隐匿性晶状体不全脱位继发青光眼的临床分析  

Clinical analysis of secondary glaucoma due to occult lens subluxation

作　　者：杨欣[1] 刘建荣 王伟伟 邓瑾 李捍民 Yang Xin;Liu Jianrong;Wang Weiwei;Deng Jin;Li Hanmin(Shaanxi Eye Hospital,Xi'an People's Hospital (Xi'an Fouth Hospital),Affiliated Guangren Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an 710004, China)

机构地区：[1]西安市人民医院(西安市第四医院)陕西省眼科医院,西安交通大学医学院附属广仁医院,710004

出　　处：《临床眼科杂志》2021年第6期515-519,共5页Journal of Clinical Ophthalmology

基　　金：国家自然科学基金青年科学基金项目(81500719)。

摘　　要：目的针对隐匿性晶状体不全脱位继发青光眼的临床特点、治疗方法及预后进行分析。方法回顾性病例研究。对2018年1月1日至2020年1月1日在我院进行治疗和随访的晶状体不全脱位继发青光眼患者共30例(30只眼)的资料进行回顾性分析,予以降眼压、激光治疗或手术治疗,针对治疗前后不同的时间点进行检查,对结果进行统计学分析。结果所有患者在我院首次就诊诊断为隐匿性晶状体不全脱位,眼压升高、浅前房,平均眼压(31.2±10.2)mmHg,视力为眼前光感至0.6,发病年龄为(57.5±5.1)岁。其中13例在当地医院被误诊为原发性急性闭角型青光眼患者,给予缩瞳及降眼压药物,眼压控制欠佳,患者病情加重转诊我院治疗,2例行YAG激光虹膜周边切除术,9例行白内障摘除+人工晶状体植入+房角分离术,15例行白内障摘除+人工晶状体植入+囊袋张力环植入+房角分离术,4例行晶状体摘除+小梁切除术+虹膜周边切除+前部玻璃体切除术,眼压均得到了有效控制,视力有所提高。结论隐匿性晶状体不全脱位继发青光眼临床上极易误诊,临床确诊后,及时给予散瞳、降眼压、根据晶状体不全脱位程度分别行YAG激光虹膜周边切除术或白内障摘除人工晶状体植入+房角分离术或青光眼滤过联合前部玻璃体切割术均能够取得较好的疗效。隐匿性晶状体半脱位继发青光眼应早治疗,根据不同程度采用不同的手术方案治疗是安全有效的,可以有效地控制眼压,恢复一定的视力。Objective To analyze the clinical characteristics,treatment and prognosis of secondary glaucoma due to occult lens subluxation.Methods Non-comparative retrospective observational case series.The clinical data of 30 patients(30 eyes)with secondary glaucoma due to occult lens subluxation in our hospital from 2018.1.1 to 2020.1.1 were retrospectively analyzed.Intraocular pressure(IOP),surgical treatment were taken in all paients.The ophthalmology examination were performed at different time points before and after treatment,and the results were analyzed clinically.Results All patients were showed lens subluxation,high intraocular pressure,shallow anterior chamber.The average intraocular pressure was 31.2±10.2mmHg,visual acuity before the treatment was LP~0.6,and the average age was 57.5±5.1 years.13 patients were misdiagnosed as primary acute angle-closure glaucoma and given Pilocarpine,leading to the disease exacerbation.After dilating pupil,lowering intraocular pressure and surgical treatment(2 cases of YAG laser iridectomy,9 cases of cataract extraction+intraocular lens implantation+angle separation,15 cases of cataract extraction+intraocular lens implantation+tension ring implantation+angle separation,4 cases of cataract extraction and trabeculectomy and anterior vitrectomy.),the IOP was controlled and the visual acuity was improved.Conclusios The patients with secondary glaucoma due to lens subluxation were easily misdiagnosed.After accurate clinical diagnosis,the application of dilation pupil,reduction of intraocular pressure,YAG laser iridectomy,angle separation+cataract extraction intraocular lens implantation and glaucoma filtering surgery can achieve better results.The secondary glaucoma due to lens subluxationwere should be diagnosed and treated correctly as early as possible to avoid delays in treatment due to misdiagnosis.Adequate surgeries should be chosen to reduce the IOP and restore the vision functions of these patients.

关 键 词：隐匿性晶状体不全脱位 青光眼 误诊 治疗 

分 类 号：R68[医药卫生—骨科学]