虹膜角膜内皮综合征114例临床特征分析  

Clinical characteristics of 114 patients with iridocorneal endothelial syndrome

作　　者：叶雯青 邓宇轩 左菁菁 张绍丹 王海鸥 李锦阳 郑钦象 梁远波 陈蔚 Ye Wenqing;Deng Yuxuan;Zuo Jingjing;Zhang Shaodan;Wang Haiou;Li Jinyang;Zheng Qinxiang;Liang Yuanbo;Chen Wei(The Eye Hospital,School of Ophthalmology and Optometry,Glaucoma Research Institute,Wenzhou Medical University,National Clinical Research Center for Ocular Diseases,Wenzhou 325027,China;Department of Ophthalmology,Qingdao Municipal Hospital,Qingdao 266011,China)

机构地区：[1]温州医科大学附属眼视光医院温州医科大学青光眼研究所国家眼部疾病临床医学研究中心,温州325027 [2]青岛市市立医院眼科中心,青岛266011

出　　处：《中华眼科杂志》2022年第1期35-40,共6页Chinese Journal of Ophthalmology

基　　金：国家重点研发计划(2020YFC2008200);浙江省高层次创新人才计划(2016025)。

摘　　要：目的分析虹膜角膜内皮(ICE)综合征患者的临床特征。方法回顾性病例系列研究。收集2014年1月至2020年5月在温州医科大学附属眼视光医院诊断为ICE综合征患者的临床资料。记录患者的临床类型、生活视力、临床特征及继发性青光眼情况。采用广义估计方程中的Waldχ^(2)检验等方法对3种临床类型的临床特征进行比较。结果共纳入114例(127只眼)ICE综合征患者,其中女性64例,男性50例;就诊年龄为(49±13)岁。Chandler综合征(CS)53例(46.5%),进行性虹膜萎缩(PIA)36例(31.6%),Cogan-Reese综合征(CRS)24例(21.0%),无法明确临床类型1例(0.9%)。101例(88.6%)患者为单眼发病。在CS、PIA及CRS中分别有81.7%(49/60)、56.1%(23/41)及41.7%(10/24)患眼的生活视力低于0.3;角膜水肿在CS中最多见(52.5%,32/61),其次是PIA(29.3%,12/41)以及CRS(20.8%,5/24);瞳孔异位在CS、PIA、CRS中分别占78.7%(48/61)、95.1%(39/41)、95.8%(23/24);多瞳在PIA中最多见(29.3%,12/41),CS与CRS中分别占3.3%(2/61)及8.3%(2/24)。葡萄膜外翻多见于CRS(54.2%,13/24),CS与PIA中分别占16.4%(10/61)、12.2%(5/41)。74.0%(94/127)的患眼合并继发性青光眼,其中CS、PIA及CRS患眼继发青光眼比例分别为60.7%(37/61)、80.5%(33/41)、95.8%(23/24)。不同临床类型ICE综合征在生活视力、角膜水肿、瞳孔异位、多瞳、葡萄膜外翻以及继发性青光眼比例上的差异均有统计学意义(Waldχ^(2)=13.87,10.77,965.78,11.45,15.00,222.04;均P<0.05)。86.2%(81/94)患眼进行了抗青光眼手术治疗,43.6%(41/94)患眼在各种辅助降眼压治疗下眼压得到控制。结论ICE综合征以单眼发病、中青年发病为主,CS是主要的临床类型,且该类患者视力损伤最为严重。约3/4的患眼合并继发性青光眼,大部分患者需要进行手术干预,但眼压预后不佳。Objective To investigate the clinical features in patients with iridocorneal endothelial(ICE)syndrome.Methods A retrospective case series study.Data of clinical manifestations of patients with ICE syndrome including clinical subtypes,presenting visual acuity,clinical features and secondary glaucoma were collected from January 2014 to May 2020 in the Eye Hospital,School of Ophthalmology and Optometry,Wenzhou Medical University.The Wald′s Chi-square test of generalized estimating equations was performed to analyze the differences in three clinical subtypes.Results A total of 127 eyes of 114 subjects(64 females and 50 males)were included.Mean±SD age at presentation was(49±13)years.There were 53 patients(46.5%)with Chandler′s syndrome(CS),36 patients(31.6%)with progressive iris atrophy(PIA),24 patients(21.0%)with Cogan-Reese syndrome(CRS)and one patient(0.9%)with an undetermined subtype.And 101 patients(88.6%)had uniocular ICE syndrome.Approximately 81.7%(49/60),56.1%(23/41)and 41.7%(10/24)of eyes presented visual acuity<0.3 in patients with CS,PIA and CRS,respectively.Corneal edema was most common in CS(52.5%,32/61),followed by PIA(29.3%,12/41)and CRS(20.8%,5/24).Corectopia was found in 95.8%(23/24)of eyes with CRS,95.1%(39/41)of eyes with PIA and 78.7%(48/61)of eyes with CS.Polycoria was observed in 29.3%(12/41)of eyes with PIA,3.3%(2/61)of eyes with CS and 8.3%(2/24)of eyes with CRS.Ectropion uvea was most common in CRS(54.2%,13/24),followed by 16.4%(10/61)in CS and 12.2%(5/41)in PIA.Glaucoma was found in 94 eyes(74.0%,94/127).Among them,60.7%(37/61)of CS,80.5%(33/41)of PIA and 95.8%(23/24)of CRS had secondary glaucoma.The difference of presenting visual acuity,corneal edema,corectopia,polycoria,ectropion uveae and secondary glaucoma in three clinical subtypes all had statistical significance(Waldχ2=13.87,10.77,965.78,11.45,15.00,222.04;all P<0.05).And 86.2%of eyes(81/94)had glaucoma surgeries and 41 eyes(43.6%,41/94)had the intraocular pressure well controlled with various interventions.Conclusions ICE syn

关 键 词：虹膜角膜内皮综合征 青光眼 回顾性研究 

分 类 号：R772.2[医药卫生—眼科] R773.1[医药卫生—临床医学]