原发性窄角型开角型青光眼误诊临床分析

The clinical analysis of primary narrow-open-angle glaucoma making an incorrect diagnosis

目的分析原发性窄角型开角型青光误诊的原因、临床表现及治疗方法。方法收集2001年12月至2005年8月我院收治的被误诊为急性闭角型青光眼的原发性窄角型开角型青光眼15例(17眼)的临床资料,进行回顾性总结,分析其临床特点、误诊的原因和治疗效果。结果1.眼压:入院时的眼压43.38～81.78mmHg,平均为(51.66±5.46)mmHg;手术后的两年随访,在没有用降眼压药物的情况下,眼压在10mmHg以下有2例,10～15mmHg有4例,15～20mmHg有7例,20～25mmHg有2例,平均为(15.92±4.55)mmHg。经统计学处理,手术前后的眼压差异有显著性(p<0.001);2.视力:手术前的视力在0.3～1.0,手术后视力0.4～1.2,手术前后视力差异无显著性(p>0.05)。3.误诊原因:7例病人根本无房角检查情况,4例病人房角检查情况因为医师经验不足而有误,4例病人是手术前没有停用降眼压药物,其中有1例手术前匹罗卡品眼药水每小时点眼一次,而单单根据眼压控制,房角开放而采用周边虹膜切除。4.误诊情况:误诊为急性闭角型青光眼急发作的4例(4眼),误诊为急性闭角型青光眼慢性期的7例(9眼),已行周边虹膜切除后残余性青光眼4例(4眼)。结论原发性窄角型开角型青光眼可以有急性闭角型青光眼发作的临床表现,临床的确诊要靠房角检查,治疗要按照开角型青光眼进行处理。

Objective To analyse the cause of erroneous diagnosis, clinical manifestatation, and treatment in the primary narrow-open-angle glaucoma. Methods The clinical informations of 15 cases （17 eyes） of primary narrow-open-angle glaucoma diagnosed in our hospital between December 2001 and August 2005 were analyzed, vistaed summary. Results 1.IOP of the patients admitted to hospital was 43.38-81.78 mmHg, the average was （51.66 ± 5.46）mmHg; Two years after the operation, the IOP of 2 cases were less than 10mmHg, the IOP of 4 cases were 10-15mmHg, the IOP of 7 cases were 15-20mmHg, The IOP of 2 cases were 20-25mmHg. For all subjects the average intraocular pressure was （15.2 - 4.55） mmHg.There was a significant difference between pre-operation and post-operation status. 2. Vision： Before the operation, the vision was 0.3-1.0; after the surgery, the vision was 0.4-1.2. No obvious significance was found between pre-operation and post-operation. （P〉0.05）. 3.Reasons for making an incorrect diagnosis： 7 cases did not get the angle of anterior chamber examined. 4 cases were incorrectly examined on the angle of anterior chamber by an inexperienced oculist. 4 cases took medicine continuously for decreasing intracocular pressure before the operation, one of the patients used pilocarpine once an hour before the operation, only based on the control of intraocular pressure, the angle of anterior chamber openning with peripheral iridectomy. 4.Characteristics of patients incorrectly diagnosed： 4 cases （4 eyes） were wrongly identified as acute AACG, 7 cases （9 eyes ） with chronic AACG, and 4 cases （4 eyes） have made peripheral iridectomy. Conslusion The primary narrow-open-angle glaucoma have clinical manifestatation of primary closed-angle glaucoma, correctly diagnosed to be relied examination of angle of anterior chamber, treated as primary open-angle glaucoma.