晶状体不全脱位致急性闭角型青光眼的显微手术处理方式探讨

The explore of management of secondary acute angle-closure glaucoma associated with lens subluxation by microsurglcal operation

目的探讨晶状体不全脱位致急性闭角型青光眼的临床诊治经验。方法回顾性分析我院确诊为晶状体不全脱位致急性闭角型青光眼的患者资料。本组病例共20例(21眼),临床表现均为急性闭角型青光眼;所有病例皆已根据患者晶状体移位程度及视力情况给予相应手术治疗。结果患者出院后平均随访(16.95±15.69)个月。1例患者经保守治疗后出院。余患者术后最佳矫正视力3眼0.01～0.10,7眼0.10～0.30,4眼0.30～0.50,7眼>0.50,眼压均控制在正常范围。经保守治疗的患者眼压控制在正常范围,无晶状体移位加重的情况出现;手术后患者无一例严重并发症,无再次手术者,眼压控制及视力恢复良好。结论晶状体不全脱位致急性闭角型青光眼的临床特点与原发性急性闭角型青光眼类似,易误诊。细致的眼科检查将有助于提高正确诊断率。正确诊断是有效治疗的基础。

Objective To explore the clinical experience on diagnosis and management of secondary acute angle-closure glaucoma associated with lens subluxation. Methods A retrospective study was performed on 20 cases （21 eyes） with secondary acute angle-closure glaucoma associated with lens subluxation. Clinical features and surgical management were discussed. All cases had similar symptoms and signs with primary angle-closure glaucoma but had typical or atypical lens dislocation under careful examination. Results The mean follow-up was （ 16.95 ± 15.69） months. All patients went through surgical treatments except one patients under medications only. The postoperative visual acuity were： 3 eyes between 0. 01 and 0. 10, 7 eyes between 0. 10 and 0. 30, 4 eyes between 0. 30 and 0. 50,7 eyes better than 0. 50. There was no severe intraoperative complication or postoperative complication. The postoperative intraocular pressures were all kept in normal range. Conclusion Secondary acute angle-closure glaucoma associated with lens subluxation was easy to be confused with primary acute angle-closure glaucoma. Appropriate diagnosis and careflu examination are necessary for management of these kinds of patients.