恶性青光眼的诊疗进展及新认识

Progress in diagnosis and treatment of malignant glaucoma

恶性青光眼主要病理生理机制为房水逆流并阻滞于玻璃体中,推动晶状体-虹膜隔前移导致中央和周边前房普遍变浅,伴或不伴高眼压。基于虹膜周切-部分悬韧带切除-玻璃体前界膜切开-前部玻璃体切除术(irido-zonulo-hyaloid-vitrectomy,IZHV)这一治疗恶性青光眼金标准术式的推广及普及,对睫状体-悬韧带-晶状体-玻璃体前界膜-前部玻璃体组织复合体(ciliary body-zonules-crystalline lens-hyaloid-anterior vitreous complex,CZLHV)这一结构和功能异常在恶性青光眼发生发展中的作用认识逐渐深入。本文将基于这一复合体概念重新认识和理解恶性青光眼的发病机制,并阐述针对这一复合体结构和功能异常的恶性青光眼防治方案,以指导临床诊疗,改善预后。

The fundamental pathophysiological mechanism of malignant glaucoma is the posterior misdirection of aqueous humor into the vitreous,which results in the forward displacement of the lens-iris diaphragm and the shallowing of the entire anterior chamber,with or without elevated intraocular pressure.The promotion and dissemination of the irido-zonulo-hyaloid-vitrectomy(IZHV)procedure,which is considered the gold standard for treating malignant glaucoma in clinical practice,have led to a deeper understanding of the role played by the structural and functional abnormalities of the ciliary body-zonules-crystalline lens-hyaloid-anterior vitreous complex(CZLHV)in the occurrence and progression of malignant glaucoma.In this review,we aim to elaborate the pathogenesis of malignant glaucoma from the view of this complex concept,and subsequently propose the modified management strategy that follows our understanding of the complex and significantly improve visual prognosis of patients with malignant glaucoma.(Ophthalmol CHN,2024,33:161-168)