关于眼的一组问题解答

问：什么是青光眼？青光眼能治吗？答：青光眼是以眼压过高为特征的眼病。正常人的眼压约为１．３３～２．６６ｋＰａ（１０～２０ｍｍＨｇ）（Ｓｃｈｉｔｚ眼压计）,超过３．１９ｋＰａ（２４ｍｍＨｇ）为病理现象。眼压长期增高可以使视神经、视网膜发生萎缩和变性,导致视功能损害,视乳头出现大而深的凹陷,视野可见青光眼性典型改变。眼压增高持续时间愈久,视功能损害愈严重,甚至可导致失明。青光眼眼压增高的原因是房水循环的动态平衡受到了破坏。少数由于房水分泌过多,但多数还是房水流出发生了障碍,如前房角狭窄甚至关闭、小梁…     

兔先天性青光眼网络膜血管改变

目的　研究青光眼对视网膜脉络膜血液循环的影响。方法　选24月龄、体重3.5～4kg的先天性青光眼大耳白兔5只(7只眼),选10只同龄大耳白兔作为对照组。另选10只2月龄、体重2kg大耳白兔前房内灌注生理盐水制成急性高眼压模型。对三组兔进行眼底照像、闪光视诱发电位(FVEP)检查,观察视网膜脉络膜血管形态和FVEP的变化。对人工急性高眼压组还进行了闪光视网膜电流图(FERG)检查。结果　先天性青光眼组与同龄对照组相比视网膜脉络膜末梢血管网明显减少;人工急性高眼压组眼压升高后首先使视网膜脉络膜末梢血管网灌流不足,随着眼压的继续升高脉络膜大血管变细,末梢血管网灌流不足加重,眼压极度升高时脉络膜大血管血流中断。同龄正常对照组的FVEP的主波P100潜伏期是(83±9)ms,先天性青光眼组则为(112±14)ms,差异有非常显著意义(P＜0.01);人工急性高眼压组高眼压前为(69±5)ms,眼压60～80mm　Hg时延长为(81±7)ms,眼压在100～130mmHg时FVEP波形低平,近似直线;眼压恢复正常后2hFVEP的P100潜伏期为(82±8)ms。人工急性高眼压前后FERG变化显著。结论　青光眼可以影响视网膜脉络膜血液循环;可使FVEP、FERG发生变化。     

93例老年青光眼患者的护理体会

青光眼,尤其是原发性急性闭角型青光眼被认为是眼科中最重要的身心性疾病。是一种发病迅速、危害性大,可随时导致失明的常见于中老年人的疑难眼病。其临床特征是眼内压间断或持续性升高水平超过眼球所能耐受的程度而给眼球各部分组织和视功能带来损害,导致视神经萎缩、     

谷氨酸受体在实验性青光眼视网膜细胞损伤中的作用

青光眼是第二大致盲性眼病,为不可逆致盲的最主要原因。视网膜神经节细胞损伤和死亡是青光眼所致视功能损害的根本原因。在青光眼视神经损伤的众多病理过程中,谷氨酸受体功能的改变是导致神经节细胞凋亡的重要因素。本研究组在大鼠慢性高眼压实验性青光眼模型上,围绕这一主题开展了一系列研究。研究结果表明,一方面,高眼压导致的众多信号变化通过直接调控谷氨酸的NMDA和AMPA受体功能参与神经节细胞的凋亡过程;另一方面,高眼压导致的细胞外谷氨酸集聚激活Müller细胞上的Ⅰ型代谢型谷氨酸受体(group Ⅰ metabotropic glutamate receptors,mGluRI),经下调细胞膜的Kir4.1钾通道引发Müller细胞的胶质化激活,进而导致神经节细胞的凋亡。结合这些结果,本文综述了有关谷氨酸受体在实验性青光眼视网膜细胞损伤中的作用及机制的若干研究进展。     

青光眼——不可忽视的眼疾

青光眼是以视神经凹陷性萎缩和视野缺损为共同特征的疾病,其特征就是眼内压间断或持续性升高的水平超过眼球所能耐受的程度,给眼球各部分组织和视功能带来损害,导致视神经萎缩、视野缩小、视力减退,直至失明。     

慢性高眼压下兔视网膜组织蛋白质组变化的初步研究

应用蛋白质组学技术对兔青光眼慢性高眼压视网膜组织的蛋白进行初步分析。左眼前房注入0.2mL复方卡波姆溶液制作成慢性高眼压模型,右眼为对照眼。28d后分离各组视网膜组织,用双向电泳分离试验组和对照组的蛋白,然后分析电泳图谱,对比、分析其表达蛋白质点的差异,寻找兔视网膜中与慢性高眼压相关的蛋白质。结果表明,慢性高眼压诱导视网膜组织3种蛋白质出现明显差异表达。质谱鉴定出3个蛋白质,分别为热休克蛋白70(heat shock 70 kD protein,HSP70),丙酮酸激酶(Pyruvate kinase)和烯醇酶(enolase)。通过双向电泳,发现兔视网膜蛋白质表达与对照眼相比有质和量的变化,这些变化涉及与神经节细胞(retinal ganglion cells,RGCs)糖酵解及应激反应有关的几组蛋白质,提示上述蛋白质组改变可能参与了慢性青光眼神经节细胞凋亡的过程。     

健康教育在青光眼病人中的应用

青光眼是病理性高眼压或正常眼压合并视乳头、视网膜神经纤维损害和青光眼性视野改变的一种致盲眼病。一般为双眼先后发病,如病人对青光眼的知识不了解,不及时救治可导致失明。因此,对病人及家属进行针对性的健康教育,使病人了解有关疾病的常识及住院、出院的注意事项,是很重要的,它可以减缓或阻止病情的发展,提高病人生活质量。     

几种主要眼遗传病在我国的发病情况与遗传规律

中国遗传学会眼科遗传协作组于1979年成立后,组织了对国内主要眼遗传病发病情况及遗传规律的研究,现已进行了70万人的普查,整理分析了各种眼遗传病5000余家系。本文报告了先天性红绿色盲、高度近视、视网膜色素变性、先天性上睑下垂、先天性小眼球、先天性白内障、先天性青光眼、Leber视神经萎缩、家族性角膜营养不良、先天性原发性眼球震颤、先天性眼内组织缺损、先天性无虹膜、视网膜母细胞瘤、家族性黄斑变性、近视和原发性青光眼的群体患病率与遗传规律。     

马来酸噻吗洛尔联合拉坦前列腺素治疗高眼压型开角型青光眼的效果

目的:探讨马来酸噻吗洛尔联合拉坦前列腺素治疗高眼压型开角型青光眼的临床效果。方法:选取高眼压型开角型青光眼患者210例,随机分为治疗组和对照组,每组各105例。对照组患者给予马来酸噻吗洛尔治疗,治疗组患者给予马来酸噻吗洛尔联合拉坦前列腺素治疗。观察并比较两组患者治疗前后视力改善情况,眼压、视乳头杯盘比值变化情况,眼结膜充血、眼内干涩、角膜点状浸润以及一过性视觉模糊等不良反应的发生情况等。结果:治疗组患者视力改善率为85.7%,对照组为71.4%,治疗组高于对照组,差异具有统计学意义(P0.05);治疗后两组患者眼压、视乳头杯盘比值均明显下降,且治疗组明显低于对照组,差异具有统计学意义(P0.05)。治疗组患者眼结膜充血、眼内干涩、角膜点状浸润以及一过性视觉模糊等不良反应明显低于对照组,差异具有统计学意义(P0.05)。结论:马来酸噻吗洛尔联合拉坦前列腺素治疗高眼压型开角型青光眼能够改善患者视力水平,值得临床推广应用。此外,我们分析其作用可能与降低视乳头杯盘比值有关。     

日本开发出诊断青光眼的软件

日本早稻田大学内山明彦教授近日成功开发出用于诊断青光眼的软件,使青光眼的检查更为方便,确诊正常眼压青光眼也变得更为容易。 一般青光眼是由患者眼压升高引起,过高的眼压会导致眼底视神经乳头塌陷,视野变窄,视力下降,严重者可能失明。此外还有一种正常眼压青光眼,即患者的眼底视神经乳头在眼压正常的情况下发生塌陷,而本人很难感觉到发病症状,当发现视力下降时,病情已相当严重。目前日本四十岁以上的人群中大约有三十分     

Fine mapping of the gene for autosomal dominant juvenile-onset glaucoma with iridogoniodysgenesis in 6p25-tel

Glaucoma is a group of ocular disorders leading to reduced visual capabilities and sometimes blindness. The biochemical defect is unknown but it is shown that reduced drainage of the aqueous humour from the anterior chamber may lead to increased intraocular pressure and gradual atrophy of the optic neurons. Families with various forms of autosomal dominant (AD) glaucoma have been linked to 1q21-31, 2cen-q13, 4q25-27, and 13q14 and autosomal recessive congenital glaucoma have been localized to chromosome 1p36 and 2p21. Recently, a locus for AD iridogoniodysgenesis anomaly (IGDA) was mapped to chromosome 6p25. This study refines the localization of IGDA to an approximately 6–cM interval between D6S1600 and D6S1617/D6S1713 at 6p25-tel, based on recombinations in affected individuals with AD juvenile-onset glaucoma and concomitant iridogoniodysgenesis. Received: 5 May 1997 / Accepted: 15 June 1997     

Corneal thickness in congenital glaucoma

Central corneal thickness is very important measurement in glaucoma treatment because it influences the eye pressure measurements. A thinner cornea gives us artifactually lower intraocular pressure and a thicker cornea gives higher intraocular pressure reading, so it has to be corrected in both cases. The aim of this study is to compare central corneal thickness between congenital glaucoma patients and normal subjects. Prospective study included 27 patients with congenital glaucoma and 35 patients in control group. First group was subdivided in two subgroups: A--8 earlier operated patients, B--19 patients treated with topic therapy. Patients had no other corneal disorders, history of trauma, corneal surgery and they were not contact lens wearers. Measurements were performed by specular microscope Tomey EM 3000 on central corneas. This study showed that patients with congenital glaucoma have lower central corneal thickness than normal subjects. Also, the study showed that antiglaucomatous operation doesn't influence central corneal thickness. Central corneal thickness need to be a routine part of examination measurements because of need to correct intraocular pressure according to it, but also the thinner corneas values can suggest congenital glaucoma diagnosis beside the other parameters.     

Application of 5-Fluorouracil-Polycaprolactone Sustained-Release Film in Ahmed Glaucoma Valve Implantation Inhibits Postoperative Bleb Scarring in Rabbit Eyes

This study was designed to investigate whether 5-fluorouracil (5-Fu)-polycaprolactone sustained-release film in Ahmed glaucoma valve implantation inhibits postoperative bleb scarring in rabbit eyes. Eighteen New Zealand white rabbits were randomly divided into three groups (A, B and C; n = 6 per group). Group A received combined 5-Fu-polycaprolactone sustained-release film application and Ahmed glaucoma valve implantation, group B received local infiltration of 5-Fu and Ahmed glaucoma valve implantation, and group C received Ahmed glaucoma valve implantation. Postoperative observations were made of the anterior segment, intraocular pressure, central anterior chamber depth, blebs, drainage tube, and accompanying ciliary body detachment. The pathology of the blebs and surrounding tissues were observed at month 3 postoperatively. We revealed that the 5-Fu-polycaprolactone sustained-release film maintained a release concentration range of 13.7 ± 0.12 to 37.41 ± 0.47 μg/ml over three months in vitro. Postoperatively, diffuse blebs with ridges were found in all eyes in group A, two blebs were observed in group B, and no bleb formation was present in group C. The postoperative central anterior chamber depth in group A was significantly less than that of the other two groups. The postoperative intraocular pressure of group A stabilized at 6.33–8.67 mmHg, whereas that of group C gradually remained at 7.55–10.02 mmHg. The histopathology showed that the fibrous tissue thickness of the blebs in group A was significantly thinner than that of the other groups. We conclude that the 5-Fu-polycaprolactone sustained-release film had a sustained drug release effect, which promoted the inhibition of bleb scarring after Ahmed glaucoma valve implantation.     

Corneal thickness in pseudoexfoliative glaucoma

Measurements of central cornea thickness (CCT) have a very important value in glaucoma patients; if the central cornea is thinner than it suggests, then the intraocular pressure is falsely low. This study compares the central cornea thickness between patients with pseudoexfoliative glaucoma, open angle glaucoma, angle closure glaucoma and control group. This study included 34 patients with pseudoexfoliative glaucoma, 31 patient with open angle laucoma, 28 patients with angle closure laucoma and 36 normal subjects in a control group. Patients in all groups and also normal subjects in control group had no other corneal disorders, no history of trauma, corneal surgery and were not patients with contacts lens use. Patients with pseudoexfoliative glaucoma and also patients with open angle glaucoma had significantly lower values of central cornea thickness compared with normal subjects in control group. Tomey EM 3000 is a non contact specular microscope which was used to measure central corneal thickness in this study. Pachymetry is an important method for diagnoses of glaucoma and for examination of the intraocular pressure in glaucoma patients, because values of the central corneal thickness affect the exact intraocular pressure readings.     

Morphogenesis of the anterior segment in the zebrafish eye

Background  

The ocular anterior segment is critical for focusing incoming light onto the neural retina and for regulating intraocular pressure. It is comprised of the cornea, lens, iris, ciliary body, and highly specialized tissue at the iridocorneal angle. During development, cells from diverse embryonic lineages interact to form the anterior segment. Abnormal migration, proliferation, differentiation, or survival of these cells contribute to diseases of the anterior segment such as corneal dystrophy, lens cataract, and glaucoma. Zebrafish represent a powerful model organism for investigating the genetics and cell biology of development and disease. To lay the foundation for genetic studies of anterior segment development, we have described the morphogenesis of this structure in zebrafish.     

两种手术方式治疗原发性闭角型青光眼疗效比较

目的:探讨治疗原发性闭角型青光眼二种手术方式的适应症和初步临床疗效观察。方法:拟订手术适应症,对临床收治的42例48眼原发性闭角型青光眼进行手术处理:单纯抗青光眼手术--小梁切除术(Trabeculectomy,Trab)、青白联合手术--超声乳化白内障吸除联合小梁切除+人工晶体植入术(Phacotrabeculectomy+IOL,PhacoTrab+IOL)。比较不同适应症下二种手术方式初步的临床疗效。包括术前术后眼压情况、前房深度、眼轴长度的变化。随访时间平均1个月。结果均经统计学处理。结果:原发性闭角型青光眼患者术后眼压有显著改变,有统计学差异,Trab组手术后平均(10.92±1.74)mmHg,Phaco Trab+IOL组手术后平均(10.86±1.73)mmHg。术后眼压明显降低(t检验,P值<0.001),Trab组和Phaco Trab+IOL组两组间术后眼压无显著差异(t检验,P值>0.05)。Trab组手术前后前房深度无统计学差异(t检验,P值>0.05),Phaco Trab+IOL组手术前后前房深度有统计学差异(t检验,P值均<0.001)。术前分别为(1.74±0.16)mm、(1.72±0.16)mm,术后分别为(1.74±0.17)mm、(2.06±0.14)mm。Trab组及Phaco Trab+IOL组手术前后眼轴长度无统计学差异(t检验,P值>0.05)。结论:青-白联合手术可以改善前房深度,明显降低眼压,不同手术方式适合不同的病人情况,但要注意适应症的选择。利用A超检查可快速、有效、准确地观察眼前节结构,有助于早期进行手术。     

Optic Disc Change during Childhood Myopic Shift: Comparison between Eyes with an Enlarged Cup-To-Disc Ratio and Childhood Glaucoma Compared to Normal Myopic Eyes

BackgroundProgressive disc tilting and the development or enlargement of peripapillary atrophy (PPA) are observed during a myopic shift in children. This could be related to the changes around the optic nerve head during eyeball elongation. If the biomechanical properties at or around the optic nerve head are changed after exposure to elevated intraocular pressure (IOP) in glaucoma eyes, different response of the disc tilting and PPA changes could take place during eyeball elongation by myopic shift. On the basis of this background, the aim of this study was to compare the morphological changes in the optic disc induced by a myopic shift during childhood between normal control eyes, eyes from disc suspects with an enlarged cup-to-disc ratio (CDR), and eyes with childhood glaucoma.MethodsTotal of 82 eyes from 82 subjects younger than 14 years of age were included in the study. Serial disc photographs were classified into one of two groups: eyes with an optic nerve head (ONH) or peripapillary atrophy (PPA) change or without an ONH/PPA change. Using ImageJ software, the outlines of the optic disc and PPA were plotted, and the vertical disc diameter (VDD), horizontal disc diameter (HDD), and maximum PPA width (PPW) were measured. The changes in the ratios of these parameters and the relationships between the degree of myopic shift or the ONH/PPA change were analyzed.ResultsTwenty-five eyes with normal optic disc appearance, 36 eyes with enlarged cup-to-disc ratio, and 21 eyes of glaucoma patients were analyzed. The initial intraocular pressure (IOP) at diagnosis was significantly different among the groups (P<0.001). The degree of myopic shift during follow-up period was not significantly different among the groups (P=0.612). However, the changes in the HDD/VDD and PPW/VDD ratios were significantly greater in the disc suspect group and significantly smaller in the glaucoma group. Among the 42 eyes with an ONH/PPA change, 16 (38.1%) were from the normal control group, 24 (57.1%) were from the disc suspect group, and 2 (4.8%) were from the glaucoma group (P < 0.001).

Conclusions and Relevance

The optic disc change during childhood myopic shift was different in eyes with various conditions. Eyes of childhood glaucoma showed less change in the disc morphology during myopic shift compared to eyes with normal disc or enlarged cup-to-disc ratio.     

雷珠单抗联合Ahmed青光眼阀植入术对新生血管性青光眼患者眼动脉血流动力学和血清VEGF、PDGF的影响

摘要 目的：观察雷珠单抗联合Ahmed青光眼阀植入术治疗新生血管性青光眼（NVG）的疗效及对眼动脉血流动力学和血清血管内皮生长因子（VEGF）、血小板衍生生长因子（PDGF）的影响。方法：选择2018年4月~2021年2月期间华中科技大学同济医学院附属协和医院眼科收治的NVG患者60例94眼,采用随机数字表法将患者分为对照组和研究组,分别为30例48眼和30例46眼。对照组患者予以Ahmed青光眼阀植入术,研究组眼内注射雷珠单抗一周后再行Ahmed青光眼阀植入术,观察治疗效果,对比两组眼动脉血流动力学和血清VEGF、PDGF,观察虹膜与前房角新生血管消退率及并发症发生率。结果：研究组的疗效明显优于对照组（P<0.05）。研究组治疗后3个月血流阻力系数（RI）低于对照组,收缩期峰值流速（PSV）、舒张末期流速（EDV）高于对照组（P<0.05）。治疗后3个月两组VEGF、PDGF均下降,且研究组低于对照组（P<0.05）。治疗后3个月两组眼压下降,视力升高,且研究组的改善程度优于对照组（P<0.05）,研究组虹膜与前房角新生血管消退率高于对照组（P<0.05）。研究组的并发症发生率少于对照组（P<0.05）。结论：NVG采用Ahmed青光眼阀植入术联合雷珠单抗治疗,可有效恢复视力、眼压,具有更好的疗效,这可能与联合治疗可改善眼动脉血流动力学及血清VEGF、PDGF水平有关。     

Homozygous mutations in PXDN cause congenital cataract, corneal opacity, and developmental glaucoma

Anterior segment dysgenesis describes a group of heterogeneous developmental disorders that affect the anterior chamber of the eye and are associated with an increased risk of glaucoma. Here, we report homozygous mutations in peroxidasin (PXDN) in two consanguineous Pakistani families with congenital cataract-microcornea with mild to moderate corneal opacity and in a consanguineous Cambodian family with developmental glaucoma and severe corneal opacification. These results highlight the diverse ocular phenotypes caused by PXDN mutations, which are likely due to differences in genetic background and environmental factors. Peroxidasin is an extracellular matrix-associated protein with peroxidase catalytic activity, and we confirmed localization of the protein to the cornea and lens epithelial layers. Our findings imply that peroxidasin is essential for normal development of the anterior chamber of the eye, where it may have a structural role in supporting cornea and lens architecture as well as an enzymatic role as an antioxidant enzyme in protecting the lens, trabecular meshwork, and cornea against oxidative damage.