葡萄膜炎继发闭角型青光眼的急诊治疗新探索  

Novel exploration of emergency treatment for ueific acute angle closure glacuma

作　　者：程钢炜[1] 赵家良[1] 刘小力[1] 卞爱玲[1] 徐冬冬[1] 张美芬[1] 毛进[1] 马建民 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院眼科,100730 [2]首都医科大学附属同仁医院眼科

出　　处：《中华医学杂志》2011年第34期2411-2415,共5页National Medical Journal of China

摘　　要：目的探讨裂隙灯下前房穿刺联合瞳孔成形术急诊治疗葡萄膜炎继发急性闭角型青光眼（ACG）效果。方法分别在发病早期对14例葡萄膜炎继发急性ACG患者进行裂隙灯下前房穿刺联合瞳孔成形治疗（穿刺成形组），对10例葡萄膜炎继发急性ACG患者行激光周边虹膜切除术（激光周切组）。通过观察眼压、前房反应、瞳孔阻滞程度、其他不良事件比较近期治疗效果和安全性的差异。结果穿刺成形组治疗后1h眼压为（9．2±2．1）mmHg（1mmHg=0．133kPa），治疗后48h眼压为（12．4±3．7）mmHg，10d后眼压为（14．1±2．6）mmHg；激光周切组患者治疗后1h眼压为（24．5±7．1）mmHg，治疗后48h眼压为（22．2±8．6）mmHg，10d后眼压为（19．3±9．3）mmHg。穿刺成形组在治疗后1h及48h的前房反应与激光周切组差异无统计学意义，在治疗10d后的前房反应轻于激光周切组；穿刺成形组和激光周切组在治疗10d内再次出现瞳孔阻滞的患者分别为1例（1／14）和6例（6／10）；穿刺成形组中有2例早期出现瞳孔缘少量出血，均在10d内吸收。结论裂隙灯下前房穿刺联合瞳孔成形术可能是一种安全有效的急诊治疗方法，为患者的进一步治疗提供了初步保障。Objective To explore the effects of anterior chamber paracentesis plus pupillary block relief under slit-lamp mieroscope for the emergency treatment of uveitic acute angle closure glaucoma （ACG）. Methods In early stage, 14 uveitc acute ACG patients received anterior chamber paracentesis plus pupillary block relief while another 10 uveitc acute ACG patients underwent laser peripheral iridectomy （LPI）. The intraocular pressure （IOP） , degree of Tyndall, degree of pupillary block and severe adverse events were recorded at each observation timepoint. Results The IOP values for the paracentesis plus papillary block relief group were （9.2 ±2.1 ）mm Hg, （ 12.4 ±3.7） mm Hg and （ 14.1 ±2.6） mm Hg at 1, 48 h and10 d vs （24.5±7.1） mmHg, （22.2±8.6） mmHgand （19.3±9.3） mmHgrespectively for the LPI group. The inflammatory reaction of anterior chamber was more relieved in the paracentesis plus pupfllary block relief group at Day 10. Pupillary block was observed in 1 （ 1/14 ） patient from the paraeentesis plus pupillary block relief group and 6 （6/10） patients from the LPI group at Day 10. Mild hemorrhage at pupillary margin was observed in 2 cases from the paracentesis plus pupillary block relief group. Both were self-absorbed within 10 days. Conclusion Anterior chamber paracentesis plus pupillary block relief under slit-lamp microscope is the safe and effective emergency treatment for uveitic acute ACG. And it may offer a basis for further therapy.

关 键 词：葡萄膜炎 青光眼 闭角型 穿刺抽液术 瞳孔阻滞 激光周边虹膜切除术 

分 类 号：R773.9[医药卫生—眼科] R775[医药卫生—临床医学]