药物诱发急性闭角型青光眼发作的临床分析

目的 探讨药物诱发急性闭角型青光眼发作的临床特点、药物种类及发生机制。方法 收集天津医科大学眼科医院2016年8月—2017年11月收治及外院会诊的药物诱发急性闭角型青光眼发作的10例患者（13只眼）的临床资料，详细记录其原发病、用药史、临床特征、治疗及预后等，进行总结分析。结果 10例患者中男3例，女7例，年龄46~81岁，平均61.1岁，3例双眼发病，7例单眼发病；10例患者中涉及的系统性疾病包括急腹症、有机磷中毒、外科疾病全麻术后、脑梗死、舌癌术后整形、呼吸系统疾病、三叉神经痛、抑郁症等，其中3例有青光眼发作史，且发作眼行抗青光眼手术或虹膜周边激光切除治疗；10例患者中涉及诱发急性闭角型青光眼发作的药物包括阿托品、前列地尔、沙丁胺醇、异丙托溴铵、卡马西平、奥氮平、劳拉西泮、艾司唑仑、氢氯噻嗪；8例保守治疗，2例行青光眼白内障联合手术；4例患者经保守治疗急性发作缓解，1例患者保守治疗眼压控制不理想，最终失明，2例患者手术治疗，眼压控制稳定，视功能恢复理想，3例患者失访。结论 急性闭角型青光眼发作可因系统性疾病全身用药而诱发，处理不当可能引起严重并发症；临床医生应详细询问病史，早期预防，积极处理，联合治疗，以挽救视功能。

The clinical analysis of drug induced acute angle-closure glaucoma

Objective To explore the clinical characteristics, drug types and mechanism of drug induced acute angleclosure glaucoma. Methods Clinical data of 10 patients (13 eyes) with drug induced glaucoma were collected in TianjinMedical University Eye Hospital from August 2016 to November 2017. The history of primary disease, medication history,clinical features, treatment and prognosis were recorded and analyzed. Results There were 3 males and 7 females in 10patients, with the average age 61.1 years old (46-81 years old). There were three cases of binocular glaucoma and sevencases of monocular glaucoma. In 10 patients the involved systemic diseases included acute abdominal disease,organophosphate poisoning, postoperative general anesthesia, cerebral infarction, plastic surgery of tongue cancer, respiratorysystem diseases, trigeminal neuralgia and depression. Among them, 3 cases had glaucoma history, and they were treated withanti-glaucoma surgery or laser iridotomy. The drugs involved in acute angle-closure glaucoma including atropine,alprostadil, albuterol, isopropyl, bromide, carbamazepine, olanzapine, lorazepam, azolam and hydrochlorothiazide. Eightpatients accepted the conservative treatment and two accepted glaucoma cataract surgeries. Four patients were relieved afterconservative treatment and 1 patient was eventually blinded due to higher intraocular pressure. Two patients underwentsurgical treatment, intraocular pressure control was stable, and vision function was restored. Three patients were lost tofollow-up. Conclusion Acute angle-closure glaucoma can be induced by the medication treatment for the systemicdiseases, which can lead to serious complications. The clinicians should inquire the medical history, and take measures toprevent the onset of glaucoma, in order to save the visual function.