ObjectiveTo evaluate the efficacy and safety of phacoemulsification cataract extraction combined with 180° trabeculotomy assisted by gonioscopy (GT) and combined glaucoma filtration surgery (GFS) in the treatment of primary open angle glaucoma (POAG) with cataract. MethodsThe patients with POAG and cataract in the ophthalmology center of the People’s Hospital of Leshan from June 2021 to March 2022 were included. The patients were divided into GT group and GFS group according to surgical methods. Intraocular pressure (IOP), best corrected visual acuity (BCVA) logMAR, number of anti-glaucoma drugs used, success rate, and complications were compared between the two groups after 1-year followed-up. ResultsA total of 27 patients (43 eyes) in the GT group and 26 patients (34 eyes) in the GFS group were included. There was no significant difference in baseline between the two groups (P>0.05). BCVA logMAR in the GT group was lower than that in the GFS group at 1 year after surgery, the difference was statistically significant (P<0.01). The postoperative IOP in GT group was lower than that in GFS group, the difference was statistically significant (P<0.05). The difference in total effective rate, the number of anti-glaucoma drugs and the incidence of complications between the two groups were not statistically significant (P>0.05). ConclusionPhacoemulsification cataract extraction combined with GT is safe and effective in the treatment of POAG with cataract and has a good effect on reducing IOP.
Objective To identify genes associated with juvenile open-angle glaucoma (JOAG) by screening for gene mutation loci and clinical phenotype analysis in a JOAG family. Methods In January 2021, an ophthalmic examination was performed on members of a family with JOAG. Whole-exome sequencing was done on the proband to look for pathogenic genes. Family members were validated using Sanger sequencing, and a long-term follow-up was conducted. Results Three generations of the family comprised eight individuals, including three patients with JOAG. All patients carried a missense mutation in the MYOC gene c.1130C>G (p.Thr377Arg), which showed autosomal dominant inheritance. Other unaffected family members were not found to have the mutation. Conclusion The c.1130C>G (p.Thr377Arg) mutation in the MYOC gene may be responsible for the pathogenesis of this JOAG family.
Objective To explore the diagnostic value on 24 hour monitoring of intraocular pressure (IOP) for primary open angle glaucoma (POAG). Methods A prospective study was applied, and a total of 372 subjects through January 2012 to May 2015 for 24 hour IOP monitoring were collected successively, including 137 subjects (271 eyes) with glaucoma (glaucoma group) and 235 subjects (470 eyes) with non-glaucoma (Control group). Data was analyzed using SPSS 13.0 software, and the Kappa statistics was used to evaluate concordance between 24 hour monitoring of IOP and gold standard for POAG diagnosis. Results The mean value of IOP at all monitoring period in glaucoma group was significant higher than that in the control group (P < 0.001). The peak of IOP occurred at 6:00 am and 10:00 in the glaucoma group, and the fluctuation value of IOP in women patients at night (especially at 22:00 pm) was higher than that of men (t=2.064, P=0.04). The sensitivity and specificity of 24 hour IOP monitoring for POAG were 97% and 78.7%, respectively, and with a high consistency comparing to the result of gold standard for POAG diagnosis, with the Kappa values of 0.707 (P < 0.000 1). Conclusion 24 hour IOP monitoring is efficacy and convenient tool, which can be applied alone or combined with other tools to assist early diagnosis patients who are suspected with POAG, so as to improve the diagnostic accuracy.
【摘要】 目的 了解原发性开角型青光眼患者用2%盐酸卡替洛尔滴眼液后的眼压及眼脉动幅度变化特征。 方法 选取2009年1－12月确诊为原发性开角型青光眼患者19例32只眼。给予2%盐酸卡替洛尔滴眼液点眼1周，2次/d。用动态轮廓眼压计测量患者用药前后的眼压、眼脉动幅度，同时测量患者的血压及心率。比较用药前后眼压及眼脉动幅度的变化，并用SPSS 14.0统计学软件对用药前后的眼压及眼脉动幅度数据进行配对t检验及Pearson相关性分析。 结果 患者用药前后眼压分别为（22.76±4.29）、（17.79±2.93） mm Hg（1 mm Hg=0.133 kPa），眼脉动幅度分别为（3.47±1.00）、（2.63±0.86） mm Hg。患者的眼压及眼脉动幅度用药后较用药前明显降低，差异有统计学意义（Plt;0.01），用药前后的眼压与眼脉动幅度之间存在正相关关系（r=0.444， 0.364；P=0.011， P=0.040）。眼压及眼脉动幅度与患者的血压及心率均无相关性。 结论 原发性开角型青光眼患者用2%盐酸卡替洛尔滴眼液后眼压及眼脉动幅度均有显著降低，眼压与眼脉动幅度有正相关性。眼压及眼脉动幅度与血压及心率无相关关系。【Abstract】 Objective To investigate the variations of intraocular pressure (IOP) and ocular pulse amplitude (OPA) in patients with primary open-angle glaucoma after 2% carteolol hydrochloride was applied. Methods Thirty-two eyes of 19 patients with primary open-angle glaucoma diagnosed between January and December 2009 were chosen to be the study subjects. The patients received 2% cartelol hydrochloride eye drops twice a day for one week. IOP and OPA before and after using cartelol were measured by dynamic contour tonometry (DCT). Blood pressure and heart rate were detected at the same time. The variations of IOP and OPA were analyzed by SPSS 14.0. t test and Pearson correlation analysis were applied. Results The mean IOP and OPA before and after using cartelol were respectively (22.76±4.29) mm Hg (1 mm Hg=0.133 kPa) vs. (17.79±2.93) mm Hg, and (3.47±1.00) mm Hg vs. (2.63±0.86) mm Hg. Both of them decreased significantly after the use of cartelol (P＜0.01). OPA was obviously correlated with IOP both before and after using cartelol (r=0.444, 0.364; P=0.011, 0.040). OPA and IOP had no correlation with blood pressure and heart rate. Conclusions OPA and IOP decreases signifficantly after the use of 2% carteolol hydrochloride. OPA is signifficantly correlated with IOP. OPA and IOP have no correlation with blood pressure and heart rate.
ObjectiveTo systematically review the association between myopia and open-angle glaucoma (OAG). MethodsForeign and domestic articles published from January 2000 to May 2013 were searched in PubMed, EMbase, WanFang Data, VIP and CNKI for observational studies on the association between myopia and OAG. According to the inclusion and exclusion criteria, the studies were screened, the data were extracted, and the method quality of included studies was assessed. Then meta-analysis was performed using Stata 12.0 software. ResultsEleven cross-sectional studies including 45 996 participants were finally included. The results of meta-analysis showed that, myopia increased the risk of OAG. Besides, the results of subgroup analysis by the severity of myopia showed that, low-degree myopia (more than-3.00 D) increased 1.52 times the risk (OR=1.52, 95%CI 1.23 to 1.88) while middle/high-degree myopia (no more than-3.00 D) increased 2.41 times (OR=2.41, 95%CI 1.91 to 3.03). ConclusionIndividuals with myopia have increased risk of OAG.
ObjectiveTo systematically review the diagnostic value of optical coherence tomography angiography (OCTA) for primary open-angle glaucoma (POAG). MethodsThe CNKI, WanFang Data, VIP, CBM, PubMed, Embase, Web of Science, and Cochrane Library databases were electronically searched to collect diagnostic test on OCTA for POAG from inception to February 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using Stata 15.0 software. ResultsA total of 12 diagnostic tests involving 993 subjects were included. Meta-analysis results showed that the sensitivity/specificity of OCTA for diagnosing peripapillary vessel density, retinal vessel density, and optic nerve fiber changes in patients with POAG were 0.77/0.92, 0.56/0.92, and 0.85/0.91, respectively, and the AUC of the SROC curve was 0.94, 0.92 and 0.95, respectively. ConclusionOCTA has high diagnostic accuracy for POAG. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo observe the changes of subfoveal choroidal thickness (SFCT) under the macular center recess after trabeculectomy in eyes with open-angle glaucoma (POAG), and to preliminarily analyze its relationship with visual function. MethodsA retrospective case-control study. 117 patients with POAG who were diagnosed by ophthalmologic examination and treated with trabeculectomy in Department of Ophthalmology of Shangluo Hospital of Traditional Chinese Medicine from January 2021 to December 2023 were included in the study. Among them, 63 cases were male; 54 cases were female. All of them underwent naked-eye visual acuity, best-corrected visual acuity (BCVA), refraction, optical coherence tomography (OCT) examination, and axial length measurement. SFCT was measured using enhanced deep imaging with an OCT instrument. Based on the visual function reduction at 1 month after surgery, the patients were categorized into a visual function unreduced group and a visual function reduced group of 67 and 50 cases, respectively. Visual function included binocular adjustment amplitude and sensitivity; visual quality included objective scattering index (OSI) and modulation transfer function (MTF). Changes in SFCT and visual function-related indexes were analyzed by repeated-measures analysis of variance; the risk associated with changes in SFCT and visual function-related indexes was evaluated by a binary logistic regression model; and the relationship between SFCT and post-surgical visual function loss was analyzed by a Joint model; the SFCT and post-surgical visual function reduction was analyzed by a Joint model; the dose-response relationship between SFCT and post-surgical visual function decompensation was analyzed by applying the restricted cubic spline (RCS). Decision curve (DCA) was used to predict visual hypoplasia. ResultsComparison of the percentage of patients with different ages, anterior chamber hemorrhage, and post-surgical anterior chamber inflammatory response in the unreduced visual function group and the reduced visual function group showed statistically significant differences (P＜0.05). The results of the main effect test showed that the differences between SFCT and visual function adjustment amplitude, sensitivity time effect, between-group effect, and interaction effect were statistically significant in both groups (P＜0.05). The results of the separate effects test showed that compared with the preoperative period, the SFCT, accommodation amplitude, and sensitivity of the affected eyes of the two groups were significantly increased at different times after surgery, and the differences were statistically significant (P＜0.05). The results of multivariate ANOVA showed that SFCT, accommodation amplitude, and sensitivity at different times before and after surgery were significantly lower in the group with reduced visual function than in the group without reduced visual function, and the differences were statistically significant (P＜0.05). The △naked-eye visual acuity, △BCVA, △OSI, and △MTF of the patients in the group with reduced visual function were significantly lower than those in the group without reduced visual function, and the differences were all statistically significant (P＜0.05). Correlation analysis showed that SFCT was positively correlated with △adjustment amplitude, △sensitivity, △naked-eye visual acuity, △BCVA, △OSI, and △MTF (r=0.426, 0.419, 0.311, 0.315, 0.325, 0.285; P＜0.05). Multiple linear regression analysis showed that △SFCT was positively correlated with △adjustment amplitude, △sensitivity, △naked-eye visual acuity, △BCVA, △OSI, and △MTF before and after adjusting for confounders (P＜0.05). The results of Joint modeling analysis showed that the risk of visual function decompensation was increased by 5% for every 1 µm increase in SFCT. The results of RCS analysis showed a nonlinear correlation between SFCT and surgical The RCS analysis showed that there was a nonlinear relationship between SFCT and post-surgical visual impairment for nonlinear test (P＜0.001); the threshold effect analysis showed that the fold point at which SFCT affected post-surgical visual impairment was 243.25 µm.The DCA analysis showed that SFCT predicted a significant increase in the net clinical benefit rate of post-surgical visual impairment for risk thresholds ranging from 0.00 to 0.84. ConclusionsAfter POAG trabeculectomy, SFCT of those with or without reduced visual function are significantly thickened compared to pre-surgery; the magnitude of visual function adjustment and sensitivity tended to increase significantly after surgery. Naked eye visual acuity, BCVA, OSI, and MTF all have a significant effect on postoperative visual function.
Objective To evaluate the efficacy and safety of latanoprost versus travoprost for primary open-angle glaucoma (OAG) and ocular hypertension (OH). Methods All the randomized controlled trials (RCTs) about treating primary open-angle glaucoma and ocular hypertension with latanoprost and travoprost were collected by searching MEDLINE, EMbase, OVID and CNKI. The assessment of methodological quality and data extraction of the included studies were performed independently by two reviewers, and the meta-analysis was conducted with RevMan 5.0 software. Results A total of 13 RCTs involving 1 433 patients were included. The results of meta-analyses showed that, a) At the second week, travoprost showed greater intraocular pressure (IOP) lowering efficacy compared with latanoprost (WMD= –1.47, 95%CI –2.62 to –0.33). At the first month (WMD= –0.50, 95%CI –1.52 to 0.52) and the sixth month (WMD= –0.12, 95%CI –0.85 to 0.61), the difference of IOP reduction between latanoprost and travoprost group was not significant; and b) The latanoprost-treated group showed fewer reported conjunctival congestion than the travoprost-treated group (OR=0.47, 95%CI 0.35 to 0.63). The difference in adverse events of eye pain (OR=0.55, 95%CI 0.27 to 1.12) and iris or skin depigmentation (OR=1.25, 95%CI 0.53 to 2.92) between latanoprost and travoprost group was not significant. Conclusion Latanoprost and travoprost are comparable in lowering IOP for OAG and OH patients. Latanoprost shows greater ocular tolerability with lower incidence of side effects as conjunctival congestion. This conclusion is not powerful enough in proof due to the medium methodology quality of the included studies, so a large number of high-quality RCTs with large sample are needed for objectively, entirely and precisely evaluating the efficacy.