Prevalence of Open-angle Glaucoma in Southwestern China: the Yongchuan Glaucoma Study简

This study examined the prevalence of primary open-angle glaucoma（POAG） among residents aged ≥50 years living in Yongchuan district of Chongqing. Stratified cluster sampling was employed in random selection to estimate the prevalence of glaucoma from April to June, 2005. Twenty-nine villages or neighborhood communities were randomly selected in urban area（Zhongshan Road）, suburban area（Shanjiao Town） and exurban area（Zhutuo Town） of this district. All the respondents underwent detailed ophthalmic examinations. The examinations included questionnaire investigation, visual acuity test, naked-eye examination, measurement of peripheral anterior chamber depth（Van Herrick＇s technique）, detection of intraocluar pressure（IOP） with a Perkins hand-held applanation tonometer（HA-2） and examination of the optic disc by using a 78 diopters（D） lens（including the cup-disc ratio, cup/disc ratio asymmetries, horizontal and vertical diameter, notching and optic disc hemorrhages）. A total of 5938 residents were actually examined, and the response rate was 85.19%. The crude prevalence of POAG was 0.86%（n=51/5938, 95% CI 0.64%–1.11%）. There were 24 males and 27 females in the glaucoma group. The glaucoma prevalence was not significant different in case number between the male and female subjects（P=0.4900）. Furthermore, no association between age or schooling and POAG was noted（P=0.8030, 0.0734）. Out of 51 subjects with POAG, unilateral glaucoma-related blindness occurred in 38 subjects（74.5%） and bilateral glaucoma-related blindness was found in 7 subjects（13.7%）. This study exhibited that the prevalence of POAG was 0.86% among residents aged ≥50 years living in Yongchuan District of Chongqing. The vision loss caused by POAG in this population was obviously higher than that previously reported in other studies. Glaucoma management, detection of affected persons and handling of the burden of glaucoma should be the priorities of the agenda of local health authorities of Western China.     

拉坦前列腺素对原发性开角型青光眼患者的疗效

目的:研究拉坦前列腺素对原发性开角型青光眼(POAG)患者的治疗效果.方法:POAG患者135例,随机分为观察组(n=70)和对照组(n=65),观察组给予拉坦前列腺素治疗,对照组给予噻吗心安治疗;记录2组患者治疗前后的眼压及波动值、视野缺损及视网膜纤维层(RNFL)厚度及不良反应.结果:两组患者治疗后昼夜平均眼压、眼压波动值及视野缺损范围均较治疗前明显降低,差异有统计学意义(P＜0.05);治疗后观察组昼夜平均眼压、眼压波动值较对照组降低更明显,下方视野、颞侧视野及鼻侧视野缺损范围较对照组明显缩小,上方视盘、下方视盘、颞侧视盘及鼻侧视盘较对照组明显增厚,差异均有统计学意义(P＜0.05);治疗后观察组9例(12.86％)、对照组11例(16.92％)出现不良反应,差异无统计学意义(P＞0.05).结论:拉坦前列腺素治疗原发性开角型青光眼效果优于噻吗心安.     

高度近视眼结构功能的改变及其与原发性青光眼发病的关系

青光眼是世界范围内第一大不可逆致盲性疾病,严重影响人们的视觉健康,但其发病的具体机制有待明确。大量研究表明,高度近视与青光眼特别是开角型青光眼的发病密切相关。高度近视眼的各个结构在眼轴延长中受到机械性伸展,可产生各种可能与青光眼发病相关的病理生理性改变,进而导致青光眼发病风险增加。本研究回顾分析近10年中英文文献,就高度近视眼各结构及功能的改变及其对青光眼发病的可能影响作一综述。     

视盘边缘出血常见疾病的临床分析（附64例）

目的 通过观察视盘边缘出血的临床特征,探讨视盘边缘出血常见的疾病.方法 回顾性分析60例64眼视盘边缘出血患者的视力、眼压、眼底、视野、荧光素眼底血管造影(FFA)及相关临床资料.结果 60例64眼视盘边缘出血的患者中,非动脉炎性前部缺血性视神经病变(NAION)38例41眼,占64.1%;青光眼14例15眼,占23.4%;视盘血管炎Ⅰ型6例6眼,占9.3%;视盘玻璃疣1例1眼,占1.6%;视盘前血管袢1例1眼,占1.6%. 结论 视盘边缘出血是一种常见的临床体征,它有助于诊断相关疾病,从而更好地指导治疗.     

光学相干断层扫描仪测量视网膜视盘周边区神经纤维层与黄斑厚度对青光眼的诊断价值

目的 比较视盘周边区神经纤维层(RNFL)厚度与黄斑区视网膜厚度(MRT)的光学相干断层扫描仪(OCT)不同测量部位对青光眼的诊断价值.方法 48例(71眼)青光眼患者纳入该研究,并取40例(63眼)健康体检者为正常对照组,均行OCT检查.采用ROC曲线和曲线下面积(AUC)比较RNFL厚度与黄斑厚度对青光眼的诊断价值.结果 青光眼患者视盘周边区平均RNFL(t=12.950,P=0.000)与黄斑(t=8.917,P＝0.000)的厚度均比正常人减少;并且RNFL与黄斑的厚度与青光眼的严重程度呈负相关,rs为0.361(t=4.516,P=0.024).AUC比较显示RNFL周边厚度的诊断价值均要高于黄斑厚度;在RNFL周边厚度中,又以RNFL周边6点钟的厚度指标AUC最大(95%CI 0.664～-0.865).相应诊断界值下,RNFL周边6点钟和黄斑厚度的诊断特异度、灵敏度和诊断符合率分别为85.6%、91.2%、87.1%和80.2%、88.4%、84.6%.结论 视盘周边区RNFL厚度与黄斑厚度对青光眼均有较好的早期诊断价值,而又以视盘周边区下部RNFL厚度的诊断效果为最佳.     

Retinal nerve fiber layer in primary open-angle glaucoma with high myopia determined by optical coherence tomography and scanning laser polarimetry

Background Fundus changes associated with high myopia (HM) may mask those associated with primary open-angle glaucoma (POAG).This study aim to determine the characteristics of RNFL thickness changes in...     

Distribution and associated factors of optic disc diameter and cup-to-disc ratio in an elderly Chinese population

BackgroundGlaucoma is the second leading cause of blindness worldwide and East Asian people account for almost half of those affected. Vertical elongation of the optic cup is a characteristic feature of glaucoma. However, there is a significant overlap in the vertical cup-to-disc ratio (VCDR) between normal eyes and eyes affected by glaucoma. The purpose of this study was to determine the distribution of VCDR and vertical disc diameter (VDD) and their predictive factors in a population of elderly Chinese residents in Taiwan.MethodsFour hundred and sixty elderly Chinese residents aged 72 years and older in the Shihpai district, Taipei, Taiwan participated in this study. Slit lamp biomicroscopic measurement of the VCDR and VDD after pupil dilation with a 78 diopter lens was performed by one glaucoma specialist. Multiple linear regression analyses were used to fit the best model for independent variables.ResultsThe VCDR was recorded for 438 right eyes and 430 left eyes. After excluding participants with glaucoma, the mean ± SD VCDR was 0.44 ± 0.17 for both eyes, and the 97.5^th percentile was 0.8. A greater VCDR was associated with a longer axial length [VCDR = −0.47 + 0.04(axial length)] under multiple regression analysis. The VDD was obtained for 420 right eyes and 406 left eyes. The mean ± SD VDD for all participants was 1.77 ± 0.22 mm for the right eye and 1.79 ± 0.22 mm for the left eye. A higher body mass index (BMI) and a longer axial length were significantly associated with a larger VDD under multiple regression analysis. [VDD = −0.05 + 0.07 (axial length) + 0.06 (obesity); if BMI <24, then obesity = 0; if BMI ≥24, then obesity = 1]. A larger VDD was associated with a larger VCDR (p < 0.001) and the VCDR could be predicted by the equation VCDR = −0.07 + 0.3VDD.ConclusionA greater VCDR was related to a longer axial length. A greater VDD was related to a higher BMI and a longer axial length.     

半导体激光小梁成形术治疗原发性开角型青光眼、无晶体性慢性青光眼临床观察

目的 观察半导体激光小梁成形术对降低原发性开角型青光眼及部分无晶体性慢性青光眼眼压临床疗效。方法 半导体激光小梁成形术治疗原发性开角型青光眼45例，无晶体性慢性青光眼26例，术后随访1～24个月眼压变化情况。结果 原发性开角型青光眼、无晶体性慢性青光眼激光小梁成形术后6个月眼压控制在20．55mmHg以内分别占78．89％、83．25％。24个月眼压略有回升。结论 观察半导体激光小梁成形术治疗药物控制不良原发性开角型青光眼及部分无晶体性慢性青光眼临床疗效满意。     

视网膜断层扫描仪测量广西汉族正常人群视盘参数的研究

目的了解本地区汉族正常人群视盘参数的正常值。方法将三代居住广西隆林县无血缘关系的120例正常汉族成年人纳入研究对象,运用海德堡视网膜断层扫描仪（Heidelberg retina tomograph-Ⅱ,HRT-Ⅱ）分别检测不同年龄段汉族人群视乳头地形图总体参数。结果正常汉族人视盘参数正常值：视盘面积（DA）为（2．2165±0．4266）mm^2,视杯面积（CA）为（0．4816±0．2979）mm^2,盘沿面积（RA）为（1．7311±0．3217）mm^2,视杯／视盘面积比值（C／DAR）为（0．2074±0．1092）,盘沿／视盘面积比值（R／DAR）为（0．7923±0．1091）,视杯容积（CV）为（0．1076）mm^3,盘沿容积（RV）为（0．5196±0．1519）mm^3,平均视杯深度（MCD）为（0．2055±0．0798）mm,最大视杯深度（MxCD）为（0．6039±0．1949）mm,视乳头轮廓线高度变化值（HVC）为（0．4513±0．1639）mm,视杯形态测量（CSM）为（-0．2155±0．0617）mm,平均视网膜神经纤维层厚度（mRN-FLT）为（0．3059±0．0845）mm,视网膜神经纤维层截面面积（RNFLA）为（1．5785±0．3830）mm^2。按年龄分成4组,正常汉族人mRNFLT、RNFLA在49岁以下与50岁以上比较差异有统计学极显著意义（P〈0．01）,而49岁以下各组之间比较差异无统计学意义（P〉0．05）。性别间各参数比较差异无统计学意义（P〉0．05）。眼别间比较差异元统计学意义（P〉0．05）。汉族C／DAR比值双眼差值范围为0．048～0．112。RV和HVC两个参数不受视盘大小影响。结论HRT-Ⅱ可定量检测广西汉族正常人视盘参数,且不同年龄视盘参数的均值与性别及眼别无关,RV和HVC可做为一个评价指标。     

Octopus 101GKP动静态自动视野计在原发性开角型青光眼诊断中的应用

目的评估Octopus101 GKP动静态自动视野计在原发性开角型青光眼（POAG）诊断中的应用价值。方法 对2006年10月-2007年3月在我院门诊确诊的30例POAG患者及34例正常人分别进行Octopus101GKP动静态自动视野计的GKP及TOP程序的检查。分析比较这两组受试者的视力、眼压、眼底C／D值及联合检查所得的平均缺陷度（MD）、丢失方差（LV）、不同视标参数下等视线的面积和检查时间等参数。结果 POAG组的平均视力、平均眼压和眼底平均C／D值与正常对照组相比差异均有显著性（P均=0．000）;两组的眼压（IOP）与平均缺陷度及等视线面积均无相关性;Ⅲ4e与Ⅰ2e两种不同的视标参数对POAG患者检出的等视线面积差异有显著性（P=0．000）;POAG组的平均检查时间为（307．78±134．50）s,明显高于正常对照组的（228．12±75．33）s（P=0．001）;正常对照组静态视野检查所得的平均缺陷度和丢失方差明显小于POAG组（P均=0．000）;静态视野检查的敏感性为80％,特异性为45％;动态视野检查的敏感性为86％,特异性为63％;两者联合检查敏感性为90％。结论 Octopus101GKP动静态自动视野计可同时完成静态及动态视野检查,通过反应时间减少个体差异,提高检查结果的准确性;同时还可通过改变视标大小、背景光明暗、视标移动速度提高POAG早期缺损检出的可能性,大大提高了POAG检出的敏感性,对于一些早期有小的周边缺损的患者更具优势。     

原发性开角型青光眼发病机制及其中西医治疗研究进展

原发性开角型青光眼是青光眼疾病中发病机制较为复杂、临床诊疗较为困难的一类疾病。由于此病发病隐匿,在疾病早期患者常无明显自觉症状,发展至中晚期才常常以视力下降就诊,而此时无论药物或手术治疗均已不能有效提高视力,视神经已明显受损很难逆转。然而目前对原发性开角型青光眼发病机理的研究尚无统一定论,治疗方法也参差不齐,该文综述了近年来原发性开角型青光眼在发病机制和中医西医治疗方面的有关文献,为临床诊治本病提供参考。     

Retinal nerve fiber layer in primary open-angle glaucoma with high myopia determined by optical coherence tomography and scanning laser polarimetry with variable corneal compensation

Background Fundus changes associated with high myopia (HM) may mask those associated with primary open-angle glaucoma (POAG). Characteristic retinal nerve fiber layer (RNFL) thickness profiles in patients with POAG and HM were examined using optical coherence tomography (OCT) and scanning laser polarimetry with variable corneal compensation (GDxVCC), and the diagnostic capabilities of these imaging modalities were compared. Methods Twenty-two eyes with POAG and HM (spherical equivalent [SE] between -6.0 and -12.0 D) were evaluated, and 22 eyes with HM were used for comparison. RNFL parameters evaluated included superior average (Savg-GDx), inferior average (Iavg-GDx), temporal-superior-nasal- inferior-temporal (TSNIT) average, and nerve fiber indicator (NFI) on GDxVCC and superior average (Savg-OCT), inferior average (Iavg-OCT), nasal average (Navg-OCT), temporal average (Tavg-OCT), and average thickness (AvgThick-OCT) on OCT (fast RNFL scan). Visual field testing was performed and defects were evaluated using mean defect (MD) and pattern standard deviation (PSD). Results The RNFL parameters (P < 0.05) that were significantly different between groups included Savg-GDx, Iavg-GDx, TSNIT average, NFI, Savg-OCT, Iavg-OCT, Tavg-OCT, and AvgThick-OCT. Significant correlations existed between TSNIT average and AvgThick-OCT (r = 0.778), TSNIT average and MD (r = 0.749), AvgThick-OCT and MD (r = 0.647), TSNIT average and PSD (r = -0.756), and AvgThick-OCT and PSD (r = -0.784). The area under the receiver operating characteristic curve (AUROC) values of TSNIT average, Savg-GDx, Iavg-GDx, NFI, Savg-OCT, Iavg-OCT, Navg-OCT, Tavg-OCT, and AvgThick-OCT were 0.947, 0.962, 0.973, 0.994, 0.909, 0.917, 0.511, 0.906, and 0.913, respectively. The NFI AUROC was the highest value. Conclusion RNFL thickness was significantly lower in all but the nasal quadrant in patients with POAG and HM, compared to patients with only HM. Measurements with OCT and GDxVCC were well-correlated, and both modalities detected RNFL thickness changes. However, GDxVCC was better than OCT in detecting POAG in HM patients.     

海德堡视网膜断层扫描仪在开角型青光眼诊断中的价值

目的 评价海德堡视网膜断层扫描仪 (Heidelberg retina tomograph,HRT)在开角型青光眼(primary open angl glaucom,POAG)诊断中的应用价值.方法 对照组98例(98眼)和POAG组36例(36眼)分别行HRT检查,比较各组间视盘结构参数的差异,并用ROC曲线下面积分析不同参数的诊断灵敏度和特异度.结果 对照组与POAG组间杯盘面积比、视杯容积、盘沿容积、视杯形态测量指数及平均视网膜神经纤维层厚度差异均有统计学意义(P＜0.05).ROC曲线下面积分析特异度最高的为视杯形态测量指数,灵敏度最高的为平均视网膜神经纤维层厚度.结论 HRT检查对开角型青光眼的诊断有很大帮助.     

原发性开角型青光眼视神经病变诱导反应蛋白基因突变的研究

目的　研究原发性开角型青光眼 (POAG)散发病例视神经病变诱导反应蛋白 (OPTN)基因突变情况 ,以及OPTN基因突变与开角型青光眼临床表型的关系。方法　应用聚合酶链反应(PCR)扩增 118例原发性开角型青光眼和 15 0例无青光眼对照组全基因组DNA ,用单核苷酸构象多态性 (SSCP)分析OPTN基因编码区域 13个外显子序列和非编码区改变。SSCP异常者进行双向测序。结果　共发现 11个序列的改变 ,其中 6个序列的改变已有报道 (T34T、T4 9T、M 98K、IVS6 5C→T、IVS6 10G→A、和R5 4 5Q) ,5个为新序列改变 (IVS6 9C→T、IVS6 14G→A、IVS7 36G→A、IVS8 5 1T→C和K4 35R)。K4 35R序列的改变在 1例患者中发现 ;IVS6 9C→T和IVS6 14G→A在 1例无青光眼对照组发现。具有IVS6 5C→T序列改变在患者组和对照组比较差异有显著意义 (P <0 0 0 1) ;具有IVS6 10G→A序列改变的患者组和对照组比较差异有显著意义 (P =0 0 1)。结论　推测OPTN基因单核苷酸多态性可能与我国POAG的发病有关。     

Profile of pediatric glaucoma patients in Shanghai Eye, Ear, Nose and Throat Hospital

Background The extent of our knowledge of the epidemiology of pediatric glaucoma in China is limited. To better characterize the epidemiology of pediatric glaucoma in eastern China, we report the clinical profile, etiologies, and treatment modalities in patients 〈18 years of age in Shanghai Eye, Ear, Nose and Throat Hospital. Methods The medical records of patients presenting glaucoma between January 2003 and December 2010 were retrospectively reviewed. The demographic characteristics, the proportion of different glaucoma subtypes and surgical precedures were collected and analyzed. Results A total of 1 142 eyes of 734 pediatric patients （500 males） were included. Congenital glaucoma was the leading subtype, accounting for 47.55% of all patients. The ratio of boys to girls was 2.5：1. Patients with congenital glaucoma affecting both eyes accounted for 72.5% of all patients examined. Patients with primary juvenile glaucoma were the second most common group （n=125, 17.03%）. Traumatic glaucoma was the third most common subtype （n=81, 11.03%）. The type of surgery was related to the subtype of glaucoma. Conclusions Congenital glaucoma, primary juvenile glaucoma, and traumatic glaucoma are the most prevalent subtypes in pediatric glaucoma patients in Shanghai Eye, Ear, Nose and Throat Hospital. The characteristics of congenital glaucoma in China are similar to those in Western countries.     

EX-PRESS引流钉植入术与小梁切除术后早期对角膜内皮细胞的影响

目的 观察EX-PRESS引流钉植入术及小梁切除术后早期对原发性开角型青光眼患者角膜内皮细胞(corneal endothelial cell density,CECD)的影响.方法 收集南通市第一人民医院眼科2015年2月至2016年9月收治的36例(72眼)原发性开角型青光眼患者.根据患者采用的不同手术方法 分为EX-PRESS青光眼引流钉植入术组(16例20眼)和小梁切除术组(20例25眼).所有患者于术前1天和术后1个月、3个月行角膜内皮镜检查,记录角膜内皮细胞的数量、密度、形态.结果 小梁切除术后1个月、3个月角膜内皮细胞数分别为(2115±249) 个/mm2和(2092±251)个/mm2,与术前的(2221±262)个/mm2比较,差异有统计学意义(P<0.05).EX-PRESS引流钉植入术后1个月、3个月角膜内皮细胞数分别为(2329±250) 个/mm2和(2316±231)个/mm2,与术前的(2339±248)个/mm2比较,差异无统计学意义(P>0.05).术后1个月、3个月角膜内皮细胞数在小梁切除术组与EX-PRESS组间比较,差异有统计学意义(P<0.05).结论 EX-PRESS引流钉植入术后早期对角膜内皮细胞影响较小.     

原发性开角型青光眼患者血管内皮、血小板功能改变及与中医证型关系的研究

目的：探讨原发性开角型青光眼的发病机制。方法将85例原发性开角型青光眼患者分为高眼压型组、正常眼压型组,并与24例正常人进行对照,对其血管内皮和血小板功能指标的改变及与中医辨证分型的关系进行了研究。结果原发性开角型青光眼高眼压型患者和正常眼压型青光眼患者与正常组相比,内皮素（ET）、血浆血栓素B2（TXB2）、血浆β-血栓球蛋白（β-TG）、vonWillebrand 因子（vWF）、6-酮-前列环素 F1α（6-keto-PGF1α）、T/K 比值均有显著性差异（P<0.05或 P<0.01）。原发性开角型青光眼中医辨证分型各组与正常组比较,均表现为ET-1、TXB2、β-TG、vWF和T/K比值升高,6-keto-PGF1α下降。其中肝郁气滞证和肝肾亏虚证组分别与正常组相比,TXB2、β-TG、vWF、6-keto-PGF1α和T/K比值均有显著性差异（P<0.05或P<0.01）;痰湿泛目证组与正常组相比,T/K比值有显著性差异（P<0.05）。结论原发性开角型青光眼高眼压型患者和正常眼压型青光眼患者均存在明显的血管内皮细胞受损和血小板聚集性增强,血液呈现高凝状态的血瘀病理改变,而正常对照组的血瘀改变不明显。在中医证型中,这种血瘀病理以肝郁气滞证最明显,肝肾亏虚证次之,痰湿泛目证最轻,呈现肝郁气滞证>肝肾亏虚证>痰湿泛目证的趋势。     

原发性开角型青光眼患者眼底荧光血管造影及血液流变学改变与中医证型关系的研究

目的：探讨原发性开角型青光眼的发病机理。方法将85例原发性开角型青光眼患者分为高眼压型组、正常眼压型青光眼组,并与24例正常人进行对照,对其眼底荧光血管造影和血液流变学指标的改变及与中医辨证分型的关系进行研究。结果原发性开角型青光眼高眼压型患者和正常眼压型青光眼患者与正常组相比,高(VH)、中(VM)、低(VI)切变率下全血表观粘度值、红细胞压积升高,差异均有显著统计学意义（P<0.01）。原发性开角型青光眼中医辨证分型各组与正常组比较,均表现为红细胞压积升高（P<0.01）。其中肝郁气滞证和肝肾亏虚证组分别与正常组相比,高(VH)、中(VM)、低(VI)切变率下全血表观粘度值、红细胞压积升高;痰湿泛目证组与正常组相比,红细胞压积比值差异有统计学意义（P<0.05）。原发性开角型青光眼高眼压型患者和正常眼压型青光眼患者与正常组相比,眼底荧光血管造影中臂-脉络膜充盈时间（A-CT）、臂-视网膜动脉充盈时间（A-AT）、视网膜动-静脉充盈时间（A-VT）延长差异均有统计学意义（P<0.01）。原发性开角型青光眼中医辨证分型各组与正常组比较,均表现为A-CT、A-AT、A-VT延长。其中肝郁气滞证、肝肾亏虚证组与痰湿泛目证组与正常组相比差异有统计学意义（P<0.05）。结论原发性开角型青光眼高眼压型患者和正常眼压型青光眼患者均存在明显的血液呈现高凝状态的血瘀病理改变,而正常对照组的血瘀改变不明显。在中医证型中,这种血瘀病理以肝郁气滞证最明显,肝肾亏虚证次之,痰湿泛目证最轻,呈现肝郁气滞证＞肝肾亏虚证＞痰湿泛目证的趋势。