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王宁利教授丨中国正常眼压性青光眼诊疗专家共识(2019年)

2019-09-07 Fiona MedSci原创

青光眼是一组威胁视神经视觉功能,主要与眼压升高有关的临床征群或眼病。即眼压超过了眼球内组织,尤其是视网膜视神经所能承受的限度,将带来视功能损害。目前研究结果显示中国正常眼压性青光眼(NTG)的患病率达到1.0%,眼压正常值划分不当易导致误诊。2019年,中华医学会眼科学分会青光眼学组综合近年NTG的研究进展和成果,以眼科循证医学为基础,发布了《中国正常眼压性青光眼诊疗专家共识(2019年)》。在本



青光眼是一组威胁视神经视觉功能,主要与眼压升高有关的临床征群或眼病。即眼压超过了眼球内组织,尤其是视网膜视神经所能承受的限度,将带来视功能损害。

目前研究结果显示中国正常眼压性青光眼(NTG)的患病率达到1.0%,眼压正常值划分不当易导致误诊。2019年,中华医学会眼科学分会青光眼学组综合近年NTG的研究进展和成果,以眼科循证医学为基础,发布了《中国正常眼压性青光眼诊疗专家共识(2019年)》。

在本次中华医学会第二十四次全国眼科学术大会上,王宁利教授为我们讲解了该共识

目前,我国原发性开角型青光眼(POAG)的总体合并患病率为2.0%,NTG为1.0%。

NTG占POAG患者中的比列分别如下图:

 

那NTG的发病机制有哪些新发现呢?

目前,已有研究证实眼压降低30%可阻止部分NTG视野进展。说明眼压确实参与了NTG的发病机制。

中国人健康人眼压的95%正常上界低于21mmHg,根据21mmHg来区分NTG/HTG,6.32%POAG被诊断为NTG,实为HTG。

除眼压外, 还有下列其他机制:

非眼压依赖机制----低颅压。研究表明,60%-70%NTG患者颅内压偏低。
非眼压依赖机制----低BMI。根据研究及临床经验,NTG患者BMI指数较HTG及正常人低,BMI与颅内压呈线性相关。
Pasquale通过大规模前瞻性队列研究发现,对于女性来说,BMI每增加1单位,患正常眼压青光眼的风险降低6%。
较高BMI可能因脂肪细胞作为内分泌器官分泌雌激素作用于存在于视网膜节细胞中的雌激素受体,从而起到视神经保护作用。

非眼压依赖机制----Flammer综合征。该类患者具有血管痉挛症状,视神经血流灌注短时间减少。

非眼压依赖机制----筛板缺损。筛板缺损沟通眼内及视神经蛛网膜下腔间隙压力梯度再平衡,视野进展停止。

由此可见,NTG诊疗规范应结合最新研究成果进行进一步修订。

增大压力梯度可导致眼底视网膜血管变细、血流减少。由于NTG视神经损伤的真正原因为眼-颅压力梯度,因此诊断时若单纯以眼压为标准,会造成漏诊率升高。因此在诊断前,需要严格排除以下情况,包括视野缺损相关疾病、视盘异常相关疾病、假性低眼压相关疾病等。

假性低眼压相关疾病包括间歇性贴附性房角关闭、角膜切削手术后的开角型青光眼;糖皮质激素激发青光眼患者停用激素后残留青光眼性视神经损伤;全身应用某种药物后眼压下降,使HTG眼压“正常”等情况,容易造成误诊。

在NTG的治疗方面,我们依据不同NTG类型进行个性化治疗。
 
 

 

 




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    2020-04-30 yzh399
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    2019-09-09 swallow
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盘点:青光眼研究进展

Semin Ophthalmol:XEN植入治疗青光眼的文献综述 希腊雅典Kapodistrian大学医学院的Chatzara A等人近日在Semin Ophthalmol杂志上发表了一篇综述文章,总结了目前关于XEN植入物治疗青光眼的研究现状。 他们对关于XEN植入物及其在治疗青光眼中的应用进行全面的文献检索。筛查出42篇文章,发现37篇文章与其研究相关。这其中,有21篇文章是在评论

Int J Environ Res Public Health:感官听力损失患者中青光眼患病率增加

最近,有研究人员评估了青光眼在诊断为感官听力损失(SNHL)患者中的患病率情况,使用的数据为中国台湾的健康数据库。研究人员进行了回顾性的群体研究,招募了那些符合入选标准的诊断为SNHL的患者,还包括了不患有SNHL的匹配对照组,比例为1:2。主要的结果为青光眼诊断代码的出现情况。研究人员还利用Cox比例风险回归在多变量模型中分析了青光眼的患病率和调整后风险比(aHR)。研究总共包括了15686名诊

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