青光眼研究进展及展望

山东大学硕士学位论文分类号：R775单位代码：10422密级：学号：003170241论文题目：青光眼研究进展及展望作者姓名张玮专业眼科学（青光眼）指导教师姓名申家泉专业技术职务教授1山东大学硕士学位论文目录中文摘要················································································································1英文摘要················································································································2符号说明················································································································4前言················································································································7青光眼的诊断········································································································8青光眼的治疗······································································································11青光眼的神经损伤及保护···················································································16趋势与展望··········································································································35参考文献··············································································································36致谢··············································································································422山东大学硕士学位论文青光眼研究进展及展望研究生：张玮导师：申家泉教授中文摘要青光眼是全球常见且不可逆的严重致盲眼病，早期诊断和有效的治疗可大大降低其致盲率。其中视网膜神经节细胞凋亡是青光眼视神经损伤的昀终共同通路，阻断或延缓神经节细胞原发性和(或)继发性损伤的治疗方法称为青光眼视神经保护治疗。在未来的青光眼治疗中视神经保护治疗很可能成为一种重要的辅助治疗措施，将和包括降眼压药在内的其他手段一起来减少各种原发性和(或)继发性致病因素对视网膜神经节细胞的损伤。昀近研究表明，青光眼患者外侧膝状体、视皮质等中枢视路也存在相应损伤，提示青光眼可能是一种神经退变性疾病。本文将近年来青光眼的诊断和治疗进展作一综述，并重点对中枢损伤的病理形态学及病理机制研究、视神经损害的机制、视网膜神经节细胞凋亡的研究现状及青光眼视神经保护治疗方面的研究进展进行阐述，并对青光眼的研究前景进行展望。关键词青光眼；诊断；治疗；中枢神经系统；视网膜神经节细胞；视神经保护3山东大学硕士学位论文THEPROGRESSOFINVESTIGATIONANDTHEEXPECTATIONOFGLAUCOMAPostgraduate:ZhangWeiTutor:ShenJiaquanProfessorAbstractGlaucomaisoneoftheleadingcausesofirreversibleblindnessworldwide.Earlydiagnosisandeffectivetreatmentmayremarkablydecreasetherateofblindnesspatients.Andthefinalcommonpathwayofglaucomatousopticneuropathyisretinalganglioncellsdeath.Becauseloweringintraocularpressureisnotalwayssufficienttohalttheprogressionofthisopticneuropathy,therehasbeenconsiderableefforttodeveloptherapeuticsthatpreventordelaytheretinalganglioncellsfromundergoingprimary/secondarydegeneration.Thistherapeuticstrategyistermedneuroprotection.Infuture,opticneuroprotectioninglaucomawilllikelybecomeanimportantadjunctivetherapywithothercaresincludingintraocularpressure-loweringtreatmenttolessentheprimary/secondaryinsultsofretinalganglioncells.Whileglaucomatousdamagesalsohavebeenfoundinthecentralvisualsystem,includinglateralgeniculatenucleusandvisualcortex.Recentstudieshaveindicatedthatglaucomaisaneurodegenerativedisease.Thisarticlereviewstherecentadvancesonthediagnosisandthetreatmentofthedisease,andexpatiatesthepathomorphologyandpathologicmechanismsofglaucomatousdamagesinthecentralvisualsystem,themechanismsofglaucomatousopticnervedamage,therecentinvestigationaboutapoptosisofretinalganglioncellandthetreatmentwithneuroprotection.Atlast,ithasaexpectationaboutthefuturedirectionandtheprogressofinvestigationinthefieldofglaucoma.4山东大学硕士学位论文KeywordsGlaucoma;diagnosis;treatment;centralneuralsystems;retinalganglioncell;neuroprotection5山东大学硕士学位论文符号说明AAOAmericanAssociationofOphthalmology美国眼科学会ADAlzheimer'sdisease阿耳茨海默(氏)病AGFAxonGrowthFactor轴突生长因子AMPAAlpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionicAcidα-氨基羟甲基恶唑丙酸APOEApolipoproteinE载脂蛋白EATPAdenosineTriphosphate三磷酸腺苷BDNFBrain-derivedNeurotrophicFactor脑源性神经营养因子bFGFBasicFibroblastGrowthFactor基本成纤维细胞生长因子CDIColorDopplerImaging彩色多普勒血流成像cGMPCyclicGuanosineMonophosphate环磷酸鸟甙CNTFCiliaryNeurotrophicFactor睫状神经营养因子Cop-1Copolymer-1氨基酸聚合物-1COXCycloxygenase环氧化酶CTAConfocalTomographicAngiography共焦图像血管造影DNQX6,7-dinitroquinoxaline-2,3-dione6,7-二硝基喹恶啉上卫四EGFEpidermalGrowthFactor表皮生长因子ETsEndothelins内皮素FFAFluoresceinFundusAngiography荧光素眼底血管造影FGFFibroblastGrowthFactor成纤维细胞生长因子GABAGamma-aminobutyricAcidγ-氨基丁酸HHTHomoharringtonine高三尖杉酯碱HRFHeidelbergRetinaFlowmetry海德堡视网膜血流仪HRTHeidelbergRetinaTomography海德堡视网膜地形图分析仪6山东大学硕士学位论文HSFHepatocyte-excretedFactor肝细胞分泌因子ICGIndocyanineGreen吲哚氰绿IGFInsulin-likeGrowthFactor胰岛素样生长因子IOLIntraocularLens眼内透镜(人工晶状体)KYNAKynurenicAcid犬尿喹啉酸LGNLateralGeniculateNucleus外侧膝状体核L-kynLaevo-kynurenine左旋犬尿氨酸L-NANG-nitro-L-arginine氮G-硝基-左旋精氨酸L-NAANG-amino-L-arginine氮G-氨基-左旋精氨酸L-NAMENG-Nitro-L-arginineMethylEster氮G-硝基-左旋精氨酸甲酯L-NIOL-N5-1-iminoethyl-ornithine氮-乙基亚胺基-左旋鸟氨酸L-NMANW-monomethyi-L-arginine氮W-单甲基-左旋精氨酸L-NMMANG-momonethyi-L-arginine氮G-单甲基-左旋精氨酸mERGMultifocalElectroretinography多焦视网膜电图MIFMacrophage-inhibitingFactor巨噬细胞抑制因子MMCMitomycinC丝裂霉素CNADPHReducedFormofNicotinamide-adenineDinucleotidePhosphate还原型辅酶ⅡNGFNerveGrowthFactor神经生长因子NMDAN-methyl-D-aspratateN-甲基-D-天(门)冬氨酸NOSNitricOxideSynthase一氧化氮合酶7山东大学硕士学位论文NPG/NTGNormalPressureGlaucoma/Normal-tensionGlaucoma正常眼压性青光眼NTNeurotrophicFactor神经营养因子OAGOpenAngleGlaucoma开角型青光眼OCTOpticalCoherenceTomography光学相干断层扫描OLMOphthalmicLaserMicroendoscope眼内激光显微内镜系统PDGFPlatelet-derivedGrowthFactor血小板源性生长因子PLPProteolipidProtein蛋白脂质蛋白POAGPrimaryOpen-angleGl