高能聚焦超声睫状体成形术治疗青光眼的疗效及其影响因素

目的：评估高能聚焦超声睫状体成形术(UCP)治疗青光眼的疗效,并探讨影响疗效的相关因素。

方法：收集天津爱尔眼科医院、重庆爱尔眼科医院、重庆南坪爱尔眼科医院2019-01/2022-01实施UCP治疗患者110例134眼,包括原发性闭角型青光眼、原发性开角型青光眼、继发性青光眼三组患者,记录术后6、12 mo的最佳矫正视力、眼内压,以及使用抗青光眼药物种类等的情况。

结果：术后6 mo,原发性闭角型青光眼组、原发性开角型青光眼组、继发性青光眼组的眼压与术前相比有差异(均P<0.05)。术后12 mo,原发性闭角型青光眼组及原发性开角型青光眼组的眼压与术前相比有差异(均P<0.05)。术后6、12 mo,各组视力与术前相比无差异(均P>0.05)。术后6 mo,眼压变化与年龄、既往青光眼手术史、基线白对白(角膜横径)和UCP治疗扇区有相关性(均P<0.05)。

结论：UCP能有效降低青光眼患者的眼压,其疗效可能受到年龄、既往青光眼手术史、基线白对白(角膜横径)和UCP治疗扇区的影响。UCP对视力没有影响,安全性好。     

Mesenchymal stem cells for repairing glaucomatous optic nerve

Glaucoma is a common and complex neurodegenerative disease characterized by progressive loss of retinal ganglion cells (RGCs) and axons. Currently, there is no effective method to address the cause of RGCs degeneration. However, studies on neuroprotective strategies for optic neuropathy have increased in recent years. Cell replacement and neuroprotection are major strategies for treating glaucoma and optic neuropathy. Regenerative medicine research into the repair of optic nerve damage using stem cells has received considerable attention. Stem cells possess the potential for multidirectional differentiation abilities and are capable of producing RGC-friendly microenvironments through paracrine effects. This article reviews a thorough researches of recent advances and approaches in stem cell repair of optic nerve injury, raising the controversies and unresolved issues surrounding the future of stem cells.     

Prevalence and management of elevated intraocular pressure in patients with Graves' orbitopathy

AIMS—To investigate the prevalence and to discuss the necessity of treating elevated intraocular pressures (IOP) in patients with Graves' orbitopathy (GO). In addition, to study the effects of orbital decompression and extraocular muscle surgery on IOP.
METHODS—The records of consecutive patients with GO referred in a 5 year period were studied and those selected, in which glaucoma medication had been prescribed, or a diagnosis of primary open angle glaucoma (POAG) or of ocular hypertension (22 mm Hg) (OH) had been made. The necessity of treating these patients with glaucoma medication was questioned and the effects of corticosteroids, orbital decompression, and extraocular muscle surgery on the IOP were evaluated.
RESULTS—Of 482 patients with GO, 23 (4.8%) met the inclusion criteria. Four patients (0.8%) had POAG, four had elevated IOPs and visual field defects consistent with dysthyroid optic neuropathy, and 15 (3.1%) had only elevated IOPs. Five patients with OH showed a permanent drop of IOP after orbital decompression, two had a marked decrease of their IOP after recession of the inferior rectus muscle.
CONCLUSIONS—POAG has the same prevalence in the general Dutch population as in the GO subgroup. The combination of elevated IOPs and visual field defects in GO patients may be attributed to other mechanisms than obstructed aqueous outflow in the trabecular meshwork and should be treated accordingly. Orbital decompression and extraocular muscle surgery may lower the IOP in patients with GO.

Keywords: Graves' orbitopathy; primary open angle glaucoma; intraocular pressure     

心理干预对青光眼患者情绪和T细胞亚群的影响

目的观察心理干预对青光眼患者焦虑情绪和外周血T细胞亚群的影响.方法将入选的60例青光眼住院病人随机分为心理干预组和对照组,两组病人给予常规降低眼压和青光眼手术治疗,干预组同时实施支持性心理干预和放松训练等心理治疗,观察治疗前后两组病人的焦虑情绪和外周血T细胞亚群的变化情况.结果干预组干预前后SAS得分无显著差异,T细胞亚群CD4及CD4/CD8比值干预后较干预前上升(52.70±6.79vs48.72±6.87.t=2.739,P＜0.01;1.69±0.33 vs1.50±0.36.t=2.470,P＜0.05),CD3值升高,CD8值降低,但无显著性差异.对照组手术后较手术前SAS得分高(42.1±7.2vs39.0±5.9,t=-2.21,P＜0.05),T细胞亚群CD3、CD4及CD4/CD8比值手术后较手术前下降,CD8值增高,但差异无显著性.手术后住院时间干预组7.5±3.8天,对照组9.4±3.8天,明显少于对照组(t=1.96,P＜0.05).结论心理干预可降低手术引起的青光眼患者情绪焦虑和提高外周血T细胞亚群的功能,促进青光眼的好转.     

雷珠单抗玻璃体腔注射辅助显微手术治疗对新生血管性青光眼患者血管内皮生长因子和血小板衍生生长因子含量的影响

目的研究雷珠单抗玻璃体腔注射辅助显微手术治疗对新生血管性青光眼(NVG)患者血管内皮生长因子(VEGF)和血小板衍生生长因子(PDGF)含量的影响。方法对我院32例(32眼)NVG患者资料进行回顾和分析,所有患者接受玻璃体腔注射雷珠单抗、小梁切除术和全视网膜光凝治疗。比较患者治疗前后眼压、视力、VEGF和PDGF,记录术后并发症和治疗成功率。结果 32例患者随访(8.57±1.69)个月,小梁切除术后1周、1个月、3个月、6个月眼压显著低于注药前,差异具有统计学意义(P0.05);术后末次随访视力较注药前显著提高(P0.05),视力提高率90.63%;患者注药后5 d和小梁切除术后1周、1个月、3个月、6个月房水、玻璃体液的VEGF和PDGF水平较注药前显著降低,差异具有统计学意义(P0.05);小梁切除术后前房出血率6.25%,包裹性滤过泡率6.25%,脉络膜脱落率3.13%;术后6个月手术成功率93.75%。结论雷珠单抗玻璃体腔注射辅助用于小梁切除术和全视网膜光凝治疗,可显著降低NVG患者VEGF和PDGF水平,降低眼压、提高视力,安全有效。     

探讨护理干预对急性闭角型青光眼伴焦虑抑郁患者眼压及焦虑抑郁评分的影响

目的 探讨护理干预对急性闭角型青光眼患者围手术期的护理效果?方法 选取146例急性闭角型青光眼患者随机分为观察组和对照组,每组各73例?对照组施以常规护理,观察组在对照组的基础上进行优化护理干预。结果 观察组患者的眼压、护理满意度均明显优于对照组,差异具有统计学意义(P<0.05)?治疗后两组HAMA及HAMD评分均明显下降,且观察组HAMA及HAMD评分明显低于对照组（P<0.05）。结论本研究对闭角型青光眼患者给予的优化护理干预措施,可以有效改善的临床症状,减轻患者病痛,改善患者的焦虑及抑郁状态,提高患者的护理满意度,使患者尽快恢复,从身心双重角度回归社会,值得临床借鉴?     

针刺对青光眼患者视功能影响的临床观察

[目的]探讨针刺治疗对眼压稳定的青光眼患者视功能影响。[方法]选取青光眼患者68例,采用前瞻性随机对照研究,将68例青光眼性视神经病变者随机治疗组及对照组。对照组继续接受原来的降眼压基础治疗;治疗组在基础治疗外予以针刺治疗,取穴如下：主穴风池、太阳、睛明、合谷,配穴：球后、四白、承泣、童子髎、丝竹空,百会等,每日1次,每周治疗6 d,4周为1个疗程,连续治疗3个疗程（12周）,观察患眼视力、眼压、视野、视觉诱发电位的变化。[结果]1）治疗后,治疗组视力均数较治疗前提高（P<0.05）;2）两组患者治疗前后眼压未见明显改变及差异（P<0.05）;3）治疗后,与治疗前比较,治疗组视野平均敏感度（MS）值提高（P<0.05）,视野平均缺损值（MD）降低（P<0.05）;4）治疗12周后两组的P100波峰均提高,潜伏期时间缩短。[结论]针刺治疗青光眼虽不能明显提高患者视力、降低眼压,但可以改善视野光敏度、降低平均缺损值,值得临床作为青光眼的辅助治疗以保护视神经、改善视功能。     

Etiology and management of the hypertensive phase in glaucoma drainage-device surgery

Insertion of glaucoma drainage devices has become a mainstay in the surgical management of multiple forms of glaucoma, and the indications for this procedure continue to expand. A unique clinical challenge in the postoperative care of these devices is the hypertensive phase, a period of postoperative intraocular pressure elevation in the first three months after surgery. We discuss the influence of a variety of factors on the development of the hypertensive phase after glaucoma drainage implantation, including type of device, device material, and device surface area. Furthermore, several intraoperative and postoperative interventions are investigated as attempts to mitigate this phenomenon. Included among these are the use of antimetabolites, collagen matrix, and a variety of approaches to postoperative inflammation and intraocular pressure control. We provide an overview of our current knowledge of the etiology and management of the hypertensive phase.     

Caffeine and the eye

Caffeine, a popular psychostimulant that acts as an adenosine receptor antagonist, is the most widely used drug in history, consumed daily by people worldwide. Knowledge of the physiological and pathological effects of caffeine is crucial in improving public health because of its widespread use. We provide a summary of the current evidence on the effect of caffeine on the eye. Most of the research conducted to date is in relation to cataract and glaucoma, two of the most common eye diseases among the elderly.