Objectives To assess the clinical effectiveness of non-penetrating trabecular surgery versus trabeculectomy for open angle glaucoma. Methods We searched the Cochrane Central Register of Controlled Trials (issue 2, 2007), MEDLINE (1966 to May 2008), EMbase (1980 to May 2008), and CMB-disk (1979 to May 2008). We also hand searched relevant journals and conference proceedings. Data were extracted by two reviewers independently using an extraction form. The Cochrane Collaboration’s RevMan 5.0 software was used for statistical analysis. Results Three RCTs involving 127 participants (144 eyes) with previously untreated open angle glaucoma were included. Meta-analysis showed that compared with non-penetrating trabecular surgery, trabeculectomy increased the proportion of patients with reduced postoperative intraocular pressure (WMD2.78, 95%CI 1.41 to 4.15), improved the operation success rate (RR 0.53, 95%CI 0.37 to 0.77), and reduced the use of postoperative antiglaucoma medication (WMD 0.96, 95%CI 0.84 to 1.08). Non-penetrating trabecular surgery reduced the incidence of postoperative complications (RR 17.00, 95%CI 8.36 to 26.00). Conclusion Since the sample sizes of the included trials are relatively small, and the two procedures are also related to progressive visual field loss and optic disk damage, more well-designed large-scale RCTs are required.
目的：本研究通过观察经地塞米松处理前后培养的人小梁细胞的变化,探讨激素性青光眼房水排出阻力增加的机制。方法：将人类小梁细胞培养至接近体内的高分化状态，用地塞米松处理后,观察细胞形态的变化，并检测以下蛋白的分布和表达：(1)myocilin/TIGR蛋白；(2)纤连蛋白；(3)肌动蛋白交联网的形成；(4)血清淀粉样物质A蛋白。结果：人小梁细胞经地塞米松处理后(1)胞体变大，排列不规则，边界模糊，呈“融合”状；(2)细胞内外myocilin/TIGR蛋白表达均明显增加，其胞外表达与纤连蛋白位置一致,提示相互作用；(3)纤连蛋白表达增加；(4)CLANs形成，细胞间连接增强；(5)血清淀粉样物质A蛋白表达增加。结论：人类小梁细胞经地塞米松处理后形态发生变化，可能与应力纤维变化及myocilin蛋白在细胞内积聚有关。细胞间边界不清，与细胞外基质蛋白过度表达、沉积有关。小梁细胞外基质沉积以及异常的细胞间连接等改变与房水排出阻力增加的病理过程有关。
Objective To prepare carboxymethyl-chitosan/hyaluronic acid/poly(vinyl alcohol) (CHP) blend membrane, evaluate its physicochemical properties and intraocular biocompatibil ity and to investigate its feasibil ity to be appl ied to glaucoma filtering surgery. Methods CHP blend membrane was prepared using solution casting method after blending carboxymethyl-chitosan, HA and poly(vinyl alcohol) in a proportion of 5 ∶ 4 ∶ 1 (M/M). Its water absorption rate, swell ing rate, permeabil ity, and mechanical properties were detected. Subconjunctival fibroblasts separated from subconjuncitival tissue of New Zealand white rabbits were cultured, and the cells at passage 4 were cultured on cell culture plate with or without the CHP blend membrane, serving as the experimental group and the control group, respectively. Effectof the CHP blend membrane on the subconjunctival fibroblasts was tested by MTT method 24, 48, and 72 hours after culture. Six New Zealand white rabbits were randomly divided into two groups (n=3 rabbits per group), and the CHP blend membrane and SK gel were implanted into the rabbits’ subconjunctival space and anterior chamber in the experimental group and the control group, respectively. Sl it lamp observation and binocular reaction record were conducted 1, 3, 5, 9, 11, 20, 30, 45, and 60 days after operation. Corneal tissue harvested from the experimental group was observed using scanning electron microscope 15 days after operation to study ophthalmic biocompatibil ity and biodegradabil ity. Results The water absorption rate and the swell ing rate of the CHP blend membrane was 83.8% ± 1.3% and 3.59 ± 0.50, respectively. The tensile strength of the dry and the wet CHP blend membrane was (20.59 ± 1.73) and (0.51 ± 0.13) MPa, respectively. The breaking elongation rate of the dry and the wet CHP blend membcane was 10.69% ± 1.16% and 53.15% ± 2.46%, respectively. The CHP blend membrane had good permeabil ity to NaCl and L-tyrosine. Absorbance (A) value of the experimental group 24, 48, and 72 hours after breeding was 0.207 ± 0.083, 0.174 ± 0.080, and 0.181 ± 0.048, respectively, while the A value of the control group was 0.284 ± 0.011, 0.272 ± 0.083, and 0.307 ± 0.056, respectively. Significant difference was evident between two groups (P lt; 0.05). In the experimental group, a small amount of floccus was exuded around the implanted membrane 1 day after operation; the floccus was absorbed on the third day, and there was no obvious inflammatory reaction occurring on the eleventh day. Most of the membrane degraded on the sixtieth day. Scanning electron microscope observation showed that the hexagonal morphology of the corneal endothel ial cells was intact, and no degradation particles adhered to the surface. In the control group, the implantation of SK gel into anterior chamber was unsuccessful because the SK gel was quite soft and easily broken. In the experimental group, mild hyperemia emerged around the implanted membrane 1 day after the subconjunctival implantation of the membrane, and it became normal on the ninth day. No corneal edema and inflammatory reaction of anterior chamber occurred till the sixtieth day. The results in the control group and the experiment group were similar. Conclusion Due to its good physicochemical properties and biocompatibil ity, the CHP blend membrane has potential appl ications in glaucomafiltering surgery.
Objective To observe the location of peripapillary choroidal watershed zones relative to the optic disc in the different types of glaucoma. Methods A total of 98 patients (98 eyes) with glaucoma (glaucoma group) were enrolled in this study. The eyes included 34 eyes with primary open-angle glaucoma (POAG group), 33 eyes with normal tension glaucoma (NTG group) and 31 eyes with chronic angle closure glaucoma (CACG group). Thirty-seven fellow eyes of 37 patients with monocular blunt trauma were selected in this study as control group. The differences of age (t=1.197), sex (chi;2=3.548), average diopter (t=-1.644) between glaucoma group and control group were not statistically significant (P＞0.05). The differences of age (F=2.645), sex (F=1.984), average diopter (F=2.621), and visual fields mean defect (MD) (F=0.899) between different types of glaucoma were also not statistically significan(P＞0.05).Simultaneous indocyanine green angiography (ICGA) and fundus fluorescein angiography (FFA) were performed on all subjects. The watershed zones were classified into three types according to its location relative to the optic disc: in type Ⅰ, the watershed zone did not include the optic disc or could not be observed; in type Ⅱ, the watershed zone partially included the optic disc; in type Ⅲ, the watershed zone completely included the optic disc. The location of watershed zones relative to the optic disc in the different types of glaucoma was comparatively analyzed. The relationship between watershed zones, type and age, and MD were also analyzed by Pearson analysis method. Results The constituent ratio of type Ⅱ and Ⅲ watershed zones were 81.6% and 56.8% in glaucoma group and control group, respectively; with a statistically significant difference (chi;2=8.756,P＜0.003). The constituent ratios of type Ⅱ and Ⅲ watershed zones were 82.4%, 90.9%, 71.1% in POAG, NTG and CACG group, respectively. No significant differences were found between POAG and NTG group (chi;2=1.039), POAG and CACG group (chi;2=1.039, 1.166;P＞0.05). But there was significant difference between NTG and CACG group (chi;2=4.107,P＜0.05). Significant differences were found between POAG and control group, NTG and control group (chi;2=5.352, 10.141;P＜0.05). No significant difference was found between CACG and control group (chi;2=1.444,P＞0.05). There was no correlation between age and watershed zone type (r=0.114,P＞0.05). The watershed zones type of glaucoma group positively correlated with MD (r=0.354,P=0.000). Conclusion The peripapillary choroidal watershed zones in glaucoma patients include the optic disc more than in healthy eyes.
Objective To measure optic disc parameters in Mongolian and Han healthy subjects with or without family history of glaucoma, to explore the causes of the differences and their significance in the diagnosis of early glaucoma. Methods Fifteen healthy Mongolian individuals (30 eyes), 30 healthy Han individuals (60 eyes) with a family history of open-angle (30 eyes) or angle-closure (30 eyes) glaucoma, and 45 healthy Han individuals (90 eyes) without a family history of glaucoma were enrolled in this study. The 45 healthy Han individuals without a family history of glaucoma included three age-groups: 20 to 29 years old group, 30 to 39 years old group and 40 to 49 years old group, each group have 15 subjects (30 eyes). Thirteen parameters were measured by Heidelberg retina tomography (HRT) for all subjects, including disc area, cup area, rim area, cup volume, rim volume, cup/disc area ratio, linear cup/disc ratio, mean cup depth, maximum cup depth, cup shape, disc height variation contour, mean retinal nerve fiber layer (RNFL) thickness and optic nerve fiber layer crosssectional area. The results were analyzed and compared between the above groups. Results There was no statistically significant (t=0.791,P=0.132) of the height variation contour between Mongolian and Han without a family history of glaucoma (20 to 29 years old) group. The other parameters of Mongolian were smaller than Han without a family history of glaucoma (20 to 29 years old) group, but the difference was not statistically significant (t=-1.039, -0.799, -0.840,-1.108, -0.956, -0.695, -0.931, -1.099, -1.074, -0.580, -0.204, -1.425; P＞0.05). The parameters in Han with a family history of open-angle glaucoma group were bigger than Han without a family history of glaucoma (30 to 39 years old) group. The differences were statistically significant for disc area, cup area, rim area, cup volume, rim volume, cup area ratio, linear cup/disc ratio, mean cup depth, cup shape measure, nerve fiber layer cross-sectional area (t=4.758, 3.187, 2.544, 2.674, 1.798, 3.676, 2.721, 2.715, 2.510, 2.373; P＜0.05), but were not statistically significant for maximum cup depth, disc height variation contour and mean RNFL thickness (t=1.649, 1.565, 0.767; P＞0.05). Most parameters in Han with a family history of angle-closure glaucoma group were the same as that in Han without a family history of glaucoma (40 to 49 years old) group, including cup area, rim area, cup volume, rim volume, cup/disc area ratio, linear cup/disc ratio, mean optic cup depth, maximum cup depth, cup shape, disc height variation contour, mean RNFL thickness, optic nerve fiber layer cross-section (t=1.201, 1.697, 1.000, 0.516, 0.740, -0.172, -0.070, -0.972, 1.530, -0.390, -0.091, 0.659; P＞0.05); but the difference of disc area between these 2 groups was statistically significant (t=2.224,P＜0.05). Conclusions The family history of glaucoma can change the optic disc parameters of healthy individuals, especially those with a family history of open-angle glaucoma. There is no difference of optic disc parameters between healthy Mongolian and Han subjects.