青光眼是一组以视盘萎缩凹陷、视野缺损以及视力下降为共同特征的视神经退行性疾病，也是世界首位不可逆性致盲眼病，导致患者生活质量降低、引起极大卫生经济负担。但其发病机制尚不明确，促进房水排出从而降低眼内压仍是目前减缓疾病进展的唯一治疗手段。房水排出的主要途径是经由小梁网进入Schlemm's管最后汇入巩膜外静脉，因此小梁网在调节房水排出以及平衡眼内压方面发挥重要作用。近年来，体内以及体外房水排出测量技术和小梁网成像技术不断突破，众多研究表明小梁网存在压力依赖的节律性搏动，在房水的脉冲式排出中起到关键作用，但在青光眼中这种搏动随疾病的进展减弱甚至消失。文章以小梁网的泵理论为核心，总结青光眼中房水排出的最新研究进展，并从恢复小梁网功能的角度出发探索可能有效的治疗策略，为青光眼的临床诊治提供新的思路。

Glaucoma, a group of optic nerve degenerative diseases, is characterized by papillary atrophy, visual field defects, and decreased vision. It is also the leading cause of irreversible blindness worldwide, significantly reducing patients’ the quality of life of patients and posing considerable health economic burdens. However, the pathogenesis of glaucoma remains unclear, and promoting aqueous humor outflow to reduce intraocular pressure is the only treatment option available to slow disease progression. The main pathway for aqueous humor outflow is through the trabecular meshwork into Schlemm's canal and finally into the episcleral veins, highlighting the crucial role of the trabecular meshwork in regulating aqueous humor outflow and maintaining intraocular pressure balance. In recent years, there have been notable breakthroughs in in vivo and in vitro aqueous humor outflow measurement techniques and trabecular meshwork imaging technologies.Many studies suggest that the trabecular meshwork exhibits pressure-dependent rhythmic pulsation, playing a crucial role in the pulse-like outflow of aqueous humor. Unfortunately, in glaucoma, this pulsation weakens or even disappears as the disease progresses. This article focuses on the trabecular meshwork's pump theory and summarizes the latest research progress in aqueous humor outflow in glaucoma, exploring potential effective therapeutic strategies aimed at restoring trabecular meshwork function. This provides new insights for the clinical diagnosis and treatment of glaucoma.

目的：利用双向孟德尔随机化方法(mendelian randomization,MR)探索骨关节炎与青光眼的潜在因果关系。方法：使用全基因组关联研究(genome-wide association studies,GWAS)数据，挑选出与骨关节炎和青光眼高度相关的单核苷酸多态性(single nucleotide polymorphism,SNP)作为工具变量。本研究以逆方差加权法(inverse variance weighted,IVW)作为主要的分析手段，以加权中位数法、加权模型法、简单众数法及MR-Egger回归法作为辅助方法，采用F统计量、Cochran Q检验、MR Egger截距测试、留一法(leave one out)及多效性残差和离群值法(mendelian randomization pleiotropy RESidual sum and outliers,MR-PRESSO)进行敏感性分析。本研究采用比值比(odds ratio,OR)作为主要的效应量度指标，以95%置信区间(confidence interval,CI)评估关联强度，探讨骨关节炎与青光眼的双向因果关系。结果：IVW结果表明骨关节炎可增加青光眼的患病风险(95%CI: 1.00~1.20，OR=1.10，P=0.043)，辅助方法的结果显示了相同的因果方向，但无统计学意义。在反向MR分析中，IVW结果表明，青光眼不会增加患骨关节炎的风险(OR=1.02，95%CI: 0.97~1.08)，4种辅助方法均支持IVW结果。所选SNP的F统计量均超过10，无弱工具变量。Cochran Q检验、MR-Egger截距检验以及MR-PRESSO分析结果均未显示所选SNP之间存在异质性或水平多效性。反向MR分析结果显示Cochran Q检验有异质性，但未发现水平多效性。留一法结果显示没有对整体分析结果产生了显著影响的SNP。结论：正向MR分析表明骨关节炎可能会增加患青光眼的风险，二者之间存在正相关。反向MR分析结果表明，青光眼对骨关节炎无因果效应。

Objective: To investigate the potential bidirectional causal association between osteoarthritis and glaucoma through the application of bidirectional Mendelian randomization (MR). Methods: Instrumental variables were selected in this study based on single nucleotide polymorphisms (SNP) strongly associated with osteoarthritis and glaucoma, as utilizing genome-wide association studies (GWAS) data. The inverse variance weighting (IVW) method was served as the primary analytical approach, while the weighted median mode, simple plurality and MR-Egger regression methods were employed as complementary methods. Sensitivity analyses were conducted using F-statistic, Cochran Q-test, MR Egger's intercept test, leave-one-out, and multiplicity of residuals and outliers method (MR-PRESSO). The ratio of odds ratios (OR) was adopted as the primary effect estimate, and the strength of association was evaluated by 95% confidence interval (CI) to explore the bidirectional causal relationship between osteoarthritis and glaucoma. Results: The IVW analysis revealed that osteoarthritis elevates the risk of glaucoma with an odds ratio of (OR) of 1.10(95% CI: 1.00-1.20). While the adjunctive methods concurred with this causal direction, their findings did not reach statistical significance. In contrast, the inverse Mendelian randomization (MR) analysis utilizing the inverse variance weighting method demonstrated that glaucoma does not enhance the risk of developing osteoarthritis (OR=1.02, 95% CI: 0.97-1.08). This conclusion was upheld by all four auxiliary methods. The F-statistic values for the selected SNP exceeded 10, indicating the absence of weak instrumental variables. Furthermore, the Cochran Q test, MR-Egger intercept test, and MR- PRESSO analyses revealed no evidence of heterogeneity or horizontal pleiotropy among the SNP. However, the inverse MR analysis displayed heterogeneity in the Cochran Q test, yet no horizontal pleiotropy was detected. The leave-one-out method analysis identified no significant influence of any individual SNP on the overall results. Conclusions: Forward MR analyses indicated that osteoarthritis may serve as a risk factor for glaucoma, indicating a positive correlation between the two conditions. Conversely, reverse MR analysis failed to establish a causal link between glaucoma and osteoarthritis.

青光眼是世界首位不可逆性致盲性眼病，降眼压是唯一被证实有效的干预措施。手术是降低眼压的主要途径，近年来创伤更小、术后炎症反应更轻、并发症更少的微创青光眼手术逐渐在临床得到应用。超声睫状体成形术(ultrasound cycloplasty, UCP)是一种新型微创青光眼治疗技术。本文综述了国内外现有研究，表明UCP在治疗各种类型青光眼中均表现出良好的降眼压效果，但不同类型青光眼疗效存在一定差异。UCP可减少术后局部抗青光眼药物的使用数量，同时显示出较少的并发症和较轻的术后反应。与其他睫状体分泌功能减弱性手术相比，该手术在缓解难治性青光眼患者因高眼压导致的局部疼痛方面尤为有效。青光眼类型、超声探头型号匹配及治疗扇区数量是影响疗效的主要因素，其适应证的准确把握及手术参数设计的优化将进一步提高其治疗效果。本文归纳了UCP治疗青光眼的作用原理、手术操作与术后用药、适应证与禁忌证、有效性、安全性及其疗效的影响因素，以期为其临床应用和研究提供参考依据。

Glaucoma is the leading cause of irreversible blindness worldwide. Lowering intraocular pressure (IOP) is the only proven intervention to effectively prevent visual field deterioration and slow the progression of glaucoma. Surgery plays a critical role in reducing IOP, with traditional glaucoma surgeries focusing primarily on classic filtration procedures. In recent years, minimally invasive glaucoma surgeries (MIGS), characterized by less trauma, milder postoperative inflammation, and fewer complications, have been increasingly applied and continuously refined in clinical practice. Ultrasound cycloplasty (UCP) is a novel, minimally invasive technique for glaucoma treatment. This article reviews existing research both domestically and internationally, showing that UCP demonstrates good IOP-lowering effects in various types of glaucoma, though its efficacy varies across different glaucoma types. UCP reduces the need for postoperative anti-glaucoma medications, while also exhibiting fewer complications and milder postoperative reactions. Compared with other ciliary body function-reducing surgeries, UCP is particularly effective in alleviating local pain caused by elevated IOP in patients with refractory glaucoma. The type of Glaucoma, matching of the ultrasound probe model, and the number of treatment sectors are key factors influencing UCP efficacy. Accurate selection of indications and optimization of surgical parameters will further enhance its therapeutic outcomes. This article summarizes the mechanisms, surgical procedures, postoperative medication, indications and contraindications, efficacy, safety, and factors influencing UCP outcomes in glaucoma treatment, aiming to provide a reference for its clinical application and research.

目的：探讨青光眼日间手术患者的自我管理行为现状及影响因素分析。方法：采用便利抽样法选取2021年9月—2022年5月于广州市某三级甲等眼科专科医院就诊的223例青光眼日间手术患者。采用一般资料调查表、青光眼自我管理行为量表、慢性疾病自我效能量表和青光眼知识学习问卷进行问卷调查。结果：青光眼日间手术患者的自我管理行为得分为(54.03±6.95)分，其中生活调整维度得分最低。慢性病自我效能与自我管理行为呈正相关(r=0.368, P<0.001)。疾病知识与自我管理行为无显著相关性(r=0.077, P=0.252)。多因素线性回归分析结果显示，患者的文化程度(P<0.001)和自我效能(P=0.028)是自我管理行为的影响因素，可解释自我管理行为总变异的12.4%。结论：青光眼日间手术患者具有良好的自我管理行为，较低的自我效能和文化程度是自我管理行为的危险因素，因此应优先提高患者的自我效能，并提供个性化教育。

Objective: To determine self-management and its association with self-efficacy and knowledge among glaucoma patients undergoing day surgery. Methods: A total of 223 glaucoma patients were recruited from September 2021 to May 2022and they were investigated with the Glaucoma Self Management Questionnaire (GSMQ), The Self- Efficacy in Chronic Disease Scale (SECD-6), and the glaucoma knowledge questionnaire. Results: Of the 223 study participants, the study population had a total GSMQ score of 54.03±6.95 with the lowest score found in the life adjustment dimension. The total SECD-6 score was showing a significantly positive correlation with the total GSMQ score(r =0.368, P <0.001). The total score of disease knowledge was without significant correlation with the total GSMQ score (r =0.077, P =0.252). Multivariate linear regression analysis showed that self-efficacy (P <0.001) and education level was independently associated with self-management(P =0.028). Conclusions: Glaucoma patients undergoing daytime surgery demonstrated good overall self-management, yet further improvement was required in terms of life adjustment. Low self-efficacy and educational level were identified as risk factors for self-management. Therefore, self-management programs should prioritize enhancing patients' self-efficacy and delivering individualized education.

青光眼是全球第一大不可逆性致盲性眼病，影响全球7 000多万人，其特征是视网膜神经节细胞的退行性病变。到2040年，预计全球青光眼患者人数将增加至1.12亿，其中约10%的人至少一只眼睛失明。由高眼压诱发、多种致病因素导致的视网膜神经节细胞死亡是青光眼进展过程中视功能损伤的主要病理过程，也是青光眼病程中视功能损害不可逆的重要原因。目前降眼压治疗是唯一的干预疗法，然而其仍然不能完全遏止视网膜神经节细胞进行性损伤，并且既往病程造成的视神经损伤不可逆转。探索青光眼进程中视网膜神经节细胞退行性改变的直接致病因素，寻找关键的治疗靶点，以及开发新的具有神经保护作用的治疗药物，具有重要意义。文章回顾了近年来青光眼中视网膜神经节细胞退行性病变的机制和治疗的新进展，强调了神经血管单元的改变在青光眼发病机制中的重要作用和干预价值。同时，靶向代谢的药物应用、抑制早期炎症反应和减少氧化应激，辅以营养和运动支持等可能延缓和抑制神经退行性病变的发生，起到神经保护作用。未来青光眼发病机制的研究重点仍然在眼压之外的致病因素上，从血流、代谢和免疫串扰的病理环境中发掘对神经退行性改变重要的致病因素并进行干预治疗具有广阔的前景。在多种动物模型中验证干预手段的神经保护作用，也有望提高青光眼神经保护的临床转化成功率，以拓展青光眼的治疗理念与药物选择。

Glaucoma stands as the leading cause of irreversible blindness globally, affecting over 70 million individuals. It is characterized by progressive degeneration of retinal ganglion cells (RGCs). By 2040, the global prevalence of glaucoma is expected to rise to 112 million, with approximately 10% experiencing blindness in at least one eye. The primary pathological basis for visual function impairment in glaucoma progression is the loss of RGCs induced by elevated intraocular pressure (IOP) and various pathogenic factors. Currently, IOP-lowering treatment is the only intervention available, but it cannot completely halt the progressive injury to RGCs, nor can it reverse the optic nerve damage caused by prior disease progression. Exploring the direct pathogenic factors of RGC degeneration in glaucoma, identifying key therapeutic targets, and developing new neuroprotective treatments are of great importance. This review discusses recent advancements in the mechanisms and treatments of retinal ganglion cell degeneration in glaucoma, highlighting the significant role of neurovascular unit changes in the pathogenesis of glaucoma and the potential value of interventions. Additionally, targeting metabolites, inhibiting early inflammatory responses, and reducing oxidative stress, supplemented by nutritional and exercise support, may help delay and inhibit neurodegenerative processes, offering neuroprotective effects.Future research on glaucoma pathogenesis should focus on factors beyond IOP, exploring pathogenic factors in the pathological environment of blood flow, metabolism, and immune crosstalk for targeted therapeutic interventions. Also, verifying the neuroprotective effects of these interventions in various animal models holds promise for improving the clinical translation success rate of neuroprotection in glaucoma, thus expanding therapeutic concepts and drug options.

青光眼是全球首位不可逆性致盲性眼病，其特征是视网膜神经节细胞(retina ganglion cells, RGCs)的退行性改变，对全球经济和健康造成了重大影响。其病理变化的分子及生物机制尚不明确，目前青光眼手术和药物治疗仍然局限于将眼压控制在正常范围。小梁网作为房水排出的重要途径，是眼压控制的关键一环。眼压改变引起的视网膜退行性改变是青光眼重要病理过程之一。小梁网及视网膜的体外模型构建是研究青光眼发生发展的主要研究方法。三维培养技术可以使细胞在体外形成一定的空间结构，有利于细胞-细胞及细胞-环境的相互作用，相比传统二维培养，三维培养更加接近体内细胞的生理环境，对于研究疾病的病理生理变化及高通量药物筛选具有重要意义，同时，三维培养更有利于对细胞空间构象变化及其力学性质改变进行研究。三维打印等新技术也在三维细胞培养中有所应用，为三维定制化培养提供技术基础。文章综述了小梁网及视网膜细胞三维培养在青光眼基础研究中的应用研究进展，旨在为进一步探究青光眼病理生理机制提供新的思路。

Glaucoma is the world's first irreversible blinding eye disease, characterized by degenerative changes in retinal ganglion cells (RGCs), which have a significant impact on the global economy and health. The molecular and biological mechanisms of its pathological changes are still unclear. At present, glaucoma surgery and drug therapy are still limited to controlling the intraocular pressure in the normal range. Three-dimensional culture technology can enable cells to form a certain spatial structure in vitro, which is conducive to cell-cell and cell-environment interactions. Compared with traditional two-dimensional culture, three-dimensional culture technology is closer to the physiological environment of cells in vivo, which is of great significance for the study of pathophysiological changes of diseases and high-throughput drug screening. This review discusses the application of trabecular mesh and three-dimensional culture of retinal cells in the basic research of glaucoma, aiming to provide new ideas for further exploring the pathophysiological mechanism of glaucoma.

儿童白内障是全球范围内可治疗儿童盲症的主要原因之一。对于这些患儿而言，手术是恢复或保护视力的主要方法。然而，手术后的并发症，特别是青光眼相关不良事件(glaucoma-related adverse events, GRAEs)，常常成为导致儿童二次致盲的主要原因，这引起了眼科医疗领域的广泛关注。文章综述了儿童Ⅱ期人工晶状体植入术后GRAEs的影响因素，包括手术设计、眼部解剖特征、其他眼部发育异常和全身疾病等。手术设计中是否植入人工晶状体(intraocular lens，IOL)以及植入的时机和位置都对GRAEs的发生有显著影响。此外，眼部解剖特征如角膜直径、眼轴长度、前房深度、中央角膜厚度和术前晶状体厚度等，也是影响GRAEs发生的重要因素。同时，其他眼部发育异常和全身疾病，如先天性无虹膜、先天性风疹综合征等，也会增加儿童白内障术后青光眼的发生率。文章还总结了预测GRAEs的方法，并推荐使用Cox回归模型建立预测模型。这种模型可以有效地预测儿童Ⅱ期IOL植入术后在特定时间段内发展为GRAEs的概率，从而为早期识别GRAEs高危儿童提供了重要的借鉴。通过对GRAEs影响因素的深入分析和预测模型的建立，文章旨在帮助眼科医生更好地理解GRAEs的发生机制，并在手术前对患儿进行风险评估，从而选择最佳的手术方案和预防措施。这对于改善患儿的术后恢复、减少并发症、保护视功能具有重要的临床意义。

Pediatric cataract is one of the leading causes of treatable childhood blindness worldwide. For these children, surgery is the primary method to restore or preserve vision. However, postoperative complications, particularly glaucoma-related adverse events (GRAEs), often become the main reason for secondary blindness in children, attracting widespread concern in the field of ophthalmology. This study reviews the impact factors of glaucoma-related adverse events after secondary intraocular lens (IOL) implantation in children, including surgical design, ocular anatomical characteristics, other ocular developmental abnormalities, and systemic diseases. Whether to implant an IOL in the surgical design and the timing and positioning of the implantation have a significant impact on the occurrence of GRAEs. In addition, ocular anatomical characteristics, such as corneal diameter, axial length, anterior chamber depth, central corneal thickness, and preoperative lens thickness, are also important factors affecting the occurrence of GRAEs. At the same time, other ocular developmental abnormalities and systemic diseases, such as congenital aniridia and congenital rubella syndrome, also increase the incidence of glaucoma after pediatric cataract surgery. The article also summarizes methods for predicting GRAEs and recommends using the Cox regression model to establish a predictive model. This model can effectively predict the probability of children developing GRAEs after secondary IOL implantation within a specific time period, providing an important reference for the early identification of high-risk children for GRAEs. Through in-depth analysis of the impact factors of GRAEs and the establishment of predictive models, the article aims to help ophthalmologists better understand the mechanisms of GRAEs and assess the risks of children before surgery, thereby selecting the best surgical plan and preventive measures. This is of great clinical significance for improving postoperative recovery in children, reducing complications, and protecting visual function.

高度近视(high myopia，HM)作为一种特殊类型的屈光型眼病，不仅会导致进行性、退行性眼底改变，其视神经损伤的患病率也很高。青光眼是全球范围内最常见的一种不可逆致盲性眼病，原发性开角型青光眼(primary open-angle glaucoma，POAG)是最常见的青光眼类型。近年来的研究发现HM与POAG的病理改变存在相似之处。由于HM眼底改变与早期POAG眼底改变容易混淆，HM患者早期发现POAG对延缓或阻止疾病进展很重要。HM患者长期随访不仅要观察黄斑病变，视神经形态与结构改变的观察也不容忽视。

As a special type of refractive eye disease, high myopia (HM) not only causes progressive and degenerative fundus changes, but also has a high prevalence of optic nerve damage. Glaucoma is the most common form of irreversible blinding eye diseases worldwide, among which, primary open-angle glaucoma (POAG) is the most common type. In recent studies, HM is found to have similarities on pathological changes as that of POAG. And HM fundus changes are easily confused with early stage POAG fundus changes; thus, the early detection of POAG on HM patients is highly important on disease deferment or prevention of disease progression. Macular degeneration as well as optic nerve morphology and structural changes are to be observed in the long-term follow-up for HM patients.

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：检索并总结开角型青光眼患者眼部用药规范化护理管理的最佳证据，为临床实践提供参考。方法：通过护理循证方法提出实践问题，按照循证证据检索数据库的“6S”分类模型，检索有关开角型青光眼患者眼部用药管理的所有证据资源类型，包括临床指南、最佳实践信息册、证据总结、系统评价和专家共识等。由2名循证护理研究员对纳入文献的质量进行独立评价并进行证据的归纳总结。结果：最终纳入12篇文献，包括4篇指南、3篇证据总结和5篇系统评价；汇总了19条有关开角型青光眼眼部用药管理的最佳证据，包括滴眼技术指导、依从性管理和信息提供3个方面。结论：总结开角型青光眼眼部用药管理的最佳证据，可为临床医务人员管理患者提供参考和借鉴，以达到患者规范用药、控制眼压和延缓疾病进展的目的。

Objective: To retrieve and summarize the best evidence on standardized ocular medication management among open-angle glaucoma patients. Methods: With evidence-based nursing method, practical problemswere identified. According to the “6S” pyramid model of evidence resource, studies on standardized ocular medication management among open-angle glaucoma patients were retrieved, including clinical guidelines, best practice information booklet, systematic reviews, and expert consensus. Two evidence-based nursing researchers independently evaluated the quality of the included literature and summarized the evidence. Results: A total of 12 articles were ultimately enrolled, including 4 clinical guidelines, 3 evidence summaries and 5 systematic reviews. Finally, 3 aspects including 19 pieces of best evidence were summarized, which were Eye drop technical instruction, medication adherence management and related information provision. Conclusion: The best evidence for the medication management of open-angle glaucoma patients were summarized, which provide reference for clinical medical staffs to manage patients, so as to achieve the purpose of standardizing medication,controlling intraocular pressure and preventing disease progression.