剥脱性青光眼患者的临床诊治体会

Experience in clinical diagnosis and treatment of patients with exfoliative glaucoma

目的对来本院就诊的剥脱性青光眼患者行手术及术后药物治疗,总结其诊断要点及治疗经验,以供临床参考。方法本研究为1例82岁确诊为剥脱性青光眼的男性患者实施白内障超声乳化术,依据其眼部典型的临床体征,结合超声生物显微镜、光学相干断层扫描等辅助检查做出剥脱性青光眼的诊断;并将术中所取晶状体前囊膜行电镜扫描观察其结构,探讨眼压升高的机制。追踪其术后3个月的视力、眼压及视野变化情况。结果患者术后1周,左眼视力0.4,眼压12 mmHg(1 mmHg=0.133 kPa)。术后1个月,左眼视力0.5,眼压15 mmHg,人工晶状体正位。术后2个月,左眼视力0.6,眼压22 mmHg,人工晶状体轻度后倾位,无中心偏移。术后3个月,左眼视力0.8,眼压27 mmHg,人工晶状体位置较前无明显变化,使用拉坦复合制剂滴眼1周后,测得左眼视力0.8,眼压14 mmHg,此后平均眼压基本稳定在14 mmHg,控制效果理想。结论剥脱性青光眼患者行白内障超声乳化手术,术后局部辅以拉坦复合制剂治疗,对眼压控制和视功能恢复有较好疗效。

Objective To summarize the key diagnostic points and treatment experience of one patient with exfoliative glaucoma who was treated with drug after operation at our hospital,and to provide some clinical references.Methods One male patient who was 82 years old and diagnosed with exfoliative glaucoma was treated by phacoemulsification.According to his typical symptoms,auxiliary examinations,such as ultrasound biomicroscopy,optical coherence tomography,etc.the patient was confirmed with exfoliative glaucoma.His anterior lens capsule was obtained during phacoemulsification and examined with scanning electron microscopy,in order to explore the mechanism of elevation of intraocular pressure.His visual acuity,intraocular pressure,and visual field 3 months from then were observed.Results One-week after the operation,his left visual acuity was 0.4,and his intraocular pressure was 12 mmHg(1 mmHg=0.133 kPa).One month after the operation,his left visual acuity was 0.5,his intraocular pressure was 15 mmHg,and his artificial lens was in the right place.Two months after the operation,his left visual acuity was 0.6,his intraocular pressure was 22 mmHg,and his lens tilted a little back,with no deviation from the center.Three months after the operation,his left visual acuity was 0.8,his intraocular pressure was 27 mmHg,and his lens was in the similar place as before;after treatment with latanoprost/timolol fixed combination for one week,his left visual acuity was 0.8 and his intraocular pressure was stable around 14 mmHg,under good control.Conclusion Treatment with latanoprost/timolol fixed combination after phacoemulsification for patients with exfoliative glaucoma has a good control of intraocular pressure and is effective for the recovery of visual function.