继发性瞳孔阻滞性青光眼的超声生物显微镜检查

Ultrasound biomicroscopic examination of secondary pupillary block glaucoma

目的 研究继发性瞳孔阻滞性青光眼超声生物显微镜的影像特征。方法 对 11例临床上疑似睫状环阻滞性青光眼 ,而经超声生物显微镜检查诊断为瞳孔阻滞性青光眼患者的影像特征进行分析。结果 11例患者的超声生物显微镜检查并不表现为典型瞳孔阻滞性青光眼的影像特点 ,但是后房均存在 ,支持瞳孔阻滞性青光眼的诊断。瞳孔阻滞性青光眼的影像特点因原发疾病的不同而异 :外伤后晶状体半脱位的患者 ,晶状体和睫状突间的距离于脱位处增大 ,晶状体位置前移 ;虹膜睫状体炎的患者 ,具有严重的虹膜前、后粘连的特点 ;抗青光眼手术后引起的继发性瞳孔阻滞性青光眼的患者 ,其睫状突与晶状体赤道部间有明显的距离 ,有虹膜周边切除孔或滤过内口不通畅的特点。结论 超声生物显微镜检查对继发性瞳孔阻滞性青光眼的诊断及其与睫状环阻滞性青光眼的鉴别诊断有重要意义 ,后房存在与否为鉴别诊断的要点。

Objective To study the imaging characteristics of ultrasound biomicroscopy of secondary pupillary block glaucoma. Methods 11 cases with pupillary block glaucoma diagnosed by ultrasound biomicroscopy were studied which had been suspected as malignant glaucoma at the beginning. Results There were no obviously typical characteristics of pupillary block glaucoma shown in the images of ultrasound biomicroscopy in these cases. However, the existence of posterior chamber in each case strongly supported the diagnosis of pupillary block glaucoma. The imaging characteristics of ultrasound biomicroscopy were different in terms of the different primary disorders which resulted in the pupillary block glaucoma including iridocyclitis, lens subluxation resulted from trauma and glaucoma filtration surgery. In the cases of lens subluxation, the main characteristic was the increase of the distance between the lens and the ciliary process at the site of subluxation and the lens forward movement. In the cases of iridocyclitis, anterior and posterior synechiae were the main characteristics. And in the cases of glaucoma filtration surgery there were two main characteristics. One was that the distance between the ciliary process and the equator of lens existed obviously, and the other was the occlusion of the inner ostium of glaucoma filtration surgery or peripheral iridectomy. Conclusion Ultrasound biomicroscopy (UBM) has important value in the diagnosis of secondary pupillary block glaucoma and the differentiation between it and malignant glaucoma. Whether the posterior chamber exists or not is the differential point between the pupillary block glaucoma and the malignant glaucoma.