原发性开角型青光眼合并高度近视误诊六例分析

Analysis of Six Cases of Primary Open-Angle Glaucoma Complicated with High Myopia

目的总结原发性开角型青光眼合并高度近视的临床特点,探讨其误诊原因及防范措施。方法对2015年6月—2016年2月宝鸡市人民医院收治的21例原发性开角型青光眼合并高度近视中6例误诊病例的临床资料进行回顾性分析。结果本组误诊率为28.57%。6例中2例因视物模糊、眼眶疼痛5和10 d就诊,2例因眼前黑影、自觉眼内异物感伴视力疲劳10和15 d就诊,2例因视物模糊不清、出现黑蒙伴头晕、恶心2和3 d就诊。曾误诊为视疲劳、慢性结膜炎和偏头痛各2例。误诊时间3~10 d。6例按误诊疾病进行治疗病情均无明显改善,后均经连续测眼压及房角、眼底、视野等检查确诊原发性开角型青光眼合并高度近视。确诊后5例行单纯小梁切除术,1例行复合式小梁切除术,经上述治疗6~15 d后均病情明显好转出院;出院后随访3个月~1年,患者预后良好。结论原发性开角型青光眼合并高度近视缺乏特异性临床表现,易误诊。临床医生应加强对原发性开角型青光眼合并高度近视的警惕性及认识,以减少或避免其误诊误治。

Objective To summarize the clinical features of primary open-angle glaucoma complicated with high myopia and to analyze the causes of misdiagnosis and treatment of this disease. Methods From June 2015 to February 2016,21 patients with high myopia complicated with primary open-angle glaucoma treated in Baoji People＇s Hospital were selected as the subjects of the study. Of them,6 patients were misdiagnosed,the clinical data of whom were analyzed retrospectively. Results The misdiagnosis rate was 28.57%. Of 6 patients,2 presented with orbital pain and blurred vision at 5 and 10 days after treatment respectively; 2 presented with immediate shadow,foreign-body sensation,and visual fatigue at 10 and 15 days after treatment; 2 patients with blurred vision,dizziness,nausea and amaurosis at 3 days after treatment. For them,high myopia with primary open-angle glaucoma was misdiagnosed as asthenopia in 2 cases,chronic conjunctivitis in 2 cases and migraine in 2 cases. The duration of misdiagnosis was 3-10 d. All the patients were treated accordingly but had no improvement. Continuous measurement of intraocular pressure,chamber angle,fundus and visual field confirmed high myopia with primary open-angle glaucoma. Subsequently,simple trabeculectomy and composite trabeculectomy were performed in 5 and 1 patients respectively. After 6-15 d treatment as described above,all the patients were discharged home after the condition was significantly improved. They were followed up for periods ranging from 3 months to 1 year,and the prognosis was favorable. Conclusion Given aspecific and subtle clinical manifestations,high myopia with primary open-angle glaucoma is likely to be misdiagnosed. Therefore,clinicians should enhance the understanding of this disease,to reduce or avoid the misdiagnosis.