晶状体半脱位继发闭角型青光眼的手术治疗策略  

Surgical strategy of angle closure glaucoma secondary to lens subluxation

作　　者：余晓伟 范志刚 石砚[1] Yu Xiaowei;Fan Zhigang;Shi Yan(Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Key Laboratory of Ophthalmology and Visual Science,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、眼科学与视觉科学北京市重点实验室,北京100730

出　　处：《眼科》2023年第5期363-368,共6页Ophthalmology in China

基　　金：国家自然科学基金(82171050)。

摘　　要：晶状体半脱位继发闭角型青光眼是一类病因复杂的临床难题,其发病机制的解剖学本质为各种原因所致的晶状体悬韧带病变,其导致的悬韧带相邻组织复合体前后压力差变化是理解晶状体半脱位继发闭角型青光眼病理生理过程的关键。本文基于各类晶状体半脱位的发病机制及悬韧带相邻组织复合体压力梯度变化过程阐述悬韧带异常的眼部表现并预判其可能的手术风险,提出4个模块化处理方式以制定晶状体半脱位继发闭角型青光眼的个性化治疗方案,包括房水逆流及玻璃体处理、晶状体摘除、维持IOL的长期稳定和房角滤过功能的重建,为此类难治性青光眼的科学化治疗策略提供指导。Angle closure glaucoma(ACG)secondary to lens subluxation is a clinical problem with complex etiology.Its essential anatomic change in its pathogenesis is zonulopathies caused by various reasons.Based on the anatomical characteristics and pathophysiological functions of zonule,this article reconceptualizes the adjacent tissue complex of the zonule,and proposes that the change of pressure between the adjacent tissue complex caused by zonulopathies is the key to understand the physiological process of ACG secondary to lens subluxation.Based on the pathogenesis of various types of lens subluxation and the pathophysiological process of complex pressure change,we can understand the ocular phenotype of zonulopathy and predict its possible surgical risks.Further,we propose four modular treatment methods to make apersonalized treatment for ACG secondary to lens subluxation,including the treatment of aqueous humor countercurrent,lens extraction,maintenance of long-term stability of intraocular lens and reconstruction of angle filtration,which provides guidance for the scientific treatment strategy of this kind of refractory glaucoma.

关 键 词：晶状体半脱位继发闭角型青光眼 悬韧带病变 手术治疗 

分 类 号：R779.6[医药卫生—眼科]