原发性急性闭角型青光眼合并晶体脱位的超声生物显微镜观察

Primary acute angle closure glaucoma concurrent lens dislocation under ultrasound biomicroscopy

目的应用超声生物显微镜(ultrasound biomicroscopy,UBM)观察原发性急性闭角型青光眼合并晶体脱位的特点,探讨原发性急性闭角型青光眼合并晶体脱位的病因、临床表现及治疗效果.方法对2000年1月1日～2004年1月1日我院收治的19例(19眼)原发性急性闭角型青光眼合并晶体脱位者常规行裂隙灯及超声生物显微镜检查,观察晶体脱位范围、手术方式、术前术后视力、眼压等情况.结果 19例19眼均被手术结果证实,晶体全脱位3眼,半脱位16眼.晶体脱位范围90度～360度,11眼行小梁切除术联合白内障超声乳化人工晶体植入术,8眼行小梁切除术联合晶体切除、前部玻璃体切除术、二期植入悬吊人工晶体.术前眼压大于21mmHg者17眼,术后眼压大于21mmHg者1眼.术前最佳矫正视力0.1以下者5眼,0.1～0.3者11眼,0.3以上者3眼;术后最佳矫正视力0.1以下者1眼,0.1～0.3者6眼,0.3以上者12眼.结论原发性急性闭角型青光眼合并晶体脱位可能由于急性发作期眼压骤然升高或应用降眼压药物引起眼压波动过大所致;也可能是患者年龄较大,晶体悬韧带部分断裂致晶体位置异常、瞳孔阻滞而引起急性闭角型青光眼急性发作.

Objective To observe the clinical charateristic of primary acute angle closure glaucoma concurrent lens dislocation under ultrasound biomicroscopy(UBM).To evaluate pathogery,clinical acquit and clinical therapeutic effect. Methods Slit lamp microscopy and ultrasound biomicroscopy(UBM)were performed in 19 eyes of primary acute angle closure glaucoma concurrent lens dislocation.We observed the range of lens dislocation,the methods of operation,visual acuity and intraocular pressure(IOP). Results 19 eyes were all approved through operation.Complete luxation of lens were in 3 eyes,subluxation of lens were in 16 eyes.The range of lens dislocation was 90～360 degrees.The intraocular pressure(IOP)above 21 mmHg before operation was in 17 eyes and after operation was in 1 eyes.The best corrected visual acuity before operation of 0.1 or worse was in 5 eyes,0.1～0.3 in 11 eyes and 0.3 or better in 3 eyes.The best corrected visual acuity after operation of 0.1 or worse was in 1 eye,0.1～0.3 in 6 eyes and 0.3 or better in 12 eyes. Conclusions Primary acute angle closure glaucoma concurrent lens dislocation may be due to intraocular pressure(IOP)raised all at once,intraocular pressure(IOP)changed obviously or apparatus suspensorius lentis rupturing in old patients.