色素性青光眼的临床特征及处理

Clinical characteristics ofpigmentaryglaucoma in Chinese patients.

目的观察色素性青光眼的临床表现及特征，探讨其治疗方法及预后。方法色素性青光眼患者8例16只眼，均为男性。年龄19～48岁（34．13±7．12）岁。观察眼压、裂隙灯显微镜、房角、超声生物显微镜（UBM）、眼底及视野等；9只眼行小梁切除术，7只眼行Nd：YAG激光周边虹膜切除。随访时间为12～36个月。结果所有病例都为近视，1例为高度近视；眼前段色素播散表现为：75％（6例12只眼）的患眼有典型的Krukenberg梭。所有患眼晶状体韧带后囊附止部及晶状体韧带小束均可见色素沉着；周边虹膜后凹；小梁网上均可见宽、均匀而较致密的色素带（Ⅲ级）；超声生物显微镜检查示所有患者均存在反向瞳孔阻滞现象，6例存在虹膜-睫状突接触。术后3月复查UBM显示所有患者周边虹膜形态平坦，反向瞳孔阻滞现象解除。所有患者眼压均控制平稳，为10．5—19mmHg（14．3±5．2）mmHg。Humphrey视野检查显示无进展情况。结论色素性青光眼为一表现相对复杂的特殊类型的青光眼，需要正确认识并适时给予恰当的治疗。

Objective To observe the clinical manifestations, signs and prognosis of pigmentary glaucoma （PG）. Methods Eight patients with PG of 16 eyes （ all were men） were studied, the range of age is 19 to 48 years （ mean＋ sd 34.13 ± 7.12 ）, IOP, KP, anterior chamber, iris, optic nerve disc and visual field were observed. Of 9 eyes were performed with trabeculectomy, 7 eyes were done with laser iridolectomy, follower up over 12 to 36 months. Results All had myopia of-0.5 D or greater, one was high myopia. All patients showed homogenous increased TM pigmentation, lenticular and/or zonular pigmentation, as well as posterior iris bowing. 75% of patients had Krukenberg spindle. None of the patients exhibited spoke-like mid-peripheral iris transillumination defects （ITDs）. All had reverse pupilary block, among them 6 patients had iris-ciliary body process contact. Three months postoperatively, peripheral iris became fiat, reverse pupilary block was deleted. The average lOP was 14.3＋/-5.25 mmHg （ranged 10.5-19mmHg）. Conclusions The most common clinical findings in Chinese PG patients include homogeneous TM pigmentation and pigment granule dusting on lens zonules and/or posterior peripheral lens surface. ITDs are uncommon in Chinese patients with PG. It should be treated appropriately