眼科

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复方托吡卡胺散瞳治疗急性发作的原发性闭角型青光眼四例

张明  彭显耀  胡城  孟京亚  吴海霞  梁远波   

  1. 210009 东南大学附属中大医院眼科(张明);325027 温州医科大学附属眼视光医院(彭显耀、胡城、孟京亚、吴海霞、梁远波)
         
  • 收稿日期:2017-08-30 出版日期:2018-01-25 发布日期:2018-01-26
  • 通讯作者: 梁远波,Email:yuanboliang@126.com
  • 基金资助:

    浙江省高级卫生创新人才(2016025)

Four cases of acute angle-closure glaucoma treated by mydriasis with compound tropicamide eye drops

ZHANG Ming1, PENG Xian-yao2, HU Cheng2, MENG Jing-ya2, WU Hai-xia2, LIANG Yuan-bo2.   

  1. 1. Department of Ophthalmology, Affiliated Zhong Da Hospital of Southeast University, Nanjing 210009,China; 2. Eye Hospital of Wenzhou Medical University, Wenzhou 325027, China
  • Received:2017-08-30 Online:2018-01-25 Published:2018-01-26
  • Contact: LIANG Yuan-bo, Email: yuanboliang@126.com

摘要:

总结2014-2016年在温州眼视光医院用复方托吡卡胺散瞳治疗有效的4例原发性闭角型青光眼(primary angle-closure glaucoma,PACG)急性发作患者的临床及UBM形态学特征。急性闭角型青光眼、慢性闭角型青光眼急性发作各2例。患者均为男性,年龄65~71岁。双眼急性发作3例,单眼急性发作1例。UBM显示单纯性瞳孔阻滞型2例,瞳孔阻滞合并睫状体前位型2例。4例患者3种以上药物治疗无效,滴用毛果芸香碱后眼压无下降甚至升高,改用复方托吡卡胺散瞳治疗后,眼压在3~15小时内进行性下降至21 mmHg以下。4例患者均无明显睫状环阻滞或晶状体不全脱位的表现,发作前房角开放≥180°,发作时全周关闭,散瞳后开放90°~360°,且再次开放位置与发作前基本一致。认为对于急性发作的PACG患者散瞳治疗的指征尚需更多的临床研究和总结。(眼科,2018, 27: 75-79)

关键词: 原发性闭角型青光眼, 瞳孔阻滞, 散瞳

Abstract:

To summarize the clinical and UBM morphological characteristics of 4 cases of primary angle closure glaucoma (PACG) with acute onset, who were well treated by application of compound tropicamide eye drops, in Eye Hospital of Wenzhou Medical University during a period from 2014 to 2016. All of these 4 patients were men, aged from 65 to 71 years old, including 2 cases of acute PACG and 2 cases of chronic PACG (3 cases of binoculus, 1 case of monocular eye). UBM showed that there were 2 cases with simple pupillary block, and 2 cases with pupillary block combined with anteriorly located ciliary body. The intraocular pressure were not controlled with more than 3 kinds of antiglaucoma drugs, even increased by dripping pilocarpine, but all the cases progressively dropped to below 21 mmHg in 3-15 hours while reversing to compound tropicamide. Among them, with no obvious ciliary block or lens subluxation, anterior chamber angle which were opened widely ≥ 180 ° before acute attack and entirely closed while attacking, opened again about 90°-360° after mydriasis accordantly with the open positions before acute attack. More researches are needed for indications of mydriatic treatment for PACG patients with acute onset. (Ophthalmol CHN, 2018, 27: 75-79)

Key words: primary angle closure glaucoma, pupillary block, mydriasis