虹膜角膜内皮综合征的误诊漏诊分析  

Analysis on misdiagnosis and missed diagnosis of iridocorneal endothelial syndrome

作　　者：冯波[1] 唐炘[1] 孙霞[1] 陈虹[1] 

机构地区：[1]首都医科大学附属北京同仁医院北京同仁眼科中心北京市眼科学与视觉科学重点实验室,100730

出　　处：《中华眼科杂志》2013年第7期637-641,共5页Chinese Journal of Ophthalmology

摘　　要：目的探讨虹膜角膜内皮综合征（ICE综合征）误诊漏诊情况及其主要原因。方法回顾性系列病例研究。收集2008年1月至2011年12月在首都医科大学附属北京同仁医院北京同仁眼科中心确诊为ICE综合征的病例65例（65只眼），采用国际通用的诊断及分型标准，分析病例中误诊漏诊情况、错误诊断类型，并对ICE综合征的误诊漏诊原因及临床特殊表现进行总结分析。结果初诊诊断正确者9例（13．8％）；错误诊断包括原发性闭角型青光眼14例（21．5％）、原发性开角型青光眼14例（21．5％）、葡萄膜炎7例（10．8％）等。误诊漏诊患者中对侧眼手术或激光治疗者12例。本组病例的不典型表现及特殊表现包括：虹膜无萎缩及轻度萎缩者54例（83．1％），继发性开角型青光眼11例（16．9％），最高眼压≥40mmHg（1mmHg=0．133kPa）者41例（63．1％），眼压降到30mmHg以下角膜无水肿者48例（73．8％），部分患眼的房角有异常黑色素沉着。结论ICE综合征是误诊漏诊率较高的一种眼病。误诊漏诊原因包括该病的临床表现多样以及临床医师对其不典型表现缺乏关注。Objective To summarize the misdiagnosis and missed diagnosis of iridocorneal endothelial syndrome （ICE syndrome） and analyze the main reasons. Methods Retrospective case series. The records of 65 patients （65 eyes） who were diagnosed to suffer from ICE syndrome in Beijing TongTen Hospital during Jan. 2008 to Dec. 2011 were studied retrospectively. The international diagnostic standards were used. The situations of misdiagnosis and missed diagnosis were evaluated and the main reasons and the related clinical characters were analyzed. Results The correct preliminary diagnosis was found in 9 cases （ 13.8% ）. Misdiagnosis included primary angle closure glaucoma （PACG） in 14 cases （21.5%）, primary open angle glaucoma （POAG） in 14 cases （ 21.5% ）, uveitis in seven cases （ 10. 8% ）, etc. The contralateral eye received operation or laser therapy in 12 of 56 cases who didn＇t get the correct preliminary diagnosis. There were many atypical and special presentations in our patients. There was no or mild atrophy of iris in 54 cases （83.1% ）. Secondary open angle glaucoma was found in eleven cases （ 16.9% ）. The maximal intraocular pressure （IOP） was ≥40 mmHg （ 1 mmHg =0. 133 kPa） in 41 cases （63. 1% ）. And there was no corneal edema when the IOP is lower than 30 mmHg in 48 cases （73. 8% ）. There is some abnormal black pigment in the anterior chamber angle in some cases. Conclusions ICE syndrome is a disease with high rate of misdiagnosis or missed diagnosis. The main reasons of misdiagnosis and missed diagnosis include that ICE syndrome has many different clinical manifestations and the doctors pay little attention of to the atypical presentations of ICE cases.

关 键 词：虹膜角膜内皮综合征 误诊 青光眼 

分 类 号：R773.1[医药卫生—眼科]