先天性青光眼266例445眼临床病例的调查与分析

Investigation of 266 Cases （445 eyes） of Congenital Glaucoma

目的 分析266例445眼先天性青光眼患者资料，探讨临床特点，为防治儿童致盲眼病提供依据。方法 回顾性研究1996年3月至2006年3月入住我院的先天性青光眼患者资料。结果 原发婴幼儿型128例1981眼（48．12％），青少年型86例1601眼（32．33％），合并其它异常52例871眼（19．55％）。年龄最小6d，最大26岁，平均（5．00±5．88）岁。就诊年龄〈1岁113例（42．48％），但生后1m内就诊者仅占3．76％。男179例（67．29％），女87例（32．71％）男：女为2．06：1。城市患者107例（40．23％），农村159例（59．77％）。有明确家族史仅6例（2．26％）。主诉畏光、流泪、眼睑痉挛169例（63．53％），眼球增大78例（29．32％）。初诊最高眼压61．75mmHg，最低3．96mmHg，平均（26．17±10．18）mmHg。角膜均有不同程度增大，角膜横径≥12mm274眼（62．99％）。角膜不同程度灰白混浊1191眼（26．74％），水肿136眼（30．56％），后弹力层破裂Haab纹58眼（13．03％）。多数入院已有视功能损害，可测视力者视力〈0．1占63．64％；有视神经损害（C／D比≥0．6）者80．10％。354眼（79．55％）行手术治疗。结论先天性青光眼多数出生即存在、并以发现患儿畏光流泪、角膜增大就诊，是儿童致盲主要原因之一。及时诊断治疗是保存残余视力和视功能的关键，但就诊年龄偏大、视功能已严重受损占了多数，值得公共卫生和防盲工作的关注。进一步研究将分析该组病例10年的追踪资料。

Objective To survey clinical characteristics of congenital glaucoma and provide useful information for fighting children＇s blindness. Methods Clinical features of 266 （445 eyes） congenital glaucoma hospitalized between March 1996 to March 2006 were retrospectively study. Results Mean age was 5.00 5= 5.88 years old. 42.48% patients on their first visit was 〈1 year old while only 3.76% was 〈1 month. Males were 179 cases （67.29%） while females 87 （32.71%） with sex ratio 2.06：1. Bilateral was 179 cases （67.29%） while unilateral 87 （32.71%）. 107 patients （40.23%） came from urban area and 159 （59.77%） from rural area. Only 6 patients （2.26%） has family history. 169 cases （63.53%） complained of photophobia, tearing and blepharospasm while eyeball enlargement 78 （29.32%）.The mean intraocular pressure at first visit was 26.17 ±10.48 mmHg. Corneal diameter enlarged ≥ 12 mm was seen in 274 eyes （62.99%） while cornea edema in 136 eyes （30.56%）, cloudy in 119 eyes （26.74%） and Haab lines in 58 eyes （13.03%）. The visual acuity was 〈0.1 in 64.04% eyes while optic nerve damaged （C/D ratio ≥0.6-1.0） in 80.10% eyes at first visit. 354 eyes （79.55%） received surgical treatment. Conclusions Congenital glaucoma is one of the leading causes of children＇s blindness diseas with obvious symptoms including newborn happened, photophobia, tearing and corneal enlargement. Prompt diagnose and treatments are keys to protect visual function. However, that most patients＇ visual function had been severely damaged at their first visit should alert the public. Further studies will investigate 10 years＇ follow-up.