ( 19. 8 ±3. 8) mm Hg of left eye in POAG group), and IOP fluctuations (5.0 ± 1.6) mm Hg of right eye and (5. 2 ± 1.7) mm Hg of left eye in normal group; (9.1 ±3.6) mm Hg of right eye and (8.6±3.8 ) mm Hg of left eye in POAG group between two groups were all of statistically significance (P ＜ 0. 01 ). Notably, the peak IOP of 59. 6% in normal control group and 73.5% in POAG group were outside working hours, especially in the time period from 00:00 to 06:00 am. The peak value of 50% in normal group and 64.7% in POAG group located between 00:00 to 06:00 in the morning. Conclusions By comparison and analysis, 24-hour intraocular pressure measurement could provide us pre-treatment basic state, so as to provide detailed information for individualized treatment. If possible, it is suggested that 24-hour IOP monitoring should be added as a routine examination of primary open angle glaucoma.     

原发性青光眼患角膜内皮细胞的改变

目的 探讨原发性开角型和闭角型青光眼患者的角膜内皮细胞密度及形态的变化。方法 青光眼患者６８人１２５只眼,与患者年龄相匹配的正常人３２人６３只眼。除外角膜病、眼部炎症、外伤及接受过内眼手术的眼。采用非接触型角膜内皮显微镜观察、测量角膜内皮细胞密度和细胞面积等各项指标,用Ｇｏｌｄｍａｎ压平式眼压计测量眼压;分析比较不同类型青光眼各组角膜内皮细胞各项测量指标的差异。结果 青光眼组角膜内皮细胞密度「（２     

白内障超声乳化摘除联合房角粘连分离术治疗青光眼合并白内障的临床研究

目的探讨白内障超声乳化摘除及人工晶体植入术治疗闭角型青光眼合并白内障的临床效果。方法对已诊断为闭角型青光眼合并白内障的161例患者的226只眼施行白内障超声乳化摘除及人工晶体植入术,对房角关闭区域用辅助钩和灌注头进行钝性分离。超声生物显微镜及房角镜观察手术前后的房角及前房变化,对视野及眼压进行追踪,随访时间≤3年者186眼,>3年者40眼。结果有1只眼再发作眼压升高,施行小梁切除术后又出现眼压升高,前房硅管植入后眼压得到控制。全部患者术后房角开放,中央前房平均加深1.1mm,周边前房平均加深0.2mm。除再发眼压升高的1只眼的视野继续损害外,215只眼均无视野缩小。结论除炎症引起的青光眼外,超声乳化白内障摘除联合房角分离术是治疗闭角型青光眼的有效方法,但具体适应证尚待进一步探讨。     

蓝黄视野在早期青光眼诊断中的意义

目的 :探讨蓝黄视野检测在早期原发开角型青光眼诊断中的应用价值。方法 :采用瑞士产Octo pus10 1型全自动视野计 ,对早期原发性开角型青光眼 3 6例 3 6眼 ,对照组正常人 3 6例 3 6眼进行B/Y及W/W检测 ,两组的年龄及性别相匹配 ,应用tG2 测试程序 ,将中心 3 0°视野内全视网膜光敏感度均值 (dB)进行比较和分析。结果 :两种视野计检测正常人B/Y较W /W检测全视网膜光敏感度均值低 ,二者差值 5 5 1dB ,差异有显著意义 (t =17 13 ,P <0 0 0 1)。早期开角型青光眼B/Y较W/W检测全视网膜光敏感度均值差为6 91dB ,差异有显著意义 (t=12 19,P <0 0 0 1)。按矫正偏差图 (correvtedprobabity)计算P <2以上缺损点数 ,显示B/Y检测总缺损点数为W /W的 2 18倍 ,差异有显著意义 (u =11.46,P <0 0 0 1)。早期青光眼组 3 6只眼B/Y检测视野阳性者 3 1眼 ,阳性率 86 1% ,W /W检测视野阳性者 19眼 ,阳性率 5 2 8%。两种视野计检测结果的异常率有显著差异 ( χ2 =9 43 ,P <0 0 0 1)。结论 :B/Y与W /W检测结果有良好的相符性 ,在早期原发开角型青光眼视野检测中 ,B/Y比W /W敏感 ,以B/Y检测出的缺损面积大而且深 ,可提高早期青光眼诊断的阳性率 ,有一定的应用价值。     

超声乳化联合小梁切除术治疗青光眼合并白内障

目的探讨超声乳化联合小梁切除术治疗青光眼合并白内障的临床疗效。方法回顾性分析24例26眼青光眼合并白内障患者行超声乳化白内障吸除人工晶体植入联合小梁切除术后的临床效果。术后随访的3～36个月,观察术后视力、眼压、滤过泡及并发症情况。结果术后最佳矫正视力：≥0.5者18眼（69.20%）,0.1～0.4者8眼（30.8%）。术后眼压24眼控制在21mmHg以下,其中20眼在15mmHg以下,术后随访期内2眼短期使用降眼压药。术后6个月功能性滤过泡23眼（88.46%）。术后并发症主要是葡萄膜反应和短暂角膜水肿。结论应用超声乳化白内障吸除人工晶体植入联合小梁切除术治疗青光眼合并白内障的患者时,能够有效控制眼压、提高视力,是目前比较理想的术式。     

脉络膜上腔引流术治疗难治性青光眼的疗效分析

目的评价脉络膜上腔引流术治疗难治性青光眼的有效性和安全性。方法对22例23眼眼压失控的难治性青光眼患者进行前瞻性连续病例研究。每眼均接受小梁切除手术和（或）睫状体破坏性手术治疗和（或）给予最大量药物治疗,基础眼压仍在（43±7）mnlHg（1mmHg=0．133kPa）。手术大体成功的判断标准为：术后眼内压（tOP）≤20mmHg,与用药和不用药时的基线IOP相比：IOP下降30％;无视盘凹陷进行性加深;无视野进行性受损。当不需要药物治疗时认为手术完全成功,未达到以上标准需要手术矫正或进一步行前房穿刺的病例视为治疗失败。患者术后平均随访时间为（18±6）个月。结果术前平均IOP为（43±7）mmHg,术后平均10P（13±5）mmHg,两者之间比较差异有统计学意义（t=20．12,P〈0．01）。术后随访16～20个月,19眼（82．6％）获得大体成功,16眼（69．5％）为完全成功,4眼（17．3％）失败。无一眼术后出现严重的浅前房、低眼压或脉络膜上腔出血。无因硅管植入而发生异物排斥反应、局部或全身炎症或感染。2眼（8．6％）因前房出血而行前房冲洗术,1眼（3．4％）因硅管脱位与角膜内皮接触而将硅管取出,3眼（13．0％）因硅管后部结缔组织形成阻塞硅管而导致引流失败者。结论这一新方法的优点是巩膜内引流通路减少了结膜糜烂和感染的危险,将硅管置于睫状体之上避免了手术性睫状体脱离,将硅管连接至脉络膜上腔可充分利用脉络膜的再吸收能力,除确保充分引流外,也能提供自然的对抗压力,避免严重的术后低眼压。该方法可能成为较有效的手术技术,为难治性青光眼提供了一种新的治疗选择。