晶状体诱导性青光眼的诊治进展

Progress in diagnosis and treatment of lens-induced glaucoma

晶状体诱导性青光眼(lens-induced glaucoma,LIG)是因晶状体蛋白相关或解剖学异常引起的一类继发性青光眼。基于发病机制,分为晶状体溶解性青光眼、晶状体颗粒性青光眼、晶状体过敏性青光眼、晶体膨胀性青光眼、瞳孔阻滞性青光眼等几类,房角可能是开放或关闭的。高分子量晶状体蛋白、晶状体颗粒释放、瞳孔阻滞、晶体体积增大是引起青光眼的机制。其病因包括膨胀期、成熟期或过熟期白内障,眼部手术和外伤,各种晶体脱位等。流行病学在发达国家和发展中国家各不相同。以视力下降、眼红、单侧眼痛等为主要临床表现,可产生青光眼性不可逆视功能损害。眼部超声检查对其诊断有帮助。需要和急性闭角型青光眼、睫状环阻滞性青光眼、脉络膜上腔出血、外伤或术后眼内炎等疾病相鉴别。治疗方法是去除晶体刺激物质,从而控制眼压。

Lens-induced glaucoma(LIG)is a kind of secondary glaucoma caused by lens proteins or anatomic abnormality of the lens.Based on the pathogenesis,LIG is classified as phacolytic glaucoma,lens-particle induced glaucoma,phacoanaphylactic glaucoma,phacomorphic glaucoma,pupillary block glaucoma.The angle may be open or closed.High-molecular-weight lens protein,release of lens particles,and pupillary block,increase in the volume of the cataractous lens are the mechanisms of glaucoma.Its pathogensis includes intumescent cataracts,mature senile cataract,hyper-mature senile cataracts,surgery and trauma in eyes,and dislocation of lens.The epidemiology varies across developed and developing countries.The common symptom includes diminution of vision,redness of the eye,and unilateral eye pain.It can cause glaucomatous irreversible visual impairment.Ocular ultrasonography is helpful for its diagnosis.Differential diagnosis includes acute angle-closure glaucoma,ciliary block glaucoma,supra-choroidal hemorrhage,post-traumatic or postoperative endophthalmitis.The management is the removal of inciting lenticular matter to control intraocular pressure.