散瞳检查在诊治隐匿性晶状体半脱位继发青光眼中的重要性

发布时间：2018-03-28 01:01

本文选题：散瞳检查　切入点：隐匿性　出处：《眼科新进展》2014年11期

【摘要】：目的分析隐匿性晶状体半脱位继发青光眼的临床特点,强调术前散瞳检查的重要性,探讨合理有效的治疗方法。方法回顾分析我院收治的21例(25眼)隐匿性晶状体半脱位继发青光眼患者的临床特点,术前散瞳检查并根据悬韧带断裂的部位和范围选择不同的手术方式,分析术后的眼压、视力及并发症。结果 21例(25眼)患者临床表现与原发性急性闭角型青光眼极其相似,但同时有虹膜震颤、发作眼前房深度较对侧眼明显变浅的重要体征。患眼前房深度为(1.17±0.48)mm,对侧眼为(2.57±0.52)mm,差异有统计学意义(P0.05)。患眼散瞳后前房深度为(1.53±0.27)mm,与散瞳前比较差异有统计学意义(P0.05)。UBM检查显示16眼(64.0%)有晶状体悬韧带断裂,散瞳检查发现有24眼(96.0%)晶状体半脱位,散瞳检查对晶状体半脱位的检出率较UBM高。术后随访3个月~2 a,术后3个月所有患者眼压恢复正常为(17.65±2.79)mmHg(1 kPa=7.5 mmHg),与术前(48.12±3.15)mmHg相比,差异有统计学意义(F=38.462,P0.05)。术后6个月,21眼(84.0%)眼压正常,4眼(16.0%)需加用降眼压药控制,眼压为(22.74±3.15)mmHg,与术前比较差异有统计学意义(F=26.547,P0.05)。术后2 a除1眼因悬吊IOL后药物无法控制眼压外,再次行抗青光眼手术,其余24眼眼压均正常,所有患者眼压为(18.95±3.74)mmHg,与术前比较差异有统计学意义(F=19.938,P0.05)。结论隐匿性晶状体半脱位继发青光眼时容易误诊;术前散瞳检查能提高晶状体半脱位的检出率,并能明确悬韧带断裂的部位及范围,从而选择合适的手术方式;小梁切除术不能完全根治此类青光眼,只有解除晶状体因素才能提高手术成功率。
[Abstract]:Objective to analyze the clinical features of glaucoma secondary to occult lens subluxation and to emphasize the importance of preoperative mydriasis. Methods 21 cases (25 eyes) with occult lens subluxation secondary glaucoma were retrospectively analyzed. The intraocular pressure, visual acuity and complications were analyzed according to the location and range of rupture of the suspended ligament. Results the clinical manifestations of 21 patients with acute angle closure glaucoma were very similar to those of primary acute angle closure glaucoma. But at the same time there was an iris tremor, The depth of anterior chamber was 1.17 卤0.48 mm in anterior chamber and 2.57 卤0.52 mm in contralateral eye (P 0.05). The depth of anterior chamber after mydriasis was 1.53 卤0.27 mm, which was significantly different from that before pupil dilation. The results showed that 16 eyes (64.0 eyes) had rupture of the suspended ligament of the lens. 24 eyes were found to be subluxated by mydriasis. The detection rate of subluxation of lens in mydriasis was higher than that in UBM. The intraocular pressure of all the patients returned to normal at 3 months after operation for 2 years, compared with 48.12 卤3.15)mmHg before operation. The difference was statistically significant (P 0.05). 6 months after operation, 21 eyes (84.0 eyes) had normal intraocular pressure (IOP) and 4 eyes (16.0%) should be controlled with intraocular pressure lowering drugs (IOP = 22.74 卤3.15mm Hg). The difference was statistically significant compared with that before operation. There was significant difference in F26.547P0.05hg after operation, except for one eye that could not control IOP after 2 years because of suspension of IOL. The other 24 eyes had normal intraocular pressure. The IOP of all the patients was 18.95 卤3.74 mm Hg, which was significantly different from that before operation. Conclusion the occult lens subluxation secondary glaucoma is easy to be misdiagnosed. Preoperative mydriasis can improve the detection rate of subluxation of lens and determine the location and extent of rupture of the suspended ligament, so as to select the appropriate surgical method, trabeculectomy can not completely cure this kind of glaucoma, trabeculectomy can not completely cure this kind of glaucoma. The success rate of surgery can be improved only by removing lens factors.
【作者单位】：山东中医药大学附属眼科医院;山东中医药大学第二附属医院;山东省五莲县人民医院;
【分类号】：R775

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