近视漂移与最小调节幅度之间的失衡:药物诱发的双侧急性睫状体脉络膜渗漏继发高眼压发病机制的假说  

Imbalance between myopic shift and the minimum amplitude of accommodation:a hypothesis for the pathogenesis of ocular hypertension secondary to drug-induced bilateral acute ciliochoroidal effusion

作　　者：司山成[1] 林加藤 张敏 陈安明 王蕾[1] 崔梦琪 胡运韬[1] 

机构地区：[1]清华大学临床医学院北京清华长庚医院眼科中心,北京市102218 [2]荣成市眼科医院眼科,山东省威海市264333 [3]北京和平里医院眼科,北京市100013

出　　处：《国际眼科杂志》2023年第12期1935-1942,共8页International Eye Science

摘　　要：目的:报告5例药物诱发的双侧急性睫状体脉络膜渗漏(DBACE)和近视漂移,伴或不伴高眼压(OHT)的病例,总结患者的临床特点和DBACE的恢复过程,探讨其可能的病理生理机制。方法:2017-06/2021-02期间进行的回顾性观察性病例研究。纳入患者接受以下眼部检查:1)最佳矫正视力;2)眼压(IOP);3)裂隙灯显微镜;4)眼底照相;5)超声生物显微镜(UBM);6)显然验光;7)眼轴长度和前房深度。所有患者每2d随访一次,直到屈光度完全恢复至病发前状态。结果:本研究共招募了5名年龄在10-45岁之间的患者,其中包括3名女性和2名男性患者。所有患者均为双侧受累(5/5),并有近视漂移(5/5),其中3例患有OHT(3/5)。随着年龄的增长,近视漂移减少,OHT增加。根据OHT,DBACE的动态加重过程分为1期(无OHT的近视漂移)和2期(有OHT的近视漂移)。随着DBACE的恶化,当近视漂移接近或超过最小调节幅度(MAA)时,眼压逐渐升高,DBACE从1期进展到2期。随着停用可疑药物后DBACE的恢复,第2期的DBACE先恢复到1期,然后恢复正常。结论:DBACE的病理生理机制分为2个阶段,包括1期(无OHT的近视漂移)和2期(有OHT的近视漂移)。这两个阶段之间的转换取决于近视漂移和MAA之间的失衡。AIM:To report 5 cases with drug-induced bilateral acute ciliochoroidal effusion(DBACE)and myopic shift,with or without ocular hypertension(OHT),summarize patients’clinical characteristics and recovery process of DBACE,and investigate the possible pathophysiological mechanism.METHODS:A retrospective observational case study conducted from June 2017 to February 2021.The included patients were subjected to a series of ocular examinations listed as follows:1)best corrected visual acuity;2)intraocular pressure(IOP);3)slit-lamp microscopy;4)fundus photography;5)ultrasound biomicroscopy(UBM);6)subjective optometry;7)axial length and anterior chamber depth.All patients were followed up every 2d until the diopters were completely restored to the state before the disease onset.RESULTS:In total,5 patients aged 10-45 years old,including 3 female and 2 male patients,were enrolled in this study.All patients were bilaterally involved(5/5),and had myopic shift(5/5),of whom 3 patients had OHT(3/5).With the increase of age,myopic shift decreased,while OHT increased.Based on OHT,the dynamic aggravation process of DBACE was subdivided into 2 stages,stage 1(myopic shift without OHT)and stage 2(myopic shift with OHT).With the deterioration of DBACE,when myopic shift approached or exceeded the minimum amplitude of accommodation(MAA),IOP gradually rose,and DBACE progressed from stage 1 to stage 2.With the recovery of DBACE after discontinuing the suspicious drugs,DBACE in stage 2 first returned to stage 1,and then returned to normal.CONCLUSION:Pathophysiological mechanism of DBACE was subdivided into 2 stages,including stage 1(myopic shift without OHT)and stage 2(myopic shift with OHT).The transition between the two stages depends on the imbalance between myopic shift and MAA.

关 键 词：药物诱发的睫状体脉络膜渗漏 最小调节幅度 眼睑肿胀 近视漂移 低浓度阿托品 过敏性结膜炎 高眼压 

分 类 号：R77[医药卫生—眼科]