急诊青光眼患者流行病学特征分析

Epidemiological characteristics of acute glaucoma in emergency clinic

目的研究急诊青光眼患者人口学特征、诊断分类、季节分布和治疗转归。设计前瞻性病例系列。研究对象2018年10月23日~2019年10月22日就诊于北京同仁医院眼科急诊的急性眼压升高的青光眼患者205例(230眼)。方法初诊时记录患者的病史、体征和诊治情况,急诊救治后由青光眼专家进一步明确诊断,完成后续治疗,随访1年以上评估患者视力预后。主要指标各类青光眼人口学特征、发病季节、治疗效果及视力预后。结果205例(230眼)患者平均年龄(61.7±13.8)岁(9~89岁),其中60~69岁最多(41.5%)。女性130例(63.4%),男女比例1:1.73。患者主要来自北京(72.7%)。从发病至就诊时间平均79.3小时(1~2160小时),平均眼压(46.4±11.8)mmHg。确定诊断包括原发性闭角型青光眼132例(64.2%,简称闭青),继发青光眼59例(28.8%,简称继青),原发性开角型青光眼5例(2.4%,简称开青),其他类型青光眼9例(4.4%)。其中闭青21例(15.9%)是双眼同时急性发作。闭青中122例(92.4%)是急性闭青,7例(5.3%)慢性闭青急性发作,3例(2.3%)既往行激光周边虹膜切除术后急性发作。继青中最多的是晶状体半脱位继发闭青(27例,45.8%),其次是新生血管性青光眼(9例,15.3%)。急诊初步诊断闭青中19例(12.6%)修正诊断为继发性闭青,其中18例晶状体半脱位,1例晶状体膨胀期。整体就诊人数最多的月份是1月(n=46,22.4%),12月(n=26,12.7%)和7月(n=23,11.2%);就诊人数最少的月份是4、5、6月(n=7、6、8)。闭青患者最多是1月份(n=31,23.5%),其次是7月份(n=20,15.2%),秋冬季(11月到次年2月份)患者最多(n=72,54.5%);就诊人数最少的月份是4~6月(各4例,3.0%);7月份男性(11例,55%)比例明显高于其他月份。168例(82.0%)使用了全身及局部降眼压药物,治疗2小时后仍有70例(34.1%)眼压不能被控制需行急诊降眼压手术,主要包括闭青47例(35.6%),晶状体半脱位继青18例(66.7%)。晶状体半脱位继青者药物治疗效果较差。末次随访视力为盲和低视力的比例分别为12.2%(n=25)和8.3%(n=17)。结论急诊青光眼患者以原发性闭角型青光眼为主,隆冬和盛夏是高发季节,积极治疗后仍有20.5%的低视力或盲。需注意晶状体半脱位继发青光眼初诊容易误诊为原发性闭角型青光眼。约1/3闭青、2/3晶状体半脱位继发性青光眼患者药物无法有效控制眼压,需要进一步手术治疗。

Objective To investigate the epidemiological characteristics and treatment outcome of acute glaucoma.Design Prospective case series.Participants 205 consecutive cases(230 eyes)of acute glaucoma visited in Beijing Tongren Hospital emergency room from October 23,2018 to October 22,2019.Methods The demographic information,initial and confirmed diagnosis,time of visit,treatment outcome were collected from the Hospital Information System(HIS)of Beijing Tongren Hospital and customized CRF.The rank sum test,the chi-square test and Fisher exact test were used for statistically analyze.Main Outcome Measures Demographic information,time of visit,diagnosis and disease proportion of all kinds of glaucoma,treatment and visual prognosis after follow up at least 1 year.Results In 205 cases(230 eyes),the majority of subjects were from Beijing(72.7%)and female(63.4%),and the mean age was 61.7±13.8 years(9~89),60~69 years old were the most(41.5%).The mean presenting IOP was 46.4±11.8 mmHg.Acute primary angle-closure glaucoma(APACG,n=132,64.4%)was the most common diagnosis,followed by secondary glaucoma(n=59,28.8%).The diagnostic agreement between emergency ophthalmologist and glaucoma specialist was 88.8%,the main misdiagnosis came from secondary glaucoma due to subluxation of lens.With medical therapy,APACG attacks resolved within 2 hours in 85 cases(64.4%),but medical treatment was unable to break the initial acute attack of 18 cases(66.7%)secondary glaucoma due to lens subluxation.Winter had higher incidence of acute high IOP attack than other seasons(χ^(2)=219.769,P<0.001).The proportion of blindness and low vision in the last follow-up were 12.2%(n=25)and 8.3%(n=17),respectively.Conclusion Emergency glaucoma patients are mainly primary angle-closure glaucoma.Midwinter and midsummer are high seasons.Glaucoma secondary to lens subluxation is easily misdiagnosed as APACG,and the effect of medication is not good enough.20.5%of low vision or blindness after active treatment.