中华眼科杂志
中華眼科雜誌
중화안과잡지
Chinese Journal of Ophthalmology
2013年
7期
637-641
,共5页
虹膜角膜内皮综合征%误诊%青光眼
虹膜角膜內皮綜閤徵%誤診%青光眼
홍막각막내피종합정%오진%청광안
Iridocorneal endothelial syndrome%Diagnostic errors%Glaucoma
目的 探讨虹膜角膜内皮综合征(ICE综合征)误诊漏诊情况及其主要原因.方法 回顾性系列病例研究.收集2008年1月至2011年12月在首都医科大学附属北京同仁医院北京同仁眼科中心确诊为ICE综合征的病例65例(65只眼),采用国际通用的诊断及分型标准,分析病例中误诊漏诊情况、错误诊断类型,并对ICE综合征的误诊漏诊原因及临床特殊表现进行总结分析.结果 初诊诊断正确者9例(13.8％)；错误诊断包括原发性闭角型青光眼14例(21.5％)、原发性开角型青光眼14例(21.5％)、葡萄膜炎7例(10.8％)等.误诊漏诊患者中对侧眼手术或激光治疗者12例.本组病例的不典型表现及特殊表现包括:虹膜无萎缩及轻度萎缩者54例(83.1％),继发性开角型青光眼11例(16.9％),最高眼压≥40 mmHg(1mmHg=0.133 kPa)者41例(63.1％),眼压降到30 mmHg以下角膜无水肿者48例(73.8％),部分患眼的房角有异常黑色素沉着.结论 ICE综合征是误诊漏诊率较高的一种眼病.误诊漏诊原因包括该病的临床表现多样以及临床医师对其不典型表现缺乏关注.
目的 探討虹膜角膜內皮綜閤徵(ICE綜閤徵)誤診漏診情況及其主要原因.方法 迴顧性繫列病例研究.收集2008年1月至2011年12月在首都醫科大學附屬北京同仁醫院北京同仁眼科中心確診為ICE綜閤徵的病例65例(65隻眼),採用國際通用的診斷及分型標準,分析病例中誤診漏診情況、錯誤診斷類型,併對ICE綜閤徵的誤診漏診原因及臨床特殊錶現進行總結分析.結果 初診診斷正確者9例(13.8％)；錯誤診斷包括原髮性閉角型青光眼14例(21.5％)、原髮性開角型青光眼14例(21.5％)、葡萄膜炎7例(10.8％)等.誤診漏診患者中對側眼手術或激光治療者12例.本組病例的不典型錶現及特殊錶現包括:虹膜無萎縮及輕度萎縮者54例(83.1％),繼髮性開角型青光眼11例(16.9％),最高眼壓≥40 mmHg(1mmHg=0.133 kPa)者41例(63.1％),眼壓降到30 mmHg以下角膜無水腫者48例(73.8％),部分患眼的房角有異常黑色素沉著.結論 ICE綜閤徵是誤診漏診率較高的一種眼病.誤診漏診原因包括該病的臨床錶現多樣以及臨床醫師對其不典型錶現缺乏關註.
목적 탐토홍막각막내피종합정(ICE종합정)오진루진정황급기주요원인.방법 회고성계렬병례연구.수집2008년1월지2011년12월재수도의과대학부속북경동인의원북경동인안과중심학진위ICE종합정적병례65례(65지안),채용국제통용적진단급분형표준,분석병례중오진루진정황、착오진단류형,병대ICE종합정적오진루진원인급림상특수표현진행총결분석.결과 초진진단정학자9례(13.8％)；착오진단포괄원발성폐각형청광안14례(21.5％)、원발성개각형청광안14례(21.5％)、포도막염7례(10.8％)등.오진루진환자중대측안수술혹격광치료자12례.본조병례적불전형표현급특수표현포괄:홍막무위축급경도위축자54례(83.1％),계발성개각형청광안11례(16.9％),최고안압≥40 mmHg(1mmHg=0.133 kPa)자41례(63.1％),안압강도30 mmHg이하각막무수종자48례(73.8％),부분환안적방각유이상흑색소침착.결론 ICE종합정시오진루진솔교고적일충안병.오진루진원인포괄해병적림상표현다양이급림상의사대기불전형표현결핍관주.
Objective To summarize the misdiagnosis and missed diagnosis of iridocorneal endothelial syndrome(ICE syndrome)and analyze the main reasons.Methods Retrospective case series.The records of 65 patients(65 eyes)who were diagnosed to suffer from ICE syndrome in Beijing Tongren Hospital during Jan.2008 to Dec.2011 were studied retrospectively.The international diagnostic standards were used.The situations of misdiagnosis and missed diagnosis were evaluated and the main reasons and the related clinical characters were analyzed.Results The correct preliminary diagnosis was found in 9 cases (13.8％).Misdiagnosis included primary angle closure glaucoma(PACG)in 14 cases(21.5％),primary open angle glaucoma(POAG)in 14 cases(21.5％),uveitis in seven cases(10.8％),etc.The contralateral eye received operation or laser therapy in 12 of 56 cases who didn't get the correct preliminary diagnosis.There were many atypical and special presentations in our patients.There was no or mild atrophy of iris in 54 cases(83.1％).Secondary open angle glaucoma was found in eleven cases(16.9％).The maximal intraocular pressure(IOP)was ≥ 40 mmHg(1 mmHg=0.133 kPa)in 41 cases(63.1％).And there was no corneal edema when the IOP is lower than 30 mmHg in 48 cases(73.8％).There is some abnormal black pigment in the anterior chamber angle in some cases.Conclusions ICE syndrome is a disease with high rate of misdiagnosis or missed diagnosis.The main reasons of misdiagnosis and missed diagnosis include that ICE syndrome has many different clinical manifestations and the doctors pay little attention of to the atypical presentations of ICE cases.
