This study investigates the characteristics of intraocular pressure (IOP) fluctuations in Chinese patients with pigment dispersion syndrome (PDS) after drug-induced mydriasis. In this prospective cohort study, 26 PDS patients were identified and instilled with 0.5% tropicamide and phenylephrine twice randomly in one of the 2 eyes, after which IOP and pupil diameter (PD) were measured hourly for 8 hours. A slit-lamp examination was performed after each measurement. Post-mydriatic IOPs and PDs were compared with baseline. The average IOP increased to a maximum of 18.3 ± 4.9 mm Hg (vs 16.7 ± 4.5 mm Hg at baseline; P = .002) 1 hour after dilation. Accordingly, the PD reached its peak (8.3 ± 0.6 mm vs 5.9 ± 1.0 mm; P < .001). By the end of the 8-hour observation period, mean IOP had decreased to 17.4 mm Hg and mean PD to 7.1 mm. The majority of these eyes (88.5%, 23/26) exhibited mild IOP elevation of 2.5 ± 1.4 mm Hg (range: 0–4.9 mm Hg). In the non-laser peripheral iridotomy group, 2 eyes (13.3%, 2/15) developing moderate anterior chamber pigment shedding showed an increase in IOP of ≥ 5 mm Hg after dilation (21.1 and 12.6 mm Hg); 1 eye (9.1%, 1/11) receiving laser peripheral iridotomy showed a similar IOP increase (5.1 mm Hg). All clinically significant IOP elevations were resolved without treatment. No post-mydriatic IOP ≥ 40 mm Hg was detected during the study. Drug-induced mydriasis appears relatively safe in the majority of Chinese PDS patients, with generally mild effect in most. However, caution remains warranted in eyes with prominent anterior chamber pigment shedding.

Purpose: To investigate the effects of anterior chamber pigment dispersion on ocular immune privilege and the possible mechanisms involved in a DBA/2J mouse model of pigmentary glaucoma. Methods: DBA/2J mice were utilized as a pigment dispersion model, and age-matched C57BL/6J mice were used as the control group in this study. Proteins in the aqueous humor (AH) and serum were quantified using the bicinchoninic acid assay. Immune cells in the AH were detected using hematoxylin and eosin staining and immunocytochemistry. The expression of TGF-β2 in the AH and cytokine levels (IL-10, IFN-γ) in serum were measured using ELISA. Anterior chamber-associated immune deviation (ACAID) was induced in DBA/2J mice by injecting antigens into the anterior chamber. Delayed-type hypersensitivity (DTH) assays were used to assess the induction of ACAID. In DBA/2J mice, before and after pigment dispersion, following anterior chamber injection of pigment particles, and after ACAID modeling, the expression of regulatory T cells (Tregs) was detected using flow cytometry. Results: Compared to C57BL/6J mice, the protein concentration, immune cell count, and TGF-β2 levels in the AH were elevated in DBA/2J mice. Protein concentration and IL-10 levels in serum were increased, while IFN-γ levels were decreased in DBA/2J. Additionally, the expression of Treg cells in the spleen of DBA/2J mice was significantly increased after pigment dispersion and anterior chamber injection of pigment particles. At 3 and 6 months, DTH responses in DBA/2J mice were not inhibited, thus preventing ACAID induction. However, the opposite was observed at 9 months in DBA/2J mice. Furthermore, the ACAID group exhibited an augmented expression of Treg cells. Conclusions: Dispersion of pigment particles in the anterior chamber of the eye enhances the state of ocular immune privilege by influencing the immunosuppressive microenvironment and inducing more Treg cells to reestablish ACAID.

目的 探讨色素性青光眼动物模型DBA/2J小鼠房水引流通道中色素颗粒形态、大小、数量与眼压之间的关系.设计实验研究.研究对象9周龄雄性DBA/2J小鼠20只(40眼).方法 定期监测眼压和眼前节变化,12、20、28、36周龄随机各取3只(6眼),按眼压正常与否分成正常眼压和高眼压组.光镜观察不同眼压组房水引流通道结构及其内色素颗粒的分布.透射电镜观察前房和小梁网内色素颗粒的形态,用Image软件随机测量100个色素颗粒的直径,并比较不同眼压组小梁网内色素颗粒直径的差异.主要指标眼压,前房和小梁网内色素颗粒的直径.结果 DBA/2J小鼠从20周龄起出现虹膜色素颗粒脱失、播散,虹膜基质萎缩伴透照缺损.12和20周龄小鼠均未出现高眼压,28和36周龄分别有36.4％和75％的小鼠眼压升高.不同周龄间眼压差异有统计学意义(x2=37.82,P＜0.001).与正常眼压组相比,高眼压组虹膜厚度变薄,前房内和虹膜前、后表面富含色素颗粒的细胞堆积,前房角变窄,小梁网内大量色素颗粒沉积.DBA/2J小鼠前房内色素颗粒的形状为圆形,平均直径(0.44±0.12 μm);或椭圆形,平均长度(0.77±0.20 μm).58.6％的圆形色素颗粒直径和63.3％的椭圆形色素颗粒长度集中在0.40～0.80 μm.正常眼压组小梁网内53.3％的圆形色素颗粒直径和100％的椭圆形色素颗粒长度大于0.40 μm;高眼压组小梁网内100％的圆形色素颗粒直径和100％的椭圆形色素颗粒长度均大于0.40 μm.高眼压组小梁网内圆形色素颗粒的直径(0.58±0.11)和椭圆形色素颗粒的长度(0.90±0.12)均大于正常眼压组(0.42±0.12 μm、0.72±0.12 μm),差异有统计学意义(t=-6.82,-4.657;P均＜0.001).结论 DBA/2J小鼠房水引流通道中最大容许通过直径为0.40 μm,大于此直径的色素颗粒沉积引流通道狭窄处并引起阻塞是其眼压升高的主要原因.

Purpose: To characterize the distribution of pigment particles in aqueous drainage structures of DBA/2J mice with different intraocular pressure (IOP) levels. Methods: DBA/2J mice were monitored from 9 to 44 weeks of age. IOP measurements were performed periodically. At 12, 20, 28, and 36 weeks, three mice were randomly selected for each time point and divided into three IOP groups. The morphology, size, and quantity of pigment particles in aqueous drainage structures were determined via transmission electron microscopy combined with ImageJ-based analysis. Between-group differences were evaluated with a one-way analysis of variance and Fisher's least significant difference test. Results: In the anterior chamber, 74.2% (187/252) of pigment particles were round (diameter range, 0.20–0.73 µm), and 25.8% (65/252) were oval (length range, 0.35–1.20 µm ). In the high-IOP group (IOP≥15 mmHg), pigment particles in the trabecular meshwork (TM) were more abundant and larger in size than those in the normal-IOP group (P<0.001). All separate pigment particles in the TM of the high-IOP group were >0.4 µm in size. The diameters of round (IOP≤10 mmHg, 0.44±0.13 µm; IOP between 10 and 15 mmHg, 0.57±0.13 µm; IOP≥15 mmHg, 0.61±0.12 µm) and the lengths of oval (0.65±0.14 µm vs. 0.77±0.12 µm vs. 0.88±0.15 µm, respectively) pigment particles in the TM differed among groups (F=27.258 and F=27.295, respectively; both P<0.001). No such differences were discovered in the iris and around Schlemm's canal (P>0.05). Conclusions: In DBA/2J mice, large and medium pigment particles (>0.4 µm) seem to play an important role in causing aqueous outflow obstruction and IOP elevation.

Pigmentary glaucoma is a kind of secondary open-angle glaucoma with relatively simple pathogenesis. The main reason for elevated intraocular pressure is increased aqueous outflow resistance owing to an accumulation of pigment granules in the trabecular meshwork. These pigment granules can not only cause mechanical obstruction of the intertrabecular spaces, but also lead to the loss of trabecular cells which had overload phagocytized pigment granules, the fusion of trabecular lamellae with collapse of intertrabecular spaces, and the obliteration of the canal. In recent studies, the aqueous humor dynamic changes in the uveosceleral outflow pathway, complex molecular genetics and immune mechanism might be involved in the pathogenesis of pigmentary glaucoma. ( Int Rev Ophthalmol, 2021, 45: 183-187)

To report the changes of trabecular meshwork (TM) pigmentation and clinical outcomes of patients with pigment dispersion syndrome (PDS) after resolution of reverse pupillary block. Twenty one eyes of 11 PDS patients were followed up periodically for 15 years after resolution of reverse pupillary block with either Nd: YAG laser peripheral iridotomy (LPI) or trabeculectomy. Visual acuity (VA), best-corrected visual acuity (BCVA), slit lamp examination, intraocular pressure (IOP), Humphrey visual field analysis (VFA), gonioscopy and stereoscopic funduscopy were performed on admission and every 6 months postoperatively. TM pigmentation was quantitatively evaluated and graded every 5 years after the treatment, in which the circumference of anterior chamber angle was divided into 4 quadrants: superior, inferior, nasal and temporal. Postoperative IOP, VA, BCVA, VFA, TM pigmentation and adjunctive anti-glaucoma medications were main outcome measurements and compared with baseline. Eleven patients (9 males, 2 females) were identified as PDS according to the diagnostic criteria, with average age of 38.25 +/- 6.93 years (range, 31-55 years) at initial diagnosis. The mean IOP level was 33.1 +/- 9.8 mmHg (range, 22-56 mmHg) at diagnosis. Ten PDS eyes received LPI, and the other eleven eyes underwent uneventful trabeculectomy. The median TM pigmentation score of the 21 PDS eyes was 16 (interquartile range [IQR], 15-16) on admission, which changed to 14 (IQR, 13-15), 13 (IQR, 12-14), 12(IQR, 10.5-12) at 5-, 10-, 15-year follow-up visits respectively. The decrease rate of TM pigmentation was 37% in inferior quadrant, while in nasal, temporal, and superior quadrant the reduction rate was 28%, 23%, and 18%, respectively, at the last follow-up visit. Majority of these enrolled eyes (19/21) had stable VA and BCVA with average endpoint IOP of 15.1 +/- 3.4 mmHg. TM pigmentation in PDS patients attenuates with time after reverse pupillary block was resolved, in which the inferior quadrant seems faster than the other quadrants.

目的 评价他氟前列素滴眼液对正常眼压性青光眼(normal tension glaucoma,NTG)的临床治疗效果及安全性.方法 采用前瞻性队列研究方法,选择2019年1月1日至2020年8月31日在首都医科大学附属北京同仁医院眼科首诊的NTG患者56例,随机选取1只眼作为研究眼,入选后给予他氟前列素滴眼液治疗,连续3个月.比较用药前后的眼压、最佳矫正视力、视野平均缺损、视野指数、视盘周围毛细血管密度及视盘周围视网膜神经纤维层平均厚度,并观察药物不良反应的发生情况.结果 56例患者中男18例,女38例,平均年龄(45.9±10.7)岁,均为双眼发病.入选的56只眼治疗前平均眼压为(16.67±2.67)mmHg,治疗3个月后平均眼压为(13.52±2.08)mmHg,平均降低幅度为18.9％,治疗前后比较差异有显著性(P=0.007).与未接受治疗时的基线眼压相比,有8.93％(5/56)眼的眼压降低幅度≥30％,66.07％(37/56)眼的眼压降低幅度≥15％,其他眼的眼压降低幅度＜15％.治疗前后的最佳矫正视力、视野平均缺损、视野指数、视盘周围毛细血管密度、视盘周围视网膜神经纤维层平均厚度比较差异均无显著性(P＞0.05).4例患者出现中度结膜充血或异物感,无其他明显不良反应发生.结论 他氟前列素滴眼液可有效降低NTG患者的眼压,结膜充血是其常见并发症.

目的 探讨虹膜色素上皮(iris pigment epithelium,IPE)层色素颗粒对兔眼小梁切除术后滤过通道瘢痕化过程及Tenon囊成纤维细胞增生的影响.设计实验研究.研究对象新西兰大白兔18只.方法 单眼做小梁切除手术模型.实验组巩膜瓣下放置0.1 ml(100 μg/ml)猪IPE层色素颗粒并保留,阳性对照组和阴性对照组分别放置0.4 mg/ml丝裂霉素C棉片和生理盐水棉片3分钟.术后观察眼压、滤过泡形态30天,并对滤过泡及其周边组织进行组织病理学检查.主要指标眼压、滤过泡形态、手术滤过区瘢痕化程度.结果 实验组、阳性对照组、阴性对照组兔眼术前平均眼压分别为(24.78±1.40)、(24.11±1.18)、(24.00±1.53)mmHg(F=0.241,P=0.789).术后30天平均眼压分别为(20.28±1.87)、(20.39±2.28)、(23.33±1.14)mmHg(F=22.500,P=0.000).实验组与阳性对照组无显著差异(P=0.86),实验组与阳性对照组均低于阴性对照组(P均=0.000).滤过泡平均存留时间分别为(28.17±1.72)、(27.00±2.37)、(10.67±1.97)天(F=138.592,P=0.000).组织病理学检查示实验组和阳性对照组兔眼滤过区结构相似,胶原纤维和瘢痕组织相对较少,而阴性对照组胶原纤维和瘢痕组织明显增生.结论 小样本量短期实验研究表明,IPE层色素颗粒可能阻止Tenon囊成纤维细胞增生过程,有助于延缓小梁切除术后滤过通道瘢痕化.