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.

Schlemm管(Schlemm’ s canal, SC)作为房水流出的主要通道，通过调节房水外排来维持眼内压的平衡，其结构和功能的异常与高眼压及青光眼的发生发展密切相关。对SC的研究有助于阐明房水外排阻滞的发生机制、探索促进房水外排新的途径，从而为降低眼压和青光眼治疗的新药物开发提供理论基础。目前，对SC发育和功能的调节机制的认识仍然有限，缺乏针对SC的特异性治疗策略。近年来，关于SC细胞命运决定及其结构发育的细胞学机制逐渐被揭示，功能调控的关键分子靶标也相继被发现，这促进了对SC结构和功能调控的深入理解。此外，作为降眼压药物靶点和针对性手术的创新应用也在不断拓展。文章系统回顾SC的结构与功能研究，总结关键的分子和细胞学调控机制，归纳SC相关药物和手术疗法的最新进展，为青光眼的临床诊治提供了新的思路。

Schlemm管(Schlemm’ s canal, SC)作为房水流出的主要通道，通过调节房水外排来维持眼内压的平衡，其结构和功能的异常与高眼压及青光眼的发生发展密切相关。对SC的研究有助于阐明房水外排阻滞的发生机制、探索促进房水外排新的途径，从而为降低眼压和青光眼治疗的新药物开发提供理论基础。目前，对SC发育和功能的调节机制的认识仍然有限，缺乏针对SC的特异性治疗策略。近年来，关于SC细胞命运决定及其结构发育的细胞学机制逐渐被揭示，功能调控的关键分子靶标也相继被发现，这促进了对SC结构和功能调控的深入理解。此外，作为降眼压药物靶点和针对性手术的创新应用也在不断拓展。文章系统回顾SC的结构与功能研究，总结关键的分子和细胞学调控机制，归纳SC相关药物和手术疗法的最新进展，为青光眼的临床诊治提供了新的思路。

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.

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。

A 74-year-old man presented with a three-year history of foreign body sensation in the right eye after cataract surgery. He underwent uneventful trabeculectomy with mitomycin C (MMC) in the right eye seven years ago. Slit-lamp examination revealed a large avascular filltration bleb overhanging on the cornea with a thin base connected to the conjunctiva. Preoperative ultrasound biomicroscopy (UBM) impressions were confirmed by leakage of aqueous from the incision intraoperatively. Surgical dissection and revision of the bleb was performed with satisfactory outcome. Histopathologic evaluation showed proliferation of fibrous tissue under the conjunctival epithelia with irregular cystoids change. The current case may be the first report of a post-trabeculectomy overhanging filtration bleb related to cataract surgery. The possible mechanism may be related to microleakage of the surgical wound after phacoemulsiff cation which initiated the healing and scarring process.

A 74-year-old man presented with a three-year history of foreign body sensation in the right eye after cataract surgery. He underwent uneventful trabeculectomy with mitomycin C (MMC) in the right eye seven years ago. Slit-lamp examination revealed a large avascular filltration bleb overhanging on the cornea with a thin base connected to the conjunctiva. Preoperative ultrasound biomicroscopy (UBM) impressions were confirmed by leakage of aqueous from the incision intraoperatively. Surgical dissection and revision of the bleb was performed with satisfactory outcome. Histopathologic evaluation showed proliferation of fibrous tissue under the conjunctival epithelia with irregular cystoids change. The current case may be the first report of a post-trabeculectomy overhanging filtration bleb related to cataract surgery. The possible mechanism may be related to microleakage of the surgical wound after phacoemulsiff cation which initiated the healing and scarring process.

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.