恶性青光眼发病机制及临床分型的研究  

Pathogenesis and Clinical Classification of the Malignant Glaucoma

作　　者：王宁利[1] 周文炳[1] 欧阳洁[1] 陈秀琦[1] 吴京红[1] 

机构地区：[1]中山医科大学中山眼科中心,广州510060

出　　处：《眼科学报》1999年第4期238-241,252,共5页Eye Science

摘　　要：目的:研究恶性青光眼的发病机制,为它的临床分类提供依据。方法:采用眼科超声生物显微镜、眼科A,B型超声以及眼科临床检查方法及诊断性手术对12例恶性青光眼病例进行了活体眼部解剖结构的定性及定量观察,并采用对照研究的方法和对侧眼进行了比较研究,按照观察结果结合临床表现对恶性青光眼的分类提出了新的建议。结果:在12例病例中有4例(33.3％)经超声生物显微镜证实存在有睫状环阻滞的特征,且对侧眼存在眼前段狭小的解剖学特征;其余8例(76.6％)患眼超声生物显微镜检查发现晶体虹膜隔极度前移,睫状体被动牵拉变形,对侧眼解剖特征和正常人相同。12病例中有7例接受了诊断性手术,术中有6例证实玻璃体腔内有水囊存在。结论:按照本研究结果可将恶性青光眼分为两大类:一类是睫状环阻滞型,它由于睫状环阻滞引起的,与患者本身具有的狭小的眼前段解剖结构有关;另一类是虹膜-晶体阻滞型,它由于晶体-虹膜隔极度前移引起的。这两类恶性青光眼都具有共同的病理生理特征,前房变浅,后房消失,房水逆流入玻璃体腔,但发病机制并不完全相同。眼科学报1999;15:238-241。Purpose: To study the pathogenesis of the malignant glaucoma and the basis for the clinical classification of malignant glaucoma. Methods: Twelve eyes with malignant glaucoma were examed by ultrasound biomi-croscopy (UBM), type A and type B ocular ultrasounographer and other clinical ophthalmic tests and diagnostic therapy. The ocular anatomic structures of all 12 eyes were compared with those of the fellow eyes. Results: Ciliary block were confirmed in four of the twelve eyes (33. 3% ) with malignant glaucoma while the narrow and small anterior segment were found in the fellow eyes by UBM. Iris lens disphragm anterior displacement were found in the other eight of the twelve eyes (76. 6% ) and their ciliary bodies were deformed passively. The ciliary bodies and anterior segment of the fellow eyes of these eight eyes were anatomically normal. Diagnostic surgery was performed in seven of the twelve eyes and six cases with fluid existing in the vitreous cavity were identified. Conclusion: According to our study, we suggest to classify malignant glaucoma into two tyges. One is ciliary block, which caused by ciliary block and concerned with the narrow and small structure of the anterior segment of eye. The other is lens iris block, which caused by iris lens diaphragm anterior displacement. Both types have the same pathophysiologic characteristics, such as, shallow anterior chamber, posterior chamber disappearance and aqueous humor misdirection to the vitreous cavity. But their pathogengesis may not be completely same. Eye Science 1999; 15: 238- 241

关 键 词：青光眼 分类 发病机制 超声生物显微镜 

分 类 号：R775.02[医药卫生—眼科]