目的：观察并分析慢性闭角型青光眼患者小梁切除术后早期眼前节及屈光状态变化。方法：采用前瞻性研究方法，收集青光眼小梁切除手术病例20例20只眼，分别测定术前、术后1周、1个月及3个月的球面镜度数、角膜曲率、眼轴长度、前房深度，并进行统计学分析。结果：小梁切除术后1周球面镜度数较手术前差异均具有统计学意义(P<0.05)，差值为(?1.20±0.55) D；术后1个月、3个月球面镜度数较手术前差异无统计学意义(P>0.05)。术前、术后1周、1个月垂直方向角膜曲率分别为(44.89±1.20) D、(45.72±1.54) D、(45.65±1.35) D，术后1周、1个月垂直方向角膜曲率较手术前显著性增加，差异具有统计学意义(P<0.05)；术后3个月垂直方向角膜曲率较术后1个月差异无统计学意义(P>0.05)。术前眼轴长度(22.49±0.43) mm和前房深度(2.75±0.45) mm与术后1周眼轴长度(21.60±0.59) mm和前房深度(2.25±0.34) mm比较差异具有统计学意义 (P<0.01)；术后1个月和3个月前房深度、眼轴长度较手术前差异无统计学意义(P>0.05)。结论：小梁切除术后早期(术后1个月)可发生球面镜度数增加，前房变浅、眼轴变短、垂直方向曲率增加的眼前节和屈光改变。从而发生近视飘移、而影响术后视力。随时间推移(术后3个月)，前房加深、眼轴长度逐渐增加、垂直散光和近视飘移度数逐渐减少，眼前节和屈光变化逐渐趋于稳定，术后视力逐渐恢复。

Objective: To observe and analyze the changes of anterior segment and refractive state in patients with chronic angle closure glaucoma after trabeculectomy. Methods: It was a prospective study. A total of 20 cases with 20 eyes that have met the inclusion criteria undergoing trabeculectomy were collected. The diopter of spherical power,corneal curvature, axial length (AL) and anterior chamber depth (ACD) were measured before the surgery and 1 week, 1 month, and 3 months after the surgery respectively. Results: There was significant difference (P<0.05)for the diopter of spherical power before and 1 week after the trabeculectomy, the difference was (?1.20±0.55) D.After 1 month and 3 months, the diopter of spherical power was not statistically significant (P>0.05). The corneal curvature in the vertical direction was (44.89±1.20) D, (45.72±1.54) D, (45.65±1.35) before, 1 week and 1 month after operation. The corneal curvature in the vertical direction increased significantly at 1 week and 1 month after operation (P<0.05), and there was no significant difference (P>0.05) after 3 months. The preoperative mean ocular axis length (22.49±0.43 mm) and mean anterior chamber depth (2.75±0.45 mm) compared with postoperative mean ocular axis length (21.60±0.59 mm) and mean anterior chamber depth (2.25±0.34 mm) were statistically significant (P<0.01). Comparing 1 month and 3 months after operation, there was no significant difference in the depth of the anterior chamber and the length of the eye axis (P>0.05).Conclusion: In the early stage after trabeculectomy (1 month after operation), the diopter of spherical power can be increased. The ACD became shallower, the eye axis became shorter, and the curvature of vertical direction increased resulting in myopic drift,which affected postoperative visual acuity. Over time (3 months after operation), the anterior chamber deepened,the axial length gradually increased, the vertical astigmatism and myopia drift degree gradually decreased, the anterior segment and refractive changes gradually stabilized, and the postoperative visual acuity gradually recovered.

青光眼作为首位不可逆性致盲眼病给患者、家庭和社会带来重大损害和沉重的经济负担。在视觉2020计划收官之年，中国青光眼防治工作已获得较好成绩，但仍面临严峻挑战。在未来，中国青光眼防治工作将以《2020中国青光眼指南》为蓝本，有望依托人工智能技术，实现对青光眼患者的高效、便捷、准确的筛查和诊断；以患者个体特征、疾病特点和社会环境为立足点，采取个性化和精准化治疗；结合慢病管理的全生命周期概念，实现对患者的终身监测和指导。提高我国青光眼诊治水平，减少青光眼致残致盲。

Glaucoma is a leading cause of irreversible blindness in the world. It brings great damage and heavy economic burden to patients, their families and society. Under the Vision 2020 initiative, great progress has been achieved in the glaucoma prevention and treatment in China, but there are still severe challenges ahead. In the future, the Guideline for Glaucoma Care in China (2020) will act as the blueprint of the prevention and treatment of glaucoma in China. Efficient, convenient and accurate screening and diagnosis of glaucoma will be achieved relying on the artificial intelligence technology. Personalized and precision therapy will be carried out based on individual and disease characteristics and social environment. Also, lifelong monitoring and guidance of patients will be realized in the context of the whole life cycle of chronic diseases. Glaucoma care will be further improved to continuously reduce vision impairment and blindness caused by glaucoma.

青光眼作为世界第一位不可逆致盲性眼病，如何早期发现、及时诊断、恰当治疗并坚持随访管理，一直是广大眼科临床工作者所努力的方向。当前，世界处于百年未有之大变局，中国处于近代以来最好的发展时期，两者同步交织、相互激荡。在今后的5~10年中，我国青光眼防治领域将产生很多令人瞩目的成就。笔者仅以个人对本专业粗浅的理解，对未来我国青光眼防治发展作一展望，祝愿我国防盲治盲事业取得更大进步。

Glaucoma is the first irreversible blinding eye disease in the world. How to detect early, diagnose timely, treat appropriately and adhere to follow-up management has always been the direction of Chinese ophthalmic clinical workers. At present, the world is undergoing profound changes, and China is in the best period of development since modern times. In the next 5–10 years, there will be many remarkable achievements in the field of glaucoma prevention and treatment in China. Based on our personal understanding of this specialty, we look forward to the development of glaucoma management in China in the future, and wish to make greater progress in blindness prevention and treatment in China.

青光眼不仅常见，而且严重损伤患者的视功能，被认定为全球首位不可逆致盲性眼病。仔细观察发现诊断不及时、治疗不合理、随诊不规律是导致青光眼患者致盲的常见原因。机会性筛查是临床早期发现青光眼患者的主要手段。为了提高筛查的效率，筛查时应当密切关注青光眼的高危人群，包括原发性青光眼患者的直系亲属、老年人群和高度近视患者。此外，要对发生青光眼全过程加深了解，无论是原发性闭角型青光眼，还是原发性开角型青光眼，其病情的进展都存在一个连续体概念。应当在青光眼患者出现症状或严重视功能损伤之前加以诊断。合理治疗应当包括应用适当的药物、激光或手术治疗，将每只患眼的眼压控制到与该眼的视盘和视野改变相适应的目标眼压范围内，尽量提高患者用药的依从性。对青光眼的持续性防治取决于是否有能力评估治疗效果以及发现病情的不稳定性状态，并加以恰当的处理。青光眼是可防可治的眼病。通过加强青光眼的早期诊断、合理治疗和长期随诊，可降低青光眼的致盲率，从而改变青光眼是首位致盲性眼病的现状。

Glaucoma not only is common, but also seriously damages the visual function of the patients, and is recognized as the first irreversible blinding disease in the world. After careful observation, we recognize that untimely diagnosis,unreasonable treatment and irregular follow-up are leading causes to blindness. Opportunistic screening is a main measure to early find the glaucoma in clinical practice. To improve the screening efficiency, the high-risk mass of glaucoma, such as immediate family members of glaucoma patients, older adults and high myopia should be closely focused. In addition, the ophthalmologists should understand the whole process of glaucoma. The development of the primary angle closure glaucoma or primary open angle glaucoma is a concept of continuum. We should make the diagnosis of glaucoma before the patients have any symptoms or serious damage of the visual function. Reasonable treatment should include controlling intraocular pressure in the scope of the target pressure adopting to the optic damage and visual field defect in that eye by drugs, laser or surgery, and as far as possible to improve the drug compliance. Sustained control of glaucoma management depends on the ability to assess the effect of treatment, and to find the instability of the disease and the appropriate management. Glaucoma is a preventable and treatable eye disease. We can decrease the blinding rate and change the current status of the first blinding eye disease for glaucoma.

青光眼是世界范围内致盲和引起视力损害的主要眼病，也是不可逆性致盲性眼病之一。眼压是青光眼发生发展的重要危险因素，但除眼压外，血压在青光眼进展引起的影响也不可忽视。眼灌注压是血压和眼压的差值，可调节视神经的血液供应。眼压、血压、灌注压在青光眼发生发展中有一定相关性。本文通过对眼压和血压在青光眼中的影响以及24 h眼压和血压监测在青光眼中的应用进行文献索引，分析青光眼24h眼压和血压同步监测的意义。

Glaucoma is a major eye disease causing blindness and visual damage worldwide, and it is also one of the irreversible eye diseases causing blindness. Intraocular pressure (IOP) is an important risk factor for the development of glaucoma, and the influence of blood pressure (BP) on the progression of glaucoma also cannot be ignored. Eye perfusion pressure is the difference between blood pressure and intraocular pressure, regulating the blood supply to the optic nerves. IOP, BP and perfusion pressure are related to the occurrence and the progression of glaucoma. Literature review was performed related to the effects of IOP and BP on glaucoma, and the application of 24-hour IOP and BP monitoring in glaucoma, aiming to analyze the significance of simultaneous monitoring of IOP and BP for 24 hours.

晶状体悬韧带异常（包括松弛和断裂）可引起晶状体虹膜隔前移、前房变浅、房角关闭和眼压升高，即闭角型青光眼（angle closure glaucoma，ACG）的发生。特发性悬韧带异常多发生于原发性闭角型青光眼（primary angle closure glaucoma，PACG），可能是PACG的发病机制之一，但仍需前瞻性队列研究进一步证实。此类患者双眼前房深度不等，虹膜/晶状体震颤等体征及超声生物显微镜（ultrasound biomicroscopy, UBM）检查能够诊断的悬韧带异常比例较低，通常在青光眼白内障联合手术前未能被诊断而在术中被发现，故被称为隐匿性晶状体悬韧带异常。目前根据术中表现如充分散瞳可见晶状体赤道部，连续环形撕囊破囊时可见前囊放射状皱褶，超声乳化时囊袋赤道部移位或卷曲，灌注抽吸时囊袋异常飘动，囊袋口不规则等可明确诊断。根据悬韧带异常的程度、范围，选择超声乳化晶状体吸除联合人工晶体植入，联合或不联合囊袋张力环植入或人工晶体缝合固定术。PACG患者术前和术中应关注是否存在悬韧带异常，制定个体化治疗方案，以保证手术安全和疗效。

Zonulopathy (including zonular laxity and dehiscence) can cause anterior displacement of iris-lens diaphragm, shallow anterior chamber, anterior chamber angle closure and elevated intraocular pressure, resulting in angle closure glaucoma (ACG). Idiopathic zonulopathy is common in primary angle closure glaucoma (PACG), which may be one of the pathogenic mechanisms of PACG. But further prospective cohort studies are needed to verify that. ?e proportion of diagnosis ofzonulopathy in PACG patients before cataract extraction in combination with anti-glaucoma surgery is low by signs of anterior chamber depth differences between both eyes, iridodonesis / phacodonesis and UBM examination. Hence, most cases with zonulopathy in PACG are found during the operation, which is called occult zonulopathy. At present, the diagnosis of zonulopathy in PACG is often made according to the intraoperative manifestations, such as visible capsular equator aěer mydriasis, wrinkling of the anterior capsule during manual capsulorhexis, infolding of peripheral capsule or visualization of the capsular equator during the cortical or nuclear removal; loose or ěoppy capsular bag. According to different ranges and severities ofzonulopathy, phacoemulsi?cation combined with intraocular lens (IOL) implantation, with or without capsule tension ring implantation, or sclera-fixated IOL is selected. PACG patients should be paid more attention to the diagnosis and differentiation ofzonulopathy before and during operation, fully improved the preoperative examination, and formulated individualized treatment plans to ensure the safety and efficacy of operation.

Ahmed青光眼引流阀植入术作为难治性青光眼的主要治疗方案，能很大程度控制眼压，且疗效和预后均优于常规滤过性手术。但是远期引流盘周围被纤维包裹后会阻塞房水流出，引起术后高眼压，导致手术失败。因此，解决引流盘纤维包裹能很大程度地提高青光眼阀植入术后远期成功率，这也是目前的研究热点。目前临床上主要采用术前预防及术后二次操作对纤维包裹进行干预，但长期效果欠佳。本文就青光眼引流阀纤维包裹发生的组织病理学及分子机制、临床目前解决方案、前沿研究进展以及对Ahmed青光眼阀门的材料改造的探索进行综述。

Ahmed glaucoma valve implantation, as the main treatment option for refractory glaucoma, can control intraocular pressure (IOP) to a large extent. And its efficacy and prognosis are superior to those of conventional filtration surgery. IOP is well-controlled in the early postoperative stages. However, long-term fibrosis of encapsulated bleb inhibits fluid exchange and causes elevated IOP, leading to surgical failure. Therefore, treating fibrosis of encapsulated bleb can improve the long-term success rate after glaucoma valve implantation, which is also a research hotspot. Currently, the main clinical interventions are preoperative prophylaxis and postoperative secondary operations for fiber wrapping, but its long-term efficacy is not satisfactory. This article reviews the occurrence, histopathology and molecular mechanism of fibrous encapsulation, treatment in a clinical setting, cutting-edge research progress, and exploration on material modification of Ahmed glaucoma valve.

剥脱性青光眼是剥脱综合征继发的一类青光眼，临床上少见。本文报告2例患者，患眼瞳孔缘可见灰白色碎屑样物质沉积，散大瞳孔后可见晶状体前囊周边部混浊带，房角镜下可见Sampaolesi线。认识其临床特征，将有助于提高其诊治率。

Exfoliation glaucoma is a category of glaucoma secondary to exfoliation syndrome, which is rarely encountered in clinical practice. We reported 2 cases with deposits of white material on the pupillary border of the iris. Opacity band could be observed surrounding the anterior lens capsule after pupil dilation, and the Sampaolesi line was seen under gonioscope. Understanding the clinical characteristics contribute to improving the diagnosis and treatment of exfoliation glaucoma.

目的：评估右美托咪定复合舒芬太尼用于老年青光眼患者经巩膜二极管激光睫状体光凝术 (transscleral diode laser cyclophotocoagulation，TDLC)术后自控静脉镇痛(patient-controlled intravenous analgesia，PCIA)的安全性和有效性。方法：选择行TDLC术老年青光眼患者80例，采用随机数字表法将患者分为SD组(n=40)和S组(n=40)。SD组术后PCIA采用舒芬太尼1.5μg/kg+右美托咪定1.5 μg/kg+托烷司琼4mg；S组采用舒芬太尼2μg/kg+托烷司琼4mg。将相应药物置入生理盐水配成100mL混合液加入电子镇痛泵，手术结束即刻行PCIA至术后24h。观察比较两组患者基本情况和手术情况，比较术前(T0)、术后即刻(T1)、术后6h(T2)、术后12h(T3)和术后24h(T4)患者的收缩压(systolic blood pressure，SBP)、舒张压(diastolic blood pressure，DBP)、心率(heart rate，HR)、NRS疼痛评分、Ramsay镇静评分及非手术眼的眼内压(intraocular pressure，IOP)，比较术后恶心呕吐、呼吸抑制、躁动等不良反应及使用其他辅助镇痛药物的情况。结果：两组患者基本情况和手术情况的差异无统计学意义。两组各时点DBP、非手术眼IOP及NRS评分差异无统计学意义。SD组T3、T4时点SBP，T2、T3、T4时点HR以及T2、T3时点Ramsay评分均低于S组，差异有统计学意义(P<0.05)。两组患者发生不良反应的总例数差异无统计学意义，但SD组恶心呕吐(1例)和烦躁(2例)发生率均低于S组(分别为6例和9例)，差异有统计学意义(P<0.05)。两组患者呼吸抑制和眩晕嗜睡发生率以及使用其他辅助镇痛药物例数差别无统计学意义，SD组舒芬太尼使用量低于S组(P<0.05)。结论：采用右美托咪定1.5μg/kg复合舒芬太尼1.5μg/kg行PCIA时不影响非手术眼IOP，可安全有效地应用于老年青光眼患者TDLC术后镇痛。

Objective: To evaluate the safety and efficacy of dexmedetomidine combined with sufentanil for postoperative patient-controlled intravenous analgesia (PCIA) after transscleral diode laser cyclophotocoagulation (TDLC) in elderly patients with glaucoma. Methods: Eighty elderly glaucoma patients undergoing TDLC were selected and randomly divided into a SD group (n=40) and a S group (n=40) by random number table method. In SD group (n=40), sufentanil 1.5 μg/kg, dexmedetomidine 1.5 μg/kg and tropisetron 4 mg were used for postoperative PCIA, and sufentanil 2 μg/kg and tropisetron 4 mg were used in S Group (n=40). The corresponding drugs in saline solution was added into 100 mL solution with electronic analgesia pump. PCIA was performed immediately after the operation until 24 h after the operation. The basic condition and operation situation of the two groups were observed and compared, and systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), NRS pain score, Ramsay sedation score and non-operation eye intraocular pressure (IOP) at preoperative (T0), after operation (T1), postoperative 6 h (T2), 12 h after operation (T3) and 24 h after operation (T4) were compared, and postoperative adverse reactions such as nausea and vomiting, respiratory depression, restlessness and use of other auxiliary analgesic drug were also compared. Results: There was no significant difference between two groups of patients’ basic and surgical conditions. There was no significant difference between two groups at each time point DBP, non-operation eye IOP and NRS score. SBP at T3 and T4, HR at T2, T3 and T4, and Ramsay score at T2 and T3 in SD group were lower than the S group, the difference was statistically significant. There was no significant difference in the total number of adverse reactions between two groups, but the incidence of nausea and vomiting and restlessness in group SD were lower than those in group respectively, the difference was statistically significant (P<0.05). There was no significant difference between the two groups in the incidence of respiratory depression, dizziness, lethargy and the use of other auxiliary analgesics. The sufentanil usage in group SD was lower than that in group S (P<0.05). Conclusion: PCIA with dexmedetomidine 1.5 g/kg combined with sufentanil 1.5 g/kg does not affect the non-operation eye IOP. It can be safely and effectively applied to postoperative analgesia for elderly patients with glaucoma after TDLC