中国人近视与原发性开角型青光眼相关性的 Meta 分析

采用Meta分析的方法探讨中国人近视与原发性开角型青光眼（ POAG）的相关性。方法检索CNKI和VIP数据库中自建库至2013年7月20日之间公开发表的文献,对符合纳入标准的研究进行数据提取之后,采用Comprehensive Meta Analysis （ CMA） v2．2软件进行 Meta分析。结果最终纳入5个研究,其中3个研究将高度近视作为暴露因素单独列出来。 Meta分析结果显示,暴露于近视的人群罹患POAG的风险增加3．07倍（OR ＝3．07,95％CI ＝1．90-4．96;P ＜0．01）;暴露于高度近视者（屈光度数＞-6．0 D）,罹患POAG的风险增加7．15倍（OR ＝7．15,95％CI ＝4．01-12．75;P ＜0．01）。敏感性分析显示结果稳健性好,未行发表偏倚分析。结论当前证据表明近视很可能是开角型青光眼的一个独立的、有意义的危险因素,并且高度近视者罹患POAG的风险高。     

Population-based glaucoma prevalence studies in Asians

Glaucoma-related population-based studies from Japan, Mongolia, India, Singapore, Thailand, China, Bangladesh, Myanmar, Sri Lanka, and South Korea show a higher glaucoma prevalence in Asian patients, including a higher incidence of primary angle-closure glaucoma, than in white patients, although primary open-angle glaucoma (POAG) is still the most commonly reported. Among POAG, normal tension glaucoma predominates over high tension glaucoma, a distinctive finding. Risk factors for glaucoma in population-based studies in both Asian and white patients are similar, except that myopia is a greater risk factor in Asian patients. Diagnostic criteria differ among studies, some using the International Society of Geographic and Epidemiologic Ophthalmology (ISGEO) classification and others not. The devices used to observe the optic disk and test the visual field are also not uniform across studies. Moreover, the ages of patients, and whether rural or urban, were different. To allow reliable comparison of the results of epidemiologic studies, efforts to standardize the diagnostic criteria, devices, and the age range of the study population are required.     

原发性开角型青光眼进展的危险因素研究概况

原发性开角型青光眼(POAG)进展的危险因素包括全身性及眼部因素,眼部因素包括眼压及非眼压因素.在以往的多中心研究中,眼压对于由高眼压症发展为POAG及其在POAG进展中的作用已经明确,而目前降低眼压也是临床惟一有效地延缓、控制青光眼视神经损害进展的主要因素.制定目标眼压,进行降眼压治疗尤其是控制昼夜眼压波动对于阻止青光眼进展非常重要.非眼压危险因素包括高龄、中央角膜厚度增厚、视乳头出血、晶状体囊膜剥脱征、初始的青光眼严重程度及双眼罹患青光眼等.其他因素包括近视、青光眼家族史、眼部低灌注压、低血压、心血管疾病、高血压、高血脂等血管或血液性因素.POAG进展的危险因素研究在一定程度上揭示了POAG的发病机制及临床发病规律,对于指导临床医师决定随诊频率、选择治疗方案及提高治疗效率意义重大.     

Risk factors for primary open-angle glaucoma in a Burmese population: the Meiktila Eye Study

PURPOSE: To report the risk factors associated with primary open-angle glaucoma (POAG) in the Burmese population. METHODS: The Meiktila Eye study, a population-based cross-sectional study, included inhabitants 40 years of age and over from villages in the Meiktila District. Of 2481 eligible participants identified, 2076 participated in the study and sufficient examination data to diagnose glaucoma in at least one eye was obtained in 1997 participants. The ophthalmic examination included slit-lamp examination, tonometry, gonioscopy and dilated stereoscopic fundus examination. Definitions adhered to the International Society for Geographic and Epidemiological Ophthalmology's recommendations. Univariate and multivariate analyses of potential risk factors were performed. RESULTS: The overall prevalence of POAG was 2.0% (95% CI 0.9-3.1). In the univariate analysis, increasing age (P = 0.024), spherical equivalent (P = 0.01), axial length (P = 0.023) and intraocular pressure (IOP; P < 0.001) were significantly associated with POAG. And in the multivariate analysis, myopia <0.5 D (P = 0.049), increasing age and IOP (P < 0.001) were significant risk factors for POAG. CONCLUSION: POAG in this Burmese population was associated with increasing age, axial myopia and IOP.     

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和正常眼压性青光眼危险因素的研究

目的：探讨原发开角型青光眼（POAG）和正常眼压性青光眼（NTG）发病相关的危险因素。方法：对592例（1156眼）原发开角型青光眼和53例（100眼）正常眼压青光眼患者进行眼科常规检查,视野检查,屈光,血糖,血压检测,家庭史及药物史和全身病调查,结果：NTG组与POAG组相比较,在患病年龄的分布上有差异：POAG组以20－40岁年龄最常见,而NTG组以50－60岁年龄最常见;两组患者均有较高的近视患病率（POAG组为42．1％,NTG组为66．04％）,NTG组低血压患病率67．92％）,阳性家族史为20．75％,两者均明显高于POAG组,差异有显著性,结论：年龄,近视,低血压,青光眼家族史可能是POAG和NTG发病的重要因素。     

高度近视合并POAG的临床特征研究进展

高度近视常常同时合并POAG,由于其眼底视盘和视网膜脉络膜等改变使其很难在早期发现POAG的合并存在。早期诊断和及时治疗高度近视合并POAG对提高患者的视觉和生存质量具有重要意义。现就高度近视与POAG的联系,高度近视合并POAG时相关的视功能改变做一综述,期望为临床诊断提供有益线索。     

原发性开角型青光眼与近视的关系

目的 :在人群为基础的眼病调查中评价原发性开角型青光眼 (POAG)与近视的关系。方法 :调查北京市南部 3个自然村及 4个城区社区 4 0岁以上居民 4 4 5 1例。进行问卷及视力、屈光、倍频视野检查、非接触眼压测量、裂隙灯眼前节数码照相、晶状体后照明数码照相、散瞳眼底照相等检查。采用电脑验光结合插片法确定屈光状态。近视的定义为等效球镜度≤- 1 0D。近视又分为轻度近视及中、高度近视。根据存在典型的青光眼性视神经与视野改变、前房角开放诊断POAG。结果 :近视者与无近视者的POAG患病率分别为 3 31%、1 4 3% (校正性别与年龄的OR =2 16 ,P =0 0 0 1)。轻度近视者与中高度近视者POAG患病率分别为 2 4 6 %、4 4 9% (OR =0 5 0 9,P =0 0 74 )。与无近视者相比 ,轻度近视者POAG患病率校正性别、年龄因素的OR值为 1 5 2 (P =0 188) ;中高度近视者POAG患病率校正OR值为 3 17(P =0 0 0 0 )。 4 0～ 5 9岁组有、无近视者POAG患病率分别为 1 39%、0 5 6 % (OR =2 5 6 ,P =0 0 5 ) ;>6 0岁组有、无近视者POAG患病率分别为 5 72 %、2 77% (OR =2 0 4 ,P =0 0 0 8)。近视者的平均眼压较无近视者高 0 5 3mmHg(P =0 0 0 2 )。结论 :近视是POAG的重要危险因素。近视程度越高 ,年龄越大 ,POAG患     

高度近视与原发性开角型青光眼关系的研究进展

临床和实验研究均发现,青光眼患者近视发生率高于非青光眼人群。反之,近视,尤其高度近视（high myopia,HM）人群较其它人群更常伴有青光眼。当HM与原发性开角型青光眼（primary open—angle glaucoma,POAG）并存时,病情变得尤其复杂。两者发病机制之间的关系,目前在分子和基因水平的研究重点是：胶原基因学说和升压基因学说。从病理学角度讲,高度近视与青光眼都是胶原病变;此外,二者的小梁网细胞在糖皮质激素诱导下易表达特异性蛋白,这可能与高度近视、原发性开角型青光眼的TIGR（trabecular meshwork induced glucocorticoid response protein）基因突变有关。本文从流行病学、发病机制、临床特征及诊断注意要点等方面对高度近视与原发性开角型青光眼的关系及研究进展进行综述。     

Influence of Family History as a Risk Factor on Primary Angle Closure and Primary Open Angle Glaucoma in a Chinese population

Purpose: To identify the likelihood of family history as a risk factor for the presence and severity of primary angle closure (PAC) and primary open angle glaucoma (POAG) in a Chinese population.

Methods: All participants were asked to complete a questionnaire and undergo a comprehensive eye examination. Past history of hypertension, diabetes mellitus, hyperopia, high myopia, and family history of glaucoma were recorded. For those patients with a family history of glaucoma, the relationship between the patient and the affected relatives has been specified.

Results: A total of 332 PAC patients, 228 POAG patients and 193 controls were included. Of the 332 PAC patients, 83 (25.00%) had glaucoma family history. Characteristic-adjusted odds ratio (OR) of family history for PAC was 4.82 [95% confidence interval (CI): 2.08–11.19] and for severity of PAC was 1.61 (95% CI: 1.05–2.49). Among first-relatives only parents account for the family history rate of PAC [OR 8.76 (95% CI: 2.00–38.32)]. Of the 228 POAG patients, 49 (21.49%) had a family history of glaucoma. Odds ratio for POAG was 8.38 (95% CI: 3.33–21.07) and for severity of POAG was 1.81 (95% CI: 1.05–3.14). Unlike patients with PAC, only siblings and offspring account for the family history rate of POAG [OR 8.99 (95% CI: 2.38–33.99) and OR 19.23 (95% CI: 1.53–241.24) respectively].

Conclusion: Our study showed that a family history of glaucoma is associated with the presence and severity of PAC and POAG. This supports the finding that screening first-degree relatives will be an effective way to detect glaucoma in a population.     

Primary open-angle glaucoma genes

A substantial fraction of glaucoma has a genetic basis. About 5% of primary open angle glaucoma (POAG) is currently attributed to single-gene or Mendelian forms of glaucoma (ie glaucoma caused by mutations in myocilin or optineurin). Mutations in these genes have a high likelihood of leading to glaucoma and are rarely seen in normal subjects. Other cases of POAG have a more complex genetic basis and are caused by the combined effects of many genetic and environmental risk factors, each of which do not act alone to cause glaucoma. These factors are more frequently detected in patients with POAG, but are also commonly observed in normal subjects. Additional genes that may be important in glaucoma pathogenesis have been investigated using quantitative traits approaches. Such studies have begun to identify genes that control the magnitude of important quantitative features of glaucoma that may also be important risk factors for POAG, such as central corneal thickness. Each of these different approaches to study glaucoma genetics is providing new insights into the pathogenesis of POAG.     

眼底杯盘比〉0.3人群原发性开角型青光眼危险因素分析

目的分析眼底杯盘比〉0.3人群的临床特点,并探讨原发性开角型青光眼（POAG）的危险因素。方法本研究为一项基于医院的研究,研究对象为临床发现垂直向杯盘比（VCDR）〉0.3的人群,经过傅里叶相干光断层扫描（OCT）、视野和其他临床检查后,被判断为正常、青光眼可疑或POAG。将该3组作为因变量,性别、年龄、屈光度、VCDR等因素作为自变量,用logistic回归分析这些因素与POAG的关系,并用危险度（OR）和95%可信限（CI）加以表示。结果共有5 137名受试者入选,其中2 828（55.05%）为正常,1 525（29.69%）为青光眼可疑,784（15.26%）被确诊为POAG;正常组、青光眼可疑组、POAG组VCDR的中位数分别为0.5、0.6、0.8。多元回归分析显示：男性（OR=1.484,95%CI：1.323-1.667）,年龄（OR=1.207,95%CI：1.128-1.291每增加20岁）,近视（OR=1.369,95%CI：1.298-1.493）,VCDR（OR=1.765,95%CI：1.698-1.834每增加0.1）是罹患青光眼的危险因素。结论男性、老龄（尤其是〉60岁）、近视（尤其是中高度近视）以及大VCDR是POAG发生的危险因素,VCDR〉0.6的人群患青光眼的风险大大增加,应着重筛查。     

原发性开角型青光眼的系统性危险因素

眼压异常升高是原发性开角型青光眼最主要的危险因素。临床目前一直沿用以眼压为靶点的青光眼诊疗模式。近年来发现,循环血流、体质指数、颅内压、营养代谢、中医偏颇体质类型、某些系统性疾病等多种系统性危险因素可能与青光眼发生、发展和转归相关。纠正系统性危险因素能否延缓青光眼进展被日益关注,成为潜在的青光眼辅助诊疗靶点。本文对各类青光眼系统性危险因素进行介绍,倡导重视系统性危险因素,提出以系统危险因素评估和个性化眼体同治相结合的青光眼诊疗体系。（眼科,2022,31:325-329）     

Medical treatment for correction of hemodynamic, rheological and metabolic changes in young patients with glaucoma associated with myopia

The goal is to estimate the use and efficacy of differentiated approach to complex treatment of glaucomatous optic neuropathy in patients with primary open-angle glaucoma (POAG) associated with myopia. 71 patients aged 18-32 years old with POAG and high myopia and surgically or drug-induced normalized intraocular pressure were examined. The 1st group included 39 patients with ischemic form of POAG, 2nd group--32 patients with discirculatory form of POAG and the 3rd control group--10 patients of similar age with stable high myopia. Patients of the 1st group took glycine, ceraxon, actovegin and lymphotropic 1.0% nicotinic acid solution. Vasobral and cortexin were administered in the 2nd group. Medication provides correction of hemodynamic, theological and metabolic changes, that influence the clinical course of glaucoma associated with myopia.     

高度近视合并原发性开角型青光眼的临床诊断研究进展

临床和试验研究均发现,高度近视患者并发原发性开角型青光眼的概率高于非高度近视患者,特别是当高度近视与原发性开角型青光眼并存时,病情变得尤其复杂。对于个体而言,近视和青光眼之间的关系在很多情况下仍然很不明确,高度近视是造成青光眼的风险因素之一,多数情况下从青光眼的眼底变化中也很难分辨出是近视导致还是功能异常,因此高度近视合并原发性开角型青光眼的早期诊断非常困难但意义重大。本文从流行病学特征、视盘结构、视野改变、眼压测量等方面对高度近视与原发性开角型青光眼的关系及诊断进行综述。     

The Effect of MTHFR Ala222Val Polymorphism on Open-angle Glaucoma: A Meta-analysis

Glaucoma is the second leading cause of irreversible blindness worldwide, among which primary open-angle glaucoma (POAG) is the most common form of glaucoma in some populations. To date, published data on the association between MTHFR (Ala222Val) polymorphism and POAG risk are still inconclusive. In this work, we performed a meta-analysis of available case-control study in order to assess the association between MTHFR (Ala222Val) polymorphism and POAG susceptibility. In total we compiled 13 studies (1970 POAG patients and 1712 control subjects) into the meta-analysis. Overall, no obvious associations between MTHFR (Ala222Val) polymorphism and POAG susceptibility was found under all four genetic models (Val/Val versus Ala/Ala: OR?=?1.05, 95% CI?=?0.77–1.43; Ala/Val versus Ala/Ala: OR?=?1.05, 95% CI?=?0.86–1.26; Ala/Val + Val/Val versus Ala/Ala: OR?=?1.08, 95% CI?=?0.87–1.34; Val/Val versus Ala/Val + Ala/Ala: OR?=?1.14, 95% CI?=?0.67–1.92). In the stratified analysis by ethnicity, significant associations were still not observed in all genetic models. In conclusion, based on 13 eligible studies, the result provided strong evidences that MTHFR Ala222Val polymorphism is not associated with POAG.     

Glaucoma in a rural population of southern India: the Aravind comprehensive eye survey

PURPOSE: To determine the prevalence of glaucoma and risk factors for primary open-angle glaucoma in a rural population of southern India. DESIGN: A population-based cross-sectional study. PARTICIPANTS: A total of 5150 subjects aged 40 years and older from 50 clusters representative of three southern districts of Tamil Nadu in southern India. METHODS: All participants had a comprehensive eye examination at the base hospital, including visual acuity using logarithm of the minimum angle of resolution illiterate E charts and refraction, slit-lamp biomicroscopy, gonioscopy, applanation tonometry, dilated fundus examinations, and automated central 24-2 full-threshold perimetry. MAIN OUTCOME MEASURES: Definite primary open-angle glaucoma (POAG) was defined as angles open on gonioscopy and glaucomatous optic disc changes with matching visual field defects, whereas ocular hypertension was defined as intraocular pressure (IOP) greater than 21 mmHg without glaucomatous optic disc damage and visual field defects in the presence of an open angle. Manifest primary angle-closure glaucoma (PACG) was defined as glaucomatous optic disc damage or glaucomatous visual field defects with the anterior chamber angle partly or totally closed, appositional angle closure or synechiae in the angle, and absence of signs of secondary angle closure. Secondary glaucoma was defined as glaucomatous optic nerve damage and/or visual field abnormalities suggestive of glaucoma with ocular disorders that contribute to a secondary elevation in IOP. RESULTS: The prevalence (95% confidence interval) of any glaucoma was 2.6% (2.2, 3.0), of POAG it was 1.7% (1.3, 2.1), and if PACG it was 0.5% (0.3, 0.7), and secondary glaucoma excluding pseudoexfoliation was 0.3% (0.2,0.5). On multivariate analysis, increasing age, male gender, myopia greater than 1 diopter, and pseudoexfoliation were significantly associated with POAG. After best correction, 18 persons (20.9%) with POAG were blind in either eye because of glaucoma, including 6 who were bilaterally blind and an additional 12 persons with unilateral blindness because of glaucomatous optic neuropathy in that eye. Of those identified with POAG, 93.0% had not been previously diagnosed with POAG. CONCLUSIONS: The prevalence of glaucoma in this population is not lower than that reported for white populations elsewhere. A large proportion of those with POAG had not been previously diagnosed. One fifth of those with POAG had blindness in one or both eyes from glaucoma. Early detection of glaucoma in this population will reduce the burden of blindness in India.     

青光眼合并高度近視視野的改燮特徵

目的研究合并高度近视的青光眼和非高度近视的青光眼的视野改变有无差别。方法 利用Octopus 101全自动视野计对36例(51眼)合并高度近视的原发性开角型青光眼(primary open angle glaucoma,POAG)和16例(23眼)非高度近视的POAG进行静态中心阈值视野检查,并分析其视野缺损形式,视野缺损与生理盲点及固视点的关系和视野指数的改变。结果合并高度近视的POAG视野缺损形式与非高度近视的POAG视野缺损形式相似,差异无显著性(早期POAG,X~2=0.000138,P>0.05,中晚期POAG,X~2=1.1494,P>0.05)。合并高度近视的POAG视野缺损较多的与生理盲点相速或/和与固视点相近(或相连),但与非高度近视的POAG相比,差异无显著性(早期POAG,X~2=1.3892,P>0.05,中晚期POAG,X~2=2.6852,P>0.05)。随着近视度数的增加,MS值逐渐下降,MD和LV值逐渐升高。结论 合并高度近视的POAG视野缺损较多的与生理盲点和/或固视点相连或相近,近视度数越高,其视野损害越明显。     

Choroidal hemodynamic in myopic patients with and without primary open‐angle glaucoma

Purpose: To investigate the change in subfoveal choroidal blood flow in patients with glaucoma and to assess the effect of myopia, as one of the vascular risk factors for glaucoma on this flow. Methods: Subfoveal choroidal blood flow in groups of 12 myopic and glaucomatous eyes has been investigated by means of the laser Doppler flowmetry (LDF), comparing the results with those of 17 myopic eyes without glaucoma, 34 non‐myopic glaucomatous eyes and of 50 control eyes. The subfoveal choroidal LDF parameters, that is, blood velocity (ChBVel), volume (ChBVol), and flow (ChBF), as well as the vascular resistance were studied in each group. Statistical analysis was performed by means of anova and t‐test according to the Bonferroni procedure for multiple comparisons. Pearson correlation was used to establish the correlations between the hemodynamic parameters and the degree of myopia in dioptres. Results: All LDF parameters (ChBVel, ChBVol and ChBF) were significantly reduced in glaucomatous patients (1.3 ± 0.4, 0.14 ± 0.06 and 4 ± 2 respectively) and myopic patients with primary open‐angle glaucoma (POAG) (1.3 ± 0.4, 0.08 ± 0.04 and 2 ± 0.7 respectively) and without POAG (1.2 ± 0.3, 0.11 ± 0.08 and 2 ± 1 respectively) in comparison with age‐matched controls (1.5 ± 0.4, 0.27 ± 0.1 and 8 ± 2 respectively). On the other hand, the choroidal vascular resistance (Rm) was increased in the previously described studied patients groups (16 ± 7, 26 ± 9 and 24 ± 9 respectively) compared with controls (7 ± 2). The LDF parameters did not differ significantly between myopic subjects without and with POAG (p = 0.09, p = 0.09, p = 0.2, p = 0.08 and p = 0.9 respectively). Compared to patients with emmetropic glaucomatous, significant reduction in the ChBVol and ChBF and increased Rm were recorded in patients with glaucomatous myopia (p = 0.05, p = 0.04 and p = 0.04 respectively). Pearson correlation demonstrated a significant correlation between the degree of myopia in dioptres and the ChBF (p = 0.012). Conclusions: The subfoveal choroidal LDF parameters were reduced in patients with POAG and myopia. Theses alterations are more in glaucomatous patients with myopia in comparison with age‐matched glaucomatous patients without myopia. These data suggest that the impaired choroidal circulation caused by myopia might be an important additional risk factor involved in the glaucomatous damaging process.     

Primary open-angle glaucoma and systemic diseases

The exact pathomechanism of primary open-angle glaucoma (POAG) is still not completely understood. Besides elevated intraocular pressure, which has been identified as a major risk factor, there is mounting evidence for the involvement of systemic factors in the development of glaucomatous damage. Systemic peculiarities described in POAG include cardiovascular, endocrine, neurodegenerative, and sleep alterations. However, some of the studies available on systemic findings in glaucoma patients are contradictory, making further research necessary to identify the exact role of such disturbances in the pathogenesis of the damage. Another difficulty is that many studies are limited by their small sample size, their retrospective nature, and potential selection bias, thus making data interpretation more difficult. Moreover, it is not always clear whether we are dealing with coincidence or a true association between glaucoma and a particular systemic disease. Nevertheless, there is ample evidence for the involvement of vascular factors such as vascular dysregulation and blood pressure in the pathogenesis of POAG.