眼科 ›› 2026, Vol. 35 ›› Issue (2): 92-96.doi: 10.13281/j.cnki.issn.1004-4469.2026.02.002

• 专家讲座 • 上一篇    下一篇

真性小眼球继发闭角型青光眼并发症的病理生理机制及手术治疗策略

余晓伟  石砚  范志刚   

  1. 首都医科大学附属北京同仁医院  北京同仁眼科中心 眼科学与视觉科学北京市重点实验室,北京100730  
  • 收稿日期:2025-12-05 出版日期:2026-03-25 发布日期:2026-03-07
  • 通讯作者: 范志刚,Email: fanzhigang@mail.ccmu.edu.cn

Surgical strategies based on the pathophysiological mechanism of complications in nanophthalmos with secondary angle-closure glaucom

Yu Xiaowei, Shi Yan, Fan Zhigang   

  1. Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing 100730, China

  • Received:2025-12-05 Online:2026-03-25 Published:2026-03-07
  • Contact: Fan Zhigang, Email: fanzhigang@mail.ccmu.edu.cn
  • Supported by:
    国家自然科学基金(82471072,82171050)

摘要:  真性小眼球继发闭角型青光眼(NSACG)术后易出现恶性青光眼、葡萄膜渗漏乃至驱逐性出血等严重并发症。针对NSACG的复杂发病机制,剖析其易出现严重手术并发症的病理生理机制,我们围绕“复合体异常、房角关闭、葡萄膜渗漏”这三大因素进行了模块化手术设计,包括超声乳化白内障摘除联合人工晶状体植入、虹膜周边切除-部分悬韧带切除-玻璃体前界膜切开-前部玻璃体切除术(IZHV)、房角分离/Ahmed青光眼引流阀植入术、巩膜开窗术等。基于NSACG患者不同眼部情况,选择性地整合上述手术方式,可为此类难治性青光眼提供个性化模块化手术治疗策略,以期降低手术并发症风险,改善预后。

关键词: 真性小眼球, 闭角型青光眼/继发性, 恶性青光眼, 葡萄膜渗漏

Abstract: Nanophthalmos with secondary angle-closure glaucoma (NSACG) carries significant surgical risks, including malignant glaucoma, uveal effusion, and even suprachoroidal hemorrhage. To address the complex pathogenesis of NSACG and its underlying pathophysiological mechanisms leading to severe complications, we developed a modular surgical strategy targeting three core factors: anterior segment dysgenesis, angle closure, and uveal effusion. This integrated approach combines: phacoemulsification with intraocular lens implantation (Phaco-IOL), irido-zonulo-hyaloid-vitrectomy (IZHV), goniosynechialysis (GSL) or Ahmed glaucoma valve (AGV) implantation, and sclerotomy with scleral window. By selectively tailoring these surgical components according to individual ocular characteristics, we provide personalized modular surgical management for this refractory glaucoma subtype. This strategy aims to reduce surgical complication risks and improve long-term outcomes.

Key words:  Nanophthalmos, Angle-closure glaucoma/secondary, Malignant glaucoma, Uveal effusion