论著

原发性慢性青光眼患者双眼视觉和生活质量相关性研究

Correlation between the binocular visual field and visual function quality of life in patients with primary chronic glaucoma

:465-472
 
目的:评估与原发性慢性青光眼患者生活质量最具相关性的视觉指标。方法:回顾性病例系列研究。收集2010年3月至2010年8月就诊于首都医科大学附属北京同仁医院且符合入选及排除标准的原发性慢性闭角型青光眼和原发性开角型青光眼患者131例262只眼。采用Humphrey Field AnalyzerII 750i型视野分析仪对入选患者分别进行单眼Central 24-2程序和Esterman双眼视野检查程序(Esterman Binocular Visual Field Test,EBVFT)各两次检查,以保证所得数据的可靠性。使用LogMAR视力表检查并记录受试者日常单眼生活视力和日常双眼生活视力、非接触式眼压计测量眼压、直接眼底镜检查视神经的杯盘比。记录病史及目前所使用抗青光眼药物,角膜及晶状体状态。应用视功能相关生活质量量表-25(25-Item National Eye Institute Visual Function Questionnaire,VFQ-25)对患者进行生活质量评估,并将双眼日常生活视力、较好眼生活视力、较差眼视野MD(mean defect)值、较好眼视野MD值、(Esterman Visual Field Test,EVFT)效用值和VFQ-25得分进行相关性分析。结果:共有131例受试者符合入选条件。在患者生存质量的统计中,自我评价视力、近距离活动、远距离活动、社会功能、依赖程度、色觉、视野这7项得分较好,即受试者完成该7项的能力较高。VFQ-25总分与EBVFT效用值成正相关(r=0.24998,P=0.004<0.05),与双眼日常生活视力成负相关(r=?0.37778,P<0.0001),与较差眼视野MD值成正相关(r=0.22917,P=0.0187<0.05),与较好眼生活视力、较好眼视野、较差眼生活视力无明显相关关系。结论:原发性慢性青光眼患者双眼视觉(双眼视野和双眼日常生活视力)和VFQ-25有良好的相关性,可用于评估慢性青光眼患者的生活质量。
Objective: To assess the correlation between the Esterman binocular visual field (EBVF) and the visual function quality of life (VFQ) in primary chronic glaucoma patients. Methods: It is a retrospective case series study.One hundred and thirty-one patients, that is to say, two hundreds and sixty-two eyes, with primary chronic glaucoma satisfying the methodological criteria were recruited for this study, who were chosen from Beijing Tongren Hospital, Capital Medical University from March 2010 to August 2010. The Humphrey Field Analyzer Model II 750i (Humphrey Instruments, Zeiss Company) was used to perform an Esterman binocular visual field test (EBVFT) and bilateral monocular full-threshold central visual field testing using the 24-2 SITA Standard program. Visual acuities were examined by logarithm of the minimum angle of resolution (logMAR) scale. Intraocular pressure and cup-disc ratio were also recorded. The history with glaucoma and anti-glaucoma drugs, and the state of the cornea and crystalline lens were also remarked. All interviews were administered face to face by the same experienced interviewer, by using the 25-Item National Eye Institute Visual Function Questionnaire (VFQ-25). Agreement between the scores from these tests and the VFQ-25 was evaluated. Results: A total of 131 patients were recruited. In the statistics of the quality of life, seven domain scores of the VFQ-25 (self-assessment vision, color vision, near action, distant action, social function, mental health and peripheral vision) were better than the others, which meant the ability of completing the seven domain was higher. Substantial agreement was found between the composite score of the VFQ-25 and the Esterman test (r=0.24998, P=0.004<0.05), strong negative correlation was found between the composite score of the VFQ-25 and the binocular visual acuity of daily life (r=?0.37778, P<0.0001), and positive correlation was found between the composite score of the VFQ-25 and the MD of the worse eye (r=0.22917, P=0.0187<0.05).Conclusion: In this sample of clinic-based patients with primary chronic glaucoma, the efficiency score of the binocular visual field tests correlated well with the composite score of the VFQ-25. Binocular visual function can be well used in evaluating the quality of life of the glaucoma patients.
论著

温州青光眼进展研究报告之四:睡眠体位与其青光眼视神经损害及其进展的关系

No. 4 report of Wenzhou Glaucoma Progression Study: association between sleeping position and glaucomatous optic nerve damage and its progression

:457-464
 
目的:探讨正常眼压性青光眼(normal tension glaucoma,NTG)患者睡眠体位与其双眼不对称损害的关系。方法:纳入2014年1月至2018年9月在温州青光眼进展研究(Wenzhou Glaucoma Progression Study,WGPS)项目中的NTG患者。眼部主要检查有视野和光学相干断层扫描(optical coherence tomography,OCT)。睡眠体位数据通过基线睡眠体位问卷获得。根据侧卧位睡眠偏好,将NTG患者眼部参数分为卧位高侧眼和卧位低侧眼进行讨论;根据双眼不对称损害,将患者眼部参数分为较好眼和较差眼讨论。双眼不对称损害定义为双眼视野平均偏差(mean deviation,MD)差值>6 dB或杯盘比差值>0.2。结果:共纳入158例NTG患者,最长随访时间为48个月,其中122例(77.22%)患者存在睡眠偏好;存在睡眠偏好的患者中,83例(68.03%)患者存在侧卧位偏好;存在侧卧位偏好的患者中,大多数患者偏好右侧卧位[右vs左:59 (71.1%) vs 24 (28.9%),P<0.001]。对存在侧卧位偏好的患者进行分析,发现卧位高侧眼与卧位低侧眼眼部参数之间,差异无统计学意义(P>0.05);卧位低侧眼的视野进展速率[视野指数(visual field index,VFI)、MD]慢于卧位高侧眼(0.48%±1.66%/年 vs ?0.45%±3.07%/年;0.54±0.96 dB/年 vs 0.2±1.15 dB/年),差异无统计学意义(P=0.086,P=0.308)。对同时存在侧卧位偏好及双眼不对称损害的患者进行分析,发现卧位高侧眼与卧位低侧眼的眼部参数之间,差异无统计学意义(P>0.05);卧位低侧较好眼的个数及占比高于卧位低侧较坏眼[23 (57.5%) vs 17(42.5%)],但差异无统计学意义(P=0.132);卧位低侧眼的视野进展速率(VFI、MD)也慢于卧位高侧眼(1.19%±1.65%/年 vs ?0.86%±3.65%/年;0.71±1.13 dB/年 vs0.13 dB/年),但差异无统计学意义(P=0.064,P=0.419)。结论:存在睡眠体位偏好的NTG患者中,约68%存在侧卧位偏好;存在侧卧位偏好的患者中,约70%偏好右侧卧位。但本研究并未发现睡眠体位与青光眼患者双眼不对称损害及其疾病进展存在相关性。
Objective: To investigate the association between lateral decubitus position (LDP) and asymmetric loss in normal tension glaucoma (NTG) patients. Methods: NTG patients were enrolled from Wenzhou Glaucoma Progression Study (WGPS) in Jan. 2014 to Sep. 2018. The main eye examinations included visual field test and optical coherence tomography (OCT). A questionnaire to determine the preferred sleeping position was administered to each patient in the baseline. According to the LDP, the eye parameters were divided into non-dependent eyes(higher lateral eyes) and dependent eyes (lower lateral position eyes) for discussion. According to the asymmetric damage, the ocular parameters of the patients were divided into the better eyes and the worse eyes for analysis.Asymmetric loss was defined as a difference in mean deviation (MD) between the 2 eyes of at least 6 dB or disc/cup >0.2. Results: One hundred and twenty-two patients (77.22%) had sleep preferences among the 158 NTG patients who was finally recruited and the longest follow up time was 48 months. Among the patients with sleep preference, 83 patients (68.03%) preferred the lateral decubitus position. Patients who had the lateral decubitus position mostly preferred the right lateral position [59 (71.1%) vs 24 (28.9%), P<0.001]. For patients who had the lateral decubitus position, the ocular parameters between the dependent eyes and the non-dependent eyes had no statistical difference(P>0.05); the rate of visual field progression in the dependent eyes was slower than that in non-dependent eyes, but there was no statistical difference between the two groups (0.48%±1.66%/year vs ?0.45%±3.07%/year; 0.54±0.96 dB/year vs 0.2±1.15 dB/year; P=0.086, P=0.308, respectively). For patients who had the lateral decubitus position and asymmetric damage, the ocular parameters between the dependent eyes and the non-dependent eyes had also no statistical difference (P>0.05); the number and ratio of the dependent-better eye and the dependent-worse eye were 48 and 41, respectively [23 (57.5%) vs 17 (42.5%), P=0.132]; the rate of visual field progression in the dependent eyes was also lower than that in non-dependent eyes, but there was no statistical difference between the two groups (1.19%±1.65%/year vs ?0.86%±3.65%/year; 0.71±1.13 dB/year vs 0.13 dB/year; P=0.064, P=0.419 respectively). Conclusion: About 68% of NTG patients with sleep preferences preferred the lateral decubitus position; and about 70% of patients with the lateral decubitus position preferred the right side sleeping. However, this study did not find a correlation between lateral decubitus position and asymmetric visual field loss.
论著

超声造影在评价青光眼视神经血液供应中的临床应用

Ocular haemodynamic in patients with glaucoma measured by contrast-enhanced ultrasound

:449-456
 
目的:应用彩色多普勒超声造影检查测定不同类型原发性青光眼患者的视神经血液供应情况,探讨血流变化与青光眼的关系。方法:选取2012年1 2月至2014年3月在哈尔滨医科大学附属第二医院眼科经临床确诊的原发性闭角型青光眼(primary angle closure glaucoma,PACG)患者16例(20只眼)和原发性开角型青光眼(primary open angle glaucoma,POAG)患者8例(10只眼),分别设为PACG组和POAG组;同时,选取1 0例1 0只正常眼设为对照组。所有受试者分别行彩色多普勒及超声造影检查,观察眼动脉(ophthalmic artery,OA)、视网膜中央动脉(central retinal artery,CRA)、睫后短动脉(short posterior ciliary artery,SPCA)的血流动力学指标,包括收缩期最大血流速度(peak systolic velocity,PSV)、舒张末期血流峰值速度(diastolic peak velocity,EDV)、血流阻力指数(resistance index,RI)、造影剂到达时间(arrival time,AT)及消退时间(departure time,DT)等指标,并对结果进行统计学分析。结果:超声造影测定POAG组的眼动脉造影剂AT较正常对照组延长(P=0.035),PACG组及POAG组的眼动脉造影剂DT均较正常对照组延长(P=0.010);彩色多普勒测定PACG组及POAG组的OA和SPCA,以及POAG组的CRA的PSV、EDV均较正常对照组减低(P=0.003);同时,PACG组及POAG组的OA以及POAG组的CRA的RI较正常对照组增高(P<0.001)。结论:彩色多普勒及超声造影可以检测青光眼患者的眼部血供明显低于正常人群,为临床诊治青光眼及评价眼部疾病患者的眼部血供状态提供了一种新的技术手段。
Objective: This study used Doppler imaging and contrast-enhanced ultrasound to measure ocular haemodynamic of patients with primary angle-closure glaucoma (PACG) and primary open-angle glaucoma (POAG), to investigate the association between the blood flow changes and glaucoma. Methods: Doppler imaging and contrast-enhanced ultrasound were performed on 16 PACG patients (20 eyes, PACG group), 8 POAG patients(10 eyes, POAG group) who were diagnosed in the Department of Ophthalmology, the Second Affiliated Hospital of Harbin Medical University from Dec. 2012 to Mar. 2014. The normal eyes from 10 persons were selected as control group. The flow velocity of ophthalmic artery, central retinal artery, and posterior ciliary artery were observed, including the peak systolic velocity, diastolic peak velocity, resistance index, and the arrival time and departure time of the ultrasound microbubbles (SonoVue). Results: Compared to control group, the arrival timeof the ultrasound microbubbles (SonoVue) of ophthalmic artery of patients with POAG increased (P=0.035),and the departure time of ophthalmic artery of patients with PACG and POAG increased (P=0.010). Both peak systolic velocity and diastolic peak velocity of the ophthalmic artery and short posterior ciliary artery of patients with PACG and POAG and the central retinal artery of patients with POAG decreased (P=0.003). Meanwhile, the resistance index of ophthalmic artery of patients with PACG and POAG and the central retinal artery of patients with POAG were higher than those in the control group (P<0.001). Conclusion: The flow velocity of ocular vascular was worse than that of normal group respectively. This study provides a new technology for the diagnosis of glaucoma and the evaluation of the flow velocity of ocular vascular.
论著

青光眼视网膜血流密度与视野缺损程度的相关分析

Correlation between retinal vascular density and visual field loss in primary chronic angle-closure glaucoma

:433-438
 
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.
论著

原发性开角型青光眼患者5年视野缺损进展情况及相关因素

Progression and influencing factors of 5-year visual field damage in patients with primary open-angle glaucoma

:426-432
 
目的:了解原发性开角型青光眼(primary open angle glaucoma,POAG)患者视野缺损的进展情况,探讨其发生进展的相关危险因素。方法:回顾性分析2014年1月至2018年7月就诊于北京大学第三医院眼科并有至少4次视野检查的POAG患者。按照患者首次视野检查的平均偏差或平均缺损进行分期。将历次随访视野检查的平均偏差或平均缺损与时间进行线性回归分析,取其斜率(dB/年)。根据平均偏差或平均缺损的斜率将患者分为进展组与无进展组。分析患者视盘周围视网膜神经纤维层(retinal nerve fiber layer,RNFL)厚度损害位置、平均随诊间隔时间、基线视野分期等因素与青光眼视野缺损进展的关系。结果:共纳入128例患者(252只眼),其中129眼使用Octopus视野计检查随访,基线视野缺损值为(10.91±5.76) dB;123眼使用Humphrey视野计,基线视野偏差值为(–10.62±6.89) dB。视野缺损早、中、晚期的比例分别为26.19%、36.51%和37.30%。进展组31只眼(12.30%),无进展组221只眼(87.70%)。上下方RNFL都存在重度损害的患者,其视野缺损更易进展(P<0.001)。平均随诊间隔时间≤4个月的患眼,发生进展的比例高于平均随诊间隔时间>4个月的患眼(P=0.058)。基线视野分期、年龄、性别、总随访时间与视野缺损进展未见显著相关性。结论:青光眼患者的视功能损害出现恶化是普遍存在的。上下方RNFL均存在重度损害、随诊间隔时间短与视野缺损进展相关。视神经结构的改变与功能损害具有相关性,结构改变的方位对功能损害进展有提示功能。规律随诊对病情监测有重要意义,对于可能快速进展的患者,应缩短随诊间隔时间。
Objective: To investigate the progression of visual field defect in primary open angle glaucoma (POAG), and to explore the related risk factors for its progression. Methods: A retrospective analysis was performed on patients with POAG who had at least 4 visual field examinations in the Department of Ophthalmology, Peking University Third Hospital from January 2014 to July 2018. The visual field was staged according to the mean deviation or mean defect of the first visual field examination. Linear regression analyses of mean deviation or mean defect were performed against time, and corresponding regression slopes (in decibels per year) were calculated. Patients were divided into progressive and non-progressive groups according to the mean deviation slope or mean defect slope. The relationship between retinal nerve fiber layer (RNFL) thickness lesion location, mean follow-up interval, baseline visual field staging, and the progression of visual field defect in glaucoma were analyzed. Results: A total of 128 patients (252 eyes) were included. Among them, 129 eyes were followed up with an Octopus perimeter, and the average mean defect value of the baseline visual field was 10.91±5.76 dB; while the other 123 eyes were followed up with a Humphrey perimeter, and the average mean deviation value of the baseline visual field was –10.62±6.89 dB. The proportion of early, middle and late visual field defects was 26.19%, 36.51% and 37.30%. There were 31 eyes (12.30%) in the progressive group and 221 eyes (87.70%) in the non-progressive group. Patients with severe damage to both the upper and lower RNFLs had more visual field defects (P<0.001). Patients with an average follow-up interval ≤4 months had a higher rate of progression than those with an average follow-up interval >4 months (P=0.058).There were no significant differences in baseline visual field stage, age, gender, and total follow-up time between the progression and progression-free groups. Conclusion: Deterioration of visual function impairment is common in glaucoma patients. The progression of visual field defects is associated with severe impairments which are present both in the upper and lower RNFLs, and short follow-up intervals. Optic nerve structure changes are related to functional impairment, and the location of structural changes is suggestive of functional impairment progression.Regular follow-up visits are of great significance for disease monitoring. For patients who may progress rapidly, the follow-up interval should be shortened.
论著

慢性闭角型青光眼小梁切除术后早期眼前节及屈光变化的临床研究

Clinical study of early anterior segment and refractive changes after trabeculectomy on chronic angle-closure glaucoma

:420-425
 
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.
专家述评

中国青光眼防治工作展望

Outlook on the prevention and treatment of glaucoma in China

:400-404
 
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.
专家述评

展望未来,我国青光眼防治亮点有哪些?

What are the highlights of glaucoma prevention and treatment in China in the future?

:393-399
 
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.
专家述评

改变青光眼作为首位不可逆致盲性眼病的现状

Current status on the change of glaucoma as the first irreversible blinding disease

:389-392
 
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.
综述

同步监测青光眼患者24h眼压与血压的意义

Significance of simultaneous monitoring of intraocular pressure and blood pressure for 24 hours in glaucoma

:160-166
 
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.
其他期刊
  • 眼科学报

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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  • Eye Science

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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