目的：分析人工晶体术后继发青光眼的临床特征。方法：分析36例36只眼人工晶体术后继发青光眼患者视力、眼压、房角、人工晶体情况、青光眼类型、超声生物显微镜（UBM）检查及治疗情况。结果：36眼视力为无光感～0.8，平均眼压为42.8±15.1mmHgo26只眼（72.2%）房角关闭，9只眼（25%）房角开放。11只眼（30.5%）人工晶体偏位（6只眼人工晶体夹持）；人工晶体拌位置异常者7例（19.4%）.继发闭角型青光眼26只眼（72.2%），开角型青光眼9只眼（25.0%）。15只眼行UBM检查，图象显示4只眼虹膜膨隆房角关闭，5只眼虹膜平坦房角关闭，3只眼为宽角;2只眼睫状体水肿.9只眼人工晶体位置正常，6只眼人工晶体和域拌位置异常，2只眼晶体皮质残留。33只眼施手术治疗，3只眼单纯药物治疗，治疗后眼压为12.0±4.6mmHg，治疗后视力低于0.3者26只眼（72.2%）。结论：人工晶体术后继发青光眼原因复杂，临床表现多样化，治疗棘手，视功能恢复不良。UBM对人工晶体术后继发青光眼诊断、分析及处理有较好的辅助作用。

Objectives To investigate image characteristics and thickness of the retinal nerve fiber la yer (RNFL) in normal and glaucomatous eyes using optical coherence tomography (OCT), and analyze the relationship between RNFL thickness and visual field index. Methods Eighty-three normal persons (150 eyes) and 83 patients with primary open angle glaucoma (POAG, 149 eyes) underwent OCT examinations with 3.4mm diameter circ le scan to calculate the RNFL thickness. Statistical analysis was used to compa re differences in RNFL thickness in quadrants and means between the normal and glaucomatous groups and the different stages of POAG. Linear correlation and reg ression analysis were used to show the correlation between RNFL thickness and vi sual field index of 115 eyes in glaucomatous patients. Reproducibility, sensiti vity and specificity of RNFL measurements using OCT were evaluated. Results RNFL thickness measured by OCT in normal subjects was thicker in superior and in ferior, less in temporal, and thinnest in nasal quadrants. The curve showed dou ble peaks. RNFL of glaucomatous patients showed local thinning or defect, diffu se thinning, or both. The mean RNFL thicknesses of the normal group in the temp oral, superior, nasal and infeior quadrants were 90.1±10.8μm, 140.4±10.5μm, 85.2±14.0μm, and 140.4±9.7μm, respectively with a mean of 114.2±6.0μm.The numbers for the glaucomatous group were respectively 56.0±31.0μm, 81.0±36.3μm, 47.1±27.5μm, and 73.4±38.4μm for th e four quadrants, with a mean of 64.6±28.8μm. There was a significant dif ference in RNFL thickness between the normal and glaucomatous groups (P<0.000), and the three stages (early, developing and late) of glaucomatous groups (P<0.000). There was a close negative relationship between RNFL thickness a nd visual field index (r=-0.796, P<0.0001). The sensitivity and speci ficity of RNFL thickness in POAG measured using OCT were 93.3% and 92.0%, res pectively. Conclusions OCT can quantitatively measure RNFL thickness differences between normal persons and glaucomatous patients. RNFL thickness gradually decreases while visual fie ld defect increases with the development of POAG.

【目的】探讨羊膜在青光眼滤过手术中应用的降压效果及安全性。【方法】将各类型青光眼38例44只眼分为3组，A组为巩膜瓣下羊膜移植术（AMT）组（20只眼）；B组为巩膜瓣下联合应用丝裂霉素组（12只眼）；C组为对照组（12只眼），行单纯小梁切除术。观察手术前、术后第1、2、3、7、14、21天、第1、3、6个月各组的视力、眼压、滤过泡类型和充血程度、前房深度、眼底情况及并发症，用前房激光蛋白细胞检测仪（LFCM）测量术前和术后第1、3、7天和1个月的前房蛋白含量，进行统计学分析。【结果】3组术后平均眼压均控制在21mmHg以下，术后7～14d眼压最低：3组各观察点之间比较P值均大于0.05，差异无显著性。44只眼中40只眼为Ⅱ型滤过泡，4只眼为包裹性囊状滤过泡。羊膜组滤过泡术后2d较扁平，第3天起隆起呈弥散的Ⅱ型泡；羊膜组早期滤过泡充血较轻，与其它两组比较差异有显著性（P<0.05）。羊膜组前房蛋白含量术前、术后第1天、第30天均高于其他两组，差异有显著性（P<0.05）。【结论】羊膜运用于青光眼滤过手术中可以有效地降低眼压，减轻炎症反应，并发症较少。羊膜移植术后前房房水蛋白含量增加，可能与羊膜本身蛋白溶解有关。