PACG患者视觉生活质量和心理状况的临床研究

目的:评估原发性闭角型青光眼（primary angle-closure glaucoma,PACG）患者的心理和视觉健康相关生存质量状况,分析青光眼小梁切除手术对其影响。 方法:采用前瞻性随机临床对照的方法, 对42例PACG患者分别采用国家眼科研究视功能问卷（25-item national eye institute visual functioning questionnaire, NEI-VFQ-25）和综合医院焦虑抑郁量表（hospital anxiety and depression scale, HADS）中文版评定患者最近1mo的视觉生活质量和焦虑、抑郁评分,术后1mo再次患者评定焦虑、抑郁情况及视觉生活质量,42例健康自愿者作为对照,分析其心理和视觉健康相关生存质量变化情况。 结果:PACG患者焦虑、抑郁及共患患者发生率分别为23.8%,23.8%和 16.7%。NEI-VFQ-25评分显示患者在视觉健康相关生存质量部分亚功能（10/12）如一般健康、总体视觉、社会功能、心理问题、周边视野和依赖性等均有不同程度的损害(P<0.05)。通过小梁切除手术干预,患者焦虑、抑郁评分明显好转(P<0.05),视觉健康相关生存质量的样本中位数差值\[41.6(一般健康)、34.5 (眼痛)、32.6 (社会功能)、21.2(心理问题)、24.8(社会活动)、21.8（依赖性）\],均较手术前明显改善\[10.4(一般健康)、6.4 (眼痛)、10.6(社会功能)、8.3(心理问题)、7.3(社会活动)、6.9（依赖性）;均为P<0.05\]。 结论: PACG患者焦虑、抑郁状况加重,视觉健康相关生存质量明显降低。小梁切除术有助于患者视觉生活质量和心理康复。     

心理干预对闭角型青光眼患者心理和视野及眼压的影响

目的:评估心理治疗对闭角型青光眼患者心理、视野及眼压的影响。方法:运用SCL-90、焦虑和抑郁自评量表对100例闭角型青光眼患者进行问卷调查,并在术后3mo对患者的视野、眼压和HRTⅡ进行检查。结果:通过一定的心理干预后,干预组SCL-90量表中人际关系、抑郁、焦虑、恐怖和偏执等指标评分较非干预组有所改善。干预组与非干预组相比,焦虑和抑郁评分明显改善,差异具有统计学意义(P<0.05)。术后3mo,干预组患者的眼压较非干预组低,差异具有统计学意义(P<0.05),但干预组与非干预组的视野平均缺损和模式标准差无显著性差异。HRTⅡ中的指标,干预组中C/D和线性C/D与非干预组有显著性差异外,其余指标均无明显差异。结论:心理干预对闭角型青光眼患者的治疗作用只能是在药物和手术治疗的基础上起一定辅助作用,提高药物、手术治疗的疗效。     

原发性青光眼患者抑郁与焦虑心理状况调查分析

目的 评价原发性青光眼患者抑郁与焦虑心理状况并分析其影响因素.方法 对24例原发性闭角型青光眼(PACG)、26例原发性开角型青光眼(POAG)和对照组(n=24)进行患者健康问卷(PHQ)调查,并对问卷评分进行比较和对年龄、性别等因素进行多重线性回归分析.结果 PACG、POAG和对照组抑郁症状阳性率分别为33.3％、19.2％和8.3％,焦虑症状阳性率分别为37.5％、26.9％和8.3％.PACG组抑郁(P =0.027)、焦虑(P=0.004)程度高于对照组,POAG与PACG和对照组差异不明显(P＞0.05).抑郁焦虑评分呈正相关(P＜0.01),抑郁(β=m.149,P=0.029)焦虑(β=-0.204,P=0.025)分别与年龄呈负相关,与性别无关.结论 PACG抑郁焦虑程度高于正常人,PACG与POAG之间无明显差异.青光眼患者抑郁焦虑状况与年龄相关,与性别无关.     

正念减压疗法对开角型青光眼患者药物治疗依从性的影响

目的:探讨正念减压疗法对青光眼患者焦虑情绪、依从性及视功能的影响.方法:选取64例我院门诊确诊为原发性开角型青光眼(primary open angle glaucoma,POAG)并长期局部用药控制眼压的患者,随机分为观察组与对照组,各32例.对照组给予药物治疗和常规心理干预;观察组在药物治疗和常规心理干预的同时进行正念减压疗法.评估两组患者焦虑情绪评分、治疗依从性以及平均视敏度缺损情况.结果:观察组治疗后焦虑情绪评分显著低于对照组(P<0.01);观察组治疗后依从性显著高于对照组(P<0.01).结论:正念减压疗法能有效改善POAG患者的焦虑情绪,提高其治疗依从性.     

剥脱性青光眼与原发性开角型青光眼行青白联合手术疗效观察

目的：比较剥脱性青光眼(PXG)与原发性开角型青光眼(POAG)行青光眼白内障联合手术的临床疗效。

方法：回顾性选取2015-01/2018-01于我院住院治疗的PXG患者38例40眼作为PXG组，另选取基线资料相匹配的POAG患者36例46眼作为POAG组。观察两组患者行小梁切除+白内障超声乳化摘除+人工晶状体植入术后视力、眼压、抗青光眼药物使用数量及并发症发生情况，并根据标准A(IOP≤21mmHg)、B(IOP≤18mmHg)评定手术疗效，手术完全成功定义为满足上述标准且不进行药物治疗，手术条件成功定义为满足上述标准但需进行药物治疗(≤3种)。

结果：术后两组患者视力均较术前改善，眼压均明显降低，抗青光眼药物使用数量均减少。术后1、3mo两组手术完全成功率及条件成功率均无差异(P>0.05)。术后6mo，1、2a，根据标准A，PXG组手术条件成功率(90%、80%、74%)均略低于POAG组(91%、86%、82%，均P>0.05)，手术完全成功率(50%、40%、29%)均明显低于POAG组(85%、64%、61%，均P<0.05)； 根据标准B，PXG组手术条件成功率(70%、70%、59%)略均低于POAG组(80%、80%、75%，均P>0.05)，手术完全成功率(45%、30%、18%)均明显低于POAG组(78%、61%、54%，均P<0.05)。

结论：PXG及POAG患者实施青光眼白内障联合手术后能够显著提高视力、降低眼压，两者短期手术成功率相似，但PXG患者远期手术成功率明显偏低，且无法达到低标准眼压控制。     

原发性开角型青光眼患者焦虑症伴随状况及特征分析

目的:了解原发性开角型青光眼(primary open angle glau-coma,POAG)患者焦虑症伴随状况及其影响因素。方法:用Hamilton焦虑量表(HAMD)对82例POAG患者及82例非青光眼患者进行焦虑测试,对比两组患者焦虑症伴随比率,并对82例POAG患者以不同性别、年龄、文化程度等进行分组比较,分析焦虑症发生的影响因素。结果:POAG组与对照组伴发焦虑者分别为13例(16%)和5例(6%),经χ2检验,差异有统计学意义(P=0.046)。对82例POAG患者内部分组比较显示:性别、年龄、文化水平、病程、视野为POAG伴发焦虑的相关因素。结论:POAG患者心理健康状况应予以关注,尤其对病程长、年龄大、文化程度低、视功能损害严重的女性患者,应同时给予心理评估及干预,以改善POAG患者的生活质量及预后。     

深层巩膜切除术联合透明质酸片植入治疗原发性开角型青光眼

目的:探讨深层巩膜切除联合透明质酸片植入(DSHI)治疗原发性开角型青光眼(POAG)的临床疗效。方法:回顾性总结在Saarland大学眼科医院行DSHI治疗的POAG。结果:符合条件并入选的有216患者的377只POAG。平均随诊31(5～51)mo。术前平均眼压(28.3±8.4)mmHg(1mmHg=0.133kPa),术后1wk,6mo,1、2、3、4a眼压分别为(9.7±3.6)、(12.4±5.3)、(15.5±8.7)、(15.4±6.8)、(16.1±6.7)、(17.4±7.5)mmHg。术前平均视力为0.65,术后1wk,6mo,1、2、3、4a视力分别为0.63、0.68、0.72、0.71、0.76、0.70。术后1a显效(不加抗青光眼药物且眼压≤21mmHg)率为89%,有效(加抗青光眼药物时眼压≤21mmHg)率为9%。术后4a时,显效率为45%,有效率48%。并发症包括切口渗漏、前房出血、脉络膜脱离等。结论:DSHI对POAG治疗效果良好,并发症少且轻微。     

和谐及企图和谐异常视网膜对应共同性内斜视患者生活质量和心理状况的临床研究

目的评价和谐及企图和谐异常视网膜对应共同性内斜视患者生活质量和心理状况,分析斜视手术对其影响。方法通过前瞻性随机临床对照的方法,对和谐及企图和谐异常视网膜对应共同性内斜视患者36例分别采用《国家眼科研究视功能问卷》和《综合医院焦虑抑郁量表》中文译本评定患者最近1个月的视觉生活质量和焦虑、抑郁评分,手术后1个月再次评定患者焦虑、抑郁情况及视觉生活质量,36例健康志愿者作为对照,比较两组患者生活质量和心理状况的差异。结果和谐及企图和谐异常视网膜对应共同性内斜视患者焦虑、抑郁及共患患者发生率分别为22.2%、25.0%、27.8%。《国家眼科研究视功能问卷》评分显示术前共同性内斜视患者在视觉健康相关生活质量部分亚功能(7/12)如一般健康、总体视觉、驾驶、社会功能、心理问题、周边视野和依赖性等均有不同程度的损害(均为P<0.05)。通过斜视手术干预,患者视觉生活质量和心理状态均有明显好转(均为P<0.05)。通过斜视手术干预,患者焦虑、抑郁评分明显好转(均为P<0.05),视觉健康相关生活质量的样本中位数差值[43.3(一般健康)、38.2(社会功能)、12.4(心理问题)、17.5(社会活动)、16.4(依赖性)、12.4(周边视野)],均较手术前明显改善[8.6(一般健康)、7.3(社会功能)、3.5(心理问题)、3.6(社会活动)、2.8(依赖性)、5.6(周边视野),均为P<0.05]。结论斜视手术可使和谐及企图和谐异常视网膜对应共同性内斜视患者心理状况和视觉健康相关生活质量得到明显改善。斜视手术有助于患者视觉生活质量和心理康复。     

缝线引导GATT联合白内障超声乳化术治疗原发性开角型青光眼

目的:探讨缝线引导GATT联合白内障超声乳化术治疗原发性开角型青光眼(POAG)的临床疗效。方法:选取2021-01/2022-07于我院行手术治疗的合并白内障的POAG患者84例84眼,随机分成两组,联合组43例43眼行缝线引导GATT联合白内障超声乳化术,单纯组41例41眼行缝线引导GATT术。随访3mo,比较两组患者手术成功率、眼压、局部使用降眼压药物种类、视力及术后并发症情况。结果:术后3mo,联合组和单纯组患者手术总成功率无显著差异(88%vs 85%,P>0.05)。两组患者术后1wk, 1、3mo眼压水平、局部使用降眼压药物种类均较术前显著降低(均P<0.05),但两组间无显著差异(均P>0.05)。术后1wk, 1、3mo联合组患者视力均显著优于单纯组(P<0.01)。随访期间,联合组患者前房出血、一过性高眼压发生率均显著低于单纯组(P<0.05)。结论:缝线引导GATT手术是否联合白内障超声乳化术均可有效治疗POAG,但缝线引导GATT联合白内障超声乳化术后前房出血、一过性高眼压发生率更低。     

超声乳化联合选择性小梁激光成形术在开角型青光眼中的作用

目的：比较选择性小梁激光成形术(SLT)和超声乳化联合选择性小梁激光成形术(Phaco+SLT)在药物控制良好的开角型青光眼(POAG)中的降眼压作用。

方法：采用前瞻性临床病例对照研究,24例30眼药物控制眼压良好的开角型青光眼随机分为两组,其中Phaco+SLT组11例14眼; SLT组13例16眼。测量术后3,6,9mo的眼压及术后9mo的视力和抗青光眼用药数量。

结果：两组术后平均眼压比术前眼压明显降低。Phaco+SLT组在术后6,9mo的平均眼压明显低于SLT组,两组眼压比较有统计学意义(P=0.001); 两组术后抗青光眼用药数量比术前明显降低,两组间比较有统计学意义(P=0.03)。

结论：Phaco+SLT和SLT能明显降低开角型青光眼患者眼压,Phaco+SLT降眼压作用明显优于SLT。     

Quantifizierung der subjektiven visuellen Lebensqualit?t bei Glaukompatienten

Background

There is an increasing interest in assessing the quality of life as an additional guide for therapeutic choices, especially in patients with chronic diseases, e.g. glaucoma. Most standardized questionnaires are available in English making them inapplicable for daily use in non-English-speaking environments. The ??Glaucoma Quality of Life 15 Questionnaire?? (GQL-15) is a test designed for glaucoma patients in English and was translated into German in order to analyze its practicability in a daily clinical setting.

Patients and methods

The GQL-15 was handed out to glaucoma patients during the hospital stay. The questionnaires were analyzed retrospectively and correlated to clinical indices, such as age, visual acuity, visual field, parametric mean deviation (MD) and frequency of pharmacologic treatment.

Results

A total of 31 patients were evaluated. It could be demonstrated that the quality of life summary scores correlated with visual field loss. Evaluation of subscale scores of visual function revealed that glare and dark adaptation were correlated with glaucoma severity especially in the early stages of the disease.

Conclusions

The German translation of the GQL-15 was well accepted by glaucoma patients. In our analysis disability of vision-related activities as expressed in the translated GQL-15 correlated with glaucoma severity. This first use of the translated GQL-15 encourages further studies in German glaucoma patients and their quality of life.     

Cross sectional study of depression,anxiety and quality of life in glaucoma patients at a tertiary centre in North Kerala

Purpose:To determine the magnitude and direction of association of anxiety and depression and the quality of life (QoL) in persons with glaucoma.Methods:This prospective cross-sectional study in conducted in a tertiary eye center in north Kerala included glaucoma patients and normal subjects aged 40–80 years. The Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), Glaucoma Quality of Life (GQOL), and glaucoma evaluation were performed for all participants. One-way analysis of variance was used for statistical analysis.Results:The study included 148 subjects with glaucoma and 150 subjects without glaucoma. The prevalence of depression (35.81%) and anxiety (25.0%) was significantly higher in glaucoma patients. In a multivariate regression model, PHQ-9 (adjusted OR: 2.39, 95% CI: 1.31–4.38, P < 0.001), GAD-7 (adjusted OR: 2.06, 95% CI: 1.01–4.19, P = 0.01) and GQOL (coefficient: 6.92, 95% CI: 4.52–9.31, P = < 0.001) was significantly associated with glaucoma. The GAD-7 score was significantly higher (P = 0.02) in PACG compared to POAG in moderate and severe anxiety. ADL scores (one-way ANOVA, P = 0.001) and GQOL scores (one-way ANOVA, P < 0.001) were significantly associated with vision impairment and blindness.Conclusion:Depression and anxiety are common in glaucoma patients, indicating the need for screening protocols using PHQ and GAD scales to identify persons at risk. The lack of ophthalmic risk factors associated with depression and anxiety emphasizes the importance of psychological evaluation and combined management with a psychiatrist in glaucoma management.     

Characteristic Profiles of Inflammatory Cytokines in the Aqueous Humor of Glaucomatous Eyes

Purpose: To analyze cytokine profiles of the aqueous humor of eyes with primary open-angle glaucoma (POAG), neovascular glaucoma (NVG), and cataract (as controls).

Methods: A multiplex bead assay was used to measure concentrations of 27 cytokines in aqueous humor samples from 54 eyes.

Results: Detection rates were as follows: IL-7: NVG higher than POAG; IL-10: POAG lower than cataract or NVG; and GM-CSF: cataract higher than POAG or NVG. Concentrations were as follows: IL-8, IP-10, MCP-1, and MIP-1β: POAG and NVG higher than cataract; IL-9: POAG lower than NVG; IL-12: POAG lower than cataract or NVG; and VEGF: NVG higher than cataract or POAG and POAG lower than cataract. Further analysis showed that IL-8, IP-10, MCP-1, and MIP-1β were correlated with intraocular pressure and age.

Conclusions: The detection rates and levels of various cytokines had different patterns in POAG and NVG patients, suggesting distinctive alterations in the microenvironment in different types of glaucoma.     

Xen45 Gel Stent implant: patient reported outcomes

Our aim was to report quality of life (QOL) outcomes following Xen45 Gel Stent implantation surgery in patients suffering with primary open angle glaucoma (POAG). A retrospective analysis was performed on all patients who had Xen45 implantation surgery during a 2-year period (Jun, 2016-Apr, 2018). Of 52 consecutive patients were included with a total of 58 eyes being operated on. QOL was compared both pre-operatively and 6 weeks post-operatively using the GQL-15 questionnaire. There was an overall improvement in GQL-15 summary scores for our patient group. All item scores showed either no change or some degree of improvement. The Xen45 Gel Stent Implant is a promising new intervention which has shown improved QOL scores in our patient group. Further, higher power studies are now needed to compare the Xen45 to trabeculectomy (TE), which is currently the gold standard.     

康柏西普玻璃体腔注射联合EX-PRESS青光眼引流器植入治疗NVG

目的：观察康柏西普玻璃体腔注射应用EX-PRESS青光眼引流器植入治疗新生血管性青光眼的疗效。

方法：选择2015-01/2018-01在我院眼科就诊的新生血管性青光眼患者37例37眼,随机分为试验组与对照组,两组在术前均行康柏西普玻璃体腔注射,试验组和对照组分别选择EX-PRESS青光眼引流器植入术和小梁切除术。对比两组术后成功率、最佳矫正视力、眼压、滤过泡、并发症。

结果：术后12mo, 两组手术成功率、BCVA及滤过泡率均无差异(P>0.05)。两组不同时间点眼压比较有差异(F_组间=10.0,P_组间=0.003; F_时间=496.27,P_时间<0.0001)。所有并发症经对症处理后改善。

结论：EX-PRESS青光眼引流器植入联合康柏西普玻璃体腔注射治疗新生血管性青光眼对降低眼压、减少术后并发症有一定的临床价值。     

Impact of moderate and severe primary open-angle glaucoma on quality of life due to activity limitation

Purpose:To study the impact of moderate and severe primary open-angle glaucoma (POAG) on the quality of life (QoL) due to activity limitation using glaucoma-specific questionnaires.Methods:This cross-sectional study enrolled 122 participants, 50% (n = 61) being controls and 50% were diagnosed cases of moderate/severe POAG. Three orally administered glaucoma-specific QoL instruments were used: Glaucoma Activity Limitation (GAL-9), Glaucoma Quality of Life (GQL-15), and Viswanathan questionnaires. The questions related to activity limitation were identified and analyzed for each questionnaire separately.Results:The mean age of the participants was 61.04 ± 9.88 years and a majority were males (64.8%, n = 79). The mean scores in controls, moderate glaucoma, and severe POAG patients for GAL-9 questionnaire were 9.77 ± 1.36 (P = 0.44), 13.75 ± 4.76 (P < 0.001), and 23.45 ± 5.62 (P < 0.001), for GQL-15, these were 16.39 ± 2.18 (P = 0.5), 22.75 ± 7.89 (P < 0.001), and 39.34 ± 9.42 (P < 0.001), respectively, while for the Viswanathan questionnaire, they were 9.49 ± 0.94 (P = 0.38), 7.91 ± 1.59 (P < 0.001), and 4.41 ± 2.20 (P < 0.001), respectively. The GQL-15 and GAL-9 questionnaires concluded that activity limitation pertaining to dark adaptation-related tasks affected the QoL the most in moderate as well as severe POAG (P < 0.001). Using the Viswanathan questionnaire, it was observed that the peripheral vision-related activity limitation was most significant for the decrease in QoL in moderate POAG while near vision-related activity limitation affected the QoL the most in severe POAG (P < 0.001).Conclusion:All three questionnaires concluded that the activity limitation due to moderate and severe glaucoma has a negative impact on the QoL. The limitation of the tasks involving dark adaptation/glare and peripheral vision has the most significant impact on the QoL in moderate glaucoma. As the disease progresses to a severe category, the limitation of activities requiring central and near vision causes the most significant worsening in QoL.     

Analysis of risk factors that may be associated with progression from ocular hypertension to primary open angle glaucoma

Background: As a multifactorial disease, glaucoma may be associated with pressure‐dependent and pressure‐independent factors. Ocular hypertension (OHT) may develop into primary open angle glaucoma (POAG) for many patients. Groups with OHT and POAG were compared for pressure‐dependent and independent risk factors. A high prevalence of any factor(s) could indicate a contribution to progression from OHT to POAG. Methods: A sample of patients with POAG (n = 438) and with OHT (n = 301) were selected from those attending a tertiary referral private glaucoma practice, and data were collected regarding age and intraocular pressure at the time of diagnosis, sex, family history of glaucoma, systemic hypertension, diabetes, Raynaud's phenomenon, migraine and myopia. Results: After multivariate analysis, older age at time of diagnosis (χ²₅ = 73.89, P < 0.001), myopia (odds ratio [OR] = 1.5, 95% confidence interval [CI] 1.0?2.2; P < 0.05), a family history of glaucoma (OR = 1.6, 95% CI 1.1?2.3; P < 0.01) and a high intraocular pressure (χ²₄ = 16.96; P = 0.002) were found to be more prevalent among those with POAG. No other significant differences could be found between the two groups. Conclusion: Patients who have OHT may be at higher risk of developing POAG if they also have myopia, a family history of glaucoma or are of older age.     

原发性开角型青光眼患者房水中IL-37和IL-6的表达及意义

目的:检测原发性开角型青光眼(POAG)患者房水中IL-37和IL-6的含量,并分析IL-6和IL-37含量与眼压或视野平均缺损的相关性。方法:采用前瞻性病例对照研究,利用酶联免疫吸附试验(ELISA)对2019-06/2020-01在南京医科大学附属眼科医院连续就诊的25例POAG患者和25例年龄相关性白内障(ARC)患者房水中IL-37和IL-6含量进行检测。同时测定POAG组患者眼压、视野平均缺损。结果:房水中IL-37和IL-6含量POAG组患者为25.80±2.87、43.87±7.75pg/mL,ARC组患者为23.75±3.88、36.53±7.60pg/mL,两组间IL-37和IL-6含量比较均有差异(P<0.05)。IL-6与眼压正相关(r=0.5817,P<0.05),IL-37与视野缺损正相关(r=0.4520,P<0.05)。结论:POAG患者房水中IL-37、IL-6含量均显著高于ARC组。IL-37和IL-6介导的免疫炎症反应可能参与了POAG的发病机制。     

EX-PRESS引流钉植入术对POAG患者角膜内皮细胞及眼压的影响

目的：评价EX-PRESS引流钉植入术对原发性开角型青光眼(POAG)患者角膜内皮细胞及眼压的影响。

方法：前瞻性临床研究。收集2016-05/2017-12在我院行EX-PRESS引流钉植入术的原发性开角型青光眼患者32例38眼,随访至术后24mo,观察中央、鼻侧、颞侧、上方、下方5个方位的角膜内皮细胞密度、眼压及最佳矫正视力情况,并观察前房深度及引流钉与虹膜、角膜的位置情况及手术疗效。

结果：手术前后,本组患者5个方位的角膜内皮细胞密度和最佳矫正视力均无明显变化(P>0.05),但术后各时间点眼压均较术前明显降低(P<0.05)。术后24mo,本组患者手术完全成功率为66%,条件成功率为21%,失败率为13%,手术失败的主要原因为滤过泡包裹。本组患者术中和术后随访期间均未出现前房完全消失; 术后1眼出现浅前房,5眼引流钉与虹膜面相贴,余32眼引流钉均位于虹膜与角膜内皮之间,位置良好。

结论：EX-PRESS引流钉植入术对POAG患者角膜内皮细胞无明显影响,且能有效控制眼压,是治疗原发性开角型青光眼的安全有效的方法。