晶状体悬韧带与原发性闭角型青光眼之已知与未知  

Lens zonulopathy and primary angle closure glaucoma:what we know and what we don’t know

作　　者：张慧 张烨 张烁(综述) 乔春艳(审校) ZHANG Hui;ZHANG Ye;ZHANG Shuo;QIAO Chunyan(Beijing Tongren Eye Center,Beijing Institute of Ophthalmology,Beijing Ophthalmology&Visual Science Key Lab,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

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,北京市眼科研究所,北京市眼科学与视觉科学重点实验室,北京100730

出　　处：《眼科学报》2023年第2期140-147,共8页Eye Science

基　　金：首都卫生发展科研专项基金(CFH 2022-2-2058)。

摘　　要：晶状体悬韧带异常(包括松弛和断裂)可引起晶状体虹膜隔前移、前房变浅、房角关闭和眼压升高,即闭角型青光眼(angle closure glaucoma,ACG)的发生。特发性悬韧带异常多发生于原发性闭角型青光眼(primary angle closure glaucoma,PACG),可能是PACG的发病机制之一,但仍需前瞻性队列研究进一步证实。此类患者双眼前房深度不等,虹膜/晶状体震颤等体征及超声生物显微镜(ultrasound biomicroscopy,UBM)检查能够诊断的悬韧带异常比例较低,通常在青光眼白内障联合手术前未能被诊断而在术中被发现,故被称为隐匿性晶状体悬韧带异常。目前根据术中表现如充分散瞳可见晶状体赤道部,连续环形撕囊破囊时可见前囊放射状皱褶,超声乳化时囊袋赤道部移位或卷曲,灌注抽吸时囊袋异常飘动,囊袋口不规则等可明确诊断。根据悬韧带异常的程度、范围,选择超声乳化晶状体吸除联合人工晶体植入,联合或不联合囊袋张力环植入或人工晶体缝合固定术。PACG患者术前和术中应关注是否存在悬韧带异常,制定个体化治疗方案,以保证手术安全和疗效。Zonulopathy(including zonular laxity and dehiscence)can cause anterior displacement of iris-lens diaphragm,shallow anterior chamber,anterior chamber angle closure and elevated intraocular pressure,resulting in angle closure glaucoma(ACG).Idiopathic zonulopathy is common in primary angle closure glaucoma(PACG),which may be one of the pathogenic mechanisms of PACG.But further prospective cohort studies are needed to verify that.The proportion of diagnosis of zonulopathy in PACG patients before cataract extraction in combination with anti-glaucoma surgery is low by signs of anterior chamber depth differences between both eyes,iridodonesis/phacodonesis and UBM examination.Hence,most cases with zonulopathy in PACG are found during the operation,which is called occult zonulopathy.At present,the diagnosis of zonulopathy in PACG is often made according to the intraoperative manifestations,such as visible capsular equator after mydriasis,wrinkling of the anterior capsule during manual capsulorhexis,infolding of peripheral capsule or visualization of the capsular e quator during the cortical or nuclear removal;loose or floppy capsular bag.According to different ranges and severities of zonulopathy,phacoemulsification combined with intraocular lens(IOL)implantation,with or without capsule tension ring implantation,or sclera-fixated IOL is selected.PACG patients should be paid more attention to the diagnosis and differentiation of zonulopathy before and during operation,fully improved the preoperative examination,and formulated individualized treatment plans to ensure the safety and efficacy of operation.

关 键 词：晶状体悬韧带异常(松弛、断裂) 晶状体不全脱位 原发性闭角型青光眼 术前诊断 青光眼白内障联合手术 

分 类 号：R775.2[医药卫生—眼科]