青光眼治疗中应用前房穿刺的疗效观察

目的探讨前房穿刺术在青光眼治疗中的临床应用。方法对110例120眼青光眼患者在术前或术中实施前房穿刺以降低眼压或观察手术效果等。其中22眼为急性闭角型青光眼急性发作高眼压经药物治疗不能有效控制的患者,行前房穿刺放出房水降低眼压;98眼为青光眼小梁切除术中常规行前房穿刺放出房水,注入平衡盐,以调节眼压,促进前房及滤枕形成,预防并发症发生。结果急性高眼压患者经前房穿刺放液后症状迅速缓解,眼压下降,视力提高;青光眼做小梁切除术后除2例2眼发生Ⅰ度浅前房外,未见其他并发症。结论前房穿刺应用于青光眼治疗中是降低眼压、预防术中及术后并发症的有效方法 ,特别适合于基层医院推广。     

改良青光眼小梁切除滤过术及其临床应用

目的对青光眼小梁切除滤过术进行改良,以降低青光眼小梁切除滤过术后房水引流不畅及斑痕形成发生率。方法利用自体巩膜条作为引流物,在常规小梁切除术后的巩膜瓣后,再做一板层巩膜条,植入巩膜瓣下．引流房水。结果治疗38例（50只眼）,术后早期前房形成良好,眼压正常;随访2年,1只眼滤过泡消失（手术失败）,49只眼维持功能滤过泡,眼压正常。结论自体巩膜作为引流物能长期保持滤过功能及防止并发症。     

小梁切除术治疗青光眼术中应用生物羊膜“三明治”式植入的疗效及安全性

目的小梁切除术治疗青光眼过程中应用生物羊膜"三明治"式植入对滤过泡及眼压的影响。方法该院2006年1月至2011年1月在小梁切除术中巩膜瓣下及结膜瓣下"三明治"式植入生物羊膜治疗青光眼患者26例(30只眼),术后随访12～48个月,观察术后眼压、视力、视野、滤过泡、术后并发症等情况。结果患者术后最终随访完全成功27眼(90%),条件成功1眼(3.3%),手术失败2眼(6.7%),手术总成功率为93.3%。在不用任何降眼压药物下眼压值为〔(16.75±2.10)mmHg〕,与术前眼压〔(44.32±5.2)mmHg〕相比,差异有显著统计学意义(t=43.25,P<0.05)。保持功能性滤过泡28眼;术后视力提高2行以上者21眼(70%),并发症主要包括浅前房(3眼)和低眼压(1眼)。未出现排斥反应及其他严重的并发症。结论生物羊膜"三明治"式植入应用在小梁切除术治疗青光眼能有效控制滤过道的瘢痕化,使之保持通畅,术后眼压降至正常,提高手术成功率,是一种效果良好的、安全的改良手术方法。     

持续高眼压性青光眼小梁切除术的探讨

目的 探讨高眼压状态下行小梁切除术的必要性和手术方法。方法 在用药物尽可能降低眼压的前提下,先行前房穿刺放液,虹膜根部切除,然后作小梁切除术,并在术中使前房形成。结果 持续性高眼压及时行小梁切除术在挽救视功能方面取得满意效果,33例中31例眼压得到控制,视力不同程度提高,未见严重并发症。结论 对用各种药物均不能控制眼压的青光眼患,应力争早日手术。     

改良小梁切除术治疗青光眼92例临床观察

目的 观察改良小梁切除术治疗青光眼的临床疗效.方法 将186例青光眼患者随机分为观察组92例(156眼)和对照组94例(160眼),对照组行传统小梁切除术;观察组行改良小梁切除术,手术要点为术中加固巩膜瓣缝合、应用丝裂霉素及可松解缝线.术后随访3个月～1 a,观察两组眼压、前房形成、滤过泡形态及并发症发生情况.结果 术后第1天浅前房发生率观察组和对照组分别为4%、20%(P＜0.05);术后1 a观察组和对照组功能性滤过泡分别占89%、66%,眼压控制在21 mmHg以下者分别为95%、67%,P均＜0.05.结论 改良小梁切除术可减少巩膜瓣瘢痕、主动调节房水过量、促进功能性滤过泡形成,并减少并发症发生,利于提高手术成功率.     

小切口白内障取出人工晶状体植入联合小梁切除治疗青光眼伴白内障疗效观察

目的观察M形巩膜遂道小切口白内障整核取出人工晶状体植入联合小梁切除术治疗青光眼伴白内障的疗效。方法 36例（36眼）青光眼伴白内障患者,眼压3.73-8.82 kPa,平均5.47 kPa;视力0.01-0.05者13例,眼前手动12例,光感11例。均采用M形巩膜遂道小切口白内障整核取出人工晶状体植入联合小梁切除术治疗。结果本组2例术中少许前房出血,止血后清除;34例手术过程顺利,未出现后囊膜破裂等其他并发症。术后3个月复查,本组患者矫正视力0.7-1.5者6例,0.3-0.6者23例,0.05-0.2者4例,眼前指数-0.04者3例。术后32例患者眼压控制在1.33-2.80 kPa;2例眼压〈1.33 kPa,前房较浅;2例眼压〉2.80 kPa。术后出现角膜线状混浊11例,前房炎症细胞反应16例,前房胶冻样渗出物3例。结论 M形巩膜遂道小切口白内障整核取出人工晶状体植入联合小梁切除术治疗青光眼伴白内障患者疗效确切。     

复合式小梁切除术治疗急性闭角型青光眼54例体会

目的探讨急性闭角型青光眼持续高眼压状态下行复合式小梁切除术的疗效及安全性。方法对54例（54眼）经药物治疗后眼压仍〉40mmHg的急性闭角型青光眼患者行复合式小梁切除术,术后应用抗生素眼水及皮质类固醇眼水点眼,常规阿托品散瞳。术后7—14d根据眼压、前房形成情况及滤过泡功能拆除可调整缝线。随访视力及眼压控制情况。结果术后1—2d内前房形成25眼,3—5d前房形成20眼,1周后6眼浅前房者形成稳定前房。51眼形成功能型滤过泡,无严重并发症发生。随访3—18个月,眼压〈21mmHg52例,需二次手术治疗2例,视力均有所提高。结论对应用药物治疗不能有效控制眼压的急性闭角型青光眼患者行复合式小梁切除术安全有效,可避免视功能进一步受损。     

超声乳化白内障吸除联合小梁切除术对急性闭角型青光眼合并老年性白内障的疗效及安全性

目的探究超声乳化白内障吸除联合小梁切除术治疗急性闭角型青光眼合并老年性白内障的疗效及安全性。方法急性原发性闭角型青光眼合并白内障患者81例,94眼,随机分成实验组和对照组,各47眼。实验组采用白内障超声乳化吸除术人工晶体植入联合小梁切除术治疗,对照组采用超声乳化吸除联合人工晶体植入进行治疗。对比分析两组患者手术前及术后的视力、眼压、前房及并发症情况。结果两组患者治疗前视力、眼压及前房情况相比均无显著性差异(P0.05);两组患者治疗后眼压水平均显著低于治疗前,视力及前房情况水平均显著高于治疗前(P0.05),组间比较差异不显著(P0.05)。术后对照组并发症发生率显著高于实验组(P0.05)。结论超声乳化吸除联合小梁切除术治疗急性原发性闭角型青光眼合并老年性白内障疗效显著,能有效改善患者临床症状和炎症反应,安全可靠、值得推广。     

复合式小梁切除术治疗原发性青光眼的临床观察

目的观察复合式小梁切除术治疗原发性青光眼的疗效、安全性、实用性和并发症,探讨该手术在治疗青光眼中的临床应用前景。方法选取原发性青光眼98例（110眼）为对照组,采用常规小梁切除术;另选取原发性青光眼106例（118眼）为观察组,采用复合式小梁切除术。术后随访3～12个月,观察两组术后眼压、视力、滤过泡以及并发症发生等情况。结果观察组术后浅前房发生率为2.5%,眼压平均为（10.221±1.806）mmHg,形成功能性滤过泡占90.7%;对照组分别为22.7%、（8.033±6.768）mmHg、53.6%。两组比较差异均有统计学意义（P〈0.01）。结论复合式小梁切除术治疗原发性青光眼在防止术后浅前房、术后滤过泡形成和眼压控制方面均比传统小梁切除术有明显优点,成功率及安全性高,并发症少。     

超声乳化联合小梁切除术治疗青光眼伴白内障老年患者的效果

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老年患者的临床疗效。方法回顾性分析青光眼合并白内障的老年患者的临床资料,根据治疗方式的不同将患者分为观察组和对照组。观察组采用超声乳化联合小梁切除手术方式,对照组采用单纯小梁切除术。对比两组的临床治疗效果,分析比较两组手术前后视力、眼压和前房深度的变化,对比两组术后并发症的发生率。结果观察组治疗有效率显著高于对照组(91. 04%vs 75. 41%;χ2=5. 691,P=0. 017)。观察组术后眼压显著低于对照组,前房深度显著大于对照组,术后视力显著优于对照组,差异均具有统计学意义(均P<0. 05)。两组患者术后各出现1例角膜水肿和1例低眼压,差异无统计学意义(χ2=0. 009,P=0. 924)。两组均未发生后囊破裂等严重并发症。结论运用超声乳化联合小梁切除术对老年患者青光眼伴白内障的眼压、视力有明显改善作用,优于单纯小梁切除术,是一种安全有效的手术方式。     

老年性白内障膨胀期继发性青光眼的治疗方法

目的 探讨老年性白内障膨胀期继发性青光眼的治疗方法. 方法 对16例16眼老年性白内障膨胀期继发性青光眼患者在应用常规降眼压药物治疗后不能有效降低眼压(用药后眼压仍＞ 40 mmHg)时,采用1ml注射器做前房穿刺放液,待眼压稳定2d后再行白内障联合抗青光眼手术治疗. 结果 所有患者经前房穿刺放液后眼压迅速降低,眼痛、头痛缓解,视力有不同程度的提高,手术前眼压控制在10～18 mmHg.行白内障联合抗青光眼手术后患者矫正视力均≥0.12. 结论 毫针穿刺放液可以缩短降眼压时间,为及早行白内障联合抗青光眼手术创造条件.对白内障膨胀期继发性青光眼患者行联合手术的远期疗效较好.     

Inhibition of nitric-oxide synthase 2 by aminoguanidine provides neuroprotection of retinal ganglion cells in a rat model of chronic glaucoma

Glaucoma is an optic neuropathy with cupping of the optic disk, degeneration of retinal ganglion cells, and characteristic visual field loss. Because elevated intraocular pressure (IOP) is a major risk factor for progression of glaucoma, treatment has been based on lowering IOP. We previously demonstrated inducible nitric-oxide synthase (NOS-2) in the optic nerve heads from human glaucomatous eyes and from rat eyes with chronic, moderately elevated IOP. Using this rat model of unilateral glaucoma, we treated a group of animals for 6 months with aminoguanidine, a relatively specific inhibitor of NOS-2, and compared them with an untreated group. At 6 months, untreated animals had pallor and cupping of the optic disks in the eyes with elevated IOP. Eyes of aminoguanidine-treated animals with similar elevations of IOP appeared normal. We quantitated retinal ganglion cell loss by retrograde labeling with Fluoro-Gold. When compared with their contralateral control eyes with normal IOP, eyes with elevated IOP in the untreated group lost 36% of their retinal ganglion cells; the eyes with similarly elevated IOP in the aminoguanidine-treated group lost less than 10% of their retinal ganglion cells. Pharmacological neuroprotection by inhibition of NOS-2 may prove useful for the treatment of patients with glaucoma.     

Interface Fluid Syndrome Induced by Uncontrolled Intraocular Pressure Without Triggering Factors After LASIK in a Glaucoma Patient: A Case Report

This study sought to describe a glaucoma patient with interface fluid syndrome (IFS) induced by uncontrolled intraocular pressure (IOP) without triggering factors after laser in situ keratomileusis (LASIK).Case report and review of the literature.A 23-year-old man with open-angle glaucoma underwent bilateral LASIK for myopia in 2009. Two years later, the patient reported sudden vision loss. The IOP in the right eye was not measurable using Goldmann applanation tonometry (GAT), but was determined to be 33.7 mm Hg using a noncontact tonometer. IFS was diagnosed based on the presence of space-occupying interface fluid on anterior segment optical coherence tomography images. After a trabeculectomy was performed, the IOP decreased to 10 mm Hg, and GAT measurement became possible. However, the corneal fold remained visible in the flap interface. Six months later, the IOP in the left eye increased, and a trabeculectomy was performed during the early stages of this increase in IOP. Following this procedure, the IOP decreased, and visual acuity remained stable.In glaucoma cases that involve a prior increase in IOP, IOP can continue to increase during the disease course even if temporary control of IOP has been achieved. If LASIK is performed in such cases, the treatment of glaucoma becomes insufficient because of underestimation of the typical IOP. In fact, the measurement of IOP can become difficult because of high-IOP levels. Therefore, LASIK should not be performed on patients with glaucoma who are at high risk of elevated IOP.     

Intraoperative malignant glaucoma during femtosecond laser-assisted cataract surgery: A case report

Rationale:Femtosecond laser-assisted cataract surgery (FLACS) has grown in popularity among ophthalmologists as a novel surgical technique. However, malignant glaucoma (MG) is a complication of FLACS. Herein, we report a case of MG following FLACS.Patient concerns:A 66-year-old woman presented with complaints of blurred vision in the right eye and a foreign body sensation in both eyes. Ophthalmological examinations showed that the corrected distance visual acuity was 20/50 and 20/25 in the right and left eyes, respectively. Without any topical anti-glaucoma medication, the intraocular pressure (IOP) was 20 mmHg in the right eye and 17 mmHg in the left eye. Slit-lamp examination of the right eye revealed a transparent cornea with a defect in the punctate overlying epithelium; the central anterior chamber depth was shallow the peripheral iris laser shot was visible, the pupil was normal, and the lens was mainly cortical opacified.Diagnoses:Based on the patient''s symptoms, examination results, and preliminary diagnoses, age-related cataract in the right eye, binocular post-antiglaucoma surgery, pseudophakicin in the left eye, and Sjogren syndrome were included.Interventions:FLACS was performed to facilitate anterior capsulotomy and segmentation of the nucleus in the right eye. MG occurred after the femtosecond procedure, and with the treatment of medicines combined with phacoemulsification, IOP was eventually normal without further antiglaucoma therapy.Outcomes:IOP was 16 mmHg on postoperative day 1. Ocular ultrasonography revealed no choroid detachment or hemorrhage in the right eye. Two weeks postoperatively, uncorrected visual acuity was 20/25, and IOP remained normal with no further antiglaucoma treatment on 1 month postoperatively.Conclusions:We describe the occurrence of MG after FLACS and illustrate that miosis and bubble formation after FLACS may be risk factors for MG during FLACS.     

Rescula as an alternative therapy for beta-blockers with long-term drift effect in glaucoma patients

The purpose of this study was to evaluate both the intraocular pressure (IOP)-decreasing and neuroprotective effects of Rescula (0.12% unoprostone isopropyl) as an alternative therapy to betablockers with a long-term drift effect in patients with glaucoma. Twenty-eight patients with unilateral or bilateral glaucoma were treated with Rescula instead of the original beta-blocker therapy. IOP was measured using a Goldmann applanation tonometer, and visual field defects were evaluated quantitatively by Humphrey automatic perimetry central 30-2 threshold test. The mean follow-up time was at least 1 year. Rescula achieved a significant (p = 0.00001) and long-lasting reduction in IOP (from 20.78 +/- 2.71 to 17.14 +/- 2.70 mmHg) in patients with open-angle glaucoma after 12 months of follow-up. It also demonstrated a significant (p = 0.02) IOP-reducing effect (from 20.67 +/- 3.60 to 16.36 +/- 3.67 mmHg) in patients with angle-closure glaucoma 12 months later. The mean deviation of visual field defects changed from -13.27 dB baseline to -10.64 dB at 12 months as evaluated by Humphrey field analyzer II central 30-2 threshold test after Rescula; however, there was no statistical difference (p = 0.098). Our results showed that Rescula has a significant IOP-reducing effect as an alternative therapy to beta-blockers with long-term drift effect in patients with open-angle and angle-closure glaucoma. However, a neuroprotective effect to prevent further progression of the visual field defect in patients with glaucoma was not demonstrated in this study.     

Calcineurin cleavage is triggered by elevated intraocular pressure, and calcineurin inhibition blocks retinal ganglion cell death in experimental glaucoma

Increased intraocular pressure (IOP) leads, by an unknown mechanism, to apoptotic retinal ganglion cell (RGC) death in glaucoma. We now report cleavage of the autoinhibitory domain of the protein phosphatase calcineurin (CaN) in two rodent models of increased IOP. Cleaved CaN was not detected in rat or mouse eyes with normal IOP. In in vitro systems, this constitutively active cleaved form of CaN has been reported to lead to apoptosis via dephosphorylation of the proapoptotic Bcl-2 family member, Bad. In a rat model of glaucoma, we similarly detect increased Bad dephosphorylation, increased cytoplasmic cytochrome c (cyt c), and RGC death. Oral treatment of rats with increased IOP with the CaN inhibitor FK506 led to a reduction in Bad dephosphorylation and cyt c release. In accord with these biochemical results, we observed a marked increase in both RGC survival and optic nerve preservation. These data are consistent with a CaN-mediated mechanism of increased IOP toxicity. CaN cleavage was not observed at any time after optic nerve crush, suggesting that axon damage alone is insufficient to trigger cleavage. These findings implicate this mechanism of CaN activation in a chronic neurodegenerative disease. These data demonstrate that increased IOP leads to the initiation of a CaN-mediated mitochondrial apoptotic pathway in glaucoma and support neuroprotective strategies for this blinding disease.     

Experimental and clinical evidence of neuroprotection by nerve growth factor eye drops: Implications for glaucoma

Elevated intraocular pressure (IOP) in glaucoma causes loss of retinal ganglion cells (RGCs) and damage to the optic nerve. Although IOP is controlled pharmacologically, no treatment is available to restore retinal and optic nerve function. We evaluated the effects of NGF eye drops in a rat model of glaucoma. We also treated 3 patients with progressive visual field defects despite IOP control. Glaucoma was induced in rats through injection of hypertonic saline into the episcleral vein. Initially, 2 doses of NGF (100 and 200 μg/mL) were tested on 24 rats, and the higher dose was found to be more effective. Glaucoma was then induced in an additional 36 rats: half untreated and half treated with 200 μg/mL NGF QID for 7 weeks. Apoptosis/survival of RGCs was evaluated by histological, biochemical, and molecular analysis. Three patients with advanced glaucoma underwent psychofunctional and electrofunctional tests at baseline, after 3 months of NGF eye drops, and after 3 months of follow-up. Seven weeks of elevated IOP caused RGC degeneration resulting in 40% cell death. Significantly less RGC loss was observed with NGF treatment (2,530 ± 121 vs. 1,850 ± 156 RGCs/mm²) associated with inhibition of cell death by apoptosis. Patients treated with NGF demonstrated long lasting improvements in visual field, optic nerve function, contrast sensitivity, and visual acuity. NGF exerted neuroprotective effects, inhibiting apoptosis of RGCs in animals with glaucoma. In 3 patients with advanced glaucoma, treatment with topical NGF improved all parameters of visual function. These results may open therapeutic perspectives for glaucoma and other neurodegenerative diseases.     

联合手术治疗晶状体脱位或半脱位疗效观察

为评价晶状体、玻璃体等联合手术治疗晶状体脱位、半脱位的疗效,对37例(40眼)先天性、外伤性晶状体脱位或半脱位患者采用晶状体、玻璃体联合手术去除脱位或半脱位的晶状体,并用小梁切除术、玻璃体视网膜联合手术治疗因晶状体脱位引起的并发症,其中26例(29眼)同期植入后房型人工晶状体。结果本组患眼均成功去除晶状体,60.0％患眼术后矫正视力≥0.5,16例继发青光眼患者术后眼压获得控制,5例视网膜脱离全部复位。认为晶状体、玻璃体等联合手术治疗晶状体脱位、半脱位及其并发症,疗效显著,视力提高明显。     

Corneal biomechanical properties in thyroid eye disease

The purpose of this study is to investigate the effect of thyroid eye disease (TED) on the measurement of corneal biomechanical properties and the relationship between these parameters and disease manifestations. A total of 54 eyes of 27 individuals with TED and 52 eyes of 30 healthy control participants were enrolled. Thyroid ophthalmopathy activity was defined using the VISA (vision, inflammation, strabismus, and appearance/exposure) classification for TED. The intraocular pressure (IOP) measurement with Goldmann applanation tonometer (GAT), axial length (AL), keratometry, and central corneal thickness (CCT) measurements were taken from each patient. Corneal biomechanical properties, including corneal hysteresis (CH) and corneal resistance factor (CRF) and noncontact IOP measurements, Goldmann-correlated IOP (IOP_g) and corneal-compensated IOP (IOP_cc) were measured with the Ocular Response Analyzer (ORA) using the standard technique. Parameters such as best corrected visual acuity, axial length, central corneal thickness, and corneal curvature were not statistically significant between the two groups (p > 0.05). IOP measured with GAT was higher in participants with TED (p < 0.001). The CH of TED patients was significantly lower than that of the control group. There was no significant difference in the corneal resistance factor between groups. However, IOP_g and IOP_cc were significantly higher in TED patients. CH and VISA grading of TED patients showed a negative correlation (p = 0.007). In conclusion, TED affects the corneal biomechanical properties by decreasing CH. IOP with GAT and IOPg is found to be increased in these patients. As the severity of TED increases, CH decreases in these patients.     

The effect of the aspiration of pericardial effusion on intraocular pressure

OBJECTIVE: To assess the effect of pericardial effusion on intraocular pressure (IOP). PATIENTS AND METHODS: Twenty-two patients with pericardial effusion were enrolled into the study. The average pericardial effusion was 2245 +/- 257 cc, and the mean IOP was 26.1 +/- 2.1 mm Hg in the initial examination. Pericardial effusion was aspirated via canula under topical anaesthesia at two or three-day intervals. IOP was measured after every aspiration of pericardial fluid. We statistically compared the changes in the mean IOP after every aspiration (one-way ANOVA), and calculated the correlation (regression analysis) between the amount of fluid and the changes in IOP. RESULTS: An average of 400 ml of fluid was aspirated at two or three-day intervals. The mean IOP decreased to 23.3, 21.2, 19.1 and 16.3 mm Hg after aspirations, respectively. These decreases in the mean IOP were statistically significant (p < 0.01). In regression analysis, we observed a meaningful relationship between the changes in IOP and the amount of pericardial effusion (p < 0.001). CONCLUSION: We found that pericardial effusion affected IOP due to increased episcleral venous pressure. Therefore, patients with pericardial effusion should be referred for an ophthalmological examination with IOP measurement. IOP-lowering medication can eventually be started or adjusted by the ophthalmologist.