The Exploration Of Glaucoma Diagnoses,treatment,prognosis And Epidemiological Investigation Of Anterior Segment Parameters

PURPOSE: Globally,glaucoma is one of the leading causes of irreversible blindness.Since the pathogeny of primary open-angle glaucoma(POAG)has not been clarified yet,early diagnosis of the disease and prompt reduction of intraocular pressure are important for intervention in its progression.For the patients with congenital abnormal anatomical structures in anterior section of the eye,irreversible optic nerve damage and visual field defects will happen after several attacks of acute primary angle closure(APAC)with angle-closure glaucoma as the final word.This research will explore the early diagnosis of POAG,the mechanism and effect of new intraocular pressure-lowering drugs,the aqueous humor(AH)protein markers of APAC and the profile of parameters of anterior chamber in normal Chinese adolescent population based on the fundus imaging technology,biological detection technology,basic research methods and epidemiological investigation.METHODS:(1)The patients diagnosed as POAG were examined by posterior pole asymmetric scanning technology of optical coherence tomography(OCT)and standard automated perimetry.The results of these two tests were analyzed point by point inversely;(2)Based on DNA-encoded library technology,bioactive inhibitors targeting on ROCK were screened out and synthesized.The mechanism of action and IOP-lowering effect of these inhibitor was explored in cell and animal models;(3)The collection,detection and analysis of matricellular proteins in APAC patients' AH were to find out whether this sort of proteins could become markers of APAC's progression and prognosis;(4)Pentacam was used to measure the anterior chamber parameters of 2883 normal Chinese adolescents.The distribution of anterior chamber depth(ACD),anterior chamber volume(ACV)and anterior chamber angle(ACA)in adolescent population and their influencing factors were analyzed with statistical software.RESULTS:(1)There was a good point by point inverse relationship between the mean retinal thickness obtained with posterior pole asymmetric scanning and the visual field sensitivity threshold.The quadratic model matched best compared with linear regression and cubic model.(2)The ROCK inhibitors synthesized based on DNA-encoded library inhibit the phosphorylation of MLC protein result in the decreasion of actin filament and vinculin,the relaxation of the protein skeleton,the weakness of cell-cell connection and the increase of AH outfloow from the trabecular meshwork route;(3)The level of matricellular proteins in AH of APAC patients increased significantly compared with cataract patients,which correlated significantly with IOP;(4)The ACD and ACV in adolescent population increased with age geometrically,while the ACA was relatively stable in terms of age and gender.CONCLUSIONS: OCT posterior pole asymmetric scanning,combined with intraocular pressure test,visual field and optic disc thickness examination,can be a potential powerful method for early diagnosis of POAG.The DNA-coding library provides a new idea of searching for new drugs targetting on some certain proteins.And the ROCK inhibitors,increasing the outflow of AH through the trabecular meshwork route,can be a potential new treatment to delay the progression of glaucoma.Matricellular proteins levels,which significantly elevated in APAC patients,may play some potential roles in destroying AH outflow pathways temporarily or permanently.ACA barely changed with age in adolescents and declined with age in adulthood.It was speculated that the ACA in adolescent period is at its maximum during lifetime,so that normal adolescents with relatively narrow ACA may still face higher risk of angle closure.