葡萄膜炎继发青光眼的诊治进展

继发性青光眼是葡萄膜炎患者常见的致盲性并发症,发生率约为10%。常见类型有青光眼睫状体炎综合征、Fuchs综合征、幼年性关节炎相关的葡萄膜炎、病毒性葡萄膜炎、HLA-B27相关性葡萄膜炎、中间葡萄膜炎、Vogt-小柳原田病、Behcet病和类肉瘤病。发生机制与虹膜周边前粘连、瞳孔阻滞、小梁网炎症、Schlemm管功能异常、睫状体肿胀或长时间应用糖皮质激素滴眼液等有关。主要治疗措施是在积极抗炎的基础上应用降眼压药物治疗,眼压难以控制或发生视神经损害时应采用手术治疗,常见术式有虹膜切开术、术中加用抗代谢药物的滤过性手术、房水引流阀植入术或睫状体光凝术等,术前积极控制葡萄膜的炎症可提高手术成功率。就葡萄膜炎继发性青光眼的临床诊治进展进行综述。

Diagnosis and treatment of the secondary glaucoma with uveitis

The glaucoma of secondary to uveitis was the common blind ocular disease. Its incidence is about 10%. The types of uveitis complicated with glaucoma include glaucomatoeyclitic crisis, Fuchs heteroehromic iridocyclitis ,juvenile rheumatoid arthritis related uveitis, viral anterior uveitis, HLA-B27 related uveitis, intermediate uveitis, Vogt-Koyanagi-Harada disease, Behcet＇ s disease and sarcoidosis. Though pathophysiology of uveitic glaucoma varied, most of these diseases were related to the peripheral anterior synechiae, pupillary block, trabecular obstruction, trabeculitis, Sehlemm＇ s canalitis, forward rotation of ciliary body or prolonged usage of topical corticosteroids. The intention of comprehensive treatment is to control the inflammatory reaction and utilize anti-glaucoma medication. For the patients with glaucoma medical therapy failure, the laser or surgical iridectomy, trabeculectomy with antifibrotic drugs, drainage implants or cyclophotocoagulation are often helpful. To control uveitis appear to be an important approach to improving the outcome of glaucoma surgery.