先天性葡萄膜外翻继发性青光眼临床特征及穿透性Schlemm管成形术疗效初步分析  

Clinical characteristics and surgical management outcomes of glaucoma secondary to congenital ectropion uveae: a preliminary analysis of penetrating Schlemm′s canaloplasty

作　　者：许淑霞 叶雯青 张军涛 李金鑫 解彦茜 张绍丹 李国星 梁远波 Xu Shuxia;Ye Wenqing;Zhang Juntao;Li Jinxin;Xie Yanqian;Zhang Shaodan;Li Guoxing;Liang Yuanbo(National Clinical Research Center for Ocular Diseases,Eye Hospital,Wenzhou Medical University,Wenzhou 325027,China;Department of Ophthalmology,the Affiliated People′s Hospital of Ningbo University,Ningbo 315040,China)

机构地区：[1]温州医科大学附属眼视光医院,国家眼耳鼻喉疾病(眼部疾病)临床医学研究中心,温州325027 [2]宁波大学附属人民医院眼科中心,宁波315040

出　　处：《中华眼科杂志》2024年第5期416-422,共7页Chinese Journal of Ophthalmology

基　　金：浙江省“尖兵”“领雁”研发攻关计划(2022C03112)。

摘　　要：目的探讨先天性葡萄膜外翻继发性青光眼的临床特征和采用穿透性Schlemm管成形术治疗的效果。方法回顾性病例系列研究。收集2020年8月至2021年12月于温州医科大学附属眼视光医院确诊为先天性葡萄膜外翻继发性青光眼且行穿透性Schlemm管成形术患者的病历资料,分析虹膜外翻范围和位置、青光眼类型等临床特征,于术后1、3、6个月和1年随访,分析患者的视力、眼压、眼前节和眼底情况、滤过泡形态、降眼压药物使用情况、超声活体显微镜检查结果等指标,总结手术效果。结果纳入先天性葡萄膜外翻继发性青光眼患者6例(6只眼),均为单眼患病,左眼和右眼各3只;年龄为10.0(5.3,28.8)岁;其中男性3例,女性3例;术前眼压为(31.7±10.0)mmHg(1 mmHg=0.133 kPa),术前降眼压药物使用数量为2.0(2.0,3.2)种。6例患者虹膜外翻范围为270~360°,周边虹膜前粘连范围与虹膜外翻位置基本相同,房角关闭且房角粘连程度超过Schwalbe线。6例患者术后均未出现手术相关并发症,术后1个月眼压为(16.4±3.2)mmHg,降眼压药物使用数量为0.0(0.0,1.5)种;术后3个月眼压为(14.8±6.0)mmHg,降眼压药物使用数量为0.0(0.0,2.2)种;术后6个月眼压为(18.1±6.1)mmHg,降眼压药物使用数量为0.0(0.0,0.5)种。其中5例患者术后随访时间满1年,均在未使用降眼压药物情况下,眼压得到控制[(15.5±3.1)mmHg]。所有患者患眼手术部位均未见明显滤过泡形成。结论先天性葡萄膜外翻继发性青光眼表现为闭角型青光眼的临床特征,房角虹膜前粘连关闭范围与虹膜外翻范围存在对应关系,类型主要属于闭角型青光眼。穿透性Schlemm管成形术对其治疗的效果较好且稳定。Objective To investigate the clinical characteristics and treatment outcomes of glaucoma secondary to congenital ectropion uveae(CEU)using penetrating Schlemm′s canaloplasty.Methods This was a retrospective case series study.Medical records of patients diagnosed with glaucoma secondary to CEU and undergoing penetrating Schlemm′s canaloplasty at the Eye Hospital of Wenzhou Medical University between August 2020 and December 2021 were collected.Clinical characteristics including the extent and location of iris ectropion,type of glaucoma,were analyzed.Follow-up visits were conducted at 1,3,6 months,and 1 year postoperatively.Visual acuity,intraocular pressure(IOP),anterior segment and fundus condition,filtering bleb morphology,use of IOP-lowering medications,ultrasound biomicroscopy results,and other indicators were analyzed to summarize surgical outcomes.Results Six cases(6 eyes)of glaucoma secondary to CEU were included,all unilateral,with 3 left eyes and 3 right eyes;median age was 10.0(5.3,28.8)years;including 3 males and 3 females.Preoperative IOP was(31.7±10.0)mmHg(1 mmHg=0.133 kPa),and the preoperative number of IOP-lowering medications used was 2.0(2.0,3.2).The extent of iris ectropion in the 6 cases ranged from 270°to 360°,with peripheral anterior synechiae corresponding to the location of iris ectropion,and angle closure with the degree of synechiae extending beyond Schwalbe′s line.No surgical complications occurred in any of the 6 cases postoperatively.At 1 month postoperatively,the IOP was(16.4±3.2)mmHg,with a median of 0.0(0.0,1.5)medications used.At 3 months postoperatively,the IOP was(14.8±6.0)mmHg,with a median of 0.0(0.0,2.2)medications used.At 6 months postoperatively,the IOP was(18.1±6.1)mmHg,with a median of 0.0(0.0,0.5)medications used.Among them,5 patients had a follow-up period of 1 year postoperatively,all achieving controlled IOP without the use of IOP-lowering medications,with an average IOP of(15.5±3.1)mmHg.No obvious filtering bleb formation was observed at the surgical site

关 键 词：青光眼 闭角型 葡萄膜疾病 虹膜疾病 眼睑外翻 小梁切除术 治疗结果 

分 类 号：R47[医药卫生—护理学]