【In Press】 Comparison of total/active ghrelin levels in primary open-angle glaucoma, pseudoexfoliation glaucoma and pseudoexfoliation syndrome

AIM: To investigate the levels of ghrelin (Gh), acylated-ghrelin (AGh) and AGh/Gh ratio in the humor aqueous (HA) of cases with pseudoexfoliation syndrome (PXS), pseudoexfoliation glaucoma (PXG), primary open angle glaucoma (POAG) and to compare these with control subjects. METHODS: A prospective examination was made of the total-Gh, and AGh levels of HA of 67 patients undergoing cataract surgery. Patients were divided into 4 groups. HA samples were aspirated at the beginning of the surgery, stored at -70℃ Gh and AGh quantification was performed with ELISA kits, the AGh/total-Gh ratios were calculated. ANOVA, Kruskal-Wallis, Chi-Square and post-hoc tests were used for statistical analysis. RESULTS: Total-Gh levels in HA were 189.2±45.6 pg/mL in the control group, 199.2±32.9 pg/mL in PXS, 180.6±20.9 pg/mL in PXG and 176.8±21.4 pg/mL in POAG groups (P>0.05). AGh levels in HA were 23.09±5.01 pg/mL in the control group, 24.13±5.22 pg/mL in PXS, 22.29±1.55 pg/mL in PXG and 19.69±2.93 pg/mL in POAG groups (P>0.05). The ratio of AGh/Gh was 10.3%±2.34% in the control group, 13.03%±2.58% in PXS, 12.3%±1.54% in PXG and 11.79%±1.41% in POAG groups (P=0.044). The difference between the PXS and control groups was significant (P=0.030). CONCLUSION: In spite of statistically insignificant results, the HA total-Gh levels were lower than those of the control subjects but not parallel with the AGh levels in glaucoma patients. The relative increase in the AGh/Gh ratio in glaucoma cases supports the view that proportional increases of AGh might play a role in the pathogenesis of glaucoma.     

A new diagnostic model of primary open angle glaucoma based on FD-OCT parameters

AIM: To build a clinical diagnostic model of primary open angle glaucoma (POAG) using the normal probability chart of frequency-domain optical coherence tomography (FD-OCT). METHODS: This is a cross-sectional study. Total 133 eyes from 133 healthy subjects and 99 eyes from 99 early POAG patients were included in the study. The retinal nerve fibre layer (RNFL) thickness parameters of optic nerve head (ONH) and RNFL3.45 scan were measured in one randomly selected eye of each subject using RTVue-100 FD-OCT. Then, we used these parameters to establish the diagnostic models. Four different diagnostic models based on two different area partition strategies on ONH and RNFL3.45 parameters, including ONH traditional area partition model (ONH-T), ONH new area partition model (ONH-N), RNFL3.45 traditional area partition model (RNFL3.45-T) and RNFL3.45 new area partition model (RNFL3.45-N), were built and tested by cross-validation. RESULTS: The new area partition models had higher area under the receiver operating characteristic (AROC; ONH-N: 0.990; RNFL3.45-N: 0.939) than corresponding traditional area partition models (ONH-T: 0.979; RNFL3.45-T: 0.881). There was no statistical difference among AROC of ONH-T, ONH-N, and RNFL3.45-N. Nevertheless, ONH-N was the simplest model. CONCLUSION: The new area partition models had higher diagnostic accuracy than corresponding traditional area partition models, which can improve the diagnostic ability of early POAG. In particular, the simplest ONH-N diagnostic model may be convenient for clinical application.     

GSTM1-null and GSTT1-active genotypes as risk determinants of primary open angle glaucoma among smokers

AIM: To evaluate glutathione transferase theta 1 and mu 1 (GSTT1 and GSTM1) polymorphisms as determinants of primary open angle glaucoma (POAG) risk, independently or in combination with cigarette smoking, hypertension and diabetes mellitus. METHODS: A case-control study with 102 POAG patients and 202 age and gender-matched controls was carried out. Multiplex-polymerase chain reaction method was used for the analysis of GSTM1 and GSTT1 polymorphisms. The differences between two groups were tested by the t-test or χ2 test. Logistic regression analysis was used for assessing the risk for disease development. RESULTS: The presence of GSTM1-null genotype did not contribute independently towards the risk of POAG. However, individuals with GSTT1-active genotype were at almost two-fold increased risk to develop glaucoma (P=0.044) which increased up to 4.36 when combined with GSTM1-null carriers (P=0.024). When glutathione transferase (GST) genotypes were analyzed in association with cigarette smoking, hypertension and diabetes, only carriers of GSTT1-active genotype had significantly increased risk of POAG development in comparison with GSTT1-null genotype individuals with no history of smoking, hypertension and diabetes, respectively (OR=3.52, P=0.003; OR=10.02, P<0.001; OR=4.53, P=0.002). CONCLUSION: The results obtained indicate that both GSTM1-null and GSTT1-active genotypes are associated with increased POAG risk among smokers, suggesting potential gene-environment interaction in glaucoma development.     

基于QbD理念的黄槐片制备工艺及物理指纹图谱研

目的 基于质量源于设计（QbD）理念对黄槐片进行成型工艺研究,并对颗粒进行质量控制。方法 以黄槐提取物为主药,采用湿法制粒压片,通过单因素实验筛选辅料,考察片的成型率、片质量差异、硬度、脆碎度和崩解时限,从而确定黄槐片的最佳处方及制备工艺。采用物理指纹图谱法对黄槐颗粒各项物理质量属性指标进行综合表征,建立由9个指标（相对均齐度指数、颗粒间空隙率、卡尔指数、松密度、振实密度、干燥失重、吸湿性、豪斯纳比、休止角）构成的颗粒物理指纹图谱,评价不同批次颗粒的质量一致性并对其可压缩性进行分析。结果 黄槐片的最佳处方为黄槐颗粒0.25 g,7%交联羧甲纤维素钠、2%滑石粉,混匀。最佳工艺条件为16目筛制粒,60℃干燥1 h,18目筛整粒。5批黄槐颗粒物理指纹图谱相似度均高于0.983,5批颗粒参数指数均大于0.4,参数轮廓指数在4.82~5.70,良好可压性指数在4.44~5.25。结论 建立的黄槐片制备工艺、处方及中间体颗粒物理质量标准科学合理,工艺稳定可行,为中药复方制剂的研发提供新的思路。     

3D T1-SPACE高分辨率磁共振管壁成像诊断脑血管病的价值

目的:分析观察三维T1加权可变反转角快速自旋回波（3D T1-SPACE）高分辨率磁共振管壁成像在脑血管病诊断中 的应用价值。方法:选择100例缺血性脑血管病患者行3D T1-SPACE高分辨率磁共振管壁成像,根据有无症状分为有症 状组（n=61）和无症状组（n=39）,比较两组患者血管和斑块量化指标［病变层面血管面积（VAMLN）、病变层面管腔面积 （LAMLN）、参考层面血管面积（VARL）、参考层面管腔面积（LARL）、狭窄率、斑块负荷、重构指数（RI）、偏心指数（EI）以及正性 重构、偏心斑块、斑块表面不规则、斑块位置前壁比例］,采用Logistic回归模型分析影响症状性动脉粥样硬化大脑中动脉 狭窄的独立危险因素。结果:两组VAMLN、LAMLN、VARL、LARL、狭窄率以及斑块负荷比较,差异无统计学意义（P>0.05）,有 症状组RI、EI显著大于无症状组（P<0.05）,正性重构、偏心斑块、斑块表面不规则以及斑块位于上壁位置比例显著高于无 症状组（P<0.05）;Logistic回归分析结果显示,管腔正性重构、斑块表面不规则以及斑块位于上壁位置是影响症状性动脉 粥样硬化大脑中动脉狭窄的独立危险因素。结论:3D T1-SPACE高分辨率磁共振管壁成像可有效评估脑血管病患者动脉 斑块特征,症状性动脉粥样硬化大脑中动脉狭窄通常伴有管腔正性重构、斑块表面不规则以及斑块位于上壁位置特征,对 预测患者发生脑血管意外风险和分级具有指导意义。     

甲状腺髓样癌转移至虹膜角膜角1例

目的:报告甲状腺髓样癌在虹膜角膜角转移的病例1例。方法:患者,女,28岁,患有单一的甲状腺髓样癌伴左眼虹膜角膜角包块。随后几个月对其视网膜的随访显示其视网膜也有一些浸润病灶。结果:用激光照射姑息切除脉络膜及房角病灶后,没有发现有复发迹象和任何新病灶出现。结论:据我们所知,这是文献中第一次报告甲状腺髓样癌在虹膜角膜角的转移。     

老年原发性开角型青光眼数据库的建立

目的:针对临床老年原发性开角型青光眼(primary open angle glaucoma,POAG)治疗中目标眼压控制的难题,结合我院医疗设备条件,开发老年POAG数据库,便于资料管理和科研。方法:复习文献制定老年POAG观察资料登记表,应用Microsoft Access2003数据库软件建立老年POAG患者临床资料数据库,并联网测试使用。结果:我院老年POAG数据库初步建立,相关网络通道运行良好。结论:医院老年POAG数据库的建立有利于科学和系统地收集老年POAG相关临床数据,为老年POAG治疗研究提供依据。     

Deconstructing the mechanisms of angle closure with anterior segment optical coherence tomography

Background: To illustrate the common mechanisms of angle closure by observing the changes following a laser iridotomy and then cataract surgery with anterior segment optical coherence tomography. Design: Retrospective interventional case series. Participants: Four patients with iridotrabecular contact. Methods: The anterior chamber was imaged in different lighting conditions prior to and following a laser iridotomy and then cataract surgery. The images were superimposed on each other, using the interscleral spur line as a common baseline. Main Outcome Measures: Qualitative and quantitative analysis of the changes of the iris and the drainage angle. Results: Iridotrabecular contact was seen in dark conditions in all patients. Iridotrabecular contact related to pupil block was abolished after a laser iridotomy. Persistent iridotrabecular contact following a laser iridotomy, due to a lens‐induced mechanism, was abolished after cataract surgery. Iridotrabecular contact that persisted after a laser iridotomy and cataract surgery was due to a ‘pure’ plateau iris syndrome or peripheral anterior synechiae. These treatments lowered the height of the iris plane in the region posterior to the trabecular meshwork. Conclusion: Following a laser iridotomy and cataract surgery, there is posterior movement of the iris plane away from the trabecular meshwork, but iridotrabecular contact can persist due to the ciliary processes or peripheral anterior synechiae. These changes show that the risk of iridotrabecular contact depends on the height of the iris plane relative to the trabecular meshwork and the degree of physiologic pupil dilation, and that angle closure can be a multi‐mechanism disease rather than a pure one.     

下斜肌减弱术对眼球客观旋转角度的影响

目的:分析下斜肌减弱术对第一眼位眼球客观旋转角度所产生的影响。方法:收集我院2008年以来各种类型斜视患者中下斜肌功能亢进者需行手术治疗的患者23例30眼。应用Stratus OCTTM3000扫描仪于术前及术后1wk对患眼进行眼底扫描及图像拍摄,获取眼底图像。将所拍摄图像应用Photoshop进行分析处理,测得视盘-黄斑中心凹夹角即该眼球的客观旋转角。结果:术前及术后外旋角度比较,术前为17.200°±6.624°,术后为7.735°±6.545°,术前与术后眼球旋转角度比较,差异有显著统计学意义(P<0.01)。结论:行下斜肌减弱术可明显改变眼球在第一眼位的客观外旋转角度。本研究所得的结果即下斜肌减弱术对第一眼位眼球客观旋转角度影响的范围,对旋转斜视患者术前手术设计及预后估计具有一定的参考价值。     

选择性激光小梁成形治疗开角型青光眼的疗效分析

目的 评价选择性激光小梁成形术治疗原发性开角型青光眼的疗效和安全性.方法 局部用药治疗的原发性开角型青光眼43只眼和高眼压症7只眼.使用Q开关倍频Nd:YAG激光实施180°小梁网激光照射.激光能量0.5～1.0 mJ,50～60个击射点.术后定期测量眼压和裂隙灯检查.随访期内仍然给予降眼压眼液.结果 平均随访8.6月(6～12月).术后所眼都有轻度前节炎症反应,3天后自然消退.术后继续使用降眼压眼液.A组(基线眼压17～24 mm Hg)和B组(基线眼压26～36 mm Hg)术后1、3、6、12月眼压下降幅度分别为30.1%、26.3%、25.6%、23.3%;和17%、21.5%、15%、10.9%,2组差异有显著性(P＜0.05).结论 SLT治疗开角青光眼的并发症是轻微的,降眼压的效果与术前眼压基线高低有关.

Abstract：

Objective To investigate the safety and efficacy of selective laser trabeculoplasty (SLT) in the treatment of open angle glaucoma.Methods Forty-three eyes with open-angle glaucoma and 7 eyes with ocular hypertension were treated withafrequency doubled Q-switched Nd:YAG laser.A total of 50～60 laser spots were placed over 180° of trabecular meshwork with energy levels ranging from 0.5 to 1.0mJ per pulse. Intraocular pressure measurement and slit lamp examination were regularly performed after laser surgery. Topical anti-glaucoma drug was given during the follow up period Results The follow up was 6～12 months (average 8.6 months). Slight inflammation of anterior chamber occurred in the all eyes, and disappeared 3 days later automatically. IOP reduction of group A (baseline IOP 17～24 mmHg) and groupB(baseline IOP 26-36 mmHg) was 30.1%, 26.3%, 25.6%,23.3%; and 17%, 21.5%. 15%, 10.9% at 1,3,6and 12 months, respectively. IOP reduction between two groups was significantly difference(P＜0.05). Conclusions Adverse effects of SLT for open angle glaucoma is a mild and temporary. Effect of lowing IOP isrelated to baseline pressure.