硝酸甘油静脉滴注诱发急性闭角型青光眼

1名76岁女性慢性肾功能不全患者,因脑梗死、高血压住院治疗。住院期间患者出现胸痛、胸闷,予硝酸甘油5mg稀释于0.9%氯化钠注射液100ml中行静脉滴注。输液后,患者出现左眼疼痛,视力模糊,伴头痛。次日患者输完硝酸甘油后,左眼疼痛加剧,只有光感。左眼检查显示:瞳孔呈竖椭圆形,直径4～5mm,对光反射消失,球结膜充血水肿,角膜水肿,晶体混浊,浅前房(<1/3CT),左眼压54mmHg。诊断为闭角型青光眼急性发作。立即停用硝酸甘油,给予甘露醇静脉滴注,口服乙酰唑胺和碳酸氢钠,局部使用卡替洛尔滴眼液和毛果芸香碱滴眼液。用药8h后,患者眼部症状缓解,眼压降至正常范围。

Acute angle-closure glaucoma induced by intravenous drip of nitroglycerin

A 76-year-old woman with chronic renal insufficiency was admitted with cerebral infarction and hypertension.During hospitalization,she received IV nitroglycerin 5 mg diluted in 100 ml of sodium chloride injection 0.9% for treating chest pain and chest distress.After infusion,the patient developed left eye pain,blurred vision,and headache.After administration of nitroglycerin on day 2,her left eye pain was aggravated and visual acuity was found that only light perception remained.An ophthalmic examination of her left eye showed a vertical oval-shaped pupil(4 to 5 mm in diameter) with no light reflex,bulbar conjunctival congestion and edema,corneal edema,lens opacity,shallow anterior chamber(<1/3 CT),and an intraocular pressure of 54 mmHg.An acute attack of angle-closure glaucoma was diagnosed.Nitroglycerin was stopped immediately.He was administered with IV mannitol,oral acetazolamide and sodium bicarbonate,carteolol eye drops,and pilocarpine eye drops.After 8 hours of administration,symptom of her the left eye gradually improved,and her intraocular pressure was within normal limits.