原发性开角型青光眼患者24小时眼压变动规律的临床研究

目的:研究原发性开角型青光眼患者的24h眼压变动规律。方法:选择原发性开角型青光眼患者30人(52只眼,30～60岁),进行24h眼压测量。测量自清晨7∶30开始至第2天清晨7∶30,每2h测1次眼压,共测12次。在7∶00～23∶00时间段测量中,测受检者的坐位眼压和卧位眼压。在23∶00～7∶00时间段测受检者的平卧位眼压。结果:原发性开角型青光眼患者的眼压高峰出现在1∶30,眼压低谷出现在17∶30,24h坐、卧位眼压变动幅度大于24h卧位眼压变动幅度。结论:原发性开角型青光眼患者的眼压高峰大多出现在夜间睡眠时间,夜间眼压控制应引起重视。     

体位变化对青光眼眼压的影响

关于体位对眼内压的影响,国外已有较多报道,国内亦有胡铮等用气动眼压计、水迎波等用Perkins氏手持压平眼压计对正常眼坐位与卧位眼内压的差异进行了比较、研究。国外有人测得青光眼患者坐卧位眼压差大于正常眼,并设想利用此点帮助青光眼的诊断,亦有人对此持否定意见,本文为了研究这一问题,用Perkins氏眼压计观察了青光眼患者的坐卧位眼压差,并与正常眼在多方面进行比较。     

根据体位变化重新生成的昼夜眼压曲线中睡眠时眼压峰值增加

了解眼压昼夜波动和峰值对青光眼治疗有重要意义。既往多数研究昼夜眼压曲线仅测量坐位眼压。有研究显示健康人和青光眼患者卧位眼压较坐位眼压值高。站立或坐位时,眼球距心脏约30cm,而卧位时两者几乎处于同一水平,这种位置高度的差别可影响巩膜上静脉的血液回流,卧位时可使眶静脉压增加,房水回流阻力增加,眼压升高。本研究的目的是描述原发性开角型青光眼患者体位变化对昼夜眼压曲线的影响。方法:纳入在诊所工作时间(上午10:00~下午4:00)用非接触眼压计(PULSAIR 2000)测量眼压均<21mmHg的、未予治疗的原发性开角型青光眼患者148例。上…     

不同眼压计类型和测量体位对青光眼眼压测量值的影响

目的比较压平眼压计和非接触眼压计在坐位和卧位时测得的眼压值,探讨眼压计类型和测量体位对青光眼眼压值的影响。方法对28例原发性开角型青光眼患者进行日问眼压曲线测量,测量时间分别为9：30、11：30、13：30、15：30。先在卧位下使用压平眼压计进行测量,然后在坐位下分别使用压平和非接触眼压计进行测量。采用方差分析比较不同时间点、不同测量方法所获得的眼压值。结果卧位压平、坐位压平及坐位非接触眼压计测得的眼压平均值分别为（24．47±10．35）、（21．95±9．73）、（18．37±8．18）mmHg。当非接触眼压在10～20mmHg时,坐位压平眼压较非接触眼压高1．9～3．9mmHg,卧位压平眼压较非接触眼压高3．0～6．4mmHg。3种测量方法测得的峰值眼压超过21mmHg的患者分别为20、14、10例,使用非接触眼压计可能漏诊50％眼压失控的患者。结论使用压平眼压计和非接触眼压计及不同测量体位会对眼压值产生不同的影响,使用非接触眼压计不能对眼压是否正常作出准确的判断,尤其是当眼压处于靶眼压附近时。     

疑似青光眼患者24h眼压变化规律

目的：分析疑似青光眼患者24h眼压的变化规律。

方法：收集疑似青光眼患者48例96眼,使用Accupen手持眼压计(24-3000)和NCT非接触眼压计(CT-80)测量24h眼压,自7：30开始,每2h测一次眼压,共12次,其中7：30～21：30测量坐位眼压,23：30～5：30测量坐位及卧位眼压。

结果：两种眼压计测量的传统体位下24h眼压峰值均出现在7：30,非接触眼压计测得的结果为22.05±3.608mmHg,手持式眼压计测得的结果为19.79±4.147mmHg。手持眼压计测得习惯性体位下眼内压峰值出现在5：30,平均21.64±4.814mmHg,且两种体位24h眼内压谷值均出现在21：30,谷值眼内压平均值为15.73±3.649mmHg。两种体位均呈夜间眼压逐渐升高,白天眼压逐渐下降的趋势。

结论：疑似青光眼患者眼内压峰值多出现在清晨,夜间卧位眼压值较坐位眼压值高。     

日间与昼夜眼压曲线对异常眼压测量能力的比较

目的评价日间眼压曲线与昼夜眼压曲线对异常眼压测量的能力。方法对就诊于北京同仁眼科中心的21例原发性开角型青光眼（POAG）、11例可疑正常眼压性青光眼（SNTG）及24例可疑青光眼患者进行昼夜眼压曲线测量。间隔2 h后,先使用手持式压平眼压计测量24 h的卧位眼压得到昼夜卧位眼压曲线。在9：30、11：30、13：30、15：30,患者完成卧位眼压测量5 min后测量坐位眼压,5 min后再使用非接触眼压计测量眼压,分别得到日间卧位眼压曲线、日间坐位眼压曲线和日间非接触眼压曲线。定义眼压峰值〉21 mmHg时为峰值异常,眼压波动〉5 mmHg时为波动异常。分析日间眼压曲线与昼夜眼压曲线均值、峰值及波动值间是否存在差异。结果不同组别昼夜眼压均值为（20.24±2.45）～（22.32±6.02）mmHg,较日间眼压均值高-0.19～6.37 mmHg;昼夜眼压峰值在（24.17±3.42）～（26.43±6.23）mmHg,较日间眼压峰值高1.75～8.76 mmHg;昼夜眼压波动在（8.00±3.47）～（9.09±3.83）mmHg,较日间眼压波动高3.59～6.00 mmHg。眼压峰值多出现于夜间睡眠时,POAG、SNTG和可疑青光眼患者眼压峰值出现于23：30～5：30的概率分别为57.14%、72.73%和66.67%。日间眼压曲线无法确定昼夜眼压波动的异常,若以昼夜眼压曲线作为金标准,各组的敏感性为10.00%～36.84%。结论56例患者的峰值眼压多发生在夜间睡眠时,日间和昼夜眼压曲线测得的眼压均值、峰值、波动及发现异常眼压的能力存在差异,依靠日间眼压曲线很难对昼夜眼压的情况做出准确判断。     

视网膜脱离复位手术后硅油填充眼B超检查

目的　观察视网膜脱离复位手术后硅油填充眼的B型超声声像图特征。方法　对 197眼充填硅油的眼 (其中12 4眼屈光介质混浊 )在视网膜脱离复位术后采取不同体位 ,包括仰卧位、俯卧位、坐位、侧卧位进行B型超声扫描检查 ,回顾性分析其回声特征。结果　 5 4眼充满硅油的眼 ,在各种体位均见经硅油传播而放大的玻璃体腔及球壁回声。14 3眼硅油未充满的 ,在玻璃体腔内除硅油回声外还可见液体回声。仰卧位时 ,在后球壁前方见呈弧线状油液界面光带 ;俯卧位时 ,在玻璃体腔前部见油液界面呈曲线状回声光带 ;2种体位均可见放大的玻璃体和后球壁回声。在坐位或侧卧位 ,当探头垂直于油液界面扫描时 ,可见 2个分别来自玻璃体腔及后球壁的回声带 ;当探头斜向于硅油扫描时 ,可见被放大的玻璃体腔和后球壁回声 ;当超声仅通过液体时 ,回声图与常规检查相同。结论　视网膜脱离复位手术后硅油填充眼具有典型的B型超声声像图特征 ,这对硅油填充眼、尤其在介质混浊时 ,判定视网膜状态很有帮助     

24h眼压的重复性测量及夜间坐卧位眼压的差别

目的：评估24h眼压单次测量的准确性,以及探讨夜间不同体位测量眼压的差别。

方法：前瞻性研究。对2019-07/08在嘉兴市中医医院眼科需做24h眼压的患者24例48眼,使用手持型眼压计(iCare-PRO回弹式眼压计)连续48h进行2次24h眼压测量,时点分别为7：00、10：00、14：00、18：00、22：00、02：00、05：00。其中在22：00、02：00、05：00三个时间点,分别测量坐位及卧位的眼压,先进行卧位测量,之后要求患者保持坐位10min,再次测量一次眼压。重复测量用组内相关系数(ICC)来分析一致性,夜间不同体位的眼压以配对样本t检验分析比较测量结果。

结果：各时点的ICC值在0.79～0.94波动,大部分在0.90左右,双眼基本一致。夜间卧位的ICC值在0.73～0.91波动,大部分是0.86以上。各时点的ICC均在0.75以上,大部分在0.90左右,表明各时点眼压重复测量的一致性较好。但是夜间眼压波动的ICC结果较差,右眼夜间坐位波动的ICC为0.49,左眼夜间坐位为0.55; 夜间卧位右眼为0.40,左眼为0.43,右眼的一致性较差。而夜间卧位眼压均高于坐位眼压,各时点均有差异。

结论：单次的24h眼压测量可能不能高度再现,尤其是眼压波动,一次测量的结果可靠性有待研究,且夜间采取坐位测量眼压,或许不能代表实际夜间睡眠时的眼压。     

原发性开角性青光眼早期诊断的一点体会

一、自觉症状:头痛、眼痛、眼胀等自觉症状,不能作为诊断依据。有自觉症状的不一定是青光眼。一般眼压轻度或中度升高不一定有自觉症状,自觉症状仅仅能引起医师的注意。眼压:早期开角性青光眼仅凭一次眼压测量,难以诊断,测量24小时眼压曲线常有诊断价值。卧位眼压比坐位眼压平均高1mmHg。目前暂定正常卧位眼压范围为     

激光周边虹膜成形术治疗虹膜切除术后暗室俯卧试验阳性的原发性闭角型青光眼

目的　评价激光周边虹膜成形术治疗虹膜切除术后暗室俯卧试验阳性的原发性闭角型青光眼的临床效果。方法　对激光周边虹膜切除术后暗室俯卧试验阳性的 34例 (5 6只眼 )原发性闭角型青光眼 (非眼外引流手术指征 ,前房角粘连 <1/2周前房角范围 )患者行激光周边虹膜成形术。其中急性闭角型青光眼 2 7例 (49只眼 ) ,慢性闭角型青光眼 7例 (7只眼 )。对患者治疗前后的周边前房深度、前房角、眼压、视野及周边虹膜形态进行详细的对比观察 ,并行暗室俯卧试验及散瞳试验检查。患者术后随访 1～ 4年。结果　所有患者治疗后周边前房深度均明显加深 ,静态前房角镜检查小梁网可见范围增宽。随访期间患者未发生高眼压、前房角进行性粘连及视野损害 ,暗室俯卧试验及散瞳试验均阴性。结论　虹膜切除术后暗室俯卧试验阳性的原发性闭角型青光眼的发病机制是当瞳孔散大时 ,异常的周边虹膜组织堵塞小梁网而引起高眼压 ,瞳孔阻滞因素不起主导作用。激光周边虹膜成形术可以明显改变此类青光眼患者 (前房角粘连 <1/2周前房角范围 )的周边虹膜形态 ,从而控制病情进展。     

24小时眼压监测中夜间眼压测量方法的探讨

目的比较24h眼压监测中夜间即刻坐位眼压值和坐起休息10min后测得的眼压值,探讨夜间眼压的不同测量方法对青光眼24h眼压昼夜波动的影响。方法对已确诊且未用药、未做过手术的48例正常眼压性青光眼及17例原发性开角型青光眼患者进行24h眼压监测,每2h1次,其中测量夜间0:00、2:00、4:00眼压时,逐个唤起患者后立即测,后嘱患者坐起休息10min再测,采用SPSS软件以配对t检验分析比较测量结果。结果夜间即刻坐位眼压值和坐起休息10min后测得的眼压值差异有统计学意义(P<0.001),正常眼压性青光眼与原发性开角型青光眼间眼压差值差异有统计学意义(P<0.05)。结论即刻坐位眼压值能更准确反映夜间眼压,对24h眼压测量及青光眼诊断及治疗更有价值,值得临床应用。     

Augeninnendruckmessungen im Tages- und Nachtverlauf bei Glaukompatienten und Normalprobanden mittels Goldmann- und Perkins-Applanationstonometrie

OBJECTIVE: Our aim was to evaluate intraocular pressure (IOP) levels in primary open angle glaucoma (POAG) patients and healthy controls during both the day and night while measuring in an upright as well as in a supine position. METHODS: In a prospective clinical trial, 30 glaucoma patients on topical treatment and 50 healthy controls received IOP measurements every 4 h for a 24 h period starting at 8 am. Additionally, blood pressure and heart rate were measured and perfusion pressures were calculated. At 12 am IOP was initially measured in a sitting position and then, after 20 min, in a supine position. At midnight this was carried out conversely. At 4 am IOP was measured in a supine position; all other measurements were performed in a sitting position. Measurements in the sitting position were performed by Goldmann and Perkins tonometry and in a supine position by Perkins tonometry. RESULTS: IOP was 1 mmHg lower in Perkins tonometry measurements compared to Goldmann tonometry. There was no difference between the two patient groups. In a supine position, IOP measured by Perkins tonometry was higher than in an upright position. At 12 am the difference was 1.8 mmHg+/-2.7 mmHg (p=0.001) in healthy subjects and 1.3+/-2.7 mmHg (p=0.013) in the POAG patients. At 12 pm the increase of IOP in the supine position was even more pronounced with 2.4+/-3.4 mmHg in healthy subjects and 5.6+/-3.2 mmHg in the POAG patients (p=0.001). The blood pressure and the perfusion pressure were lowest during night measurements. CONCLUSIONS: During diurnal IOP measurements in an upright position there were no statistically significant differences in IOP changes between groups. However, in a supine position IOP was significantly higher than in a sitting position and increased more in the glaucoma patients than in healthy controls. This observation might be due to a faulty regulation of the fluid shift in glaucoma patients and could cause progression of glaucomatous damage.     

Twenty-four-hour intraocular pressure pattern associated with early glaucomatous changes

PURPOSE: To characterize the 24-hour pattern of intraocular pressure (IOP) in untreated patients with newly diagnosed early glaucomatous changes. METHODS: Measurements of IOP, blood pressure, and heart rate were taken every 2 hours during a 24-hour period from a group of 24 untreated patients (ages 40-78 years) with newly diagnosed abnormal optic discs and/or abnormal visual fields. In the 16-hour diurnal awake period, IOP was measured sitting and supine, and blood pressure and heart rate were measured supine. In the 8-hour nocturnal sleep period, all measurements were taken in the supine position. Mean diurnal and nocturnal IOP, blood pressure, and heart rate in the glaucoma group were compared with data obtained from an age-matched control group of 24 individuals with healthy eyes. RESULTS: Mean diurnal IOP, either sitting or supine, was significantly higher in the glaucoma group than in the control group. For both subject groups, nocturnal supine IOP was higher than diurnal sitting IOP. However, this diurnal-to-nocturnal increase in IOP was significantly smaller in the glaucoma group. When compared with the diurnal supine IOP, the nocturnal supine IOP was lower in the glaucoma group but higher in the control group. Around normal awakening time, the supine IOP increased in the glaucoma group and did not change in the control group. There was a diurnal-to-nocturnal decrease in mean blood pressure only in the glaucoma group. CONCLUSIONS: Compared with healthy eyes, the diurnal IOP is higher, the diurnal-to-nocturnal change of habitual IOP is less, and the posture-independent IOP pattern around normal awakening time is different in eyes with early glaucomatous changes.     

Correlation between office and peak nocturnal intraocular pressures in healthy subjects and glaucoma patients

PURPOSE: To evaluate the correlations between office-hour intraocular pressures (IOP) and peak nocturnal IOP in healthy and glaucomatous eyes. DESIGN: Retrospective review of laboratory records. METHODS: We reviewed 24-hour data of IOP collected from 33 younger healthy subjects (aged 18 to 25 years), 35 older healthy subjects (aged 40 to 74 years), and 35 untreated older glaucoma patients (aged 40 to 79 years) housed in a sleep laboratory. Measurements of IOP were taken every 2 hours using a pneumatonometer in the sitting and supine positions during the diurnal/wake period (7 AM to 11 PM) and in the supine position during the nocturnal/sleep period. Correlations between average sitting or supine IOP in the right eye between 9:30 AM and 3:30 PM (office hours) and peak right eye IOP during the nocturnal hours were analyzed. RESULTS: The average values of supine IOP during office hours were found to have the strongest correlation with peak nocturnal IOP in older glaucoma subjects (r = .713, P < .001), whereas the correlation was less in older healthy subjects (r = .523, P < .01) and was absent in younger healthy subjects (r = .224, P = .21). The correlation between average sitting IOP values during office hours and peak nocturnal IOP was also strong in older glaucoma subjects (r = .601, P < .001) and moderate in older healthy subjects (r = .412, P < .05), but absent in younger healthy subjects (r = -.077, P = .672). CONCLUSION: Using a modification of the diurnal IOP curve, the magnitude of peak nocturnal IOP in untreated glaucoma patients can be estimated during routine office visits. Supine IOP measurements estimate peak nocturnal IOP better than sitting measurements. This estimation may provide the clinician with valuable information regarding the nocturnal IOP peak in glaucoma patients.     

Intraocular pressure, ocular pulse pressure, and body position

Intraocular pressures (IOP's) were measured using the Digilab Pneuma-tonometer with the subject in both the sitting and supine positions. The IOP with the Pneuma-tonometer was greater (17.03 mm Hg) in the supine position than in the sitting position (12.90 mm Hg). The IOP measured with the Pneuma-tonometer, with the subject sitting, was similar to the IOP measured with the Goldmann applanation tonometer (13.42 mm Hg). Inasmuch as IOP tends to be lower with the patient in a sitting position, the clinician should be alert to the possibility that some patients with borderline Goldmann IOP's may have pressures well above the normal range when they are lying down. Due to the continuous recording provided by the Pneuma-tonometer, the ocular pulse pressure can be measured. We found a mean ocular pulse pressure amplitude of 1.77 mm Hg. All values are shown plus or minus 1 SD. Comparison of the ocular pulse pressure amplitude for the two eyes could aid in detecting patients with suspected carotid artery stenosis.     

Effects of head elevation on intraocular pressure in healthy subjects: raising bed head vs using multiple pillows

Purpose

To evaluate the effects of different methods of head elevation on intraocular pressure (IOP) in healthy young subjects.

Methods

Twenty-four healthy young Korean subjects were included in this prospective observational study. The IOP measurements were taken with the subjects in the sitting position and in the supine positions with the head flat and 30° up using two different methods: (1) raising the bed head and (2) using multiple pillows. IOP was measured using Tonopen AVIA in both eyes 10 min after assuming each position in a randomized sequence. The Wilcoxon signed-rank test was used to compare the IOP by changing the methods of head elevation.

Results

Mean IOP of both eyes when sitting was lower than that measured in the supine position with head flat (P=0.001). Compared with that measured in the supine position with head flat, the mean IOP was lower when measured in the supine position with the head kept 30 ° up by bed head elevation (P=0.001), whereas the mean IOP was not significantly different when measured in the supine position with the head elevated using multiple pillows (right eye, P=0.061; left eye, P=0.089).

Conclusion

In normal subjects, IOP was lower when measured in the supine position with the head kept up by the bed head elevation compared with that measured when lying flat. However, such head-up position-induced IOP reduction was not found when the head was kept up using multiple pillows. These findings suggest that elevating the head using multiple pillows may not help to reduce IOP in the supine posture.