中华眼视光学与视觉科学杂志
中華眼視光學與視覺科學雜誌
중화안시광학여시각과학잡지
CHINESE JOURNAL OF OPTOMETRY OPHTHALMOLOGY AND VISUAL SCIENCE
2011年
4期
255-257
,共3页
孙红%袁志兰%虞灵梅%胡春玲
孫紅%袁誌蘭%虞靈梅%鬍春玲
손홍%원지란%우령매%호춘령
青光眼,闭角型,年轻人%眼内压%小梁切除术%瞳孔阻滞%高褶虹膜
青光眼,閉角型,年輕人%眼內壓%小樑切除術%瞳孔阻滯%高褶虹膜
청광안,폐각형,년경인%안내압%소량절제술%동공조체%고습홍막
Glaucoma,angle-closure,young%Intraocular pressure%Trabeculectomy%Pupillary block%Plateau iris
目的 探讨年轻人原发性闭角型青光眼(PACG)的临床特征。方法 回顾性病例对照研究。收集2006年1月至2010年7月期间南京医科大学第一附属医院眼科收治的年龄＜40岁、临床确诊为PACG的患者12例（22眼），及同期单纯行小梁切除术的老年PACG患者217例（236眼）。对两组病例的临床表现、房角结构特点、手术效果以及术后浅前房和恶性青光眼的发生率进行比较。采用配对t检验和x2检验对数据进行统计学分析。结果 年轻PACG患者平均年龄为(32.8±5.7)岁，女性占75％，首次就诊时均已为中晚期，无急性发作症状，眼轴平均为(21.1±1.9)mm，11例(20眼)为高褶虹膜构型（占91％），仅1例（2眼）为瞳孔阻滞。随访时间平均为(24.8±6.3)个月，最后一次复诊时眼压较术前下降(11.6±5.2)mmHg，手术前后差异有统计学意义(t=6.456，P＜0.01)。术后并发症主要有浅前房(44％)，恶性青光眼(17％)。老年PACG患者平均年龄为(60.2±7.1)岁，女性占81％，眼轴平均为(21.5±2.7)mm，高褶虹膜构型仅占19％，瞳孔阻滞占81％，其房角构型与年轻PACG患者相比差异有统计学意义(x2=56.446、14.303，P＜0.01)。老年PACG患者术后浅前房和恶性青光眼发病率分别为10％和6％，年轻PACG浅前房发生率较老年PACG高，差异有统计学意义(x2=14.091，P＜0.01)。结论 年轻人的PACG发病隐匿，早期不易发现和诊断。小梁切除术是其有效的治疗方法，但术后容易出现浅前房。
目的 探討年輕人原髮性閉角型青光眼(PACG)的臨床特徵。方法 迴顧性病例對照研究。收集2006年1月至2010年7月期間南京醫科大學第一附屬醫院眼科收治的年齡＜40歲、臨床確診為PACG的患者12例（22眼），及同期單純行小樑切除術的老年PACG患者217例（236眼）。對兩組病例的臨床錶現、房角結構特點、手術效果以及術後淺前房和噁性青光眼的髮生率進行比較。採用配對t檢驗和x2檢驗對數據進行統計學分析。結果 年輕PACG患者平均年齡為(32.8±5.7)歲，女性佔75％，首次就診時均已為中晚期，無急性髮作癥狀，眼軸平均為(21.1±1.9)mm，11例(20眼)為高褶虹膜構型（佔91％），僅1例（2眼）為瞳孔阻滯。隨訪時間平均為(24.8±6.3)箇月，最後一次複診時眼壓較術前下降(11.6±5.2)mmHg，手術前後差異有統計學意義(t=6.456，P＜0.01)。術後併髮癥主要有淺前房(44％)，噁性青光眼(17％)。老年PACG患者平均年齡為(60.2±7.1)歲，女性佔81％，眼軸平均為(21.5±2.7)mm，高褶虹膜構型僅佔19％，瞳孔阻滯佔81％，其房角構型與年輕PACG患者相比差異有統計學意義(x2=56.446、14.303，P＜0.01)。老年PACG患者術後淺前房和噁性青光眼髮病率分彆為10％和6％，年輕PACG淺前房髮生率較老年PACG高，差異有統計學意義(x2=14.091，P＜0.01)。結論 年輕人的PACG髮病隱匿，早期不易髮現和診斷。小樑切除術是其有效的治療方法，但術後容易齣現淺前房。
목적 탐토년경인원발성폐각형청광안(PACG)적림상특정。방법 회고성병례대조연구。수집2006년1월지2010년7월기간남경의과대학제일부속의원안과수치적년령＜40세、림상학진위PACG적환자12례（22안），급동기단순행소량절제술적노년PACG환자217례（236안）。대량조병례적림상표현、방각결구특점、수술효과이급술후천전방화악성청광안적발생솔진행비교。채용배대t검험화x2검험대수거진행통계학분석。결과 년경PACG환자평균년령위(32.8±5.7)세，녀성점75％，수차취진시균이위중만기，무급성발작증상，안축평균위(21.1±1.9)mm，11례(20안)위고습홍막구형（점91％），부1례（2안）위동공조체。수방시간평균위(24.8±6.3)개월，최후일차복진시안압교술전하강(11.6±5.2)mmHg，수술전후차이유통계학의의(t=6.456，P＜0.01)。술후병발증주요유천전방(44％)，악성청광안(17％)。노년PACG환자평균년령위(60.2±7.1)세，녀성점81％，안축평균위(21.5±2.7)mm，고습홍막구형부점19％，동공조체점81％，기방각구형여년경PACG환자상비차이유통계학의의(x2=56.446、14.303，P＜0.01)。노년PACG환자술후천전방화악성청광안발병솔분별위10％화6％，년경PACG천전방발생솔교노년PACG고，차이유통계학의의(x2=14.091，P＜0.01)。결론 년경인적PACG발병은닉，조기불역발현화진단。소량절제술시기유효적치료방법，단술후용역출현천전방。
Objective To evaluate the clinical characteristics of younger patients with primary angle-closure glaucoma (PACG). Methods Retrospective case control study. Twelve patients (22 eyes) aged 40 or younger with a confirmed diagnosis of PACG from January 2006 to July 2010 were investigated. At the time of the initial diagnosis, all patients were in the middle or late stageand did not feel significant pain. Eighteen eyes underwent surgical treatment. Full ophthalmic examinations were performed. They were compared to 217 older patients (236 eyes) with PACG who underwent trabeculectomy during the same period. The clinical characteristics, including clinical presentations,surgical results and complications were evaluated. Data were analyzed with a paired t test and a chi-square test. Results The mean age of the younger patients with PACG was (32.8±5.7)years.The majority of them were female (75％). The mean axial length was (21.1±1.9)mm. Plateau iris was the most common underlying etiology (91％), and only 1 case (2 eyes) was pupillary block. The mean follow-up period was (24.8±6.3)months. There was an (11.6±5.2)mmHg reduction in the final postoperative intraocular pressure (IOP) compared to preoperative IOP (t=6.456, P＜0.01). The main postoperative complications included shallow anterior chambers (44％) and malignant glaucoma (17％). The mean age of the older patients with PACG was (60.2±7.1)years. The majority of them were females (81％). The mean axial length was (21.5±2.7)mm. Pupillary block (81％) was the most common underlying etiology,and 19％ patients were Plateau iris. The differences of plateau iris and pupillary block were significant (x2=56.446, 14.303, P＜0.01). The incidence of postoperative shallow anterior chamber and postoperative malignant glaucoma was 10％ and 6％, respectively. There was a statistically significant difference in the incidence of postoperative shallow anterior chamber when younger patients were compared to older patients with PACG (x2=14.091, P＜0.01). Conclusion The younger PACG patients cannot be easily identified and diagnosed in the early stages. They can be effectively managed by trabeculectomy, but they have higher incidences of postoperative sustained shallow anterior chamber and malignant glaucoma.
