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.
目的：通过在人小梁网细胞(human trabecular meshwork cell，HTMC)中过表达沉默信息调节因子2相关酶1(silent information regulator 1，SIRT1)，探讨SIRT1对氧化应激下HTMC功能的影响。方法：将SIRT1过表达慢病毒和GFP阴性对照慢病毒按照最佳(multiplicity of infection，MOI)分别转染入HTMC，并用实时定量PCR法对SIRT1是否在细胞中过表达进行验证。实验分为以下4组：正常组、H2O2组、H2O2+Lv-SIRT1-OE(过表达)组、H2O2+Lv-GFP组，分别采用Transwell法和CCK8法检测氧化应激下HTMC的迁移能力和活性。两组间比较采用独立样本t检验。结果：在正常组、H2O2组、H2O2+Lv-SIRT1-OE组、H2O2+Lv-GFP组这4组中，Transwel l实验结果分别为436±73、254±25、510±51、327±46，H2O2+Lv-SIRT1-OE组分别与H2O2组和H2O2+Lv-GFP组差异均有统计学意义(P<0.01)。CCK8法结果显示，H2O2+Lv-SIRT1-OE组分别与H2O2组和H2O2+Lv-GFP组相比差异均有统计学意义(P<0.01)。H2O2+Lv-SIRT1-OE组分别与H2O2组和阴性对照组(H2O2+Lv-GFP)相比，Bax表达水平明显下降，Bcl-2表达水平明显提高，差异均有统计学意义(P<0.01)。ROS活性氧测定显示H2O2+Lv-SIRT1-OE组比H2O2组的细胞活性氧水平显著降低(P<0.05)。结论：在HTMC中过表达SIRT1能有效降低氧化应激对HTMC迁移能力和活性的影响，从而对HTMC起到一定的保护作用，为后续研究SIRT1保护氧化应激下HTMC的调控机制打下基础。
Objective: To explore the effect of Silent Information Regulator 1 (SIRT1) on cell function of human trabecular meshwork cell (HTMC) under oxidative stress by overexpressing SIRT1 in HTMC. Methods: This is an experiment research. HTMCs were transfected with SIRT1-ovexpressed lentivirus and GFP-negative control lentivirus (Lv-GFP) at the optimal multiplicity of infection (MOI). Real-time quantitative PCR was used to verify whether SIRT1 was overexpressed in HTMC. The following experiments were divided into four groups: normal control group, H2O2 group,H2O2+Lv-SIRT1-OE group, H2O2+Lv-GFP group. Cell migration was detected by transwell assay. Cell viability was detected by CCK8 assay. Student’s t-test was used for two groups. P<0.05 was set as statistical signifificance. Results: The number of migration per well of normal control group, H2O2 group, H2O2+Lv-SIRT1-OE group, H2O2+Lv-GFP group were 436±73,254±25, 510±51, 327±46, respectively. Compared with H2O2 group and H2O2+Lv-GFP group, transwell assay demonstrated that the number of migrations per well of H2O2+Lv-SIRT1-OE group significantly increased (P<0.01). Likewise, CCK8 assay indicated that cell viability of H2O2+Lv-SIRT1-OE group was higher than both of H2O2 group and H2O2+Lv-GFP group (P<0.01). Compared with H2O2+Lv-SIRT1-OE group and negative control group (H2O2+Lv-GFP), the expression level of Bax decreased significantly,and the expression level of Bcl-2 increased significantly (P<0.01). ROS assay showed that the ROS level in H2O2+Lv-SIRT1-OE group was significantly lower than that in H2O2 group (P<0.05). Conclusion:SIRT1 overexpressed in HTMC can effectively reduce the effect of oxidative stress on migration ability and proliferation activity of HTMC, which lays a foundation for further study on the regulatory mechanism of SIRT1 protecting HTMC under oxidative stress.
目的：比较单眼发作的原发性急性房角关闭(acute primary angle closure，APAC)患者发作眼与未发作眼眼部生物学参数的差异，分析急性房角关闭发作的可能危险因素。方法：回顾性分析2008年1月至2020年3月中山眼科中心青光眼科222例45岁以上单眼发作的APAC病例。排除双眼发作、另眼有发作史及晶状体源性、外伤性等继发因素。A超测量晶状体厚度、眼轴长度，超生生物显微镜测前房深度。对单眼发作APAC患者的发作眼与未发作眼眼轴长度、前房深度、晶状体厚度、晶状体相对位置等进行统计学分析。结果：患者发作年龄为(62.57±9.14)岁。发作眼与未发作眼前房深度分别为(1.75±0.27) mm和(1.88±0.31) mm，眼轴长度分别为(22.34±0.80) mm和(22.35±0.83) mm，晶状体厚度分别为(5.14±0.38) mm和(5.17±0.42) mm，晶状体相对位置分别为0.195和0.198。发作眼前房深度较浅，晶状体相对位置较靠前，差异有统计学意义(均P<0.001)，发作眼的眼轴长度、晶状体厚度较未发作眼差异无统计学意义(P>0.05)。APAC发作年龄较小(45~59岁)的患者双眼眼轴均短于发作年龄较大(60~69、70岁以上)的患者；发作年龄70岁以上患者双眼前房深度均较浅，双眼晶状体相对位置均较靠前，差异均有统计学意义(P<0.05)。相关性分析表明APAC发作年龄较小的患者双眼眼轴均较短(P<0.001)。结论：APAC发作眼的前房较浅、晶状体相对位置靠前。短眼轴、女性与不同个体的APAC发作相关。浅前房、晶状体厚、晶状体相对位置靠前可能是高龄人群APAC发作的危险因素。
Objective: To compare the ocular biometric parameters between the acute primary angle closure (APAC) eyes and the fellow eyes as well as the risk factors associated with APAC. Methods: From January 2008 to March 2020,222 monocular APAC patients over 45 years old from the Glaucoma Department of Zhongshan Ophthalmic Center, Sun Yat-sen University were retrospectively studied. Patients with binocular attack, previous attack in the fellow eyes, and secondary factors such as lens-induced and traumatic glaucoma were excluded. Ocular biometric parameters including axial length (AL) and lens thickness (LT) were measured with A-scan ultrasound, while the anterior chamber depth (ACD) was measured by ultrasonic biological microscope. AL, ACD, LT and relative lens position (RLP) were compared between the APAC and the fellows eyes. Results: The average age of onset was (62.57±9.14) years. The ACD was (1.75±0.27) and (1.88±0.31) mm, AL was (22.34±0.80) and (22.35±0.83) mm,LT was (5.14±0.38) and (5.17±0.42) mm, and the RLP was 0.195 and 0.198 for the APAC and the fellow eyes,respectively. Compared with the fellow eyes, the ACD of the APAC eyes was shallower, and the RLP was more anterior (both P<0.001), while the differences of AL and LT were not statistically significant (both P>0.05).Furthermore, AL of patients with a younger age of onset (aged 45 to 59 years) was shorter than that of those with an older age of onset (aged 60 to 69 or over 70 years); patients with an onset age of over 70 years have shallower ACD and more anterior RLP, all statistically significant (P<0.05). In addition, correlation analysis indicated that younger onset age was significantly correlated to shorter axial length of APAC eyes (P<0.001). Conclusion:APAC eyes had shallower ACD and more anterior RLP. Shorter AL and female were associated with APAC attack between individuals. Shallower ACD, thicker lens and more anterior RLP are potential risk factors for APAC among aged population.
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.
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.
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.
目的：应用Cirrus HD-OCT 5000对正常眼黄斑及视盘血流参数进行血管成像测量，评估其可重复性及再现性。方法：纳入40只正常眼进行前瞻性研究。操作者A于一周内3天的同一时段(T1，T2，T3)对正常受试者的同一眼黄斑及视盘进行3次血管成像扫描，扫描过程中均开启FastTracTM图像跟踪功能，操作者B在T 2时间点再次对受试者同一眼进行相同程序扫描，使用Angio PlexMetrixTM量化软件(版本10.0)自动测量黄斑和视盘的血管长度密度(vessel length density，VD)和血管灌注密度(vascular perfusion density，PD)。应用单因素方差分析或非参数检验比较3次扫描的VD、PD是否有差异。采用组内相关系数(intraclass correlation coefficient，ICC)、变异系数(coefficient of variation，CV)评价操作者A的可重复性，采用一致性相关系数(consistent correlation coefficient，CCC)、重复性系数(repeatability coefficient，CR)、C V评价操作者间的再现性。结果：操作者A对黄斑及视盘各区域3次扫描的V D、P D之间差异无统计学意义(P >0.05)。操作者A对黄斑和视盘V D、PD 3次扫描的ICC值分别为0.260~0.517、0.362~0.898，黄斑及视盘各区域V D、P D的C V值均<8.1%。黄斑和视盘V D、P D的操作者间CCC值分别为0.3130~0.5665、0.5149~0.7801；黄斑VD和PD的CR值分别为3.2212~4.6399、0.0574~0.0832；视盘VD和PD的CR值分别为2.0675~4.0630、0.0447~0.0730。黄斑CV值均<9.0%，视盘CV值均<6.9%。结论：非同日的同一时段视盘浅层血流参数具有较好的重复性及再现性，黄斑浅层血流参数的重复性及再现性相对较差。
Objective: To evaluate the repeatability and reproducibility of quantification of macular and peri-papillary superficial capillaries in normal eyes using Cirrus HD-OCT 5000 angiography. Methods: Forty normal eyes were included in this prospective study. Angiography 3 mm × 3 mm scan protocol centered on the disc or macula of the same eye was repeated 3 times by operator A in the same period on 3 days (T1, T2, T3) within 1 week,and the FastTracTM image tracking function was turned on during the scan. Operator B repeated the same scan independently at T2 after operator A. Angio Plex MetrixTM quantification software (version 10.0) was used to automatically measure the vessel length density (VD) and vascular perfusion density (PD) of macular and peri-papillary superficial capillaries. One-way analysis of variance or nonparametric test was used to compare the VD and PD measurements of the 3 scans. The intraclass correlation coefficient (ICC) and coefficient of variation (CV)were calculated to evaluate the intra-operator repeatability. Consistent correlation coefficient (CCC), repeatability coefficient (CR), and CV were calculated to evaluate the inter-operator reproducibility. Results: There was no statistically significant difference in the measurements of VD and PD between the 3 scans of the macular and peri-papillary superficial capillaries by operator A (P>0.05). The ICC values for the 3 scans of VD and PD of the macular and peri-papillary superficial capillaries by operator A were 0.260–0.517 and 0.362~0.898, respectively.The CV values of the VD and PD of the macular and peri-papillary superficial capillaries were all <8.1%. The inter-operator CCC values of the macular and peri-papillary superficial capillaries were 0.3130–0.5665 and 0.5149~0.7801,respectively; the CR values of the VD and PD of macula were 3.2212–4.6399 and 0.0574–0.0832, respectively; the CR values of the VD and PD of optic disc were 2.0675–4.0630 and 0.0447–0.0730, respectively. The CV values of macular were all <9.0%, and the CV values of optic disc were all <6.9%. Conclusion:The macular and peri-papillary superficial capillaries parameters in the same period on different days have a good repeatability and reproducibility,while the superficial macular blood flow parameters have relatively poor repeatability and reproducibility.
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.
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.
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.
目的：了解儿童罹患青光眼的疾病类型、特点，更好地做到早期发现早期治疗。方法：收集北京同仁医院2014—2019年度834例0~18周岁住院接受抗青光眼手术的患者，回顾性分析患者的人群特点与疾病构成特点。结果：834例患者中，原发青光眼397例(47.6%)，继发青光眼429例(51.4%)。另有8例无法明确诊断青光眼类型。原发青光眼中以原发先天性青光眼最常见，继发青光眼中以白内障术后继发青光眼为主，两种类型的青光眼占总患者数的50%。结论：儿童罹患青光眼的疾病种类繁多，其中原发先天青光眼与白内障术后继发青光眼最常见，重视婴幼儿先天青光眼的筛查，监测儿童白内障术后眼压有助于早期发现青光眼，并给予治疗，延缓儿童青光眼患者视功能的损害。
Objective: To understand the types and characteristics of glaucoma in pediatric inpatients to achieve early detection and treatment. Methods: A total of 834 patients aged 0–18 years who underwent anti-glaucoma surgery in Beijing Tongren Hospital from 2014 to 2019 were collected and their population characteristics and disease composition characteristics were retrospectively analyzed. Results: In all of the 834 cases, there were 397 patients (47.6%) with primary glaucoma and 429 (51.4%) with secondary glaucoma. The type of glaucoma could not be definitively diagnosed in 8 cases. Primary infant glaucoma and secondary glaucoma following cataract surgery accounted for above 50%. Conclusion: The causes of pediatric inpatients with glaucoma are various. Screening of primary infant glaucoma should be taken seriously and monitoring intraocular pressure after cataract surgery is also important. Early detection and treatment can prevent further visual loss of pediatric patients with glaucoma.
青光眼是全世界范围内不容忽视的致盲性眼病，其起病隐匿，视功能损害进展迅速，晚期预后不理想。长期发展且未行治疗的青光眼患者视神经呈进行性损害，引起视力急剧下降、视野不可逆性缺损，严重降低患者的生活质量。为了适应逐渐恶化的视功能，患者注视行为发生明显变化，由此在日常活动中引起步态行为随之改变，意外事故频繁发生。故目前对于青光眼的研究引起国内外广泛重视，虚拟现实技术(virtual reality，VR)作为青光眼早期诊断及康复治疗的新手段已被现代医学所尝试。本文具体阐述了青光眼的视觉损害与注视行为及运动行为间的联系，并总结了目前国内外关于VR诊断青光眼及作为康复治疗的相关研究。
Glaucoma is a blinding eye disease that cannot be ignored worldwide. Its onset is insidious, visual impairment is progressing rapidly, and the late prognosis is not ideal. Long-term untreated glaucoma patients show progressive damage to the optic nerve, causing a sharp decline in vision, irreversible visual field defects, and severely reducing the quality of life of the patients. In order to adapt to the gradual deterioration of visual function, the patient’s gaze behavior changes significantly, which causes the gait behavior to change in daily activities, and accidents occur frequently. Therefore, the current research on glaucoma has attracted wide attention in the nation and abroad,and virtual reality (VR) technology has been tried in modern medicine as a new method for early diagnosis and rehabilitation of glaucoma. This article specifically elaborates the relationship between the visual impairment of glaucoma and the gaze behavior and movement behavior, and summarizes the current domestic and foreign research on the diagnosis of glaucoma and the rehabilitation of VR technology.
光学相干断层扫描血管成像术(optical coherence tomography angiography，OCTA)作为一项新兴的检查手段，现已被广泛应用于眼科临床及科研工作中。鉴于OCTA在血管成像方面的独特优势，近年来关于其在眼前段的临床应用和研究也愈发得到关注。关于OCTA对结膜、巩膜、角膜以及虹膜的血管和相关眼表疾病的研究日益增多，其在眼前段应用潜力巨大。
As a new examination method, optical coherence tomography angiography (OCTA) has been increasingly used in ophthalmology clinical work and scientific research. In view of the unique advantages of OCTA in angiography,the clinical application and research of OCTA in the anterior segment have attracted more and more attention in recent years. Studies of OCTA in vessels of conjunctiva, sclera, cornea, iris, and related ocular surface diseases have shown great potential for its application in the anterior segment.
睫状体髓上皮瘤是一种源自神经上皮层的恶性肿瘤，易因其伪装特性而被漏诊和误诊。本文报道了1例3岁9个月的男性患儿，眼部表现似晶状体破裂，经部分肿物切除活检，病理诊断为睫状体恶性髓上皮瘤。
Medulloepithelioma of the ciliary body is a kind of malignant tumor which arises from neuroepithelium. It is easily misdiagnosed or miss diagnosed due to its masquerade feature in the clinical practice. We report a boy with a tumor in his right eye at age of 3 years and 9 months presented first with lens rupture. Diagnosis of malignant medulloepithelioma of ciliary body was made pathologically by biopsy of the partial tumor.
