Objective To observe the location of the watershed zones of the choroidal blood supply relative to the optic disc in glaucoma by indocyan ine green angiography, and to investigate the mechanisms in the development of glaucomatous neuropathy. Method Simultaneous ICGA and FFA were performed on 31 eyes of 31 patients with glaucoma (17 of POAG, 14 of NTG) and 37 eyes of 37 control subjects. The watershed zones were classified into three types according to their location relative to the optic disc: by type I, no water shedzone around the optic disc; type II, the optic disc surrounded partially by watershed zone; type III, the optic disc surrounded completely by watershed zone. Each of the watershed zone types was scored (i.e., type I=1, type II=2, type III=3). Results In 87.1% of the glaucomatous eyes , the watershed zones included or partially included the optic disc. However, the figure in the control group was 56.8%. The glaucoma group had a higher score of watershed zone type than the control group. Conclusions The mechanisms in the development of glaucomatous neuropathy are correlative to the choroidal blood supply around the optic disc. (Chin J Ocul Fundus Dis，2004，20：218-220)
ObjectiveTo explore the effects of vitrectomy on neovascular glaucoma combined with vitreous hemorrhage.MethodsSeven eyes of 7 patients with neovascular glaucoma combined with vitreous hemorrhage underwent vitrectomy combined with phacoemulsification, panretinal photocoagulation, and trabeculectomy. The preoperative visual acuity ranged from light perception to 0.2, and the mean preoperative intraocular pressure was 54 mm Hg (38-64 mm Hg)(1 mm Hg=0.133 kPa). The mean follow-up was 8 months (6-15 months).ResultsThe postoperative visual acuity ranged from light perception to 0.4, and the mean postoperative intraocular pressure was 17 mm Hg (10-30 mm Hg) which was significantly lower than preoperative one (Plt;0.05). The postoperative complications mainly included fibrosis exudates in anterior chamber (7 eyes), intraocular pressure elevation 1-2 weeks after the operation (2 eyes), and postoperative suprachoroidcavity hemorrhage (2 eyes).ConclusionVitrectomy combined with phacoemulsification, panretinal photocoagulation, and trabeculectomy may be effective procedures for some cases of neovascular glaucoma combined with vitreous hemorrhage.(Chin J Ocul Fundus Dis, 2005,21:148-149)
To observe the efficacy of intravitreal injection of conbercept (IVC) combined with panretinal laser photocoagulation (PRP) in the treatment of diabetic retinopathy (DR) combined with stage I and II neovascular glaucoma (NVG).MethodsA clinical case-control study. From October 2013 to March 2019, 50 eyes (50 patients) with DR and stage Ⅰ to Ⅱ NVG diagnosed in the Department of Ophthalmology, Peoples's Hospital of Xianghe were were included in the study. There were 27 eyes (27 males) and 23 eyes (23 females); all patients were monocular with the average age of 53.5±7.13 years old. Stage Ⅰ and Ⅱ NVG were 11 and 39 eyes, respectively. All patients underwent BCVA, intraocular pressure, and fundus angiography. The BCVA examination adopted the international standard visual acuity chart, which was converted to logMAR BCVA visual acuity in statistics. The patients were divided into the Conbercept+laser therapy (combination therapy) group and the laser therapy group by random number table, with 25 eyes. The age of the two groups of patients (t=0.058), gender composition ratio (χ2=0.081), logMAR BCVA (t=0.294), intraocular pressure (t=－0.070), the number of eyes with different grades of angle and iris neovascularization（χ2=1.683, 0.854）were compared, the difference was not statistically significant (P＞0.05). The changes of BCVA, intraocular pressure, iris neovascularization, and angular neovascularization were compared and observed between the two groups one week after the completion of PRP treatment, 1, 3, 6, and 9 months. Independent sample t test was used for continuous variables. Between the combination treatment group and the laser treatment group, at different time points within the two groups and the interaction of the two factors, a single-factor repeated analysis of variance was used.ResultsCompared with the results before treatment, the combined treatment group and laser treatment group had statistically significant differences in the number of angle and iris neovascularization, intraocular pressure and logMAR BCVA at different times after treatment in the combined treatment group and laser treatment group (F=124.211, 65.153, 69.249, 26.848; P＜0.001). After treatment, the combined treatment group was better than the laser treatment group in terms of the regression of eye angle and iris neovascularization, intraocular pressure and logMAR BCVA, and the difference was statistically significant (F=47.543, 25.051, 12.265, 9.994; P=0.001, 0.001, 0.001, 0.003). At different times after treatment, compared with the laser treatment group, the number of neovascularization in the iris and angle of the eye in the combined treatment group was less, the intraocular pressure was significantly decreased, and the BCVA was increased. The difference was statistically significant (P＜0.05).ConclusionThe efficacy of Kang IVC combined with PRP in the treatment of DR with stage Ⅰ and Ⅱ NVG is better than that of PRP alone.
ObjectiveTo compare the lamina cribrosa parameters between primary open angle glaucoma (POAG) and chronic primary angle closure glaucoma (CPACG) eyes.
MethodsA total of 73 POAG eyes (73 subjects), 64 CPACG eyes (64 subjects), and 40 normal control eyes (40 subjects) with matched ages were included in this cross-sectional observational study. No significant difference was found in sex (χ2=2.07) and age (F=0.38) among three groups (P > 0.05). The intraocular pressure, average retinal nerve fiber layer (RNFL) thickness and average visual field defect were not significantly different between POAG and CPACG patients (F=15.67, 21.15, 44.40, 27.99; P < 0.05). All subjects underwent spectral-domain optical coherence tomography (SD-OCT) with enhanced depth imaging (EDI). The optic nerve head was scanned radially at the angle of 20; six high resolution B-scan images were obtained from each eye. The center and para-center lamina cribrosa thickness (LCT) and anterior lamina cribrosa surface depth (ALCSD) were measured in each image. The mean LCT and ALCSD were recorded as the average of the LCT and ALCSD of the 6 images and compared among POAG, CPACG and normal control eyes.
ResultsThe average LCT of normal control eyes were (211.48±12.07) μm, while those of the POAG eyes were (145.43±34.33) μm, CPACG eyes were (156.79±33.66) μm. The mean LCT of the POAG and CPACG eyes were thinner than those of the control eyes (t=-11.76, -9.88; P < 0.01). All LCT of the POAG eyes were significantly thinner than those of the CPACG eyes (t=-1.96, P=0.03).The average ALCSD of normal control eyes were (390.73±84.40) μm, while those of the POAG eyes were (558.51±176.66) μm, CPACG eyes were (539.39±177.30) μm, respectively. The average ALCSD of the POAG and CPACG eyes were deeper than those of the control eyes (t=5.65, 4.96; P < 0.01). But no significantly different ALCSD was shown between POAG and CPACG eyes (t=0.63, P=0.49).
ConclusionsPOAG and CPACG eyes have thinner LCT and deeper ALCSD than normal eyes. POAG eyes have thinner LCT than CPACG eyes when their visual field defect and damage of RNFL were in the same degree.
Objective To observe the changes of visual pathway of central nervous system in patients with glaucoma.Methods Thirty-five subjects were enrolled in this prospective study. There were seven patients of chronic primary angle closure glaucoma with bilateral visual field defects, 12 patients of primary open angle glaucoma with bilateral visual field defects, and 16 normal subjects. GE Signa HD 1.5 T magnetic resonance scanners and head eight phased array were used. The mean fractional anisotropy (FA) and the mean average diffusion coefficient (DCavg) of white matter tracts in visual pathway of bilateral optic nerve, optic chiasma, bilateral optic tract，bilateral optic radiation were measured by diffusion tensor imaging, meanwhile the white matter tracts were reconstructed by fiber tracking system. The volumes of lateral geniculate body were measured by coronal proton density weighted magnetic resonance imaging.Results The differences of FA among bilateral optic nerve, optic chiasma, bilateral optic tract，bilateral optic radiation were statistically significant (F=25.985，20.626，12.262，22.399，21.708，24.994，22.774；P＜0.05). There was no difference of DCavg among bilateral optic nerve, optic chiasma, bilateral optic tract，bilateral optic radiation（F=2.097，2.178，0.530，0.983，0.608, 0.866, 1.504；P＞0.05）. The differences of volume of lateral geniculate body among three groups were statistically significant （F=18.631，17.274；P＜0.05）. Conclusion There is degeneration in visual pathway of central nervous system in patients with glaucoma.
Objective
To evaluate glaucoma and anterior chamber angle changes after intravitreal silicone oil injection(SOI).
Methods
The intraocular pressure(IOP) and anterior chamber angles of 34 e yes(33 patients)undergone pars plana vitrectomy and SOI were observed.
Results
Glaucoma occurred in 9 eyes(26%),in which silicone oil glaucoma(SOG) accounted for 77%(7/9).The changes of the superior part of anterior chamber angle were peripheral anterior synechiae in 11 eye(32%) and SO emulsification droplets in 22 eyes(64%) in 1～4.5 months after surgeries.Glaucoma occurred in 6 eyes of 7 eyes undergone peripheral iridectomy at the inferio r part of the iris after the closure of iridectomy holes (plt;0.05).
Conclusion
High incidence of glaucoma was found in this series of patients after intravitreal silicone oil injection,and the main causes of SOG were closure of the inferior iridecomy hole and silicone emulsification.
(Chin J Ocul Fundus Dis, 2001,17:105-107)
ObjectiveTo observe the differences in scleral lamina curvature (SLC) of patients with pseudoexfoliation glaucoma (PXG), primary open-angle glaucoma (POAG), and primary chronic angle-closure glaucoma (CPACG) were compared and analyzed and their significance was analyzed.MethodsA retrospective clinical study. From June 2017 to December 2020, 30 PXG (PXG group), POAG (POAG group) and CPACG patients (CPACG group) diagnosed at Eye Center of Cangnan County people's Hospital of Zhejiang Province (Cangnan Hospital Affiliated to Wenzhou Medical University) were included in the study. The age difference between the three groups of patients was statistically significant (t=17.925, P=0.001); gender composition ratio (χ2=2.158, P=0.276), intraocular pressure (t=4.993, P=0.078), and axial length (t=1.956, P=0.532), central corneal thickness (t=1.407, P=0.724), average visual field defect (t=2.725, P=0.496), optic disc retinal nerve fiber layer thickness (t=2.185, P=0.492) in comparison, the differences were not statistically significant (P＞0.05). The frequency-domain optical coherence tomography deep-enhanced imaging (OCT EDI) technology was used to measure the average and 0°, 30°, 60°, 90°, 120°, 150° SLC of the affected eyes, and calculate the SLC index (SLCI) and SL curve depth (SLCD). Quantitative data comparison between groups used independent sample t test. Count data comparison used χ2 test. Univariate and multivariate logistic regression analysis were used for correlation analysis.ResultsThe results of OCT EDI examination showed that the SLC of eyes with PXG and CPACG was significantly steep, while the SLC of eyes with POAG was relatively flat. Except for the angle of 150°, the other 6 angles of SLCI and SLCD in the PXG group and CPACG group were higher than those in the POAG group, and the differences were statistically significant (P＜0.05). However, there was no statistically significant difference between PXG group and CPACG group for 7 angles of SLCI and SLCD (P＞0.05). Logistic regression analysis showed that the average SLCI [odds ratio (OR)=1.498, 95% confidence interval (CI) 1.137-2.018, P=0.001], age (OR=1.074, 95%CI 1.019-1.143, P=0.016) was significantly correlated with PXG; mean SLCI (OR=1.625, 95%CI 1.192-1.997, P=0.001), intraocular pressure (OR=1.383, 95%CI 1.106-1.993, P=0.012) was significantly correlated with CPACG. POAG group (β=0.143, 95%CI 0.032-0.208, P=0.016), CPACG group (β=0.132, 95%CI 0.079-0.315, P=0.043) intraocular pressure was correlated with mean SLCI; all factors of PXG group were correlated with SLCI without correlation (P＞0.05).ConclusionCompared with POAG, the SLC of eyes with PXG and CPACG is steeper and related to disease occurrence.
Objective
To evaluate the effects of cold provoca tion on optic dise blood flow and retinal light sensitivity of primary open-angle glaucoma (POAG) patients,and explore the relationship between the changes of optic disc blood flow and retin al light sensitivity.
Methods
A total 33 POAG patients (33 eyes)and 13 normal controls (13 eyes) were tested by usin g th e Heidelberg retinal flowmetry (HRF) and Topcon automatic perimeter,and the optic disc blood flow and retinal light sensitivity of POAG patients and normal cont rols were measured at normal conditions and after cold provocation.
Results
The mean optic disc blood flow,volume and the mean retinal light sensitivity of POAG patients decreased significantly (Plt;0.05) after cold provocation.There was a linear and significant relationsh ip between the decrease of mean optic disc blood flow and mean retinal light sen sitivity of POAG patients (r=0.615,P＜0.001). The optic disc blood flow of POAG patients with a history of migraine were more likely to r educe in response to cold provocation and reduced much more than those without such history (Plt;0.05).
Conclusion
Cold provocation can significantly reduce both the optic disc blood flow and retinal light sensitivity in POAG patients.A close correlation was fo und between the amount of mean optic disc blood flow decrease and the volume of mean retinal light sensitivity decline.
(Chin J Ocul Fundus Dis, 2001,17:37-40)
As a neurodegenerative disease of the retina, glaucoma can cause irreversible vision loss in patients. More and more evidences indicate that systemic blood flow abnormalities, decreased optic nerve blood flow, and retinal microcirculation disorders are related to the mechanism of glaucoma ganglion injury. Optical coherence tomography (OCTA) has the advantages of non-invasive, high resolution, quick inspection, three-dimensional imaging, and quantitative blood flow perfusion. Compared with other blood flow detection methods such as color ultrasound Doppler, laser speckle blood flow imaging, etc. it has higher performance and accuracy, and is easier to be applied in clinical practice. OCTA can not only be used for the early diagnosis and follow-up of glaucoma, but has a strong correlation with retinal nerve fiber layer thickness and visual field parameters; it can also provide objective data for the follow-up of patients with advanced glaucoma to assess the progress of the disease. In the future, OCTA is expected to become a routine detection method and follow-up method for the diagnosis of glaucoma.
Objective To evaluate the efficacy of intravitreal injection with Bevacizumab for iris neovascularization (INV) which caused by proliferative dia betic retinopathy (PDR) or central retinal vein occlusion (CRVO). Methods The clinical data of 39 patients (47 eyes) with INV who undergone intravitreal injection with Bevacizumab from 12,2006 to 3,2007 in Department of Ophthalmology, Peopleprime;s Hospital of Peking University were retrospectively analyzed. The patients (22 males and 17 females, 23 left eyes and 24 right eyes) aged from 28 to 82 years with the average of （57.77plusmn;13.0）years. 26 cases (34 eyes) were PDR and 13 cases (13 eyes) were CRVO. All of patients underwent intravitreal injection with 1.25 mg/0.05 ml Bevacizumab. Follow-up time was 1 day, 3 days, 1 week, 3 week s and 6 weeks after the treatment. The visual acuity, changes of intraocular pre ssure and changes of INV before and after the treatment were observed and analyzed. Results In patients with PDR, the visual acuity was improved in 19 eyes (55.9%), was stable in 15 eyes (44.1%) and none decreased. In patients with CRVO, the visual acuity was improved in 4 eyes (30.8%), was stable in 9 eyes (69.0%) and none decreased. Among neovascular glaucoma (NVG), decreas e of IOP was noticed in 16 eyes with PDR (80%) and 6 eyes with CRVO (667%). Re gression of INV was noticed in 97.1% PDR patients and 84.6% CRVO patients. Conclusions Intravitreal injection with Bevacizumab is very effective in treating INV. Further researches still needs to explore long term efficacy, safety and complications of this t reatment. （Chin J Ocul Fundus Dis，2008，24：176-179）
