房角镜辅助的内路360°小梁切开术(Gonioscopy-Assisted Transluminal Trabeculotomy,GATT)是近年来国内外开展的新型微创青光眼手术，是一种改良的小梁切开术。GATT将微导管(iTrack)环穿Schlemm's管后，利用微导管张力全周切开小梁网及Schlemm's管内壁，重建生理性房水流出通道，避免小梁网阻力，实现房水从前房直接进入集液管，通过增加房水流出机制降低眼压。GATT适应证广泛，主要应用于开角型青光眼，包括原发型开角型青光眼和继发性开角型青光眼，同时可运用于闭角型青光眼。GATT微创、不依赖滤过泡、能明显减少降眼压药物的使用、中远期疗效稳定、安全性高、较少发生威胁视力的并发症，可作为开角型青光眼的首选手术方式。本文将对GATT在青光眼中的应用、手术步骤、作用机制、有效性、并发症及影响疗效的因素等进行综述，以期为其临床运用提供参考。
As a modifed trabeculotomy, Gonioscopy-Assisted Transluminal Trabeculotomy (GAT) is a new type of minimally invasive glaucoma surgery developed at home and abroad in recent years. GAT inserts a microcatheter (iTrack) into the Schlemm's canal and advance the catheter through the canal circumferentially 360°, then circumferentially fracture the trabecular meshwork and inner wall of Schlemm’s canal. Tis method can reduce intraocular pressure by increasing the outfow of aqueous humor. Te physiological outfow pathway of aqueous humor is reconstructed, which can avoid the resistance of trabecular meshwork and realizing the direct entry of the aqueous humor directly into the collector channel from the anterior chamber. With a wide range of indications, GAT is mainly used in open-angle glaucoma, including primary open-angle glaucoma and secondary open-angle glaucoma, and is also used in primary closed- angle glaucoma. Additionally, GATT can be the preferred surgical modality for open-angle glaucoma, as it has the following advantages: minimally invasive, independent of fltration bleb, can signifcantly reduce the use of medications, stable medium- and long-term efcacy, high safety, and has fewer sight-threatening complications. In order to provide a reference for clinical application, this article reviews the indications, mechanism of action, surgical procedures, efectiveness, complication and factors afecting therapeutic efect.
目的：观察超声乳化白内障吸除人工晶状体植入术（phacoemulsification with intraocular lens implantation, PEI）联合房角分离术（goniosynechialysis, GSL）及房角切开术（goniotomy, GT）治疗中晚期原发性慢性闭角型青光眼（chronic primary angle-closure glaucoma , CPACG）合并白内障的安全性和有效性。方法：采用回顾性病例研究。收集2020年6月至2024年1月在成都市中西医结合医院行PEI联合GSL及GT的中晚期CPACG合并白内障患者94例133眼，观察最佳矫正视力（best corrected visual acuity, BCVA）、眼压、抗青光眼药物使用数量及术后并发症等情况。采用重复测量方差分析、Wilcoxon秩检验进行统计学处理。结果：术后1天，1周，1、3、6个月94例患者133眼的BCVA（logMAR）均较术前有所提升（P＜0.05）；从术后1天到6个月的所有随访时间点眼压均较术前明显下降（F = 189.79，P＜0.001）；术后6个月，患者使用的降眼压药物数量明显低于术前 ( Z = -2.392，P＜0.001)。术后1周中31眼（23%）出现角膜水肿，15眼（11%）出现前房积血，均在1周内消退；术后1个月内1眼出现眼压反跳，予以前房穿刺放液等治疗后眼压恢复到正常范围。术后6个月，121眼（91%）手术完全成功，10眼（8%）手术条件成功。结论：PEI联合GSL及GT治疗中晚期CPACG合并白内障可有效地提高视力、降低眼压，且无严重并发症。
Objective: To observe the safety and efficacy of phacoemulsification with intraocular lens implantation (PEI) combined with goniosynechialysis (GSL) and goniotomy (GT) in treating advanced chronic primary angle-closure glaucoma (CPACG) complicated by cataract. Methods: This was a retrospective case series study. We collected data from a total of 94 patients (133 eyes) who had advanced CPACG along with cataract and underwent PEI+GSL+GT at Chengdu Integrated TCM&Western Medicine Hospital between June 2020 and January 2024. We observed the best corrected visual acuity (BCVA), intraocular pressure (IOP), the number of anti-glaucoma drugs used, and postoperative complications. Repeated measures ANOVA and Wilcoxon rank test were used for statistical analysis. Results: The BCVA (logMAR) at 1 day, 1 week, 1, 3, and 6 months after surgery showed significant improvement compared to the pre-surgical values (F = 189.79，P < 0.001); The IOP at 1 day, 1 week, 1, 3, and 6 months post-surgery was significantly lower than that pre-surgical IOP (P < 0.001). The number of IOP-lowering drugs used at 6 months after surgery was also significantly reduced compared to the pre-surgical (Z = -2.392, P < 0.001). One week after surgery, corneal edema occurred in 31 eyes (23%) and hyphema in 15 eyes (11%) , both of which resolved spontaneously within 1 week. Within one month after surgery, 1 eye experienced an IOP spike, and the intraocular pressure returned to normal range after treatments such as anterior chamber puncture and drainage. Six months after surgery, the operation was completely successful in 121 eyes (91%), and conditionally successful in 10 eyes (8%), resulting in an overall surgical success rate of 99%. Conclusions: PEI combined with GSL and GT can effectively improve vision and reduce IOP in patients with advanced CPACG complicated by cataract, without causing serious complications.
目的：探讨光学相干断层扫描血管成像(optical coherence tomography angiography，OCTA)扫描信号强度对视盘周围血管密度的影响。方法：本研究为单中心横断面研究，所有受试者分别接受了身高、体重、血压、眼压、眼轴及视盘OCTA检查，利用广义估计方程分析OCTA扫描信号强度对视盘周围血管密度的影响。结果：共186人359眼纳入本研究，年龄为(47.86±17.86)岁，视盘周围血管密度为(17.75±1.99)mm?1 。单因素分析显示视盘周围血管密度与眼轴呈负相关(β=?0.5120，P<0.001)，与扫描信号强度呈正相关(β=1.0240，P<0.001)。在校正了年龄、性别、视盘面积及眼轴后的多因素分析中，OCTA扫描信号强度依然与视盘周围血管密度显著正相关(β=0.9721，P<0.001)。结论：视盘周围血管密度不仅与眼轴和视盘面积显著负相关，而且与OCTA扫描信号强度显著正相关，在临床应用或研究中，需要考虑其影响。
Objective: To explore the effect of scanning signal intensity on the peripapillary vessel density measured by optical coherence tomography angiography (OCTA). Methods: This study was a single-center cross-sectional study. All the participants received comprehensive examinations including height, weight, blood pressure,intraocular pressure, axial length, and OCTA scan of the optic disc. The effect of OCTA scanning signal intensity on the peripapillary vessel density was analyzed using the generalized estimation equation. Results: A total of 186 participants with 359 eyes were included in this study. The mean age of all the participants was (47.86±17.86)years old, and the average peripapillary vessel density was (17.75±1.99)mm?1. In a univariate analysis,peripapillary vessel density was associated with the axial length (β=?0.5120, P<0.001) and the scanning signal intensity (β=1.0240, P<0.001). After adjusting for age, gender, axial length, and optic disc area in the multivariate analysis, the OCTA scanning signal intensity was still significantly associated with the peripapillary vessel density (β=0.9721, P<0.001). Conclusion: The peripapillary vessel density is significantly negatively associated with the axial length and optic disc area, significantly positively associated with the scanning signal intensity. In clinical practice, the influence needs to be considered.
目的：探讨光学相干断层扫描血管成像(optical coherence tomography angiography，OCTA)扫描信号强度对视盘周围血管密度的影响。方法：本研究为单中心横断面研究，所有受试者分别接受了身高、体重、血压、眼压、眼轴及视盘OCTA检查，利用广义估计方程分析OCTA扫描信号强度对视盘周围血管密度的影响。结果：共186人359眼纳入本研究，年龄为(47.86±17.86)岁，视盘周围血管密度为(17.75±1.99) mm?1。单因素分析显示视盘周围血管密度与眼轴呈负相关(β=?0.5120，P<0.001)，与扫描信号强度呈正相关(β=1.0240，P<0.001)。在校正了年龄、性别、视盘面积及眼轴后的多因素分析中，OCTA扫描信号强度依然与视盘周围血管密度显著正相关(β=0.9721，P<0.001)。结论：视盘周围血管密度不仅与眼轴和视盘面积显著负相关，而且与OCTA扫描信号强度显著正相关，在临床应用或研究中，需要考虑其影响。
Objective: To explore the effect of scanning signal intensity on the peripapillary vessel density measured by optical coherence tomography angiography (OCTA). Methods: This study was a single-center cross-sectional study. All the participants received comprehensive examinations including height, weight, blood pressure, intraocular pressure, axial length, and OCTA scan of the optic disc. The effect of OCTA scanning signal intensity on the peripapillary vessel density was analyzed using the generalized estimation equation. Results: A total of 186 participants with 359 eyes were included in this study. The mean age of all the participants was (47.86±17.86) years old, and the average peripapillary vessel density was (17.75±1.99) mm?1. In a univariate analysis, peripapillary vessel density was associated with the axial length (β=?0.5120, P<0.001) and the scanning signal intensity (β=1.0240, P<0.001). After adjusting for age, gender, axial length, and optic disc area in the multivariate analysis, the OCTA scanning signal intensity was still significantly associated with the peripapillary vessel density (β=0.9721, P<0.001). Conclusion: The peripapillary vessel density is significantly negatively associated with the axial length and optic disc area, significantly positively associated with the scanning signal intensity. In clinical practice, the influence needs to be considered.
猫抓病(cat scratch disease，CSD)是由巴尔通体引起的一种人畜共患病。该病不仅有多种全身表现，还可能出现各种危害视力的眼部并发症。随着家庭饲养宠物不断增多，CSD发病率逐年上升，眼科医生应重视此病。CSD的临床表现多种多样，容易误诊，与猫等宠物接触的病史、高滴度的血清免疫球蛋白G抗体是诊断的关键，聚合酶链反应也有助于诊断。由于CSD通常是免疫能力强的个体的自限性感染，因此通常不需要抗生素治疗。然而，当免疫力低或感染重时，多西环素是最常用的抗生素。
Cat scratch disease (CSD) is a zoonotic disease caused by Bartonella, which not only has a variety of systemic manifestations, but also may have various ocular complications that endanger vision. With the increasing number of pets kept at home, its incidence shows an increasing trend year by year. Therefore, ophthalmologists should pay attention to this disease. The clinical manifestations of CSD are various, which easily lead to misdiagnosis. The medical history of contact with cats and other pets and serum immunoglobulin G antibody with high titer are the key to diagnosis, and polymerase chain reaction is also helpful to diagnosis. Because CSD is usually a self-limiting infection of individuals with strong immune ability, antibiotic treatment is usually not required. However, when immunity is low or infection is severe, doxycycline is the most commonly used antibiotic.
