目的：比较Pentacam三维眼前节分析仪与iTrace视觉分析仪在暗室环境中检测近视眼Kappa角的一致性。方法：采用回顾性研究，对近视门诊的86例志愿者共172眼使用iTrace视觉分析仪和Pentacam三维眼前节分析仪，分别测量其Kappa角，收集所测数据采用SPSS软件进行一致性分析。结果：Pentacam三维眼前节分析仪与iTrace视觉分析仪的Kappa角测量结果中，横坐标X值、纵坐标Y值和方位角度值比较差异有统计学意义(P<0.05)；弦距离值比较差异无统计学意义(P>0.05)。结论：Pentacam三维眼前节分析仪与iTrace视觉分析仪在近视患者Kappa角测量结果一致性存在差异，临床上应谨慎替换使用。
Objective: To compare the consistency of Pentacamand iTrace in detecting anglekappa. Methods: A retrospective study was carried out on a total of 172 eyes of 86 volunteers to measure the anglekappa by iTrace visual analyzer and Pentacamanterior section analyzer in Zhengzhou Aier Eye Hospital. The measured data were collected and analyzed by SPSS software. Results: In the measurement results between Pentacam and iTrace , there was a statistically significant difference in the X value, Y value, and azimuth angle values of the horizontal axis (P<0.05); There was no statistically significant difference in chord distance values (P>0.05). Conclusions: 3-D anterior section analyzer the significant difference is found in the concordance of the anglekappa measurement results between the Pentacam and iTrace. It should be caution to replace two kinds of equipment in clinical practice.
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.
Background: Primary chronic angle-closure glaucoma (PCACG) is one of the main types of glaucoma in China. Trabeculectomy is the most commonly used glaucoma filtration surgery for glaucoma in the world. Conventional trabeculectomy is prone to anesthesia-related complications intraoperative and operationrelated complications postoperative in PCACG treatment. Modified minimally invasive trabeculectomy maybe can reduce the incidence of complications.Methods: We conducted a prospective case series study and performed modified fornix-based trabeculectomy in 27 patients (30 eyes) under topical anesthesia; we then observed intraoperative anesthesia and cooperation effect, intraoperative and postoperative complications, preoperative and postoperative visual acuity, intraocular pressure (IOP), visual field, and the use of ocular hypotensive drugs. The patients were followed up for at least 12 months.Results: All operations were completed successfully with no intraoperative complications. All 27 patients (30 eyes) were followed up for at least 12 months. No significant decrease in visual acuity was observed at days 1 or 7 and at months 1, 3, 6, and 12 after operation; however, a significant decrease in IOP was observed at days 1 and 7 and at months 1, 3, 6, and 12 after operation. Moreover, no significant progression in visual field mean defect was observed at month 12 after operation, and the number of ocular hypotensive drugs required was significantly reduced at months 6 and 12 after operation. By month 12 after operation, the overall success rate was 93.33% (28/30).Conclusions: Modified minimally invasive trabeculectomy is safe and effective for the treatment of PCACG.
Background: Primary chronic angle-closure glaucoma (PCACG) is one of the main types of glaucoma in China. Trabeculectomy is the most commonly used glaucoma filtration surgery for glaucoma in the world. Conventional trabeculectomy is prone to anesthesia-related complications intraoperative and operationrelated complications postoperative in PCACG treatment. Modified minimally invasive trabeculectomy maybe can reduce the incidence of complications.Methods: We conducted a prospective case series study and performed modified fornix-based trabeculectomy in 27 patients (30 eyes) under topical anesthesia; we then observed intraoperative anesthesia and cooperation effect, intraoperative and postoperative complications, preoperative and postoperative visual acuity, intraocular pressure (IOP), visual field, and the use of ocular hypotensive drugs. The patients were followed up for at least 12 months.Results: All operations were completed successfully with no intraoperative complications. All 27 patients (30 eyes) were followed up for at least 12 months. No significant decrease in visual acuity was observed at days 1 or 7 and at months 1, 3, 6, and 12 after operation; however, a significant decrease in IOP was observed at days 1 and 7 and at months 1, 3, 6, and 12 after operation. Moreover, no significant progression in visual field mean defect was observed at month 12 after operation, and the number of ocular hypotensive drugs required was significantly reduced at months 6 and 12 after operation. By month 12 after operation, the overall success rate was 93.33% (28/30).Conclusions: Modified minimally invasive trabeculectomy is safe and effective for the treatment of PCACG.
青光眼是全球第二大致盲眼病，第一大不可逆性致盲眼病，其中原发性闭角型青光眼（primary angle closure glaucoma，PACG）占 25%。激光周边虹膜切除术（laser peripheral iridotomy，LPI）已成为 PACG 和原发性房角关闭的一线治疗。LPI 机制为利用激光在周边虹膜上打孔，解除 PACG 的瞳孔阻滞，加深前房，扩大房角，恢复生理性房水排出途径，从而降低眼压。研究表明 LPI 在原发性房角关闭各个疾病进程中均能比较好的控制眼压，是相对安全的治疗方法。
Glaucoma is the second leading cause of blindness and the most common cause of irreversible blindness worldwide. Primary angle closure glaucoma (PACG) accounts for 25% of glaucoma. Laser peripheral iridotomy (LPI) has become the first line treatment for PACG and primary angle closure (PAC). The mechanism of LPI is to use laser to create a hole in peripheral iris to relieve pupil block, deepen anterior chamber, expand chamber angle, restore pathway of physiological aqueous discharge and reduce intraocular pressure. Studies have shown that LPI can control intraocular pressure well in all stages of PAC, which is safe for PAC.
目的：观察青光眼引流钉植入术治疗难治性青光眼的疗效。方法：对联合应用抗青光眼药物无法控制的难治性开角型青光眼19例19只眼行青光眼引流钉植入术，术中应用丝裂霉素(2 mg /6~8 mL，2.5~4 min)及可松解缝线。术后1天、2周和1、3、6、12个月进行随访，观察眼压、视力、滤过泡形态、前房深度、眼底C/D、降眼压药物使用情况、完全及部分成功率 及有无并发症等情况。结果：19例患者中，术后完全成功率78.9%(15例)，部分成功率10.5% (2例)，失败10.5%(2例)。术前用3~5种降眼压药，眼压控制于27.7±10.1 mmHg。术后随访仅三人需使用1~2种降压药物。眼压下降组间有显著性意义(P<0.001)。与术前相比，术后1天(11.8±7.7 mmHg，P<0.001)，术后2周(10.1±4.2 mmHg，P<0.05)，1个月(12.0±4.0 mmHg，P=0.001)，6个月(12.2±3.4 mmHg，P<0.001)，1年(13.1±3.3 mmHg，P=0.001)及2年随访(14.5±2.5 mmHg，P=0.001)，眼压下降均具有显著性意义。术后患者视力、前房深度及C/D改变差异无显著性意 义。末次随访滤过泡弥散隆起57.9%(11例)，微囊型15.8%(3例)，瘢痕型21.1%(4例)，包裹型5.3%(1例)。所有患者均未观察到明显的术后并发症的发生。结论：房水引流钉植入术治疗难治性开角型青光眼手术成功率高，并发症少，值得推广。
目的：观察青光眼引流钉植入术治疗难治性青光眼的疗效。方法：对联合应用抗青光眼药物无法控制的难治性开角型青光眼19例19只眼行青光眼引流钉植入术，术中应用丝裂霉素(2 mg /6~8 mL，2.5~4 min)及可松解缝线。术后1天、2周和1、3、6、12个月进行随访，观察眼压、视力、滤过泡形态、前房深度、眼底C/D、降眼压药物使用情况、完全及部分成功率 及有无并发症等情况。结果：19例患者中，术后完全成功率78.9%(15例)，部分成功率10.5% (2例)，失败10.5%(2例)。术前用3~5种降眼压药，眼压控制于27.7±10.1 mmHg。术后随访仅三人需使用1~2种降压药物。眼压下降组间有显著性意义(P<0.001)。与术前相比，术后1天(11.8±7.7 mmHg，P<0.001)，术后2周(10.1±4.2 mmHg，P<0.05)，1个月(12.0±4.0 mmHg，P=0.001)，6个月(12.2±3.4 mmHg，P<0.001)，1年(13.1±3.3 mmHg，P=0.001)及2年随访(14.5±2.5 mmHg，P=0.001)，眼压下降均具有显著性意义。术后患者视力、前房深度及C/D改变差异无显著性意 义。末次随访滤过泡弥散隆起57.9%(11例)，微囊型15.8%(3例)，瘢痕型21.1%(4例)，包裹型5.3%(1例)。所有患者均未观察到明显的术后并发症的发生。结论：房水引流钉植入术治疗难治性开角型青光眼手术成功率高，并发症少，值得推广。
目的：通过光学相干断层扫描技术(optical coherence tomography，OCT)观察不同临床类型原发性闭角型青光眼(primary angle-closure glaucoma, PACG)行激光周边虹膜切开术(laser peripheral iris, LPI)前、后前房角开放距离变化，评价治疗效果。方法：选择明确诊断为PACG患者46例50眼，其中 急性闭角型青光眼临床前期及缓解期眼26例27眼，慢性闭角型青光眼20例23眼，行LPI治疗，通过OCT分别检查术前、术后2周距巩膜突500及750 μm处前房角开放距离，采用配对t检验。结果：急性闭角型青光眼LPI术前、术后2周前房角开放距离差异有统计学意义(P<0.05)；慢性闭角型青光眼术 前、术后2周前房角开放距离差异无统计学意义(P>0.05)。结论：急性闭角型青光眼LPI术后前房角开放距离增加，治疗效果较好；慢性闭角型青光眼LPI术后前房角开放距离增加不明显，术后仍存在前房角闭塞趋向。
Objective: To observe the anterior chamber angle opening distance before and after laser peripheral iris (LPI) in patients with different clinical types of primary angle closure glaucoma (PACG) by using optical coherence tomography (OCT), and evaluate the effect of the treatment. Methods: Selected 46 cases (50 eyes) of patients with PACG, including 26 cases (27 eyes) of acute angle closure glaucoma at the preclinical stage and remission phase of ocular and 20 cases (23 eyes) of chronic angle closure glaucoma, implemented LPI, examined the anterior chamber angle opening distance at the point of 500 and 750 μm from posterior to the scleral before and after surgery for 2 weeks by OCT, using a paired t-test. Results: Compared the anterior chamber angle opening distance before and after surgery for 2 weeks, the difference in patients with acute angle closure glaucoma was statistically significant (P<0.05), but not statistically significant in patients with chronic angle closure glaucoma (P>0.05). Conclusion: The opening distance of the anterior chamber angle of the patients with acute angle closure glaucoma after LPI was increased, and the treatment effect was better; but of the patients with chronic angle closure glaucoma after LPI, the distance was not obviously increased, the tendency of anterior chamber angle occlusion still existed after LPI.
青光眼是全球第二大致盲眼病，第一大不可逆性致盲眼病，其中原发性闭角型青光眼(primary angle closure glaucoma，PACG)占25%。激光周边虹膜切除术(laser peripheral iridotomy，LPI)已成为PACG和原发性房角关闭的一线治疗。LPI机制为利用激光在周边虹膜上打孔，解除PACG的瞳孔阻滞，加深前房，扩大房角，恢复生理性房水排出途径，从而降低眼压。研究表明LPI在原发性房角关闭各个疾病进程中均能比较好的控制眼压，是相对安全的治疗方法。
Glaucoma is the second leading cause of blindness and the most common cause of irreversible blindness worldwide. Primary angle closure glaucoma (PACG) accounts for 25% of glaucoma. Laser peripheral iridotomy(LPI) has become the first line treatment for PACG and primary angle closure (PAC). The mechanism of LPI is to use laser to create a hole in peripheral iris to relieve pupil block, deepen anterior chamber, expand chamber angle,restore pathway of physiological aqueous discharge and reduce intraocular pressure. Studies have shown that LPI can control intraocular pressure well in all stages of PAC, which is safe for PAC.
目的：比较四种不同原理的仪器在暗室中对年龄相关性白内障患者Kappa角测量的一致性。方法：对年龄相关性白内障术前60例(60只眼)，暗室中适应10 min后，分别应用iTrace视觉分析仪、Pentacam HR、Lenstar900、IOLMaster700测量瞳孔直径和Kappa角。四种仪器间所测量的数据比较采用单因素方差分析检验和Kruskal-Wallis非参数检验，一致性比较采用Bland-Altman分析。结果：iTrace、Pentacam HR、Lenstar900、IOLMaster700测量瞳孔直径分别为(4.64±0.71) mm，(2.96±0.47) mm，(4.86±0.76) mm，(4.66±0.92) mm；Kappa角大小分别为(0.227±0.121) mm，(0.161±0.09) mm，(0.2±0.124) mm，(0.203±0.104) mm；大于0.5 mm的Kappa角比例分比为3.33%、3.33%、1.67%、1.67%；Pentacam和iTrace的Kappa角测量结果有统计学意义(P=0.001)，Pentacam和Lenstar900、IOLMaster700的Kappa角测量结果差异无统计学意义(P=0.044，0.036)，其他三种仪器之间Kappa角测量结果差异均无统计学意义(P=0.181，0.245，0.860)； 60例被检测者对iTrace、PentacamHR、Lenstar900、IOLMaster700四种仪器测量过程中光强度主观评分结果显示60例(100%)被检测者认为Pentacam HR在测量过程中有明显的不适感，40例(66.67%)被检测者认为IOLMaster700检测过程中舒适感最好，结果差异有统计学意义(χ2=191.236，P<0.001)。结论：Pentacam HR与iTrace、Lenstar900和IOLMaster700三种仪器在暗室中Kappa角的测量结果一致性稍差，临床上需谨慎替换使用。
Objective: To compare the consistency of Kappa Angle measurements in patients with age-related cataracts using four instruments of different principles in a dark room. Methods: Sixty cases (60 eyes) of age-related cataract were adapted in the darkroom for 10 minutes. The pupil size and angle Kappa were measured by iTrace, Pentacam HR, Lenstar900 and IOLMaster700. One-way ANOVA test and Kruskal-Wallis nonparametric test were used to compare the measured data among the four instruments, and Bland-Altman analysis was used for consistency comparison. Results: The measured pupil diameters of iTrace, Pentacam HR, Lenstar900 and IOLmaster700 were 4.64±0.71 mm, 2.96±0.47 mm, 4.86±0.76 mm and 4.66±0.92 mm. The Angle Kappa sizes were 0.227±0.121 mm, 0.161± 0.09 mm, 0.2±0.124 mm, 0.203±0.104 mm. The proportion of angle Kappa larger than 0.5 mm was 3.33%, 3.33%, 1.67% and 1.67%. The measurement results of angle Kappa between Pentacam and iTrace were statistically significant (P=0.001). There was no significant difference in the measurement results of angle Kappa between Pentacam and Lenstar900, Pentacam HR and IOL-Master700 (P=0.044, 0.036). There was no significant difference in the results of angle Kappa measurement among the other three instruments. The subjective score of light intensity in the process of measurement of iTrace, Pentacam HR, Lenstar900 and IOLMaster700 showed that during the process of measurement, 60 cases (100%) experienced obvious discomfort caused by the light intensity in Pentacam HR, while 40 cases (66.67%) felt comfort in IOLMaster700. The differences among the subjective score of light intensity of four instruments were statistically significant (P<0.001). Conclusion: The consistency of the measurement results of Kappa angle between Pentacam HR and iTrace, Lenstar900, IOLMaster700 in the darkroom is relatively poor, so it is necessary to be careful to replace them in clinic.
目的：探讨原发性慢性闭角型青光眼(chronic primary angle-closure glaucoma，CPACG)患者的视网膜血流密度(vessel density，VD)与视野缺损程度的相关性。方法：光学相干断层血管成像技术(optical coherence tomography angiography，OCTA)测量89例(112眼)视野缺损的CPACG患者的黄斑区VD、视盘旁VD，分析VD与视野缺损程度的相关性。结果：视盘旁VD与视野缺损程度成负相关(r>–0.728，P<0.05)。黄斑浅层总VD的受试者工作曲线(receiver operating characteristic，ROC)及曲线下面积(area under the curve，AUC)为0.874。在控制年龄、眼压及视力的情况下，黄斑总浅层VD每降低1%，视野平均缺损(mean deviation，MD)值增加–0.639 dB。结论：CPACG患者VD与视野缺损呈线性负相关，OCTA可以方便无创地观察青光眼患者眼底血流情况，在视野缺损前发现视网膜VD降低，从而可以作为CPACG早期诊断的参考指标。
Objective: To investigate the correlation between the retinal vessel density (VD) and the degree of visual field loss in chronic primary angle-closure glaucoma (CPACG). Methods: Eighty-nine CPACG patients (112 eyes)with different degrees of visual field loss were measured with optical coherence tomography angiography (OCTA) for macular VD and para-optic microcirculation VD, and the correlation between them and the degree of visual field defect were analyzed. Results: There was a negative correlation between the VD of the microcirculation in each zone next to the optic disc and the degree of visual field loss (r>–0.728, P<0.05). The receiver operating characteristic (ROC) and area under the curve (AUC) of the total VD of the superficial macula is 0.874. Under the condition of controlling age, intraocular pressure and vision, for every 1% decrease in the total superficial macular VD, the average visual field defect mean deviation (MD) value increases –0.639 dB. Conclusion: The VD of CPACG patients is linearly negatively correlated with visual field defects. OCTA can conveniently and non-invasively observe the blood flow of the fundus in patients with glaucoma. It is found that the retinal VD is reduced before visual field defects, which can be used as a reference index for early diagnosis of CPACG.
