目的:研究噻吗洛尔与拉坦前列素联合应用对高眼压型原发性开角型青光眼(primary open angle glaucoma,POAG)患者视盘参数及视网膜神经纤维层厚度的影响,为临床研究提供指导。方法:将2013-11/2015-11期间于我院进行治疗的240例336眼高眼...目的:研究噻吗洛尔与拉坦前列素联合应用对高眼压型原发性开角型青光眼(primary open angle glaucoma,POAG)患者视盘参数及视网膜神经纤维层厚度的影响,为临床研究提供指导。方法:将2013-11/2015-11期间于我院进行治疗的240例336眼高眼压型POAG患者按随机数字表法将患者分为两组,其中对照组120例170眼,观察组120例166眼。对照组患者仅采用拉坦前列素治疗,观察组则采用噻吗洛尔联合拉坦前列素进行治疗。观察治疗后3mo内患者治疗效果,测量患者视盘参数和视网膜神经纤维层厚度,随访关注1a内患者不良反应发生率。结果:观察组和对照组患者治疗后的改善率分别为97.6%和80.6%,观察组疗效明显优于对照组,两组比较差异有统计学意义(P<0.05);治疗后两组患者眼部盘沿面积、盘沿容积、视盘容积和水平杯盘直径比均有所升高,差异有统计学意义(P<0.05),其中观察组显著高于对照组,差异有统计学意义(P<0.05),而两组患者的垂直杯盘直径明显下降,差异有统计学意义(P<0.05),观察组显著低于对照组,差异具有统计学意义(P<0.05);两组患者治疗期间眼睛干涩、角膜浸润、结膜充血、视觉模糊等并发症发生率比较差异无统计学意义(P>0.05),1a内随访患者也无其他不良反应发生。结论:采用噻吗洛尔与拉坦前列素联合应用治疗高眼压型POAG患者,患者病情有明显好转,视力得到提高,其视盘参数和视网膜神经纤维层厚度也有所改善。展开更多
Background:To compare the efficacy of Ex-PRESS implantation versus trabeculectomy combined with phacoemulsification.Methods:A retrospective 12-month study on patients with coincident primary open-angle glaucoma(POAG)a...Background:To compare the efficacy of Ex-PRESS implantation versus trabeculectomy combined with phacoemulsification.Methods:A retrospective 12-month study on patients with coincident primary open-angle glaucoma(POAG)and cataract.The patients underwent combined phacoemulsification and Ex-PRESS implant(Phaco-ExPRESS,n=35)or phacotrabeculectomy(Phaco-Trab,n=35).The morphological structures of the filtering bleb were examined by slitlamp,anterior segment optical coherence tomography(AS-OCT)and in vivo confocal microscopy(IVCM).Complete success was defined as postoperative intraocular pressure(IOP)<18 mmHg without the use of anti-glaucoma medication.Qualified success was defined as postoperative IOP<18 mmHg with or without anti-glaucoma medications.The data were collected preoperatively and postoperatively at 2 weeks,1 month,3 months,6 months,and 12 months.Results:No significant difference in the variables such as age,IOP and perimetry was found between the groups of Phaco-ExPRESS and Phaco-Trab.At the one-year postoperative visit for filtering blebs,Phaco-ExPRESS increased the mean area of epithelial microcysts significantly from 0.10±0.05 to 0.20±0.09μm^(2)perμm^(2),while Phaco-Trab decreased the mean area significantly from 0.08±0.04 to 0.04±0.06μm^(2)perμm^(2).Notably,the hyperreflective dots detected by IVCM decreased by 84.9%in Phaco-ExPRESS but increased by 36.3%in Phaco-Trab.The hyperreflective dots were further identified as neutrophil-and monocyte-like cells.The number of these cells were negatively correlated with the microcysts area(r=−0.7,P<0.01)but positively associated with the grade of connective tissue(r=0.5,P<0.01).By creating different microstructural changes in the filtering blebs,Phaco-ExPRESS produced a higher complete success rate(84.9%vs.41.2%,P<0.01)and significant decrease in the number of anti-glaucoma medications(P<0.01)when compared with those in Phaco-Trab.However,the qualified success showed no significant difference between the two groups(100.0%vs.91.2%,P=0.24).Conclusions:At 展开更多
目的:了解原发性开角型青光眼(primary open angle glaucoma,POAG)患者视野缺损的进展情况,探讨其发生进展的相关危险因素。方法:回顾性分析2014年1月至2018年7月就诊于北京大学第三医院眼科并有至少4次视野检查的POAG患者。按照患者首...目的:了解原发性开角型青光眼(primary open angle glaucoma,POAG)患者视野缺损的进展情况,探讨其发生进展的相关危险因素。方法:回顾性分析2014年1月至2018年7月就诊于北京大学第三医院眼科并有至少4次视野检查的POAG患者。按照患者首次视野检查的平均偏差或平均缺损进行分期。将历次随访视野检查的平均偏差或平均缺损与时间进行线性回归分析,取其斜率(dB/年)。根据平均偏差或平均缺损的斜率将患者分为进展组与无进展组。分析患者视盘周围视网膜神经纤维层(retinal nerve fiber layer,RNFL)厚度损害位置、平均随诊间隔时间、基线视野分期等因素与青光眼视野缺损进展的关系。结果:共纳入128例患者(252只眼),其中129眼使用Octopus视野计检查随访,基线视野缺损值为(10.91±5.76)dB;123眼使用Humphrey视野计,基线视野偏差值为(–10.62±6.89)dB。视野缺损早、中、晚期的比例分别为26.19%、36.51%和37.30%。进展组31只眼(12.30%),无进展组221只眼(87.70%)。上下方RNFL都存在重度损害的患者,其视野缺损更易进展(P<0.001)。平均随诊间隔时间≤4个月的患眼,发生进展的比例高于平均随诊间隔时间>4个月的患眼(P=0.058)。基线视野分期、年龄、性别、总随访时间与视野缺损进展未见显著相关性。结论:青光眼患者的视功能损害出现恶化是普遍存在的。上下方RNFL均存在重度损害、随诊间隔时间短与视野缺损进展相关。视神经结构的改变与功能损害具有相关性,结构改变的方位对功能损害进展有提示功能。规律随诊对病情监测有重要意义,对于可能快速进展的患者,应缩短随诊间隔时间。展开更多
Researches of glaucoma visual function damage, hemorrheololgy, ocular rheography and other related multiplex factors, with computed multifactorial stepwise regresion analysis, indicate that the elevation of intraocula...Researches of glaucoma visual function damage, hemorrheololgy, ocular rheography and other related multiplex factors, with computed multifactorial stepwise regresion analysis, indicate that the elevation of intraocular pressure (IOP) is not the only factor to induce visual impairment. POAG patients are shown to have markedly reduced diastolic purfussion pressure in ophthalmic artery, besides prolonged filling time of the retinal artery and vein, diminished erythrocyte deformability and increased platele...展开更多
文摘目的:研究噻吗洛尔与拉坦前列素联合应用对高眼压型原发性开角型青光眼(primary open angle glaucoma,POAG)患者视盘参数及视网膜神经纤维层厚度的影响,为临床研究提供指导。方法:将2013-11/2015-11期间于我院进行治疗的240例336眼高眼压型POAG患者按随机数字表法将患者分为两组,其中对照组120例170眼,观察组120例166眼。对照组患者仅采用拉坦前列素治疗,观察组则采用噻吗洛尔联合拉坦前列素进行治疗。观察治疗后3mo内患者治疗效果,测量患者视盘参数和视网膜神经纤维层厚度,随访关注1a内患者不良反应发生率。结果:观察组和对照组患者治疗后的改善率分别为97.6%和80.6%,观察组疗效明显优于对照组,两组比较差异有统计学意义(P<0.05);治疗后两组患者眼部盘沿面积、盘沿容积、视盘容积和水平杯盘直径比均有所升高,差异有统计学意义(P<0.05),其中观察组显著高于对照组,差异有统计学意义(P<0.05),而两组患者的垂直杯盘直径明显下降,差异有统计学意义(P<0.05),观察组显著低于对照组,差异具有统计学意义(P<0.05);两组患者治疗期间眼睛干涩、角膜浸润、结膜充血、视觉模糊等并发症发生率比较差异无统计学意义(P>0.05),1a内随访患者也无其他不良反应发生。结论:采用噻吗洛尔与拉坦前列素联合应用治疗高眼压型POAG患者,患者病情有明显好转,视力得到提高,其视盘参数和视网膜神经纤维层厚度也有所改善。
基金supported by the National Natural Science Foundation of Guangdong Province(Grant No.2018A030313833)supported by the National Natural Science Foundation of Guangdong Province(Grant No.2020A1515010103)supported by the National Natural Science Foundation Incubation Program of Guangdong Provincial People’s Hospital(Grant No.KY01201147 and KY01201146).
文摘Background:To compare the efficacy of Ex-PRESS implantation versus trabeculectomy combined with phacoemulsification.Methods:A retrospective 12-month study on patients with coincident primary open-angle glaucoma(POAG)and cataract.The patients underwent combined phacoemulsification and Ex-PRESS implant(Phaco-ExPRESS,n=35)or phacotrabeculectomy(Phaco-Trab,n=35).The morphological structures of the filtering bleb were examined by slitlamp,anterior segment optical coherence tomography(AS-OCT)and in vivo confocal microscopy(IVCM).Complete success was defined as postoperative intraocular pressure(IOP)<18 mmHg without the use of anti-glaucoma medication.Qualified success was defined as postoperative IOP<18 mmHg with or without anti-glaucoma medications.The data were collected preoperatively and postoperatively at 2 weeks,1 month,3 months,6 months,and 12 months.Results:No significant difference in the variables such as age,IOP and perimetry was found between the groups of Phaco-ExPRESS and Phaco-Trab.At the one-year postoperative visit for filtering blebs,Phaco-ExPRESS increased the mean area of epithelial microcysts significantly from 0.10±0.05 to 0.20±0.09μm^(2)perμm^(2),while Phaco-Trab decreased the mean area significantly from 0.08±0.04 to 0.04±0.06μm^(2)perμm^(2).Notably,the hyperreflective dots detected by IVCM decreased by 84.9%in Phaco-ExPRESS but increased by 36.3%in Phaco-Trab.The hyperreflective dots were further identified as neutrophil-and monocyte-like cells.The number of these cells were negatively correlated with the microcysts area(r=−0.7,P<0.01)but positively associated with the grade of connective tissue(r=0.5,P<0.01).By creating different microstructural changes in the filtering blebs,Phaco-ExPRESS produced a higher complete success rate(84.9%vs.41.2%,P<0.01)and significant decrease in the number of anti-glaucoma medications(P<0.01)when compared with those in Phaco-Trab.However,the qualified success showed no significant difference between the two groups(100.0%vs.91.2%,P=0.24).Conclusions:At
基金This Study was supported by China National Ministry of Health Young Grants(1987)Dr. Y. T. Fox Fund for Young Education of China NationaI Committee of Education(1989)
文摘Researches of glaucoma visual function damage, hemorrheololgy, ocular rheography and other related multiplex factors, with computed multifactorial stepwise regresion analysis, indicate that the elevation of intraocular pressure (IOP) is not the only factor to induce visual impairment. POAG patients are shown to have markedly reduced diastolic purfussion pressure in ophthalmic artery, besides prolonged filling time of the retinal artery and vein, diminished erythrocyte deformability and increased platele...
