槲皮素对N-甲基-D-天冬氨酸（NMDA）诱导损伤的视网膜神经节细胞的保护作用及其机制

目的　探讨槲皮素对N-甲基-D-天冬氨酸（N-methyl-D-aspartic acid,NMDA）诱导的视网膜神经节细胞（retinal ganglion cell,RGC）损伤的保护作用及其机制。方法　将小鼠RGC随机分为对照组,NMDA组,NMDA+1 μmol·L^-1、10 μmol·L^-1、100 μmol·L^-1槲皮素处理组,槲皮素处理组,NMDA+槲皮素+茴香霉素（anisomycin,ANISO）处理组,NMDA+槲皮素+P79350处理组。NMDA组细胞加入100 μmol·L^-1的NMDA作用24 h,NMDA+1 μmol·L^-1、10 μmol·L^-1、100 μmol·L^-1槲皮素处理组则在NMDA作用前分别加入相应浓度槲皮素预处理2 h,槲皮素处理组只加入10 μmol·L^-1槲皮素处理,NMDA+槲皮素+ANISO处理组和NMDA+槲皮素+P79350处理组在NMDA和槲皮素处理后分别加入25 μg·L^-1的ANISO和50 μmol·L^-1的P79350处理。随后利用噻唑蓝（methyl thiazolyl tetrazolium,MTT）试剂盒检测细胞活性,流式细胞术检测细胞凋亡率,酶联免疫吸附实验（enzyme-linked immunosorbent assay,ELISA）检测细胞培养上清液中活性氧（reactive oxygen species,ROS）、丙二醛（malondialdehyde,MDA）、乳酸脱氢酶（lactate dehydrogenase,LDH）、超氧化物歧化酶（superoxide dismutase,SOD）和一氧化氮（nitric oxide,NO）水平,RT-PCR检测细胞中神经型一氧化氮合酶（neuronal nitric oxide synthase,nNOS）和诱导型一氧化氮合酶（inducible nitric oxide synthase,iNOS）mRNA表达,Western blot检测细胞中Bcl-2、Bax、p38丝裂原活化蛋白激酶（p38 mitogen-activated protein kinase,p38 MAPK）、磷酸化p38 MAPK（phosphorylated p38 MAPK,p-p38 MAPK）、c-Jun氨基末端激酶（c-Jun N-terminal kinase,JNK）和p-JNK蛋白表达水平,Caspase-3活性试剂盒检测Caspase-3活性。结果　与对照组比较,NMDA组细胞活性、SOD、Bcl-2 mRNA表达水平降低,LDH,ROS,MDA,NO,iNOS mRNA、nNOS mRNA、Bax mRNA和蛋白表达水平,Caspase-3活性,p-JNK蛋白表达水平,p-p38 MAPK蛋白表达水平,细胞凋亡率均升高（均为P<0.05）。相比于NMDA组,NMDA+槲皮素处理组则提高细胞活性和SOD水平,上调Bcl-2 mRNA和蛋白表达,降低LDH、ROS、MDA和NO,下调iNOS mRNA、nNOS mRNA、Bax mRNA和蛋白,p-JNK蛋白以及p-p38 MAPK蛋白表达,并降低Caspase-3活性和细胞凋亡率（均为P<0.05）。ANISO和P79350抵消槲皮素的作用。结论　槲皮素通过JNK/p38 MAPK信号通路防止NMDA诱导的RGC损伤。     

白内障超声乳化联合人工晶状体植入术治疗闭角型青光眼合并白内障的疗效观察

目的:观察白内障超声乳化联合人工晶状体植入术治疗合并白内障的闭角型青光眼的临床疗效.方法:合并白内障的急性闭角型青光眼病人47例(56眼),房角关闭粘连范围均<180°.均行白内障超声乳化联合人工晶状体植入手术,比较病人手术前后的眼压、前房深度、前房角及矫正视力,随访6个月.结果:术后6个月,病人最佳矫正视力视力、眼压、前房深度和前房角开放度均较术前明显改善(P<0.01).结论:白内障超声乳化联合人工晶状体植入术对闭角型青光眼合并白内障病人有较好疗效.     

Topical treatment of glaucoma: established and emerging pharmacology

Introduction: Glaucoma is a collection of optic neuropathies consisting of retinal ganglion cell death and corresponding visual field loss. Glaucoma is the leading cause of irreversible vision loss worldwide and is forecasted to precipitously increase in prevalence in the coming decades. Current treatment options aim to lower intraocular pressure (IOP) via topical or oral therapy, laser treatment to the trabecular meshwork or ciliary body, and incisional surgery. Despite increasing use of trabecular laser therapy, topical therapy remains first-line in the treatment of most forms of glaucoma.

Areas covered: Novel glaucoma therapies are a long-standing focus of investigational study. More than two decades have passed since the last United States Food and Drug Administration (FDA) approval of a topical glaucoma drug. Here, the authors review established topical glaucoma drops as well as those currently in FDA phase 2 and 3 clinical trial, nearing clinical use.

Expert opinion: Current investigational glaucoma drugs lower IOP, mainly through enhanced trabecular meshwork outflow. Although few emerging therapies show evidence of retinal ganglion cell and optic nerve neuroprotection in animal models, emerging drugs are focused on lowering IOP, similar to established medicines.     

Open-angle glaucoma: therapeutically targeting the extracellular matrix of the conventional outflow pathway

Introduction: Ocular hypertension in open-angle glaucoma is caused by a reduced rate of removal of aqueous humour (AH) from the eye, with the majority of AH draining from the anterior chamber through the conventional outflow pathway, comprising the trabecular meshwork (TM) and Schlemm’s Canal. Resistance to outflow is generated, in part, by the extracellular matrix (ECM) of the outflow tissues. Current pressure-lowering topical medications largely suppress AH production, or enhance its clearance through the unconventional pathway. However, therapies targeting the ECM of the conventional pathway in order to decrease intraocular pressure have become a recent focus of attention.

Areas covered: We discuss the role of ECM of the TM in outflow homeostasis and its relevance as a target for glaucoma therapy, including progress in development of topical eye formulations, together with gene therapy approaches based on inducible, virally-mediated expression of matrix metalloproteinases to enhance aqueous outflow.

Expert opinion: There remains a need for improved glaucoma medications that more specifically act upon sites causative to glaucoma pathogenesis. Emerging strategies targeting the ECM of the conventional outflow pathway, or associated components of the cytoskeleton of TM cells, involving new pharmacological formulations or genetically-based therapies, are promising avenues of future glaucoma treatment.     

Evaluation of the effects on choroidal thickness of bimatoprost 0.03% versus a brinzolamide 1.0%/timolol maleate 0.5% fixed combination

Objective: To investigate the effects of two different medical treatment options on choroidal thickness (CT) in cases of open-angle glaucoma (OAG).

Methods: Sixty-seven eyes newly diagnosed with OAG and 52 healthy eyes constituting the control group were included in the study. Glaucomatous eyes were randomly divided into two subgroups; Group I was started on bimatoprost 0.03% and Group II on a brinzolamide 1.0%/timolol maleate 0.5% fixed combination (BTFC). Intraocular pressure (IOP), ocular pulse amplitude (OPA) and subfoveal CT measurements were performed in all eyes in the study before treatment and on weeks 2, 4 and 8 after treatment.

Results: Mean initial IOP values in groups I and II and the control group were 25.5?±?4.7, 25.1?±?5.2 and 16.1?±?2.9?mmHg, mean OPA values were 3.7?±?1, 3.6?±?1.4 and 2.4?±?0.6?mmHg and mean CT values were 269.4?±?83, 264.5?±?84.4 and 320.1?±?56.6?μm, respectively. Eight weeks after treatment, mean IOP values in Groups I and II and the control group were 18.3?±?2.6, 18.1?±?3.4 and 15.7?±?2.9?mmHg, mean OPA values were 2.9?±?1.2, 2.8?±?1.5 and 2.3?±?0.8?mmHg and mean CT values were 290.2?±?87.3, 271.8?±?82.5 and 319.3?±?56.8?μm, respectively. No significant difference was determined in terms of the decrease in IOP and OPA obtained after treatment in Group I and Group II. However, a significant difference was observed between the two groups in terms of choroidal thickening after treatment.

Conclusion: The use of topical ocular hypotensive medication in eyes with OAG results in an increase in CT. This increase is relatively greater with bimatoprost 0.03% therapy compared to BTFC.     

探讨综合性护理干预对急性闭角型青光眼患者心理状态及住院满意度的影响

目的 分析综合性护理干预对急性闭角型青光眼患者心理状态及住院满意度的影响。方法 选取2018年5月至2020年5月我院收治的60例急性闭角型青光眼患者,以双盲随机抽样法分为对照组和实验组,每组各30例,对照组采用传统护理,实验组采用综合性护理干预,对比两组患者眼压、抑郁自评量表(SDS)评分、焦虑自评量表(SAS)评分、并发症发生情况、护理满意度和住院时间。结果 护理前,两组患者眼压、SDS和SAS评分比较,差异无统计学意义(P0.05);护理后,实验组眼压、SDS评分、SAS评分低于对照组,且护理后低于护理前,差异有统计学意义(P0.05);实验组患者并发症总发生率(3.33%)低于对照组(23.33%)、总满意度(96.67%)高于对照组(73.33%),差异有统计学意义(P0.05);实验组患者住院时间短于对照组,差异有统计学意义(P0.05)。结论在治疗急性闭角型青光眼患者中应用综合性护理干预可有效降低患者眼压,减轻患者不良情绪,降低并发症总发生率,提高护理总满意度,缩短住院时间,值得借鉴。     

Comparison of corneal biomechanics among primary open-angle glaucoma with normal tension or hypertension and controls

Background:Normal tension glaucoma (NTG) is a less pressure-dependent type of glaucoma with characteristic optic neuropathy. Recently, the biomechanical mechanism has been thought to account for glaucomatous optic neuropathy to some degree. We intended to compare dynamic corneal response parameters (DCRs) among patients with primary open-angle glaucoma with normal tension or hypertension and controls. The correlations between DCRs and known risk factors for glaucoma were also analyzed.Methods:In this cross-sectional study, 49 NTG subjects, 45 hypertension glaucoma (HTG) subjects, and 50 control subjects were enrolled. We compared the differences in DCRs using corneal visualization Scheimpflug technology among the NTG, HTG, and control groups. We also analyzed the correlations between DCRs and known risk factors for glaucoma (eg, central corneal thickness [CCT], intraocular pressure [IOP], etc).Results:The maximum inverse concave radius (NTG: 0.18 [0.17, 0.20] mm⁻¹; control: 0.17 [0.16, 0.18] mm⁻¹; P = 0.033), deformation amplitude ratio of 2 mm (DAR 2 mm, NTG: 4.87 [4.33, 5.39]; control: 4.37 [4.07, 4.88]; P < 0.001), and DAR 1 mm (NTG: 1.62 [1.58, 1.65]; control: 1.58 [1.54, 1.61]; P < 0.001) were significantly higher in NTG than in the controls. The integrated radius (IR, NTG: 8.40 ± 1.07 mm⁻¹; HTG: 7.64 ± 1.31 mm⁻¹; P = 0.026) and DAR 2 mm (NTG: 4.87 [4.33, 5.39]; HTG: 4.44 [4.12, 5.02]; P < 0.007) were significantly higher, whereas the stiffness parameter at the first applanation (SP-A1, NTG: 91.23 [77.45, 107.45]; HTG: 102.36 [85.77, 125.12]; P = 0.007) was lower in NTG than in HTG. There were no significant differences in the DCRs between HTG and control groups (P > 0.05). In the univariate and multivariate analyses, some of the DCRs, such as IR, were negatively correlated with CCT and IOP, whereas SP-A1 was positively correlated with CCT and IOP.Conclusions:The cornea was more deformable in NTG than in HTG or controls. There were no significant differences in corneal deformability between HTG and controls. The cornea was more deformable with the thinner cornea and lower IOP.     

超声生物显微镜在改良二氧化碳激光辅助深层巩膜切除术后长期随诊中的应用

目的 观察超声生物显微镜(UBM)在改良二氧化碳激光辅助深层巩膜切除术(CLASS)治疗原发性开角型青光眼术后两年随诊中的作用。方法 采用病例系列研究方法。对28例(28只眼)药物治疗眼压失控的原发性开角型青光眼患者实施术前虹膜激光预处理的改良CLASS手术,记录术前及术后2年内随访的最佳矫正视力、眼压、裂隙灯检查、视野、房角镜检查结果,术后1、3、12、24个月行UBM检查。结果 患者术前平均眼压为(30.61±10.59)mmHg(1 mmHg=0.133 kPa),术后1、3、6、12、24个月的平均眼压分别为(15.15±5.87)、(12.56±3.24)、(13.15±2.73)、(13.75±2.55)、(13.75±2.46)mmHg,术后各时间点眼压均明显低于术前(P均<0.001)。术后12、24个月手术绝对成功率和相对成功率分别为60.71%、89.29%和53.57%、85.71%。成功CLASS术后UBM呈现海豚头征。术后1个月小梁狄氏膜窗厚度为(0.13±0.03)mm,与术后12(r=-0.278,P=0.144)、24个月(r=0.026,P=0.895)眼压无显著相关性;巩膜池面积缩小范围超过50%的病例在术后12个月有1只眼(3.57%),在术后24个月有3只眼(10.71%);术后巩膜池的大小与术后眼压无显著相关性。术后12、24个月分别有16(57.14%)、25只眼(89.28%)为非功能性滤过泡。术后24个月有2只眼(7.14%)发生严重周边虹膜前黏连,需手术干预。结论 UBM在改良CLASS术后随诊中可有效地观察巩膜池、房角及滤过泡的形态,早期提示并发症的发生;UBM监测下巩膜池的存在为保障CLASS手术的成功发挥重要作用。     

小切口白内障摘除联合小梁切除术21例分析

目的:观察闭角型青光眼合并白内障行小切口白内障摘除联合小梁切除术的临床效果。方法:对21例21眼闭角型青光眼合并白内障行小切口白内障摘除人工晶状体植入联合小梁切除术,观察术后视力、眼压、滤过泡及眼底改变。结果:术后6月视力达0.3及以上者18眼(85.71%),眼压控制在正常范围内(<20.55mmHg)者19眼(90.48%),功能性滤过泡19眼(90.48%),无严重并发症发生。结论:小切口白内障摘除人工晶状体植入联合小梁切除术是治疗闭角型青光眼合并白内障的有效方法。