一类罕见单眼儿童青光眼  

A rare type of unilateral childhood glaucoma

作　　者：兰远铮 陈雪莉 LAN Yuanzheng;CHEN Xueli(Department of Ophthalmology,Eye&ENT Hospital,Fudan University,Shanghai 200031,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院眼科,上海200031

出　　处：《中国眼耳鼻喉科杂志》2022年第S01期41-48,52,共9页Chinese Journal of Ophthalmology and Otorhinolaryngology

摘　　要：6个月以内患儿3例,因家长发现“单眼畏光流泪”或“单眼发灰”入院。患侧眼单眼眼压升高(>21 mmHg,1 mmHg=0.133 kPa),角膜水肿、直径扩大,前房浅或消失,虹膜膨隆,瞳孔膜闭或异位,眼底不入,健侧眼无殊。B超提示患侧眼眼轴明显增长,伴玻璃体内异常回声。超声生物显微镜检查提示虹膜高度膨隆,瞳孔区后粘于晶状体,晶状体透明,2例患儿伴虹膜前粘角膜。初步诊断为继发性青光眼,病因待查。病因鉴别主要包括永存胚胎血管继发青光眼和葡萄膜炎继发青光眼。患者手术方案皆为患侧眼虹膜周边切除+前房成形+瞳孔成形+房角分离术。术后随访眼压控制效果不一。讨论体会:先天性纤维血管瞳孔膜的患者常表现为发病年龄早、单眼发病,当出现膜引起的瞳孔阻滞时,可继发青光眼,应尽早手术干预,阻断疾病进展;但晶状体常为透明,宜谨慎进行晶状体手术。因膜可进展,且患者病情严重程度各异,需密切随访。Three children within 6 months were admitted with unilateral photophobia and tears or monocular graying.Ocular examination revealed increased intraocular pressure of(>21 mmHg),corneal edema,diameter expansion,shallow or disappeared anterior chamber,iris bombe,occlusion of pupil or corectopia in the affected eyes.B-scan ultrasonography showed that the axial length of the affected eye increased significantly,accompanied with abnormal intravitreal echo.Ultrasound biomicroscopy showed posterior synechia,clear lens,and 2 children with anterior posterior synechia.The primary diagnosis was secondary glaucoma.Regarding the cause,differential diagnoses include persistent fetal vasculature and uveitis.After peripheral iridectomy,anterior chamber forming,coreoplasty and goniosynechialysis,the intraocular pressure control varied among the three.Congenital fibrovascular pupillary membrane often shows an early and unilateral onset,and the membrane can cause secondary glaucoma.When pupillary block happens,early intervention is necessary.Normally,the lens is clear,so lens surgery is not recommended.As the pupillary membrane can progress and patients vary in severity,close follow-up is necessary.

关 键 词：继发青光眼 先天性纤维血管瞳孔膜 儿童青光眼 瞳孔阻滞 

分 类 号：R775[医药卫生—眼科]