光学相干断层扫描血管成像（OCTA）对早期原发性开角型青光眼的诊断能力

目的　探讨光学相干断层扫描血管成像（optical coherence tomography angiography,OCTA）诊断早期原发性开角型青光眼（primary open angle glaucoma,POAG）的能力。方法　选取200例200眼作为研究对象,其中包括正常组73例73眼、视野前POAG组46例46眼、早期POAG组81例81眼。观察OCTA所得视神经纤维层内放射状盘周毛细血管（radial peripapillary capillaries,RPC）的分布情况,采用分形维数的方法对不同受试者的RPC层各血管参数进行分析,并对结果进行比较。结果　正常组、视野前POAG组、早期POAG组间OCTA各血管参数:大血管占比［（39.29±6.40）%、（34.94±7.56）%、（29.00±6.56）%］、毛细血管占比［（39.24±7.47）%、（31.29±4.57）%、（25.53±4.18）%］、毛细血管间隙占比［（15.58±5.40）%、（26.25±8.04）%、（33.42±8.46）%］和无血管区占比［（5.89±3.47）%、（7.53±3.97）%、（12.16±5.35）%］差异均有统计学意义（均为P＜0.01）。视野前POAG组与正常组相比,毛细血管占比的曲线下面积（area under the curve,AUC）为0.885。早期POAG组与正常组相比,大血管占比的AUC为0.897,毛细血管占比的AUC为0.944。结论　OCTA作为一种方便无创的可测量视盘血流的血管造影技术或可为POAG的早期诊断提供新的思路。     

Evaluación de los signos de la pseudoexfoliación en el segmento anterior mediante tomografía de coherencia óptica y cámara de Scheimpflug

Objective

To evaluate different anterior segment parameters in eyes with pseudoexfoliation (PSX), fellow eyes, and controls using optical coherence tomography and a Scheimpflug imaging system.

Sutureless Scleral Tunnel Trabeculectomy: Evaluation of Feasibility and Effectiveness versus Conventional Trabeculectomy for Management of Primary Open Angle Glaucoma

Purpose: To evaluate the intraocular pressure-lowering effect of sutureless scleral tunnel trabeculectomy with Mitomycin-C (MMC) compared to the standard trabeculectomy with MMC in patients with primary open angle glaucoma (POAG). Methods: This was a masked, randomized, controlled comparison trial involving 34 eyes of 34 patients with bilateral POAG. Patients were randomized to receive sutureless sclera flap trabeculectomy with MMC or conventional trabeculectomy with MMC. The main outcome for comparison was the IOP-lowering effect of both procedures. Complete surgical success was considered if the patient’s IOP was <22 mmHg and the IOP were lowered by more than 20% with the use of maximum two anti-glaucoma medications. Results: All surgeries passed uneventfully without intraoperative complications and all patients showed significantly (p<0.05) lower IOP on the first postoperative day compared to their respective preoperative IOP with non-significant (p>0.05) difference between both study groups. All patients, irrespective of operative procedure, maintained significantly (p<0.05) lower IOP compared to their respective preoperative IOP until the end of 12 months’ follow-up. There were no recorded serious postoperative complications in either groups, like wound leaks or endophthalmitis. Conclusion: Sutureless scleral tunnel trabeculectomy exhibits potential as an alternative to conventional trabeculectomy surgery. Over 12 months of follow-up, sutureless sclera flap trabeculectomy was safe and effective with an IOP-lowering effect comparable to that achieved with the conventional technique, but with increased rate of postoperative transient hypotony.     

可疑性原发房角关闭的晶状体悬韧带松弛度研究

目的　比较可疑性原发房角关闭（primary angle closure suspect,PACS）患者与正常人各方位晶状体悬韧带松弛度差异,探究隐匿性晶状体偏位在青光眼发病中的作用。方法　纳入PACS组患者19例（19眼）和与之年龄、性别、眼别匹配的正常对照组19名（19眼）。在标准暗室下采用Pentacam完成眼前节扫描,局部滴用复方托吡卡胺眼水一滴,30 min后再次采集Pentacam图像,自动获得散瞳前后4 mm范围8个方位（上方、颞上、颞侧、颞下、下方、鼻下、鼻侧、鼻上）周边前房深度（peripheral anterior chamber,peri-ACD）。以散瞳前后peri-ACD的差值（即△peri-ACD）反映悬韧带松弛度。以散瞳后8个方位peri-ACD差异明确是否存在晶状体偏位,并通过其极差值（即散瞳后8个方位peri-ACD中最大值减去最小值）反映晶状体偏位程度。结果　PACS组与正常对照组不同方位△peri-ACD组内比较差异均有统计学意义（P<0.001、P=0.043）,组间比较PACS组颞下方（0.40±0.28）mm小于正常对照组（0.55±0.15） mm（P=0.041）,其余方位差异均无统计学意义（均为P>0.05）。散瞳后PACS组和正常对照组8个方位peri-ACD组内比较差异均有统计学意义（P=0.001、0.009）,8个方位组间比较差异均有统计学意义（均为P<0.01）。PACS组和正常对照组间极差值比较差异无统计学意义［（0.35±0.18）mm、（0.43±0.28）mm］（P=0.362）。结论　PACS组与正常对照组均存在晶状体悬韧带松弛度分布不均,而PACS组颞下方悬韧带松弛可能更为显著。     

急性原发性闭角型青光眼睫状体位置参数的变化与房角狭窄的相关性研究

目的　观察急性原发性闭角型青光眼（acute primary angle closure glaucoma,APACG）患者睫状体位置变化,并分析其房角狭窄程度与睫状体位置参数的相关性。方法　将入选对象分为APACG组和正常对照组,所有研究对象均接受超声生物显微镜（ultrasound biomicroscopy,UBM）检查,存储采集到的图像,选取其中较为清晰的图像进行定量分析。测量参数包括:房角开放距离500（angle open distance 500,AOD₅₀₀）、小梁-睫状突距离（meshwork-ciliary process distance,TCPD）、虹膜-睫状突距离（iris-ciliary process distance,ICPD）、巩膜-睫状突夹角（sclera-ciliary process angle,SCPA）、睫状体长度500（ciliary body length 500,CBL₅₀₀）。结果　共纳入研究对象89例（89眼）,其中APACG组57例（57眼）、正常对照组32例（32眼）。按照年龄、性别配对t检验求得23对测量数据的均值结果显示:APACG组的AOD₅₀₀、TCPD、ICPD、SCPA和CBL₅₀₀分别为（0.050 4±0.031 0）mm、（0.499 6±0.192 4）mm、（0.112 6±0.089 2）mm、（35.317 0±4.575 2）°、（1.060 4±0.290 2）mm,而正常对照组的分别为（0.242 6±0.078 5）mm、（0.741 7±0.240 4）mm、（0.272 6±0.218 8）mm、（44.913 0±10.089 2）°、（0.633 0±0.405 4）mm,APACG 组的AOD₅₀₀、TCPD、ICPD、SCPA均较正常对照组的小,而APACG 组的CBL₅₀₀较正常对照组的大,差异均有统计学意义（均为P<0.01）。相关性分析结果显示,APACG组中TCPD、ICPD、SCPA、CBL₅₀₀与AOD₅₀₀存在显著的相关关系（均为P<0.01）。结论　相对于正常人群,APACG患者睫状体更向前旋,而且其房角狭窄程度与睫状体前旋程度相关。