高度近视合并原发性开角型青光眼的临床分析

目的 探讨高度近视合并原发性开角型青光眼（primary open-angle glaucoma,POAG)的早期诊断依据。方法 （1）将存档的21例（40只眼）高度近视合并POAG患者资料（A组）与随机抽取的21例（40只眼）中度近视合并POAG患者的资料（B组）及21例（42只眼）低度近视合并POAG患者的资料（C组）进行对照,比较初次就诊时3组患者间视野缺损,视网膜神经纤维层缺损（retinal nerve fibre layer defect,RNFLD),最高眼压值及最佳矫正视力等指标的差异;（2）观察A组患者的三维眼底照片,分析其临床特点。结果 （1）初诊时,A组患者中,重度视野缺损和RNFLD的比例明显高于B,C组,矫正视力低于B,C组;（2）高度近视患者视乳头,视网膜的特异性变化及视乳头周围病变等,直接干扰对青光眼的早期诊断;（3）散瞳检查或立体眼底拍片是提高青光眼检出率的重要手段。结论 认识高度近视本身及合并POAG时的临床特点,有利于提高临床医师对该病的警觉性及早期诊断水平。

A clinical analysis of high myopia with primary open-angle glaucoma

Objective To approach the bases of early diagnosis of high myopia (HM) combined with primary open angle glaucoma (POAG). Methods (1) There were 3 groups of POAG: group A with HM (40 eyes of 21 cases), group B with medium myopia (40 eyes of 21 cases) and group C with low myopia (42 eyes of 21 cases). Their visual field defect, retinal nerve fiber layer defect (RNFLD), the maximum intraocular pressure and corrected visual acuity were compared. (2) The stereo photos of the HM POAG were observed directly, and their clinical characteristics were analyzed. Results (1) On the initial visit, the patients of group A obviously suffered more serious visual field defects and RNFLD, and the corrected visual acuity was lower than that of the two other groups. (2) The specific fundus changes at the papilla and its surrounding retina of the HM patients interfered with the early detection of glaucoma. The dilatation of pupil to examine the fundus and the use of stereo photos were the main measures to elevate the detectable rate of glaucoma. Conclusion Recognizing the early clinical characteristics of HM itself combined with that of POAG may help us to improve the proficiency of HM POAG early detection.