单纯非瞳孔阻滞性闭角型青光眼治疗进展

原发性闭角型青光眼是我国青光眼的主要类型,单纯非瞳孔阻滞因素作为闭角型青光眼房角关闭机制中的一种,由虹膜、睫状体的形态或位置异常形成,调节因素可能参与其中.基于房角关闭机制可采用不同的治疗策略.应用毛果芸香碱滴眼液,激光虹膜成形术和白内障摘除术可能是治疗非瞳孔阻滞性闭角型青光眼的有效方法,但目前证据并不充分.     

高褶虹膜

原发性闭角型青光眼(PACG)是亚洲,特别是中国青光眼的主要类型。PACG在激光周边虹膜切除术(LPI)后仍有很高比例发生房角关闭,高褶虹膜(plateau iris)是引起房角关闭的非瞳孔阻滞因素之一。随着超声生物显微镜(UBM)在眼科的广泛应用,对高褶虹膜的认识不断深入。本文将对高褶虹膜的概念、机制、患病率、与房角关闭的关系、诊断标准及治疗方法进行阐述,旨在更加深刻理解高褶虹膜与PACG的关系,为今后PACG的治疗和研究提供参考。     

眼内肿瘤继发青光眼的发病机制及处理

较常见的眼内肿瘤有视网膜母细胞瘤、葡萄膜黑色素瘤、脉络膜血管瘤、眼内转移癌等.眼内肿瘤继发性青光眼的发病机制包括虹膜新生血管形成及房角关闭,肿瘤组织侵犯房角,瞳孔阻滞和肿瘤前房播散,黑色素瘤溶解性青光眼,房角发育异常等.眼内肿瘤继发青光眼的处理因肿瘤类型、生长部位、病变侵犯程度等因素而异.对原发性肿瘤可以进行药物保守治疗、切除肿瘤组织或眼球摘除等手术治疗;对转移瘤可以进行药物、化学及放射治疗.     

眼内肿瘤继发青光眼的发病机制及处理

较常见的眼内肿瘤有视网膜母细胞瘤、葡萄膜黑色素瘤、脉络膜血管瘤、眼内转移癌等.眼内肿瘤继发性青光眼的发病机制包括虹膜新生血管形成及房角关闭,肿瘤组织侵犯房角,瞳孔阻滞和肿瘤前房播散,黑色素瘤溶解性青光眼,房角发育异常等.眼内肿瘤继发青光眼的处理因肿瘤类型、生长部位、病变侵犯程度等因素而异.对原发性肿瘤可以进行药物保守治疗、切除肿瘤组织或眼球摘除等手术治疗;对转移瘤可以进行药物、化学及放射治疗.     

眼内肿瘤继发青光眼的发病机制及处理

较常见的眼内肿瘤有视网膜母细胞瘤、葡萄膜黑色素瘤、脉络膜血管瘤、眼内转移癌等.眼内肿瘤继发性青光眼的发病机制包括虹膜新生血管形成及房角关闭,肿瘤组织侵犯房角,瞳孔阻滞和肿瘤前房播散,黑色素瘤溶解性青光眼,房角发育异常等.眼内肿瘤继发青光眼的处理因肿瘤类型、生长部位、病变侵犯程度等因素而异.对原发性肿瘤可以进行药物保守治疗、切除肿瘤组织或眼球摘除等手术治疗;对转移瘤可以进行药物、化学及放射治疗.     

眼内肿瘤继发青光眼的发病机制及处理

较常见的眼内肿瘤有视网膜母细胞瘤、葡萄膜黑色素瘤、脉络膜血管瘤、眼内转移癌等.眼内肿瘤继发性青光眼的发病机制包括虹膜新生血管形成及房角关闭,肿瘤组织侵犯房角,瞳孔阻滞和肿瘤前房播散,黑色素瘤溶解性青光眼,房角发育异常等.眼内肿瘤继发青光眼的处理因肿瘤类型、生长部位、病变侵犯程度等因素而异.对原发性肿瘤可以进行药物保守治疗、切除肿瘤组织或眼球摘除等手术治疗;对转移瘤可以进行药物、化学及放射治疗.     

眼内肿瘤继发青光眼的发病机制及处理

较常见的眼内肿瘤有视网膜母细胞瘤、葡萄膜黑色素瘤、脉络膜血管瘤、眼内转移癌等.眼内肿瘤继发性青光眼的发病机制包括虹膜新生血管形成及房角关闭,肿瘤组织侵犯房角,瞳孔阻滞和肿瘤前房播散,黑色素瘤溶解性青光眼,房角发育异常等.眼内肿瘤继发青光眼的处理因肿瘤类型、生长部位、病变侵犯程度等因素而异.对原发性肿瘤可以进行药物保守治疗、切除肿瘤组织或眼球摘除等手术治疗;对转移瘤可以进行药物、化学及放射治疗.     

眼内肿瘤继发青光眼的发病机制及处理

较常见的眼内肿瘤有视网膜母细胞瘤、葡萄膜黑色素瘤、脉络膜血管瘤、眼内转移癌等.眼内肿瘤继发性青光眼的发病机制包括虹膜新生血管形成及房角关闭,肿瘤组织侵犯房角,瞳孔阻滞和肿瘤前房播散,黑色素瘤溶解性青光眼,房角发育异常等.眼内肿瘤继发青光眼的处理因肿瘤类型、生长部位、病变侵犯程度等因素而异.对原发性肿瘤可以进行药物保守治疗、切除肿瘤组织或眼球摘除等手术治疗;对转移瘤可以进行药物、化学及放射治疗.     

眼内肿瘤继发青光眼的发病机制及处理

较常见的眼内肿瘤有视网膜母细胞瘤、葡萄膜黑色素瘤、脉络膜血管瘤、眼内转移癌等.眼内肿瘤继发性青光眼的发病机制包括虹膜新生血管形成及房角关闭,肿瘤组织侵犯房角,瞳孔阻滞和肿瘤前房播散,黑色素瘤溶解性青光眼,房角发育异常等.眼内肿瘤继发青光眼的处理因肿瘤类型、生长部位、病变侵犯程度等因素而异.对原发性肿瘤可以进行药物保守治疗、切除肿瘤组织或眼球摘除等手术治疗;对转移瘤可以进行药物、化学及放射治疗.     

眼内肿瘤继发青光眼的发病机制及处理

较常见的眼内肿瘤有视网膜母细胞瘤、葡萄膜黑色素瘤、脉络膜血管瘤、眼内转移癌等.眼内肿瘤继发性青光眼的发病机制包括虹膜新生血管形成及房角关闭,肿瘤组织侵犯房角,瞳孔阻滞和肿瘤前房播散,黑色素瘤溶解性青光眼,房角发育异常等.眼内肿瘤继发青光眼的处理因肿瘤类型、生长部位、病变侵犯程度等因素而异.对原发性肿瘤可以进行药物保守治疗、切除肿瘤组织或眼球摘除等手术治疗;对转移瘤可以进行药物、化学及放射治疗.     

OCT对激光周边虹膜切开术治疗原发性闭角型青光眼效果的评价

目的：通过光学相干断层扫描技术(optical coherence tomography,OCT)观察不同临床类型原发性闭角型青光眼(primary angle-closure glaucoma,PACG)行激光周边虹膜切开术(laser peripheral iris, LPI)前、后前房角开放距离变化,评价治疗效果。方法：选择明确诊断为PACG患者46例50眼,其中急性闭角型青光眼临床前期及缓解期眼26例27眼,慢性闭角型青光眼20例23眼,行LPI治疗,通过OCT分别检查术前、术后2周距巩膜突500及750μm处前房角开放距离,采用配对t检验。结果：急性闭角型青光眼LPI术前、术后2周前房角开放距离差异有统计学意义(P<0.05);慢性闭角型青光眼术前、术后2周前房角开放距离差异无统计学意义(P>0.05)。结论：急性闭角型青光眼LPI术后前房角开放距离增加,治疗效果较好;慢性闭角型青光眼LPI术后前房角开放距离增加不明显,术后仍存在前房角闭塞趋向。     

Incisional surgery for angle closure glaucoma

Angle closure glaucoma remains a major challenge for ophthalmologists. The three main challenges in the treatment of angle closure glaucoma are, firstly, to achieve rapid reduction of intraocular pressure in acute angle closure glaucoma, secondly, to prevent progression to chronic angle closure glaucoma, and thirdly, to manage established chronic angle closure glaucoma. Incisional surgery for angle closure glaucoma is typically required when laser surgery and/or medical therapy fail to control the intraocular pressure or control progressive synechial closure. The role for surgical iridectomy and emergency trabeculectomy in the modern management of acute angle closure glaucoma is diminishing. Trabeculectomy, goniosynechialysis, cyclodestructive procedures, and glaucoma implant are effective surgical options for chronic angle closure glaucoma, but none of them have been shown to be more effective than the others with proper comparative clinical trials. Trabeculectomy and goniosynechialysis are often combined with cataract extraction, which appears to offer additional pressure-control benefits to patients with chronic angle closure glaucoma.     

Incisional surgery for angle closure glaucoma

Angle closure glaucoma remains a major challenge for ophthalmologists. The three main challenges in the treatment of angle closure glaucoma are, firstly, to achieve rapid reduction of intraocular pressure in acute angle closure glaucoma, secondly, to prevent progression to chronic angle closure glaucoma, and thirdly, to manage established chronic angle closure glaucoma. Incisional surgery for angle closure glaucoma is typically required when laser surgery and/or medical therapy fail to control the intraocular pressure or control progressive synechial closure. The role for surgical iridectomy and emergency trabeculectomy in the modern management of acute angle closure glaucoma is diminishing. Trabeculectomy, goniosynechialysis, cyclodestructive procedures, and glaucoma implant are effective surgical options for chronic angle closure glaucoma, but none of them have been shown to be more effective than the others with proper comparative clinical trials. Trabeculectomy and goniosynechialysis are often combined with cataract extraction, which appears to offer additional pressure-control benefits to patients with chronic angle closure glaucoma.     

Traumatic glaucoma--a survey

Traumatic glaucomas represent a very heterogeneous group of entities due to a variety of pathomechanisms which increase the intraocular pressure in the early or late phase after traumatic injury (blunt or penetrating injury, acid or alkali burn). Little is known about the real prevalence of traumatic glaucoma. Angle recession, hyphema-associated and lens-associated mechanisms are the most common causes of traumatic glaucoma after blunt ocular trauma. Secondary angle closure due to peripheral anterior synechiae is the most common pathomechanism leading to glaucoma in patients with penetrating eye injury or acid or alkali burn. Early anti-inflammatory therapy for eye injuries is the most important step in the prevention of traumatic glaucoma. Although no general recommendations exist, topical potent corticosteroids significantly decrease the risk of glaucoma development. Medical and surgical treatment of traumatic glaucoma has often been disappointing. Therefore the visual prognosis of these eyes is often restricted. Antiglaucomatous drugs that reduce the secretion of aqueous humor (e. g., beta-blockers) should be preferred. Mitomycin-augmented trabeculectomy is the surgical method of first choice in patients with open angle traumatic glaucoma. Transscleral cyclophotocoagulation represents the method of first choice in secondary angle closure glaucoma due to anterior peripheral synechiae. New surgical techniques will increase the possibilities of an effective reduction of the intraocular pressure in secondary angle closure glaucoma. These new procedures are endoscopic cyclophotocoagulation, retinectomy, and the implantation of drainage devices via the pars plana. Further evaluation and modifications of these surgical techniques should markedly improve the visual prognosis of eyes with secondary angle closure glaucoma. For a few types of traumatic glaucoma (e. g., after epithelial ingrowth) no effective treatment modality is available at present.     

Comparison of delayed-onset glaucoma and early-onset glaucoma after infantile cataract surgery

PURPOSE: To investigate the causes and characteristics of glaucoma in children following cataract surgery. METHODS: Twenty-four patients (37 eyes) with uncomplicated congenital cataracts who developed glaucoma after cataract surgery were studied retrospectively. Variables included cataract morphology, surgical techniques, post-operative complications, time to the onset of glaucoma, gonioscopic findings, presence of microcornea and the histopathologic characteristics of the filtration angle (in one case). RESULTS: There was a bimodal onset of glaucoma after cataract surgery. Early-onset glaucoma occurred at a mean age of 6 months in 15 eyes and delayed-onset glaucoma at a mean age of 12 years in 22 eyes. Early-onset glaucoma was significantly (p = 0.018) more likely to be due to angle closure than delayed-onset glaucoma. With delayed-onset glaucoma, the filtration angle was open in 86% of eyes and significantly (p = 0.006) more eyes in the delayed-onset group had microcornea. Medical treatment was sufficient to control intraocular pressure in the delayed-onset group while the early-onset group required surgical treatment (P < 0.001). CONCLUSIONS: The onset of glaucoma after cataract surgery during infancy follows a bimodal pattern that is correlated with the configuration of the filtration angle. The early-onset glaucoma group had high incidence of angle closure requiring surgical treatment, while in the delayed-onset group non-surgical treatment was sufficient to control intraocular pressure. Prophylactic iridectomy in eyes at risk for pupillary block is recommended. Eyes with delayed-onset glaucoma have open filtration angles yet also have findings of incomplete development of filtration structures. Microcornea is a risk factor for delayed-onset glaucoma.     

A statistical comparison study of glaucoma in the Third Affiliated Hospital of China Medical College and Kyushu University

We classified 331 glaucoma patients who visited the eye clinic of the Third Affiliated Hospital of China Medical College during the 2 year period from January 1985 to December 1986 according to the type of glaucoma. The results were compared with those obtained from 275 glaucoma patients who visited the eye clinic of Kyushu University during an overlapping period of 2 years, from January 1986 to December 1987. Patients with glaucoma were found to comprise 1.5% of the 22,869 outpatients in the Third Affiliated Hospital of China Medical College, and 1.8% of the 15,585 outpatients in Kyushu University. The distribution of various types was as follows: primary angle closure glaucoma (76.4%), primary open angle glaucoma (4.8%), secondary glaucoma (11.8%), exfoliation glaucoma (0) and congenital glaucoma (5.7%) in the Third Affiliated Hospital of China Medical College, and primary angle closure glaucoma (34.5%), primary open angle glaucoma (12.7%), secondary glaucoma (22.2%), exfoliation glaucoma (14.9%) and congenital glaucoma (10.9%) in Kyushu University. The present results suggest that the incidence of primary angle closure glaucoma in China is higher than in Japan, and that the incidence of primary angle closure glaucoma is higher than that of primary open angle glaucoma in these two countries. It is of interest that the high incidence of primary angle closure glaucoma in China and Japan coincides with the study in Canadian Eskimos. The incidences of secondary glaucoma and exfoliation glaucoma in Japan are higher than in China. This might be due to differences in diagnostic facilities in the two countries.     

Surgical management of secondary angle closure glaucoma after trauma

Medical and surgical treatment of secondary angle closure glaucoma has often been disappointing. Therefore the visual prognosis of these eyes is mostly restricted. Transscleral cyclophotocoagulation is a relatively safe method for the treatment of advanced refractory glaucoma and represents the method of choice in secondary angle closure glaucoma due to anterior peripheral synechiae. In younger glaucoma patients and patients with traumatic glaucoma, long-term reduction of the intraocular pressure is only partially achieved. New surgical techniques will increase the possibilities of an effective reduction of the intraocular pressure in secondary angle closure glaucoma. On the other hand, data concerning the clinical efficacy and safety are still limited. These new procedures are endoscopic cyclophotocoagulation, retinectomy and the implantation of drainage devices via the pars plana. Further evaluation and modifications of these surgical techniques should markedly improve the visual prognosis of eyes with secondary angle closure glaucoma.     

Cyclocryotherapy: a review of cases over a 10-year period.

There are conflicting reports on the value of cyclocryotherapy in the management of glaucoma. This retrospective study was carried out to assess the efficacy and complication rate of this procedure. The case notes of all patients undergoing cyclocryotherapy at a single centre over a 10-year period were reviewed. Case records were available for 68 eyes of 64 people. Thirty-eight eyes had neovascular glaucoma, nine had aphakic glaucoma, nine had angle closure glaucoma, three had primary open angle glaucoma, and nine had secondary open angle glaucoma. The mean follow-up periods for these groups varied from 2.0-6.3 years. The mean reduction in intraocular pressure following treatment varied from 7.9 mm Hg in the secondary open angle glaucoma group to 24.3 mm Hg in those with angle closure glaucoma. Pressure was controlled in 29.4% overall, ranging from 66.7% in the angle closure and primary open angle groups to 0% in the secondary open angle group. Of the painful eyes 71% were rendered comfortable, indicating that pain relief from cyclocryotherapy is not due solely to pressure control. 30% of the patients lost their vision following the procedure, phthisis occurred in 11.8% and four eyes (5.9%) went on to enucleation. Our results indicate that cyclocryotherapy affords good pain relief, without good pressure control, in various types of glaucoma. While there is an apparent high complication rate, visual loss and phthisis cannot be ascribed directly to the procedure, since these are eyes with a poor prognosis.