眼科 ›› 2021, Vol. 30 ›› Issue (2): 89-96.doi: 10.13281/j.cnki.issn.1004-4469.2021.02.003

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跨晶状体压力差与睫状体阻滞闭角型青光眼房角关闭机制思考

梁远波  林海双  张绍丹  刘成坛  许淑霞  乐融融  解彦茜  李国星   

  1. 温州医科大学附属眼视光医院青光眼临床中心  温州医科大学青光眼研究所325027
  • 收稿日期:2021-02-21 出版日期:2021-03-25 发布日期:2021-03-12
  • 通讯作者: 梁远波,Email:yuanboliang@126. com
  • 基金资助:
    浙江省高层次卫生创新人才计划(2016025);浙江省高校领军人才培养计划(2020099);温州市科技局项目(Y2020365)

Trans-lens pressure difference and ciliary block—A new concept for the mechanism of angle closure glaucoma

Liang Yuanbo, Lin Haishuang, Zhang Shaodan, Liu Chengtan, Xu Shuxia, Le Rongrong, Xie Yanqian, Li Guoxing   

  1. Glaucoma Clinical Center, the Eye Hospital of Wenzhou Medical University; Glaucoma Institute of Wenzhou Medical University, Wenzhou 325000, China 
  • Received:2021-02-21 Online:2021-03-25 Published:2021-03-12
  • Contact: Liang Yuanbo, Email: yuanboliang@126.com
  • Supported by:
    Zhejiang Province Health Innovation Talents Fund (2016025); Zhejiang Province Leading Talents in Colleges and Universities Fund (2020099); Wenzhou Basic Scientific Research Project (Y2020365)

摘要: 闭角型青光眼是造成国人不可逆盲的主要原因之一。浅前房和窄房角是闭角型青光眼的解剖学基础及主要危险因素。基于对当前闭角型青光眼机制学说的总结以及临床实践中的思考,笔者提出“跨晶状体压力差与睫状体阻滞”假说。晶状体与睫状体之间存在的房水流体力学阻滞即睫状体阻滞,在此基础上形成了跨晶状体前后的压力差,其推动晶状体前移,进而导致中央及周边前房变浅;中央前房变浅增加瞳孔阻滞力,造成虹膜膨隆,房角变窄甚至关闭,影响房水流出。临床上通过解除睫状体阻滞,消除跨晶状体压力差,从而增加中央前房深度,可能为闭角型青光眼的防治带来新思路。(眼科,2021,30: 89-96)

关键词: 闭角型青光眼, 浅前房, 窄房角, 跨晶状体压力差, 睫状体阻滞

Abstract:  Angle closure glaucoma is (ACG) one of the main causes of blindness in Chinese. Shallow anterior chamber and narrow angle are the anatomical basis and main risk factors of ACG. Based on the current ACG mechanism and the thinking in clinical practice, the author puts forward the hypothesis of “trans-lens pressure difference and ciliary block ”. There is aqueous humor hydrodynamic block between lens and ciliary body, which called ciliary block. Trans-lens pressure difference then formed based on ciliary block. The pressure difference in front and behind the lens can promote the lens to move forward, resulting in shallow central and peripheral anterior chamber. Pupillary block which is secondary to shallow central anterior chamber, causes iris bombe and narrowing/closure of chamber angle. Aqueous humor outflow was obstructed subsequently. In clinic, we can eliminate trans-lens pressure difference by relieving ciliary block and deepening anterior chamber. That may bring new ideas for the prevention and treatment of ACG. (Ophthalmol CHN, 2021, 30: 89-96)

Key words: angle closure glaucoma, shallow anterior chamber, narrow angle, trans-lens pressure difference, ciliary block