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Comparison of Ex‑PRESS implantation versus trabeculectomy combined with phacoemulsification in primary open‑angle glaucoma:a retrospective in vivo confocal microscopy study

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Eye and Vision 2024年第2期10卷 1-11页

作者： Yuqiao Zhang Beiting He Yulin Zhang Jin Zeng Yanlei Chen Yongyi Niu Honghua Yu Yongjie Qin Hongyang Zhang Department of Ophthalmology Guangdong Eye InstituteGuangdong Academy of Medical SciencesGuangdong Provincial People’s HospitalNo.106 Zhongshan Er RoadGuangzhou 510080China Shantou University Medical College ShantouChina The Second School of Clinical Medicine Southern Medical UniversityGuangzhouChina Department of Ophthalmology School of MedicineSouth China University of TechnologyGuangzhouChina

Background:To compare the efficacy of Ex-PRESS implantation versus trabeculectomy combined with phacoemulsification.Methods:A retrospective 12-month study on patients with coincident primary open-angle glaucoma(poag)and cataract.The patients underwent combined phacoemulsification and Ex-PRESS implant(Phaco-ExPRESS,n=35)or phacotrabeculectomy(Phaco-Trab,n=35).The morphological structures of the filtering bleb were examined by slitlamp,anterior segment optical coherence tomography(AS-OCT)and in vivo confocal microscopy(IVCM).Complete success was defined as postoperative intraocular pressure(IOP)<18 mmHg without the use of anti-glaucoma medication.Qualified success was defined as postoperative IOP<18 mmHg with or without anti-glaucoma medications.The data were collected preoperatively and postoperatively at 2 weeks,1 month,3 months,6 months,and 12 months.Results:No significant difference in the variables such as age,IOP and perimetry was found between the groups of Phaco-ExPRESS and Phaco-Trab.At the one-year postoperative visit for filtering blebs,Phaco-ExPRESS increased the mean area of epithelial microcysts significantly from 0.10±0.05 to 0.20±0.09μm^(2)perμm^(2),while Phaco-Trab decreased the mean area significantly from 0.08±0.04 to 0.04±0.06μm^(2)perμm^(2).Notably,the hyperreflective dots detected by IVCM decreased by 84.9%in Phaco-ExPRESS but increased by 36.3%in Phaco-Trab.The hyperreflective dots were further identified as neutrophil-and monocyte-like cells.The number of these cells were negatively correlated with the microcysts area(r=−0.7,P<0.01)but positively associated with the grade of connective tissue(r=0.5,P<0.01).By creating different microstructural changes in the filtering blebs,Phaco-ExPRESS produced a higher complete success rate(84.9%vs.41.2%,P<0.01)and significant decrease in the number of anti-glaucoma medications(P<0.01)when compared with those in Phaco-Trab.However,the qualified success showed no significant difference between the two groups(100.0%vs.91.2%,P=0.24).Conclusions:At the one-ye

关键词： poag Ex-PRESS Phacoemulsification Confocal microscopy

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In vivo confocal microscopy: qualitative investigation of the conjunctival and corneal surface in open angle glaucomatous patients undergoing the XEN-Gel implant, trabeculectomy or medical therapy

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Eye and Vision 2020年第1期7卷 136-149页

作者： Stefano Baiocchi Cosimo Mazzotta Arianna Sgheri Alessandro Di Maggio Simone Alex Bagaglia Matteo Posarelli Leonardo Ciompi Alessandro Meduri Gian Marco Tosi Department of Medicine Surgery and NeurosciencesOphthalmology UnitPoliclinico Santa Maria alle ScotteUniversity of SienaViale Bracci 8ZIP code 53100 SienaItaly Ophthalmology Unit Department of Biomedical SciencesUniversity of MessinaMessinaItaly

Purpose:Assessing the quality of the ocular surface by in vivo scanning laser confocal microscopy(IVCM)in primary open angle glaucoma(poag)patients treated by Xen 45 Gel Stent,medical therapy and trabeculectomy.Methods:Retrospective,single-center,single-masked,comparative study including 60 eyes of 30 patients(mean age 61.16±10 years)affected by poag.Eyes were divided into 3 groups:Group 1 eyes underwent the Xen 45 Gel Stent procedure,Group 2 eyes were under medical therapy,Group 3 eyes were surgically treated by trabeculectomy.All patients underwent HRT II IVCM analysis of cornea,limbus,conjunctiva,sub-tenionian space and sclera.Results:The Xen 45 Gel stent,if properly positioned in the sub-conjunctival space preserves goblet cells and limits ocular surface inflammation.Regular corneal epithelial cells with micro-cysts,and normo-reflective sub-epithelial nerve plexus are documented by IVCM.In sub Tenon’s implants an alternative lamellar intra-scleral filtration is detectable.Combined surgical procedures show a noticeable number of inflammatory cells with rare micro-cysts.Post-trabeculectomy inflammatory reaction is more evident than Xen 45 Gel Stent associated surgical procedures,but less than medical therapy where a conspicuous presence of Langerhans cells,peri-neural infiltrates,marked loss of goblet cells and fibrosis is visible.Conclusion:Ocular surface inflammation was more notable in topical therapy than after trabeculectomy,which itself causes more inflammation than XEN Gel stents.

关键词： Glaucoma Primary open angle glaucoma poag MIGS Xen 45 gel stent Ocular surface Inflammation Confocal microscopy IVCM

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Progression of Primary Open Angle Glaucoma on Optical Coherence Tomography of the Optic Nerve Head

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Open Journal of Ophthalmology 2022年第4期12卷 345-351页

作者： Kokou Vonor Tchilabalo Tchodjoou Yaovi Tété Yawa Nagbé Roger Ahlonko Kuaovi-Koko Koffi Didier Ayéna Méba Banla Komi Patrice Balo Service d’Ophtalmologie CHR Kara Tomdè Tomdè Togo Département d’Ophtalmologie Faculté des Sciences de la Santé Université de Lomé Lomé Togo Cabinet AFIA Lomé Togo

Aims: To describe the progression of Primary open angle glaucoma (poag) on Optical Coherence Tomography (OCT) of the optic nerve head and retinal nerve fiber layers (RNFL). Method: We conducted a descriptive retrospective study from January 1, 2015 to December 31, 2019, a period of 5 years from the files of patients followed for poag and having carried out at least two OCT examinations of the optic nerve head (ONH), one automated visual field and Intraocular pression (IOP). The variables studied were: age, sex, mean IOP, glaucoma stage, progression of ONH parameters, and progression of RNFL parameters. Results: During the period, 112 eyes of 56 patients were included. The mean age was 48.96 ± 16.57 [12 - 83] years with a sex-ratio of 1.33 (32 M/27 F). The mean IOP was 21 ± 4.54 [10 - 36] mm Hg. According to the mean deviation (MD) of the visual field, 98 eyes or 87.5% were stage 1 of poag, 10 eyes or 8.9% at stage 2 and 4 eyes or 3.6% at stage 3. The mean time between the 1st and 2nd OCT examination was 28.91 ± 11.07 [6 - 56] months, corresponding to an average of 2.18 OCT per patient in 5 years of follow-up. There was an average increase of 6.2% of the Cup area and an increase in the vertical Cup/Disc ratio of 1.79% per year. The thinning average of neuro-retinal ring area was 1.64% per year. The RNFL thickness had decreased on average by 4.28 μ or 0.93% per year. The lower quadrant had the highest fiber loss with 1.08% per year followed by the upper quadrant with a loss of 1.05% per year. Conclusion: OCT of the ONH and RNFL proves to be an essential tool in the follow-up of poag. A subsequent study taking into account the OCT of the macular ganglion complex will enable to study its contribution in the follow-up of glaucomatous patients in the same population.

关键词： poag Progression OCT ONH-RNFL

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Glaucoma domiciliary service by optometrist

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International Journal of Ophthalmology(English edition) 2016年第12期9卷 1843-1845页

作者： Bhaskar Gupta Usarrma Faridi Naeem Gurmani Jim Favery Michael Smith Daniel Byles University Hospital Southampton Southampton SO16 6YDUK Dorset County Hospital Williams Avenue Dorchester DT12JY UK West of England Eye Unit Royal Devon and Exeter Hospital Barrack Road Exeter EX2 5DW UK

Approximately 10% of UK blindness registrations are attributed to glaucoma . The risk of glaucoma increases with age and it is estimated that the prevalence of chronic open angle glaucoma （COAG） is about 10% in white Europeans who are older than 70. There are an estimated 24.4 million people aged over 40 in England and around 489 000 people are currently affected by COAG.

关键词： GDS IOP Glaucoma domiciliary service by optometrist poag

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中医综合疗法治疗poag的临床疗效观察

中医综合疗法治疗POAG的临床疗效观察

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作者：满校源山东中医药大学

学位级别：硕士

目的:本文抓住poag气血不和或气血失养导致神水瘀滞的总体病机,采用中药足浴、耳尖穴放血和耳穴压豆的综合疗法来进行治疗。通过验证此中医综合疗法的有效性和安全性,为治疗poag提供新方案,且与广大医者分享一种完善中医临床随机对照试... 详细信息

目的:本文抓住poag气血不和或气血失养导致神水瘀滞的总体病机,采用中药足浴、耳尖穴放血和耳穴压豆的综合疗法来进行治疗。通过验证此中医综合疗法的有效性和安全性,为治疗poag提供新方案,且与广大医者分享一种完善中医临床随机对照试验标准化的新思路。方法:按照此试验的纳入标准,纳入46例(86眼),随机分为对照组23例(43眼),试验组为23例(43眼)。两组患者都使用布林佐胺滴眼液和思考林胶囊。试验组在西医治疗基础上加上耳尖穴放血、耳穴压豆和中药足浴疗法。试验组患者采用中医综合疗法10天1个疗程,共5个疗程,耳尖穴放血每隔两天一次。每个疗程之间间隔2天,间隔期间对患者进行血常规和感染八项检查。两组患者在此期间均连续服用思考林胶囊60天,均从试验开始第一天起连续使用布林佐胺滴眼液30天。于全部治疗结束后复查视力、视野、RNFL等指标,把两组患者治疗前后的数据作对比,并对患者进行安全性评估。结果:(1)试验组患者治疗前后的视力进行组内比较,用t检验分析得出,P值为0.001<0.01,差异有显著的统计学意义。治疗后试验组患者视力对比对照组,P值为0.009<0.01,差异具有显著的统计学意义。试验组患者视力提升有效率为83%,对照组患者提升有效率为41%,试验组有效率明显优于对照组。(2)对试验组和对照组患者治疗前后的眼压分别进行组内比较,P值均小于0.01,都有显著的统计学差异。对试验组和对照组治疗后的眼压作组间比较,P<0.01,也具有显著的统计学差异。试验组眼压均数在16mm Hg左右,对照组眼压均数在19mm Hg左右,试验组治疗效果优于对照组。(3)在完成试验的40人中,1人出现了短暂的头晕症状,休息1天后好转;一人眼压出现了短暂的波动,治疗两天后好转。两人均完成了试验。本次试验的安全率为95%,一般安全率为100%。(4)其余各项指标差异均没有统计学意义。试验前的各项数据都具有可比性。结论:本次临床试验证明了中医综合疗法对主要疗效指标视野效果甚微,但是能防止其进一步恶化。对眼压和视力有着非常好的疗效,对于视神经也有着促进恢复的可能,安全性十分的可靠,耐药性小,搭配西药能更好地保护患者的视功能。本次临床试验也为我们中医临床随机对照试验的标准化提供了新思路。

关键词： poag 总体病机耳穴放血耳穴压豆足浴临床试验标准化

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原发性开角型青光眼非穿透小梁手术患者深层巩膜瓣及小梁膜的病理学观察

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中华眼科杂志 2003年第8期39卷 462-465页

作者：孙兴怀王艳孟樊荣复旦大学附属眼耳鼻喉科医院眼科上海200031

目的　研究原发性开角型青光眼患者 (poag)非穿透小梁手术的解剖学基础 ,探讨poag患者房水外流的阻力部位及其病理改变。方法　选择行非穿透小梁手术的poag患者 12例(18只眼 ) ,取术中切除的深层巩膜瓣及撕除的外层小梁膜进行光镜、扫... 详细信息

目的　研究原发性开角型青光眼患者 (poag)非穿透小梁手术的解剖学基础 ,探讨poag患者房水外流的阻力部位及其病理改变。方法　选择行非穿透小梁手术的poag患者 12例(18只眼 ) ,取术中切除的深层巩膜瓣及撕除的外层小梁膜进行光镜、扫描电镜及透射电镜观察。结果　光镜观察标本见 :深层巩膜瓣前端为少许深层角膜基质 ,并可见Schlemm管外壁单层内皮细胞。扫描电镜观察见 :深层巩膜瓣内侧可见被打开的Schlemm管管腔和狭长的积液管开口 ;撕除膜小梁面可见角巩膜小梁的网状结构 ,排列致密 ,网眼较小 ,近管腔侧呈致密的板状结构。透射电镜观察见 :Schlemm管外壁周围散在高电子密度物质 ;撕除膜包括Schlemm管内壁 ,邻管组织 (内皮网 )和部分角巩膜小梁 ,邻管组织细胞减少 ,细胞外基质增多 ,可见大量致密斑块沉积 ;角巩膜小梁网胶原板层结构增厚 ,弹力纤维增多 ,细胞体积增大 ,尤以细胞核增大明显。晚期患者的角巩膜小梁网内有致密斑块沉积 ,阻塞了小梁间隙。结论　非穿透小梁手术的深层巩膜瓣包括Schlemm管外壁 ,撕除膜包括邻管组织和部分角巩膜小梁。邻管组织和部分角巩膜小梁是poag患者房水外流的主要阻力部位 ,同时Schlemm管外壁也是其重要构成部分。

关键词：原发性开角型青光眼非穿透小梁手术巩膜瓣小梁膜病理学 poag 手术方法

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原发性开角型青光眼视神经病变诱导反应蛋白基因突变的研究

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中华医学杂志 2004年第13期84卷 1098-1102页

作者：陈建华徐亮李杨董冰首都医科大学附属北京同仁医院北京市眼科研究所 100005

目的　研究原发性开角型青光眼 (poag)散发病例视神经病变诱导反应蛋白 (OPTN)基因突变情况 ,以及OPTN基因突变与开角型青光眼临床表型的关系。方法　应用聚合酶链反应(PCR)扩增 118例原发性开角型青光眼和 15 0例无青光眼对照组全基因... 详细信息

目的　研究原发性开角型青光眼 (poag)散发病例视神经病变诱导反应蛋白 (OPTN)基因突变情况 ,以及OPTN基因突变与开角型青光眼临床表型的关系。方法　应用聚合酶链反应(PCR)扩增 118例原发性开角型青光眼和 15 0例无青光眼对照组全基因组DNA ,用单核苷酸构象多态性 (SSCP)分析OPTN基因编码区域 13个外显子序列和非编码区改变。SSCP异常者进行双向测序。结果　共发现 11个序列的改变 ,其中 6个序列的改变已有报道 (T34T、T4 9T、M 98K、IVS6 5C→T、IVS6 10G→A、和R5 4 5Q) ,5个为新序列改变 (IVS6 9C→T、IVS6 14G→A、IVS7+36G→A、IVS8 5 1T→C和K4 35R)。K4 35R序列的改变在 1例患者中发现 ;IVS6 9C→T和IVS6 14G→A在 1例无青光眼对照组发现。具有IVS6 5C→T序列改变在患者组和对照组比较差异有显著意义 (P poag的发病有关。

关键词：原发性开角型青光眼视神经病变 poag 反应蛋白基因突变核苷酸

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Ab externo canaloplasty results and efficacy: a retrospective cohort study with a 12-month follow-up

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Eye and Vision 2019年第1期6卷 63-73页

作者： Iraklis Vastardis Sofia Fili Zisis Gatzioufas Markus Kohlhaas Department of Retina and Vitreous Narayana Nethralaya#121/C1st R BlockChord RoadRajaji NagarBengaluru 560010India. Department of Cornea and Refractive surgery Narayana Nethralaya#121/C1st R BlockChord RoadRajaji NagarBengaluru 560010India

Background:The aim of this study is to review the outcomes of canaloplasty versus canaloplasty combined with phacoemulsification in a retrospective cohort study and to evaluate the efficacy of these methods in terms of intraocular pressure(IOP)lowering effect,postoperative complications and additional glaucoma surgery or reintroduction of medical therapy over a 12-month follow-up.Methods:In a retrospective cohort study,602 eyes with primary open angle glaucoma(poag)were treated with canaloplasty or canaloplasty combined with phacoemulsification.The results were evaluated separately in two main groups;group A canaloplasty(262 eyes)and group B canaloplasty combined with phaco(322 eyes).Each group was then subdivided into three additional groups according to the severity of glaucoma.The criteria for successful treatment were evaluated between three IOP ranges;IOP≤16 mmHg,18 mmHg and 21 mmHg.Complete success was considered the percentage of eyes reaching target IOP with no medication and partial success with medication.Groups A and B subgroups were compared using the Kaplan Meier test.Mean IOP,reduction of antiglaucoma agents and additional IOP lowering methods were also evaluated.The follow-up time was 12 months.Statistical significance was set at p<0.05.Results:An incomplete intraoperative cannulation of Schlemm’s canal resulting in conversion to other glaucoma surgery occurred in 18 eyes(2.99%).In both of the main groups,postoperative hyphema,descemet membrane detachment and transient IOP rise were the most common postoperative complications.The mean IOP in group A and subgroups at 12 months was 13.26±4.5 mmHg,15.19±3.97 mmHg and 18.09±3.75 mmHg.Respectively in group B mean IOP was 14.51±4.69 mmHg,14.40±4.11 mmHg and 14.25±2.76 mmHg.Complete success was achieved in group A in 69.19,74.51 and 74.31%of eyes.In group B complete success was achieved in 81.60,77.33 and 83.33%of eyes respectively.Kaplan Meier between groups A and B was statistically significant for IOP≤16 mmHg and IOP≤21 mmHg(p=0.0041 and p=0.0312),but

关键词： Canaloplasty Schlemm’s canal surgery poag

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北京农村及城市特定人群原发性开角型青光眼的患病率调查及其筛查方法评价

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中华眼科杂志 2004年第11期40卷 726-732页

作者：徐亮陈建华李建军罗灵杨桦张蓉秀孙秀英郑远远宋维贤施玉英张士元孙葆忱赵家良马斌荣北京市眼科研究所首都医科大学北京同仁眼科中心100730 中国协和医科大学中国医学科学院北京协和医院眼科研究中心首都医科大学生物医学工程学院解放军第三〇六医院眼科

目的　了解北京地区 4 0岁以上人群原发性开角型青光眼 (poag)的患病率 ,评价poag的筛查方法。方法　于 2 0 0 1年 6～ 10月 ,采取逐户上门登记的方法 ,对北京市区北部 5个社区和北京郊区南端 3个自然村的 4 0岁以上人群进行眼病流行病... 详细信息

目的　了解北京地区 4 0岁以上人群原发性开角型青光眼 (poag)的患病率 ,评价poag的筛查方法。方法　于 2 0 0 1年 6～ 10月 ,采取逐户上门登记的方法 ,对北京市区北部 5个社区和北京郊区南端 3个自然村的 4 0岁以上人群进行眼病流行病学调查。青光眼筛查的现场检查项目包括矫正视力、验光、倍频视野计检测、非接触眼压计测定、VanHerick法评估周边前房深度、眼底照相。凡可疑青光眼及青光眼患者均进行青光眼标准检查 ,包括复查眼压、前房角镜检查、Octopus自动视野计的阈值视野检查、眼底立体照相。结果　农村及城市实查人数分别为 1980人和 2 4 71人 ,共计 4 4 5 1人 ,应答率分别为 79 5 8%和 87 13%。男性人群中农村及城市poag的患病率分别为 1 97%和 2 0 7% ,女性人群中农村及城市poag的患病率分别为 1 0 4 %和 1 4 2 %。poag的患病率随年龄增长呈上升趋势 ,上升曲线呈指数变化。诊断的青光眼患者中 ,约 5 0 %初次测定眼压 poag在农村和城市分别占 92 30 %和 87 30 % ;poag单眼致盲率在农村和城市分别为 15 4 0 %和 10 90 %。结论　采用眼底照相对视神经和视网膜神经纤维层进行综合评价的方法 ,所检出的青光眼患病率高于国内以往的研究结果。

关键词： poag 患病率筛查方法眼底原发性开角型青光眼人群慢性闭角型青光眼农村结论研究结果

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视网膜断层扫描仪在青光眼性视神经病变中的诊断价值

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中华眼科杂志 2004年第11期40卷 737-740页

作者：刘杏梁远波凌运兰黄晶晶郑小平中山大学中山眼科中心广州510060 首都医科大学北京同仁眼科中心

目的　评价视网膜断层扫描仪在青光眼性视神经病变中的诊断价值。方法　应用海德堡视网膜断层扫描仪 (HRT)检测 116例 (116只眼 )正常人和 6 3例 (99只眼 )原发性开角型青光眼(poag)患者的视乳头地形图参数 ,比较两者间各参数的差异 ;... 详细信息

目的　评价视网膜断层扫描仪在青光眼性视神经病变中的诊断价值。方法　应用海德堡视网膜断层扫描仪 (HRT)检测 116例 (116只眼 )正常人和 6 3例 (99只眼 )原发性开角型青光眼(poag)患者的视乳头地形图参数 ,比较两者间各参数的差异 ;将正常人与poag患者的视乳头地形图参数进行逐步判别分析 ,建立判别函数 ,筛选出诊断poag的敏感参数并进行回代分析。结果poag患者的视盘面积 (DA)、视杯面积 (CA)、杯 /盘面积 (C/DAR)、盘沿面积 (RA)、视乳头轮廓线高度变化值 (HVC)、视杯容积 (CV)、盘沿容积 (RV)、平均视杯深度 (MCD)、最大视杯深度 (MxCD)、视杯形态测量 (CSM)、平均视网膜神经纤维层厚度 (mRNFLT)、视网膜神经纤维层截面面积 (RNFLA)与正常人比较差异有显著意义 (P poag诊断敏感的视盘地形图参数为C/DAR、RA、CSM、CV和MxCD ;判别函数式为Y =- 2 0 83- 4 833×C/DAR - 2 0 379×CSM +2 0 35×RA +3 95 5×CV - 3 70 1×MxCD ;对poag诊断的敏感性、特异性及诊断符合率分别为 81 8%、86 2 %及 84 2 % ,与HRT自动分析程序相当。结论　poag患者视乳头地形图与正常人差异较大 ;利用我国人的数据资料建立的判别函数对poag诊断效能与HRT自动分析程序相当。

关键词： poag 诊断视乳头正常人患者 HRT 视神经病变面积参数中国

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