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1 Consensus of Glaucoma: China As a service to its members and the ophthalmologists in China, Chinese Glaucoma society has developed a consensus of glaucoma including diagnosis and treatment principles. The Consensus of Glaucoma: China is based on the evidence- based medicine data as interpreted by panels of knowledgeable glaucoma professionals, and relied on the panels collective judgment and evaluation of available evidence. 1. Ophthalmic Examination l Intraocular pressure measurement Compared to other tonometers, IOP is measured preferably by Goldmann applanation tonometry. Recording if there were lowing IOP medications before the measurement. Abnormal IOP should be considered of other influential factors. l Fundus examination Fundus examination is recommended based on direct ophthalmoscopic examination first. The preferred technique for fundus examination are slit lamp supplementary lens and fundus camera, and should be follow- up recorded the alternation. Optic rim, retinal nerve fiber layer and cup/disc ratio should be evaluated emphatically. Optic disc could be evaluated based on ISNT principle and widest part in nasal principle. l Visual field examination Automated static threshold perimetry is the preferred technique for evaluating the visual field. Consistency and reliability should be taken into consideration. l Gonioscopy First, static viewing to evaluate the depth of anterior chamber angle without changes the anatomic structure, and use Scheie scheme for grading the anterior chamber angle. Second, dynamic viewing to evaluate if the anterior chamber angle is open or closed, the degree and scope of peripheral anterior synechia. The examination result should be noted if it was evaluated under static or dynamic viewing. The results should include: the description of anterior chamber angle in clock position in

evaluation of available evidence. 1. Ophthalmic Examination l Intraocular pressure measurement Compared to other tonometers, IOP is measured preferably by Goldmann applanation tonometry.

2 words and pictures, morphology of peripheral iris(convexity or sunken), Grading of trabecular meshwork pigment, IOP and medication before gonioscopy examination. 2. Diagnosis of POAG l Definition: POAG is a kind of chronic, progressive pathology of optic nerve and pathologic high intraocular pressure is the critical cause of optical nerve lesion. Acquired optic nerve atrophy, retinal ganglion cells and axon loss are main characters of POAG. Besides, there should be no other ocular and systemic diseases that can result in the pathologic change mentioned before and the anterior angle keeps opening while intraocular increasing. l Classification :1High intraocular pressure POAG: pathologic high intraocular pressure[24h peak IOP > 21mmHg(1mmHg=0.133kPa)], characteristic glaucomatous neuropathy(retinal nerve fiber layer defect, RNFLD or optic disc change), and/or visual field loss, open anterior chamber angle, exclusion of other causes result in high intraocular, disease which presents those lesions can diagnose as POAG.2Normal tension POAG: 24h peak intraocular pressure is no more than threshold of normal IOP(IOP 21mmHg), characteristic glaucomatous neuropathy (retinal nerve fiber layer defect, RNFLD or optic disc change), and/or visual field loss, open anterior chamber angle, exclusion of other causes result in high intraocular, disease which presents those lesions can be diagnosed as normal tension glaucoma. 3Hypertension POAG: ocular pressure is higher than normal threshold but there is no characteristic glaucomatous retinal nerve fiber layer defect and/or glaucomatous optic neuropathy, wide anterior chamber angle, exclusion of secondary glaucoma or other factors result in pseudo hypertension such as thicker cornea measurements and so on. Disease that presents those lesions can be diagnosed as hypertension. But it is important to exam optic disc, retinal nerve fiber thickness and visual field. People whose IOP > 25mmHg and central corneal thickness 555μm are in high risk thus therapy to decrease the intraocular is needed. 3. Diagnosis of PACG

Acquired optic nerve atrophy, retinal ganglion cells and axon loss are main characters of POAG.

3 l Definition: Primary angle closure, which leads to acute or chronic IOP elevation, glaucomatous optic neuropathy and vision loss would exist or not. POAG could be classified into acute or chronic type according to clinical manifestation. l Early Detection: Patients with risk factors like: old age, anatomic structure of shallow anterior chamber and narrow angle should have opportunistic screening for primary glaucoma. Both Gonioscopy and UBM can be applied to PACG early detection, because they have over 80-90% consistency. Gonioscopy is preferred because it allows the clinician actual visualization of angle structures. Gonioscopy combined UBM is suggested in high level settings. l Clinical Phase: According to traditional classification, acute PACG is classified into: preclinical phase, aura phase, acute phase, remission phase and chronic phase. Chronic PACG is classified into early phase, progressive phase and advanced phase. End phase is defined for patients of blindness. l Provocative Testing: Improved provocative test to monitor short- term angle closure (Evaluate anterior chamber angle by UBM in bright and dark room or 3 min dark adaptation), then 1- hour dark room test to measure the IOP. If angle closure or IOP elevation is detected in the improved provocative test, the patients should be evaluate if he should take management. Positive result can be diagnostic basis. PACG cannot be ruled out by negative result. 4. Management of POAG l Drugs, laser and filtration operation are all available to decrease intraocular pressure and they are chosen according to the patients' intraocular, visual field and lesion degree, combining with the hospital conditions and doctors' experience. l When lowering intraocular pressure, we should set individual target IOP l Available local lowering IOP drugs: prostaglandin derivatives are suggested to be used as first- line drug.1prostaglandin analogues;2β - blockers; 3α2- agonists; 4 local carbonic anhydrase inhibitors; 5 parasympathomimetic. According to the patients' target IOP to choose

l Early Detection: Patients with risk factors like: old age, anatomic structure of shallow anterior chamber and narrow angle should have opportunistic screening for primary glaucoma.

4 single or combined drug treatment. We can choose combined drug if the single drug is not effective. l Laser treatment: Laser trabeculoplasty can be used as the primary treatment for some POAG patients. l Surgical treatment: 1If drugs or laser treatment can not control the disease progress or patients can not tolerate drugs then filtration operation should be considered. The operations include trabeculectomy, non- penetrating trabeculectomy, implantation of a glaucoma drainage device, ciliary body photocoagulation. Patients' age, disease progress, drug treatment response should been taken into account to acquire the maximum benefit.2antimetabolic agents(mitomycin and 5- fluorouracil) can be uses to prevent failure of filtration surgery. 3Implantation of a glaucoma drainage device is available for glaucoma patients fail of filtration surgery and unuseful of drugs.4ciliary body photocoagulation is one of the safe and effective surgery methods for refractory glaucoma. l Optical nerve protection therapy should be taken into consideration. 5. Management of PACG l Surgical indication of peripheral iridectomy:acute/chronic anterior chamber angle closure, the scope of angle closure<180, without glaucomatous optic neuropathy and vision loss. l Surgical indication of filtration surgery: Acute/chronic anterior chamber angle closure, the scope of angle closure>180, Pharmaceuticals that lower IOP have been unsuccessful / with severe optic neuropathy. The combined trabeculectomy is preferred. l For patients with angle closure >180 and part of the angle is open, IOP elevate, high risk for surgical complication,peripheral iridotomy should be performed. Pharmaceuticals should be given if lower IOP have been unsuccessful after surgery. l When acute ACG attack, topical and systemic medicals should be promptly given to reduce IOP. When the acute ACG attack cannot be broken of initiating treatment, paracentesis should be performed in emergency to reduce IOP before surgery, or reduce the IOP during surgery.

l Surgical treatment: 1If drugs or laser treatment can not control the disease progress or patients can not tolerate drugs then filtration operation should be considered.

5 l l l For patients of acute or chronic PACG, the fellow eye without glaucomatous sign and with angle closure possibility, peripheral iridotomy or iridectomy should be performed to prevent acute ACG attack. Iridoplasty should be performed for ACG with non- pupillary block mechanism. Surgical indication of filtration surgery combined cataract surgery: for cataract patients who have indications for filtration surgery. Surgical indication of cataract surgery: for patients who have indications for cataract surgery and need iridectomy in the same time. Panels of glaucoma professionals who made contributions on The Consensus of Glaucoma: China Jian Ge, Zhong Shan eye centre, Zhongshan University Ningli Wang, Beijing Tongren Hospital, Beijing institute of ophthalmology Xinghuai Sun, Fudan eye centre Liang Xu, Beijing Tongren Hospital, Beijing institute of ophthalmology Jialiang Zhao, Beijing Xiehe hospital Xiaoming Chen, Huaxi Hospital, Sichuan Province Hongying Cai, Tianjing Eye Hospital Xuanchu Duan, Xiangya No 2 Hospital,Central South University Aiwu Fang, Ophthalmological Hospital Affiliated to Wenzhou Medical College Pei Fu, Department of Ophthalmology, Shenzhen Hospital affiliate to Peking University Xiangge He, Department of Ophthalmology Daping Hospital of Third Military Medical University of Chongqing Lina Huang,Shenzhen Eye hospital Jianhua Lv,Hebei Xingtai Eye hospital Ding Lin, Changsha Aier Eye Hosptal Xuyang Liu, Shenzhen Eye Hospital Yingzi Pan,Department of Ophthalmology No.1 Hospital of Peking University

Surgical indication of filtration surgery combined cataract surgery: for cataract patients who have indications for filtration surgery.

6 Zeqin Ren,Department of Ophthalmology Peking University People's Hospital Naixue Sun,Department of Ophthalmology, the second hospital of Xi'an Jiao Tong University Dabo Wang, Department of Ophthalmology, Affiliated Hospital of Medical College of Qiingdao University Jiantao Wang,Tianjing Medical University Eye Centre Renyi Wu,Department of Ophthalmology, Second Affiliated Hospital of Zhejiang University Medical College Center Lingling Wu, Department of Ophthalmology, No.3 Hospital of Peking University, Peking University Eye Center Yan Xu,Henan institute of ophthalmology Lin Xie,Department of Ophthalmology Daping Hospital of Third Military Medical University of Chongqing Xinguang Yang,Department of Ophthalmology, Fourth Hospital of Xi'an Minbin Yu,Zhong Shan eye centre, Zhongshan University Zhilan Yuan,The Department of Ophthalmology of Jiangsu Province People's Hospital affiliated to Nanjing Medical University Yuansheng Yuan,Department of Ophthalmology, the First Affiliated Hospital of Kunming Medical University Huiping Yuan,Department of Ophthalmology, the Second Affiliated Hospital of Harbin Medical University Hong Zhang, Department of Ophthalmology, Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology Yajuan Zheng, Department of Ophthalmology, the second hospital of Jilin University Hezheng Zhou, Department of Ophthalmology, Wuhan General Hospital of Guangzhou Military Region Yehong Zhuo, Zhong Shan eye centre, Zhongshan University

Zhejiang University Medical College Center Lingling Wu, Department of Ophthalmology, No.

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9 Acute PACG 图图 2-4-2

10 图图 2-4-4

11 Chronic PACG 图裂隙灯检查示无眼前段缺血性损害的表现, 中央前房略深 ( 右眼 ) 图下方 5:00~6:30 位置从巩膜嵴至后部小梁逐渐向上爬行性粘连闭合 ( 右眼, 动态 )

12 图上方房角粘连关闭 ( 右眼, 动态 ) 图 :00~5:00 位置点状房角粘连 ( 右眼, 动态 )

13 图眼底立体相示双眼视乳头凹陷及视神经萎缩 ( 上方右眼, 下方左眼 )

14 图视野结果示右眼上下方及鼻侧视野缺损 ( 上方图 ), 左眼管状视野 ( 下方图 )

15 图 ( 下方图, 左眼 ) UBM 示瞳孔阻滞 + 睫状体前位机制 ( 上方图, 右眼 ); 瞳孔阻滞 + 睫状体前位机制

16 图小梁切除术后, 滤过泡苍白弥散,12 点位滤过通畅 ( 左眼 ) 图右眼上下方视神经明显变薄, 左眼全周视神经变薄 ; 双眼 GCC 普遍缺损

17 Glaucoma 图图 2-4-2

18 图图图下方 5:00~6:30 位置从巩膜嵴至后部小梁逐渐向上爬行性粘连闭合 ( 右眼, 动态 )

19 图上方房角粘连关闭 ( 右眼, 动态 ) 图 :00~10:00 位置点状房角粘连 ( 右眼, 动态 )

20 图眼底立体相示双眼视乳头凹陷及视神经萎缩 ( 上方右眼, 下方左眼 )

21 图视野结果示右眼上下方及鼻侧视野缺损 ( 上方图 ), 左眼管状视野 ( 下方图 )

22 图 UBM 示瞳孔阻滞 + 睫状体前位机制 ( 上方图, 右眼 ); 瞳孔阻滞 + 睫状体前位机制 ( 下方图, 左眼 )

23 图小梁切除术后, 滤过泡苍白弥散,12 点位滤过通畅 ( 左眼 ) 图右眼上下方视神经明显变薄, 左眼全周视神经变薄 ; 双眼 GCC 普遍缺损

24 图眼前节照相图右眼眼底照相图左眼眼底照相

25 图视盘 OCT 图右眼 Humphery 视野报告图左眼 Humphery 视野报告

26 :00 10:00 14:00 18:00 22:00 2:00 右眼左眼图小时眼压结果图前房角照相图 : 先天性无虹膜房角镜检查 : 可见短窄的残留虹膜组织及后方睫状突, 房角虹膜被牵拉向前与小梁网进行性关闭

27 图 :Axenfeld- Rieger 综合征 : 左图示虹膜发育不良, 周边角膜后胚胎环, 包含括约肌区域在内的全部虹膜前基质变薄, 瞳孔鼻侧偏位, 颞侧巨大全层虹膜结构性缺损 ( 裂孔多瞳 ), 瞳孔缘及中周虹膜白色类似瘢痕样发育异常, 表浅血管裸露见于灰白组织表面, 前房角呈现类似广泛 PAS 样的发育畸形且为小角膜右图示牙齿发育异常图 :Sturge- Weber 综合征 : 单侧 ( 面部中线分界 ) 沿三叉神经 1 2 支分布的面部皮肤红葡萄酒色样血管瘤 ; 该患儿右眼因继发青光眼角膜增大水肿图 : 原发性婴幼儿型青光眼, 右眼角膜较左眼明显增大, 右眼角膜雾状水肿, 伴流泪症状

28 图 : 角膜 Haab 纹,Descemet 膜断裂与角膜缘呈同心圆状图 : 双眼视杯增大, 杯盘比均大于 0.3, 且双眼杯盘比不对称, 提示左眼视神经损害更严重图 : 房角镜检查示房角宽, 虹膜平坦向前附止, 深棕色虹膜基底部组织 ( 虹膜突 )

29 向前遮盖睫状体带巩膜嵴和不同水平的小梁网图 :2 岁先天性青光眼患儿, 小梁切开术后半年眼压降至 18mmHg, 眼底 C/D 有所回退图患者右眼前节相

30 图患者右眼房角相图患者眼底相

31 图患者术后 3 天右前节相图患者术后 1 个月右滤过泡图患者术后 1 个月右前节相

32 图患者术后 3 个月右滤过泡图患者术后 3 个月右前节相图患者术后 4 个月右房角相

33 图患者术前左眼前节相

34 图患者术前眼底相制作巩膜瓣 25G 针头刺入前房植入 Ex-PRESS 房水引流物图 Ex-PRESS 引流物植入过程

35 图患者术后 3 天前节相

211 better than those in the control group, with significant difference between two groups (P < 0.05). The ocular hypertension of patients in the cont

211 better than those in the control group, with significant difference between two groups (P < 0.05). The ocular hypertension of patients in the cont 210 毛果芸香碱联合拉坦前列素治疗原发性急性闭角型青光眼的疗效观察符元党 1, 郑振优 2, 林再雄 2, 周吉良 1. 昌江黎族自治县中西医结合医院, 海南昌江 572700 2. 海南医学院附属医院眼科, 海南海口 570100 1 摘要 : 目的探讨