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.
目的：分析全身麻醉在青光眼日间手术中的应用特点。方法：回顾性收集2023年1月—6月于中山大学中山眼科中心在全身麻醉下接受青光眼日间手术患者71例(全麻组)，并选择同时期在局部麻醉下接受青光眼手术患者154例(局麻组)，同时以年龄为配对因素行倾向评分匹配分析。主要观察指标为患者术后离院时间，并对患者的手术时间、手术前后眼压、视力、中央前房深度、周边前房深度、甘露醇使用情况以及术后较术前眼压降低差值进行分析。结果：与局麻组比较，全麻组患者术后离院时间未有延长(P>0.05)；全麻组患者术前眼压较高(P<0.001)、中央前房深度浅(P=0.018)、周边前房深度浅(P<0.001)；且全麻组患者在术后较术前眼压降低差值更大(P=0.002)。组间术后中央前房深度、术后使用甘露醇者比例及术后视力提高者比例比较差异均无统计学意义(P>0.05)。结论：术前眼部条件较差的青光眼患者能在全身麻醉下完成日间手术，且不延长术后离院时间。
Objective: To analyze the application of general anesthesia in the ambulatory glaucoma surgery. Methods: This retrospective study collected 71 patients who underwent ambulatory glaucoma surgery withgeneral anesthesia at Zhongshan Ophthalmic Center of Sun Yat-sen University from January 2023 to June 2023, and 154 patients who underwent similar glaucoma surgery with local anesthesia during the same period. Age differences between the two groups were balanced by propensity score-matched analysis. The main outcome measures were the patient's post-operative discharge time, and the secondary end points included the duration of surgery, the patients' preoperative and postoperative intraocular pressure (IOP), visual acuity status, central anterior chamber depth, peripheral anterior chamber depth, mannitol use, the difference in IOP reduction after surgery compared to preoperative. Results: After propensity score-matched analysis, as compared with group L, general anesthesia did not prolong the patient's post-operative discharge time(P>0.05).Patients in the group G displayed significant higher IOP (P<0.001), shallower central anterior chamber depth (P=0.018), and shallower peripheral anterior depth (P<0.001). The dramatic reductions in IOP after surgery were exhibited in group G as compared with group L(P=0.002). There were no statistically significant differences in postoperative central anterior chamber depth, incidences in postoperative mannitol use, as well as incidences in visual acuity improvement on the first day after surgery. Conclusion: Glaucoma patients with poor preoperative ocular conditions were able to complete the complex glaucoma surgery under general anesthesia without prolonging their post-operative discharge time.
青光眼是一组以病理性眼压升高为主要危险因素的，以青光眼性神经萎缩和视野缺损为主要特征的全球首位不可逆性致盲眼病。超声睫状体成形术(UCP)是一种新型非侵入性青光眼治疗技术，其降眼压主要原理为利用高强度聚焦超声破坏睫状突上皮细胞以减少房水生成，并增加葡萄膜巩膜通道的房水流出。UCP适应证广泛，早期主要用于各类难治性青光眼患者，特别是晚期及绝对期患者，研究者发现其除降眼压外，还能够显著缓解该类患者的局部疼痛。近年来，UCP在未经手术治疗的青光眼患者和早、中期青光眼病例中，也表现出了良好的降眼压效果，同时显示出较少的并发症和较轻的术后反应，并可重复治疗。然而不同类型青光眼UCP疗效存在一定差异，且为达最佳治疗效果，其治疗需匹配恰当的探头型号以及适当的治疗扇区。现有较广泛应用于国外的基于眼轴和白到白参数的公式计算方法，测算精度并不适用于国人，然而精准度更高的模型法，其便捷性仍有待进一步提高。UCP虽可减少降眼压药物用量，但术后用药策略的调整仍可能导致眼压波动。综上，针对UCP手术的适应证选择、手术参数设计、疗效预判以及术后管理策略等，仍有待开展相关临床研究，以期为其临床应用提供更加可靠的依据。
青光眼是一组以病理性眼压升高为主要危险因素的，以青光眼性神经萎缩和视野缺损为主要特征的全球首位不可逆性致盲眼病。超声睫状体成形术(UCP)是一种新型非侵入性青光眼治疗技术，其降眼压主要原理为利用高强度聚焦超声破坏睫状突上皮细胞以减少房水生成，并增加葡萄膜巩膜通道的房水流出。UCP适应证广泛，早期主要用于各类难治性青光眼患者，特别是晚期及绝对期患者，研究者发现其除降眼压外，还能够显著缓解该类患者的局部疼痛。近年来，UCP在未经手术治疗的青光眼患者和早、中期青光眼病例中，也表现出了良好的降眼压效果，同时显示出较少的并发症和较轻的术后反应，并可重复治疗。然而不同类型青光眼UCP疗效存在一定差异，且为达最佳治疗效果，其治疗需匹配恰当的探头型号以及适当的治疗扇区。现有较广泛应用于国外的基于眼轴和白到白参数的公式计算方法，测算精度并不适用于国人，然而精准度更高的模型法，其便捷性仍有待进一步提高。UCP虽可减少降眼压药物用量，但术后用药策略的调整仍可能导致眼压波动。综上，针对UCP手术的适应证选择、手术参数设计、疗效预判以及术后管理策略等，仍有待开展相关临床研究，以期为其临床应用提供更加可靠的依据。
暴发性脉络膜上腔出血(subchoroidal expulsive hemorrhage，SEH)是内眼手术中罕见且严重的并发症，广东省人民医院眼科收治1名因晶状体完全脱位继发青光眼的女性患者，73岁，其手术过程中发生SEH，现报告如下。通过回顾病例，讨论及分析SEH的原因、危险因素及治疗。
Subchoroidal expulsive hemorrhage (SEH) is one of the rarest and worst complications of intraocular surgery. We treated one patient with secondary glaucoma due to complete dislocation of the lens, who developed SEH during the surgery. In this case report, the causes, risk factors and treatment of subchoroidal expulsive were discussed and analyzed by reviewing the case.
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力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力方面发挥重要作用。近年以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。文章将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。
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力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力方面发挥重要作用。近年以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。文章将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。
“锌”在青光眼研究舞台上正扮演着越来越重要的角色。糖皮质激素，作为人体内重要的激素之一，其对锌的调控已在诸多系统中被证实。研究发现，在糖皮质激素的影响下，小梁网中的锌离子转运受阻，导致细胞外基质降解失衡，从而干扰小梁网正常流出道功能，加重青光眼的病情。而视神经损伤后，锌离子在神经突触间的异常传递、不平衡分布与胞内异常累积影响视网膜神经节细胞存活和轴突的再生能力，进而损害视功能，可能成为青光眼视神经损伤发病及进展的关键因素。这些研究进展为视神经保护策略提供了新的视角，“锌”作为治疗靶点的潜力正在被逐步挖掘，通过调节锌水平来干预青光眼病理进程成为可能治疗手段。
本期封面中将汉字“锌”设计为飞天舞者，其超越时空的永恒美感，呼应了“锌”在青光眼研究中突破传统、开辟新程的角色。轻盈与自由的飞天舞者，象征着“锌”在细胞内外穿梭，精妙调控生理功能，维系细胞的和谐与平衡，为青光眼患者带来新的治疗希望。
“锌”在青光眼研究舞台上正扮演着越来越重要的角色。糖皮质激素，作为人体内重要的激素之一，其对锌的调控已在诸多系统中被证实。研究发现，在糖皮质激素的影响下，小梁网中的锌离子转运受阻，导致细胞外基质降解失衡，从而干扰小梁网正常流出道功能，加重青光眼的病情。而视神经损伤后，锌离子在神经突触间的异常传递、不平衡分布与胞内异常累积影响视网膜神经节细胞存活和轴突的再生能力，进而损害视功能，可能成为青光眼视神经损伤发病及进展的关键因素。这些研究进展为视神经保护策略提供了新的视角，“锌”作为治疗靶点的潜力正在被逐步挖掘，通过调节锌水平来干预青光眼病理进程成为可能治疗手段。本期封面中将汉字“锌”设计为飞天舞者，其超越时空的永恒美感，呼应了“锌”在青光眼研究中突破传统、开辟新程的角色。轻盈与自由的飞天舞者，象征着“锌”在细胞内外穿梭，精妙调控生理功能，维系细胞的和谐与平衡，为青光眼患者带来新的治疗希望。
青光眼是一种以视网膜神经节细胞(retinal ganglion cell, RGC)及其轴突的进行性变性和丢失为主要特征的眼病，是导致视力丧失的最常见原因。尽管其具体的发病机制尚未完全明确，但众所周知，眼内压升高是青光眼进展的主要危险因素。目前，通过药物和手术治疗降低眼内压是控制疾病进展的主要手段。他氟前列素因其能有效长期稳定地降低眼内压，且不良反应轻微、患者依从性高、无明显全身不良反应，已成为治疗原发性开角型青光眼及眼高压症的一线治疗药物。近年来的研究表明，他氟前列素除了具有降低眼内压的效果外，还可能具有神经保护作用。文章对他氟前列素的药理作用及其在神经保护方面的潜在效益进行综述，为开发更有效的治疗青光眼药物提供理论依据和科研基础。然而，目前缺乏充分的临床研究证据支持其神经保护效应，未来研究应进一步探索这一领域，以促进针对视神经保护的药物开发和基于视神经再生的视觉功能重建。
Glaucoma is characterized by the progressive degeneration and loss of retinal ganglion cells (RGC) and their axons,making it one of the most common causes of vision loss. Although the exact underlying mechanisms remain unclear, it is well known that elevated intraocular pressure (IOP) is a major risk factor for the progression of glaucoma. Currently, the primary means of controlling glaucoma involves reducing IOP through medication and surgery. Tafluprost, due to its effective and long-term ability to lower IOP, minimal side effects, high patient compliance, and absence of significant systemic side effects, has become the first-line treatment for primary open-angle glaucoma and ocular hypertension. Recent studies suggest that tafluprost may also have neuroprotective effects beyond its IOP-lowering effects. This article aims to review the pharmacological and potential neuroprotective effects of tafluprost, providing a theoretical basis and research foundation for developing more effective drugs for glaucoma treatment. However, there is still a lack of sufficient clinical evidence to support the neuroprotective effects of tafluprost, and further investigations are required to explore in this field to furnish critical theoretical backing for the development of drugs that target optic nerve protection and facilitate vision restoration through optic nerve regeneration.
糖皮质激素(glucocorticoid, GC)由于其抗炎特性被广泛用于治疗眼部炎症，而G C诱导性青光眼(glucocorticoid-induced glaucoma, GIG) 作为一种常见并发症，其发病机制长期受到关注。文章综述了锌在GIG中的关键作用及其调控机制，揭示了锌在青光眼发病机制中的重要角色。锌作为人体中含量第二丰富的过渡金属，对蛋白质结构、酶催化和细胞信号调节至关重要。GC对锌分布的调控作用在不同组织和细胞类型中表现出复杂性，影响锌的摄取和释放，进而参与青光眼的病理过程。锌通过影响小梁网细胞外基质(extracellular matrix, ECM)的降解和重塑，以及视网膜神经节细胞的存活和轴突再生，在GIG的发病机制中发挥着复杂的作用。文章同时介绍了体内锌调控的现有途径，包括补充锌和减少锌的策略，提供了潜在的治疗途径。未来的研究应深入探索锌在青光眼中的作用机制以及与GC的相互作用，评估锌补充或螯合在青光眼治疗中的安全性和有效性，以及开发新型锌递送和螯合系统，有助于全面揭示锌在青光眼中的作用及治疗潜力，以实现更加精准的防治方案，改善患者预后。
Glucocorticoid (GC) is widely used in the treatment of ocular inflammation for its anti-inflammatory propery. However, glucocorticoid-induced glaucoma (GIG) is a common complication, and its pathogenesis has been extensively studied. This review summarizes the crucial role of zinc in GIG and its regulatory mechanisms, highlighting zinc's significant involvement in the pathogenesis of glaucoma. Zinc, the second most abundant transition metal in the human body, is essential for protein structure, enzyme catalysis, and cell signaling regulation. The effects of GC on zinc distribution vary across different tissues and cell types, affecting zinc uptake and release, which may contribute to the pathological processes of glaucoma. Zinc influences the degradation and remodeling of the trabecular meshwork extracellular matrix and the survival and axonal regeneration of retinal ganglion cells, playing complex roles in the pathogenesis of GIG. We discuss available strategies for regulating zinc in vivo, including zinc supplementation and reduction strategies, providing potential therapeutic approaches. Future research should explore the mechanisms of zinc's role in glaucoma and its interaction with glucocorticoids, evaluate the safety and efficacy of zinc supplementation or chelation in glaucoma treatment, and develop novel zinc delivery and chelation systems. These efforts will help fully elucidate the role of zinc in glaucoma and its therapeutic potential, enabling more precise prevention and treatment strategies to improve patient outcomes.
先天性白内障是严重影响婴幼儿视功能的疾病。随着白内障手术和人工晶状体植入手术技术的发展，先天性白内障患者术后多可获得高质量的视觉康复。然而，如何更好防治手术相关的不良事件和并发症、先天性白内障伴随的其他眼部发育不良疾病的治疗以及形觉剥夺性弱视的治疗，仍然是先天性白内障手术后需要重视的临床问题。封面展示的是双眼先天性白内障术后继发青光眼(左眼)与正常眼(右眼)的对比示意图。该并发症起病隐匿、难以预测，是先天性白内障术后二次致盲的首要原因。针对这一术后并发症，美国婴儿无晶状体眼治疗研究组 (infant aphakia treatment study, IATS)将儿童白内障术后青光眼相关不良事件(glaucoma-related adverse events,GRAEs，包括了青光眼和可疑青光眼)定义为：1)青光眼：眼压>21 mmHg(1 mmHg=0.133 kPa)，且有以下一种或以上的解剖学改变：(a)角膜直径增加；(b)双眼不对称进行性近视漂移伴角膜直径和(或)眼轴的增加；(c)视杯直径进行性增大，杯盘比增加≥0.2；(d)必须进行手术才能控制眼压。2)可疑青光眼：停用局部糖皮质激素(激素)后连续2次眼压>21 mmHg，或可通过抗青光眼药物控制眼压，但无上述任何青光眼的解剖改变。所以，如何更精准地预防该术后并发症，防止对患儿视功能造成进一步的损害，是目前关键的临床问题。因此，文章对先天性白内障摘除及人工晶状体植入术后继发性青光眼和可疑青光眼的发生、相关危险因素、治疗和预防的手段进行总结，以期进一步提高对先天性白内障术后高眼压和青光眼防治的认识，减少术后并发症对患儿视功能造成的进一步损害。
先天性白内障是严重影响婴幼儿视功能的疾病。随着白内障手术和人工晶状体植入手术技术的发展，先天性白内障患者术后多可获得高质量的视觉康复。然而，如何更好防治手术相关的不良事件和并发症、先天性白内障伴随的其他眼部发育不良疾病的治疗以及形觉剥夺性弱视的治疗，仍然是先天性白内障手术后需要重视的临床问题。封面展示的是双眼先天性白内障术后继发青光眼(左眼)与正常眼(右眼)的对比示意图。该并发症起病隐匿、难以预测，是先天性白内障术后二次致盲的首要原因。针对这一术后并发症，美国婴儿无晶状体眼治疗研究组 (infant aphakia treatment study, IATS)将儿童白内障术后青光眼相关不良事件(glaucoma-related adverse events,GRAEs，包括了青光眼和可疑青光眼)定义为：1)青光眼：眼压>21 mmHg(1 mmHg=0.133 kPa)，且有以下一种或以上的解剖学改变：(a)角膜直径增加；(b)双眼不对称进行性近视漂移伴角膜直径和(或)眼轴的增加；(c)视杯直径进行性增大，杯盘比增加≥0.2；(d)必须进行手术才能控制眼压。2)可疑青光眼：停用局部糖皮质激素(激素)后连续2次眼压>21 mmHg，或可通过抗青光眼药物控制眼压，但无上述任何青光眼的解剖改变。所以，如何更精准地预防该术后并发症，防止对患儿视功能造成进一步的损害，是目前关键的临床问题。因此，文章对先天性白内障摘除及人工晶状体植入术后继发性青光眼和可疑青光眼的发生、相关危险因素、治疗和预防的手段进行总结，以期进一步提高对先天性白内障术后高眼压和青光眼防治的认识，减少术后并发症对患儿视功能造成的进一步损害。
目的：建立并评估儿童Ⅱ期人工晶状体(intraocular lens,IOL)植入术后青光眼相关不良事件(glaucoma-related adverse events,GRAEs)的预测模型。方法：选取于中山大学中山眼科中心行Ⅱ期IOL植入术的无晶状体眼患儿205例(356眼)，并在术后对其随访3年。采用Cox比例风险模型确定GRAEs的预测因子，并建立列线图预测模型。采用随时间变化的受试者工作特征(receiver operating characteristic,ROC)曲线、决策曲线分析、Kaplan-Meier曲线评估模型性能，并通过Bootstrapping的C指数和校准图进行内部验证。结果：行Ⅱ期IOL植入术时年龄较大(HR=1.50, 95% CI: 1.03 ~2.19)、术后一过性高眼压(HR=9.06, 95% CI: 2.97~27.67)和IOL睫状沟植入术(HR=14.55, 95% CI: 2.11~100.57)是GRAEs的危险因素(均P<0.05)，并据此建立了两个列线图预测模型。在术后1、2、3年，模型1的ROC曲线下面积(area under curve,AUC)分别为0.747(95% CI: 0.776 ~0.935)、0.765 (95% CI: 0.804 ~0.936)和0.748 (95% CI: 0.736~0.918)，模型2的AUC分别为0.881 (95% CI: 0.836 ~0.926)、0.895 (95% CI: 0.852 ~0.938)和0.848 (95% CI: 0.752~0.945)。在内部验证和评价中，两种模型均表现出良好的性能和临床净效益。Kaplan-Meier曲线显示两个不同的风险组在两个模型中都能被显著且稳健地区分。此外，本研究也构建了在线风险计算器。结论：两种列线图均能灵敏、准确地识别Ⅱ期IOL植入术后GRAEs的高危患儿，有助对其进行早期识别和及时干预。
Aims: To establish and evaluate predictive models for glaucoma-related adverse events (GRAEs) following secondary intraocular lens (IOL) implantation in paediatric eyes. Methods: 205 children (356 aphakic eyes) receiving secondary IOL implantation at Zhongshan Ophthalmic Center with a 3-year follow-up were enrolled. Cox proportional hazard model was used to identify predictors of GRAEs and developed nomograms. Model performance was evaluated with time-dependent receiver operating characteristic (ROC) curves, decision curve analysis, Kaplan-Meier curves and validated internally through C-statistics and calibration plot of the bootstrap samples. Results: Older age at secondary IOL implantation (HR=1.5, 95% CI: 1.03 to 2.19), transient intraocular hypertension (HR=9.06, 95% CI: 2.97 to 27.67) and ciliary sulcus implantation (HR=14.55, 95% CI: 2.11 to 100.57) were identified as risk factors for GRAEs (all p<0.05). Two nomograms were established. At postoperatively 1, 2 and 3 years, model 1 achieved area under the ROC curves (AUCs) of 0.747 (95% CI: 0.776 to 0.935), 0.765 (95% CI: 0.804 to 0.936) and 0.748 (95% CI: 0.736 to 0.918), and the AUCs of model 2 were 0.881 (95% CI: 0.836 to 0.926), 0.895 (95% CI: 0.852 to 0.938) and 0.848 (95% CI: 0.752 to 0.945). Both models demonstrated fine clinical net benefit and performance in the interval validation. The Kaplan-Meier curves showing two distinct risk groups were well discriminated and robust in both models. An online risk calculator was constructed. Conclusions: Two nomograms could sensitively and accurately identify children at high risk of GRAEs after secondary IOL implantation to help early identification and timely intervention.
