Safety,efficacy, and patient selection of ripasudil in patients with uncontrolled glaucoma with maximum conventional medical therapy

Purpose:Ripasudil hydrochloride hydrate (0.4%) is the first Rho-associated protein kinase (ROCK) inhibitor eye drop that lowers intraocular pressure (IOP) by increasing conventional aqueous outflow through the trabecular meshwork and Schlemm’s canal. We aimed to evaluate the safety and efficacy of ripasudil in patients using the maximum topical anti-glaucoma medications and with uncontrolled IOP.Methods:In our prospective interventional study, we enrolled 27 eligible and consenting patients (46 eyes) who presented to us between January 2021 and June 2021. Ripasudil 0.4% was added as adjunctive therapy to the ongoing glaucoma treatment. On follow-up visits at 7 days, 15 days, 1 month, 2 months, and 3 months, the visual acuity, IOP with applanation tonometer, anterior segment, and fundus were evaluated. The IOP before and after the use of ripasudil eye drops was compared by paired t-test.Results:Among the 27 patients, 18 were males and 9 were females. A statistically significant reduction in IOP was noted at all time durations (P < 0.00001) with the maximum reduction at 3 months with all patients achieving their target IOP. No patient developed any side effects necessitating the omission of ripasudil. The most common adverse event noted was conjunctival hyperemia (22 patients), which was mild and transient.Conclusion:Ripasudil showed additional IOP-lowering effect with other antiglaucoma medications and exhibited no significant side effects.     

Assessment of knowledge,attitude, and practice of glaucoma among different cadres of optometrists

Purpose:To assess the level of knowledge, attitude, and clinical practice of glaucoma among optometry students and optometry practitioners with different years of clinical experience and academic background.Methods:A survey with 20 questions on knowledge, attitude, and practice (KAP) of glaucoma was prepared and self-administered to optometry students and optometry practitioners practicing in an eye hospital/clinic/optical with varied years of clinical experience and education qualification.Results:Among the 558 participants, 57% were optometry practitioners and 43% were students. The knowledge scores among optometry practitioners increased significantly with an increase in the years of clinical experience (P < 0.001). Participants with master’s degrees scored higher than participants with bachelor’s degrees (P = 0.12). There was no statistically significant difference in knowledge scores based on the type of clinical practice - hospital, private practice, or optical (P = 0.39). Practicing optometrists who performed slit-lamp examination, gonioscopy, IOP measurements, and disc evaluation for the detection of glaucoma had significantly higher knowledge scores than those who did not perform these tests in their practice (P < 0.05). A positive attitude toward glaucoma learning through workshops and hands-on training was reported by optometrists and students.Conclusion:Knowledge about glaucoma was good among optometrists and optometry students and was better among those who handled the diagnostics. All the optometrists had a positive attitude toward enhancing their practice through proper training.     

小梁切除术联合明胶海绵植入治疗青光眼的临床研究

目的观察小梁切除术联合明胶海绵植入治疗青光眼的临床疗效。方法对24例(24只眼)青光眼患者施行小梁切除术联合明胶海绵植入。术后观察眼压、视力、滤过泡形态、并发症等,并做超声生物显微镜(UBM)观察。结果经6～18个月的随访,22只眼术后视力(91.7%)维持不变或提高。眼压由术前平均(41.15±10.24)mmHg降至末次随访平均(14.12±4.89)mmHg,有非常显著性差异(P<0.01),末次随访眼压≤21 mmHg者22只眼(91.7%),均为功能性滤过泡,术后前房变浅4只眼,术后3～7 dUBM检查睫状体脱离2只眼。结论小梁切除术联合明胶海绵植入能有效降低眼压,经济安全,术后视力稳定,值得临床应用推广。     

国内外青光眼领域近五年进展

近5年是国内外青光眼研究发展最快的时期,遵循综合与个体化趋势,在基础研究和临床诊治方面取得了长足的进展,并提出了新的诊治理念.因此有必要就青光眼的流行病学、发病机制、形态学及功能学检测、药物及手术治疗及将来的研究方向进行扼要的综述和展望,以飨读者.     

非穿透性小梁手术超声生物显微镜检查

目的：应用超声生物显微镜（ＵＢＭ）检查技术,探讨非穿透性小梁手术联合透明质酸钠生物胶植入手术区域解剖特点和房水引汉机制。方法：对１４例１６只眼行非穿透性小梁手术联合透明质酸钠生物胶植入的患者,在术后１～３个月内进行手术区域ＵＢＭ检查。检查的指标（项目）包括：巩膜瓣下形成液间腔的大小（宽和高）、透明质酸钠生物胶吸收的情况、剩余角膜小梁膜的厚度以及滤过泡的形态,并对结果进行分析。结果：１６只眼术前平均     

灯盏花提取物对青光眼视神经保护作用的临床观察

目的 评价灯盏花提取物对眼压已控制的青光眼视神经保护作用.方法 采用随机、双盲与安慰剂对照临床试验方法.对2009年10月至2009年在解放军第五医院眼科就诊符合纳入标准的青光眼患者共34例(42只眼),分为治疗组和对照组,分别给予口服益脉康胶囊和安慰剂,每两月观察安全(血压、肝功、肾功)及疗效指标(视力、视野、HRT),疗程6月,评价疗效.结果 治疗组与对照组两组治疗前及治疗后2月平均光敏感度组间比较P＞0.05,差异无统计学意义,而治疗4、6月后两组组间比较的P＜0.05,差异有统计学意义;两组治疗后2月视网膜平均光敏感度改善率组间比较P＞0.05,差异无统计学意义,而治疗4月后两组组间比较P＜0.05,差异有统计学意义.治疗6月后两组组间比较的P＜0.01,差异显著有统计学意义.结论 益脉康胶囊能提高视网膜平均光敏感度,随治疗时间延长,其改善率明显提高,表明灯盏花提取物对眼压已控制的青光眼有一定的视神经保护作用.

Abstract：

Objective To evaluate the action for optic nerve protection of engeron extracts in treating glaucoma with control of intraocular pressure. Methods Thiny-four patients (42 eyes) with glaucoma who met the inclusion criteria, in randomized, double-blind and placebo-controlled clinical trial were divided into treatment group and control group were given oral Yi Mai Kang capsules and placebo, observed every two months to test security (blood pressure, liver function, renal function) and outcome measures (visual acuity, visual field, HRT), and were evaluated after 6 months. Results The mean sensitivity of treatment group and control group, the difference was not statistically significant both before treatment and 2 months after treatment, (P＞0.05), but the difference of the two groups,4, 6 months after treatment were statistically significant (P ＜0.05). The average rate of retinal light sensitivity of the 2 months, the difFerence between two groups was not statistically significant (P ＞0.05), but the difference of the two groups, 4 months at/er treatment was statistically significant (P ＜0.05). There was statistically sipiificant difference 6 months after treatment between the two groups (P ＜0.01). Conclusions Yi Mai Kang Capsule can improve retinal mean sensitivity, with longer treatment time, the improvement rate is significantly increased. It indicates that the extract of Erigeron has certain protective effect of optic nerve on glaucoma with control of intraocular pressure.     

超声乳化白内障吸除联合小梁切除术不同手术切口选择的临床分析

目的 比较超声乳化白内障吸除人工晶状体植入联合小梁切除术采用单切口术式和双切口术式的临床疗效。方法 对开角型或慢性闭角型青光眼合并白内障患者37例（42只眼）,分别以单切口术式（单切口组,23只眼）或双切口术式（双切口组,19只眼）,行超声乳化白内障吸除人工晶状体植人联合小梁切除术,比较两种术式的手术前、后眼压和视力,观察术后滤过泡的形成和并发症情况。术后随访6个月。结果 术后两组平均眼压较术前均有明显降低,差异有显著性意义（P〈0．001）;两组平均眼压下降差异无显著意义（P〉0．05）;术后两组视力、滤过泡比较,差异均无显著意义（P〉0．05）;术后无严重并发症发生。结论 超声乳化白内障吸除人工晶状体植入联合小梁切除术治疗青光眼合并白内障安全、有效,单切口和双切口术式手术成功率无明显差别。     

小切口非超声乳化白内障青光眼联合手术的临床疗效观察

目的探讨小切口非超声乳化白内障摘除人工晶体植入联合小梁切除术治疗白内障合并青光眼的临床疗效。方法对36眼白内障合并青光眼的患者,行小切口非超声乳化白内障摘除人工晶体植入联合小梁切除术,术后观察术眼视力、眼压、滤过泡、并发症等情况,术后随访6个月～1年。结果术后6个月随访时,32眼（88.89%）术后视力有不同程度的提高,其中术后视力大于0.3者为26眼（72.2%）。术后眼压：术后1周,25眼（69.4%）眼压低于21mmHg;术后6个月,31眼（86.1%）眼压低于21mmHg,仅有3眼（8.3%）眼压高于24mmHg,给予2%卡替洛尔滴眼液治疗,眼压都能控制在正常范围,患者无不适症状。术后有33眼（91.6%）形成弥散扁平的功能性滤过泡,其中I型滤过泡21眼,II型滤过泡12眼。术后有角膜水肿7眼,浅前房4眼,术中术后未见严重的并发症。结论小切口非超声乳化白内障摘除人工晶体植入联合小梁切除术治疗白内障合并青光眼,不但能很好的控制眼压,迅速恢复视力,而且并发症少,该方法是一种安全、有效、经济实用的手术方法,值得临床应用。     

国产YDS-201自动视野计四点阈值程序在青光眼视野筛查诊断中的应用价值

目的 探讨国产YDS-201自动视野计四点阈值程序在青光眼视野筛查诊断中的临床应用价值.方法 采用国产YDS-201自动视野计的中心52及四点阈值程序对77例(140只眼)青光眼患者在半暗室环境下检测中心30°视野.分别进行定性、定位、检测时间的对比分析.结果 定性诊断:两种程序检查结果视野缺损部位一致的119只眼(85%),不一致的21只眼(15%);定位诊断:四个象限均符合者为118只眼,约占84.3%,两个或三个象限符合者为22只眼,约占15.7%,未见四个象限均不符合者;检测耗时:中心52程序检查用时183～638s,平均(302.13±99.02)s,四点阈值程序检查用时23～101s,平均(44.11±18.00)s,P＜0.001.结论 YDS-201视野计四点阈值程序在快速筛查青光眼视野缺损中具有较高敏感性和特异性,检查用时短,适合于青光眼的视野筛查,是一种在大量人群中快速筛查青光眼的良好方法.     

青光眼小梁切除术后功能性滤过泡形态与眼表改变相关性分析

目的 分析青光眼小梁切除术后功能性滤过泡眼的眼表改变,以及滤过泡形态与眼表变化的相关性.方法 20只眼青光眼小梁切除术后6个月以上的功能性滤过泡眼(滤过泡组)及20只正常眼(对照组)分别行眼表评估包括角膜荧光素染色、泪膜破裂时间(BUT)、Schirmer Ⅰ检测及泪膜干涉成像仪检查,探究功能性滤过泡眼与正常对照眼的眼表改变及滤过泡形态与BUT、Schirmer Ⅰ检测、角膜荧光素染色及泪膜干涉图像等级的关系.结果 功能性滤过泡眼表现为BUT缩短(P＜0.01),角膜荧光素染色分级增加(P＜0.05),Schirmer Ⅰ检测值高于对照组(P＜0.05).滤过泡高度与BUT呈负相关(rs=-0.668,P＜0.01);而与角膜荧光素染色呈正相关(rs=0.585,P＜0.01).结论 青光眼小梁切除术后滤过泡可影响眼表的稳定性,引起轻微干眼样症状.