青光眼睫状体炎综合征误诊误治临床分析

目的探讨青光眼睫状体炎综合征误诊误治的原因。方法收集1999年8月~2004年7月我院门诊确诊的25例(25只眼)青光眼睫状体炎综合征患者,总结患者在外院误诊误治情况并进行回顾性临床分析。结果25例(25只眼)青光眼睫状体炎综合征在外院被误诊原发性青光眼14例(14只眼),占56%;虹膜睫状体炎7例(7只眼),占28%;疱疹性葡萄膜炎2例(2只眼),占8%;中间葡萄膜炎1例(1只眼),占4%;Fuchs虹膜异色性葡萄膜炎1例(1只眼),占4%。在治疗方面均与青光眼睫状体炎综合征治疗原则不相符合,其中9例(36%)在外院施行了抗青光眼滤过手术。结论青光眼睫状体炎综合征在临床上误诊误治普遍存在,首先它容易被误诊为原发性青光眼和虹膜睫状体炎,其次为疱疹性葡萄膜炎、中间葡萄膜炎和Fuchs虹膜异色性葡萄膜炎。应重视青光眼睫状体炎综合征的诊断与治疗,注意与上述眼病鉴别,减少对青光眼睫状体炎综合征的误诊误治。     

激光周边虹膜成形术的临床观察

通过对３６例５６只原发性急、慢性闭角型青光眼施行倍频Ｎｄ：ＹＡＧ激光周边虹膜成形术后的临床观察，随访１—６月（平均４．２月），结果显示：８０—８３％眼的眼压得到控制，７３．６％眼减少了抗青光眼药物的用量，８３％眼房角增宽，６２．５％眼周边前房深度加深，３７％眼房角粘连范围减轻或重新开放。提示：激光周边虹膜成形术对治疗原发性急性闭角型青光眼发作期的患眼、周边虹膜切除术后眼压控制不理想者、慢性闭角型青光眼早期或房角粘连范围不大者有较大的实用价值。     

睫状环阻滞性青光眼的超声生物显微镜检查

目的 应用超声生物显微镜结合Ａ超检查睫状环阻滞性青光眼,以了解急性发作时睫状环阻滞的状况。方法 对２７例（３１只眼）抗青光眼术后发生的睫状环阻滞性青光眼进行实时超声生物显微镜检查,与同一眼术前的超声生物显微镜影像进行对比观察;并以５４只正常眼和７２只原发性闭角型青光眼作为对照研究。结果 睫状环阻滞性青光眼发作时,１８只眼（５８．１％）睫状体和晶体完全相贴,１３只眼（４１．９％）睫状体和晶体间有一间     

虹膜曲率半径计算机图象测量法

用普通计算机测量前房裂隙照片，按抛物线模型近似拟合虹膜轮廓曲线，并计算抛物线弯曲顶点曲率半径；用以描述虹膜轮廓曲线的弯曲程度称虹膜曲率半径（ｉｒｉｓｒａｄｉｕｓＩＲ）；建立一种新的虹膜轮廓测量方法。测量早期原发性瞳孔阻滞性闭角型青光眼６８例９３只眼的虹膜曲率半径发现：患者的虹膜曲率半径小于同年龄正常人（５３例１０６只眼），差异有显著性（Ｐ＜０．０１）。本测量法为进一步探讨瞳孔阻滞性闭角型青光眼的早期诊断及发病机制提供了一种有效的方法。     

氩激光和掺钕钇铝石榴石激光联合应用进行周边虹膜切除术

为了探讨治疗闭角型青光眼的理想术式，对１５１例２００只原发性急、慢性闭角型青光眼，部分混合型青光眼行联合激光周边虹膜切除术。先用氩激光在术眼虹膜面作分层击射，达２／３￣３／４基质层厚；然后用掺钕钇铝石榴石激光（Ｎｄ：ＹＡＧ）作穿透击射。虹膜透切率为１００．０％，１次透切成功率为９５．０％，术中、术后并发症的发生率明显较单独术式低。随访时间在２年以上者为１６１只眼。随访结果表明联合激光手术的远期疗效     

前部视网膜冷凝联合小梁切除术治疗新生血管性青光眼

目的观察前部视网膜冷凝术（ａｎｔｅｒｉｏｒｒｅｔｉｎａｌｃｒｙｏｔｈｅｒａｐｙ，ＡＲＣ）对开角型新生血管性青光眼及ＡＲＣ联合小梁切除术对闭角型新生血管性青光眼的疗效。方法对１１例（１２只眼）开角型新生血管性青光眼单独行ＡＲＣ，２２例（２２只眼）闭角型新生血管性青光眼行ＡＲＣ联合小梁切除术；另选３１例（３２只眼）闭角型新生血管性青光眼单独行ＡＲＣ或睫状体冷凝术作对照。随访６～２６个月。结果单独行ＡＲＣ可使９２％（１１／１２）的开角型新生血管性青光眼眼压恢复正常，虹膜新生血管消退，与单独行ＡＲＣ的闭角型新生血管性青光眼比较，差异有显著性（Ｐ＜０．０５）。对闭角型新生血管性青光眼，行ＡＲＣ联合小梁切除术，可使８６％（１９／２２）的患者眼压恢复正常，虹膜新生血管消退，明显优于仅行ＡＲＣ或睫状体冷凝术者（Ｐ＜０．０１）。此联合术式可使９０％（１８／２０）的患者眼痛消失，６７％（８／１２）的患者视力保持，与睫状体冷凝术比较，差异有显著性（Ｐ＜０．０５）。结论认为ＡＲＣ单独应用可治疗早期新生血管性青光眼，晚期患者需联合小梁切除术治疗。     

青光眼睫状体炎综合征32例临床分析

目的:分析青光眼睫状体炎综合征临床表现,发病原因及诊断治疗方法。方法:对我院2001-01/2008-10临床诊断为青光眼睫状体炎综合征患者32例进行追踪和回顾性分析。结果:32例病例中首诊误诊的有5例。随访时间4～8(平均6)a,长期观察表明:该综合征每年发作次数不等,差别较大,因人而异,每次发作无明确诱因,多次反复发作,大多数视功能不受影响,本组病例中仅4例患者经反复发作后药物控制不佳,出现了视野及视盘改变,进行了外滤过手术治疗,效果较好。结论:青光眼睫状体炎综合征临床表现为单眼复发性睫状体炎伴眼压升高,大多反复发作,但多数不出现视野及视盘改变。在临床上该病易被误诊,必须掌握其诊断与鉴别诊断的要点。应长期观察视野及视盘变化情况,避免造成视功能持续损害。     

青光眼睫状体炎综合征临床分析

目的 探讨青光眼睫状体炎综合征患者的临床表现、治疗、病程和视力预后.方法 收集近5年来在眼科就诊的青光眼睫状体炎综合征患者49例(55只眼),常规行矫正远视力、裂隙灯显微镜、眼底镜、房角镜和眼压检查,部分患者行视野检查,分析其临床特点、治疗效果和视力预后.结果 49例患者中,男30例,女19例;发病时年龄18～62岁,平均(37.2±15.6)岁.其中单眼发病43例,双眼交替发病6例.初次发病者32例,反复发作者17例,发作次数为2～11次.经系统抗炎和降眼压治疗后所有患者眼压均得以控制,43例患者(48只眼)视功能恢复;有6例患者(7只眼)因反复发作出现杯盘比扩大和视野损害.结论 青光眼睫状体炎综合征表现为单眼复发性虹膜睫状体炎并伴有眼压升高,多数患者经治疗后视力预后较佳,少数患者反复发作后可出现青光眼性视野损害.该病在临床上易被误诊或漏诊,临床医生应掌握其诊治要点,并对反复发作的患者定期观察视野及视盘变化,以免造成永久性视功能损害.     

激光周边虹膜成形术联合周边虹膜切除术治疗高褶虹膜型青光眼

目的探讨采用联合激光技术治疗高褶虹膜型青光眼的疗效。方法对２０例（３７只眼）早期原发性慢性闭角型高褶虹膜型青光眼，一次性行氩激光周边虹膜成形术联合氩激光加ＮｄＹＡＧ激光周边虹膜切除术（联合激光手术）。结果随访８个月至４年零７个月，平均２．７年。１７例（３２只眼）获得满意疗效，在观察期内无青光眼急性发作，眼压从５．８０±１．０４ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）下降到２．７４ｋＰａ以下，周边前房加深，房角增宽，虹膜皱缩，有效地防止了房角的进一步粘连，８６．７％的患者暗室试验转阴性。结论联合激光手术是治疗高褶虹膜型青光眼的有效方法之一。     

氟激光和掺钕钇铝石榴石激光联合应用进行周边虹膜切除术

为了探讨治疗闭角型青光眼的理想术式，对１５１例２００只原发性急、慢性闭角型青光眼，部分混合型青光眼行联合激光周边虹膜切除术。先用氖激光在术眼虹膜面作分层击射，达２／３～３／４基质层厚；然后用掺钕钇铝石榴石激光（ｎｅｅｄｙｍｉｕｍ：ｙｔｔｒｉｕｍａｌｕｍｉｎｕｍｇａｒｎｅｔ，Ｎｄ：ＹＡＧ）作穿透击射。虹膜透切率为１００．０％，１次透切成功率为９５．０％，术中、术后并发症的发生率明显较单独术式低。随访时间在２年以上者为１６１只眼。随访结果表明联合激光手术的远期疗效显著，是适宜于亚洲人虹膜特点的较为理想术式，建议在门诊推广应用。     

Incidence of secondary glaucoma in behcet disease

PURPOSE: To determine the incidence of secondary glaucoma in Behcet disease. METHODS: A total of 230 eyes of 129 patients with Behcet disease, were examined in uveitis and glaucoma clinics of Ankara Social Security Eye Hospital between January 1997 and September 2002. The data from all patients were investigated both retrospectively and prospectively. RESULTS: The mean age of 129 patients was 34.2 +/- 7.4 years (range, 18 to 55 years). In 22 patients (17%), the disease was diagnosed on the basis of the ocular findings, while in the remaining 107 patients (83%), the period between the diagnosis of Behcet disease and the onset of the ocular symptoms was 23.3 +/- 17 months (range, 1 month to 5.3 years); 122 eyes (53%) had the episodes of acute recurrent iridocyclitis, while 108 eyes (47%) developed chronic posterior uveitis, including vitreitis, retinitis, vasculitis, or optic nerve involvement. Secondary glaucoma was diagnosed in 25 eyes (10.9%); 11 eyes (44%) with steroid or inflammation induced open angle glaucoma, 6 eyes (24%) with partial angle-closure glaucoma and peripheral anterior synechiae, 5 eyes (20%) with angle closure glaucoma, peripheral anterior synechiae, and pupil block and 3 eyes (12%) with neovascular glaucoma. The treatments included YAG-laser iridotomy in 5 eyes, diode-laser cyclodestruction in 3 eyes, primary trabeculectomies with mitomycin-c in 4 eyes, secondary trabeculectomies with mitomycin-c in 2 eyes, Ahmed valve implantations in 2 eyes, and cyclocryotherapy in 3 eyes. CONCLUSIONS: We suggest that secondary glaucoma is a common and serious complication of Behcet disease. It develops as a result of multiple factors, generally triggered by recurrent intraocular inflammation. Early recognition and treatment of these factors have vital importance to avoid the visual morbidity.     

丝裂霉素C辅助小梁切除术并发症分析

目的：分析丝裂霉素C辅助小梁切除术治疗青光眼的并发症及其处理措施。方法：56例（65眼）青光眼在行小梁切除术中巩膜瓣下及结膜下敷0．4mg/mlMMC棉片5分钟,术后1、3、7天及1、3、6、12个月观察疗效及并发症。结果：并发症有：（1）角膜上皮缺损15眼（23％）;（2）滤过泡渗漏5眼（7．6％）;（3）巨大薄膜壁滤过泡4眼（6．15％）。结论：虽然MMC辅助小梁切除术提高手术成功率及大大降低眼压,但其并发症值得重视,药物浓度及作用时间个体化有助于减少并发症的发生率。     

混合型青光眼住院病人的致病机制构成分析

目的 分析混合型青光眼(mixed glaucoma,MG)住院病人的致病机制.方法 收集 2005年~2009年连续住院患者MG 109只眼(76例)的临床资料,结合眼压、C/D、视野、前房角镜及超声生物显微镜(ultrasound biomicroscopy,UBM)等临床资料,分类分析其混合致病机制的构成.结果 (1)本组病例存在12个致病机制类型:原发性开角型青光眼(primary open-angle glaucoma,POAG、原发性闭角型青光眼(primary angle-closure glaucoma,PACG)、先天性青光眼、新生血管性青光眼、青睫综合征及以下因素:晶状体膨胀或脱位、睫状体囊肿、糖皮质激素、眼外伤或眼内手术、虹膜炎、Fuchs综合征和剥脱综合征继发性青光眼.(2) 本组病例存在7类混合机制致病:POAG合并PACG35只眼,占32.1%;PACG合并继发性闭角型青光眼32只眼(29.4%);PACG合并继发性开角型青光眼13只眼(11.9%);POAG合并继发性开角型青光眼11只眼(10.1%);POAG合并继发性闭角型青光眼10只眼(9.2%);先天性青光眼合并继发性青光眼5只眼(4.6%)及不同类型的继发性青光眼合并存在3只眼(2.8%).结论 注意对青光眼发病机制的全面分析,避免明确一种青光眼致病病机制而忽略混合致病机制的存在,以便采取恰当全面的治疗方案;UBM的应用有助于MG致病机制的分析;POAG 合并PACG是MG的主要类型.     

眼动脉瘤眼部表现的临床探讨

目的:探讨眼动脉瘤所引起的眼部改变。方法:回顾性分析2003-08/2009-03首都医科大学附属北京天坛医院神经外科收治的44例眼动脉瘤患者的临床资料。结果:眼动脉瘤患者44例以眼部改变为首发者14例(32%)。视力下降者12例(27%),其中单眼者10例(23%),双眼者2例(5%);视野缺损者10例(23%)(双眼2例,单眼8例);复视者2例(5%);上睑下垂者4例(9%);误诊为球后视神经炎2例,青光眼1例。结论:眼动脉动脉瘤患者可引起眼部改变,最常见的表现为视力下降和视野缺损。     

青光眼术后浅前房的临床分析

目的：分析青光眼患者于抗青光眼手术后发生浅前房的原因，以减少术后浅前房的发生。方法：246例(280只眼)青光眼患者行巩膜下咬切术及虹膜切除术。对其病历进行分析。结果：280只眼中，手术后29只眼(10．36％)发生浅前房。经分析其原因有：1)造瘘口过大，引流过畅(8／29只眼，27．6％)；2)结胰瓣缝线过松，致房水渗漏(5／29，17．2％)；3)脉络膜脱离(4／29，13．8％)；4)恶性青光眼(2／29，6．9％)；5)虹膜睫状体炎(1／29，3．4％)；6)原因不明(9／29，31．0％)。经对症治疗后，前房均恢复正常。结论：对不同类型青光眼患者，术前应予以适当治疗，术中细心操作，术后密切观察并予以对症处理，可减少术后浅前房的发生。     

Fuchs' heterochromic iridocyclitis: A review of 26 cases

Fuchs' heterochromic iridocyclitis (FHI), an unusual form of uveitis of unknown etiology, is frequently misdiagnosed. Purpose: To report the analysis of 26 patients (27 eyes) with FHI who were diagnosed and observed over a period of 1–7 years (mean: 3.42 ± 2.2 years). Methods: Ocular and systemic examinations were performed on all patients. Results: The most common presenting symptom was visual deterioration (42.3%); one patient was affected bilaterally. Characteristic keratic precipitates (100%), cataracts (77.8%), and heterochromia (70.4%) were the major signs. Eleven eyes (40.7%) required cataract surgery. At the initial examination, four eyes (14.8%) had glaucoma, and no new cases of glaucoma developed during the follow-up period. One eye required filtration surgery. Vitrectomy was performed in two eyes (7.4%) because of vitreous opacities. Most patients (73.0%) did not require active treatment; pre- and postoperative anti-inflammatory treatment for cataract extraction was performed successfully to minimize the risk of inflammation. No severe uveitis was seen in any patient after surgery, but visual acuity did not improve greatly after cataract extraction; 54.5% eyes had visual acuity better than 20/40 before surgery, and 45.4% postoperatively. Conclusion: Posterior capsule opacification, glaucoma, and vitreous opacity were the major obstacles to visual rehabilitation after cataract surgery in patients with this type of uveitis.     

Changes in the iris vasculature and corneal endothelium in chronic cyclitis

Fluorescein angiography of the iris vasculature and specular microscopy of the corneal endothelium were used to examine two important anterior chamber tissues in cases of heterochromic cyclitis, classical chronic cyclitis and some cases of iridocyclitis. The 13 cases of heterochromic cyclitis and eight cases of classical chronic cyclitis all showed vascular hypoperfusion of the iris, except for two young females with heterochromia. In these cyclitic eyes there was pupillary leakage of dye and all but one young female with heterochromia showed evidence of microneovascularization of the iris. Most patients showed evidence of abnormalities of the corneal endothelium, but this was most marked in elderly patients with heterochromic cyclitis, probably due to the long duration of the condition. Six of the patients with chronic cyclitis had bilateral disease and five of these were elderly women with glaucoma and grey irides, the group being distinct enough to form a discrete clinical entity. Seventeen of the patients with chronic cyclitis were females with grey irides suggesting that this type of patient is more susceptible to cyclitis. Patients with acute iridocyclitis showed little abnormality on fluorescein angiography, while those with recurrent or chronic disease showed vascular hypoperfusion and microneovascularization suggesting that these changes in the iris contribute to the chronicity of the condition. It is suggested that hypoperfusion and microneovascularization of the iris and abnormal permeability are important factors in the production of chronic cyclitis, and that the integrity of the corneal endothelium is affected by these changes if they operate over a long period of time.     

Secondary glaucoma in patients with juvenile rheumatoid arthritis-associated iridocyclitis

PURPOSE: The prevalence and management of glaucoma were evaluated in patients with juvenile rheumatoid arthritis (JRA)-associated iridocyclitis. METHODS: The records of 69 patients with JRA-associated iridocyclitis were reviewed. RESULTS: Twenty-nine (42%) of these patients had secondary glaucoma or ocular hypertension. Glaucoma was controlled with topical treatment in only 7 of the 41 affected eyes (17%); systemic carbonic anhydrase inhibitor therapy resulted in control of another 8 eyes. Surgery controlled all but one of the remainder. CONCLUSION: Glaucoma is a common complication of JRA-associated iridocyclitis. It results from prolonged, inadequately treated intraocular inflammation and in some instances, from steroid use. Medical and surgical therapy for the glaucoma associated with JRA-uveitis is challenging and incompletely effective. We suspect that a more aggressive approach to the treatment of JRA-associated uveitis, earlier in the course of the disease may reduce this vision robbing contribution to the process.     

眼瘢痕性类天疱疮病例的回顾性分析

目的 探讨眼瘢痕性类天疱疮(OCP)的临床特点.方法 回顾性系列病例研究.回顾2005年1月至2008年10月于北京大学第一医院眼科和皮肤科联合确诊为OCP的系列病例5例(10只眼)患者的病史、眼科常规检查、结膜囊细菌培养及全身免疫学常规检查的结果,分析其误诊原因.结果 确诊前,5例患者在早期均误诊为慢性结膜炎,在这些病例瘢痕较明显时,1例曾被误诊为Stevens-Johnson综合征,1例误诊为干燥综合征,患者从首次就诊至确诊的时间长达2～5年.在确诊前均经过长期抗菌滴眼液的局部治疗,1例经3次内翻倒睫矫正术,术后病情加重.5例患者中诊断为OCPⅡ期3只眼、Ⅲ期5只眼、Ⅳ期2只眼,3例患者结膜囊细菌培养阳性,仅1例患者肿瘤标记物铁蛋白轻度升高,其余患者常规免疫学检查均正常.确诊后经合理治疗病情控制,但2例患者结膜瘢痕继续进展.结论 OCP早期表现类似慢性结膜炎,提高对OCP的警惕和认识是避免误诊的重要手段.