眼科

• 焦点论坛 • 上一篇    下一篇

晶状体悬韧带异常继发闭角型青光眼

樊宁  王宁利  刘旭阳   

  1. 518040广东深圳,暨南大学附属深圳眼科医院  深圳眼科学重点实验室(樊宁、刘旭阳);100005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 北京市眼科研究所(王宁利)
         
  • 收稿日期:2018-01-03 出版日期:2018-01-25 发布日期:2018-01-26
  • 通讯作者: 刘旭阳,Email:xliu1213@126.com
  • 基金资助:

    国家自然科学基金面上项目(81770924);深圳市创新委基础研究项目(JCYJ20160428144701106);深圳市医疗卫生三名工程项目(SZSM201512045 )
     

Angle-closure like glaucoma secondary to lens suspensory ligament laxity 

FAN Ning1, WANG Ning-li2, LIU Xu-yang1   

  1. 1. Shenzhen Eye Hospital, Shenzhen Key Laboratory of Ophthalmology, Jinan University, Shenzhen 518040, China; 2. Beijing Institute of Ophthalmology, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100005, China
  • Received:2018-01-03 Online:2018-01-25 Published:2018-01-26
  • Contact: LIU Xu-yang, Email: xliu1213@126.com

摘要:

晶状体悬韧带异常的病因很多,常见的有外伤性悬韧带损伤、悬韧带发育异常(如马凡综合征等)以及累及周边的视网膜变性等退行性病变。这些原因导致的晶状体悬韧带松弛或部分离断可导致晶状体虹膜隔前移、前房变浅、房角关闭以及隐匿性晶状体不全脱位,眼压可呈急性或慢性升高,临床表现类似原发性闭角型青光眼(primary angle closure glaucoma,PACG)。对于此类患者给予缩瞳、激光周边虹膜切开或者小梁切除手术,由于没有根本解决晶状体位置异常这个主要致病因素,有时不仅不能降低眼压,反而加重前房变浅、诱发房水迷流或恶性青光眼。晶状体悬韧带异常继发的此类青光眼并非典型的闭角型青光眼,二者在发病年龄、眼别、屈光状态、前房深度、眼轴长度、对散瞳剂与缩曈剂的反应、UBM特征等方面均有不同,且前者常伴有眼部其他合并症。两者的治疗也有原则性的区别,比如是缩瞳还是散瞳,是否行激光虹膜周切,选择青光眼手术还是晶状体手术等。因此临床上需仔细鉴别晶状体悬韧带异常继发的此类青光眼与PACG,并根据发病机制给予针对性治疗。(眼科, 2018, 27: 4-8)

关键词:  晶状体悬韧带;闭角型青光眼, 继发性

Abstract:

 The etiology of abnormal lens suspensory ligament laxity includes traumatic suspensory ligament injury, congenital suspensory ligament abnormalities (such as Marfan syndrome) and peripheral retinal degeneration, etc. The suspensory ligament laxity can result in antedisplacement of lens iris diaphragm, shallow anterior chamber, progressive angle closure and peripheral anterior synechia, leading to elevated intraocular pressure and glaucoma similar to primary angle closure glaucoma (PACG). The management of these disorders is critical. Commonly used treatments for PACG, such as pilocarpine eye drops and laser peripheral iridotomy or trabeculectomy, may not work, since the main pathogenic factor is not resolved. In addition, the anterior chamber may sometimes become shallower and in turn, the aqueous misdirection or malignant glaucoma may occur. Zonular abnormalities associated angle closure glaucoma differ from PACG in a number of respects, including age, monocular or bilateral, diopter, axial length, anterior chamber depth, the reaction to mydriatic agents and UBM examination. The treatment regimens are also quite different. Therefore, it is important to differentiate glaucoma secondary to suspensory ligament laxity from PACG. (Ophthalmol CHN, 2018, 27: 4-8)

Key words: lens suspensory ligament, angle-closure glaucoma, secondary