年轻人原发性闭角型青光眼的临床特征

目的探讨年轻人原发性闭角型青光眼（PACG）的临床特征。方法回顾性病例对照研究。收集2006年1月至2010年7月期间南京医科大学第一附属医院眼科收治的年龄〈40岁、临床确诊为PACG的患者12例（22眼），及同期单纯行小梁切除术的老年PACG患者217例（236眼）。对两组病例的临床表现、房角结构特点、手术效果以及术后浅前房和恶性青光跟的发生率进行比较。采用配对t检验和X^2检验对数据进行统计学分析。结果年轻PACG患者平均年龄为（32．8±5．7）岁，女性占75％，首次就诊时均已为中晚期，无急性发作症状，眼轴平均为（21．1±1．9）mm，11例（20眼）为高褶虹膜构型（占91％），仅1例（2眼）为瞳孔阻滞。随访时间平均为（24．8±6．3）个月，最后一次复诊时眼压较术前下降（11．6±5．2）mmHg，手术前后差异有统计学意义0=6．456，P〈0．01）。术后并发症主要有浅前房（44％），恶性青光眼f17％）。老年PACG患者平均年龄为（60．2±7．1）岁，女性占81％，眼轴平均为（21．5±2．7）mm，高褶虹膜构型仅占19％，瞳孑L阻滞占81％，其房角构型与年轻PACG患者相比差异有统计学意义（X^2=-56．446、14．303．P〈0．01）。老年PACG患者术后浅前房和恶性青光眼发病率分别为10％和6％，年轻PACG浅前房发生率较老年PACG高，差异有统计学意义（X^2=14．091，P〈0．01）。结论年轻人的PACG发病隐匿，早期不易发现和诊断。小梁切除术是其有效的治疗方法，但术后容易出现浅前房。

Primary angle-closure glaucoma in younger patients

Objective To evaluate the clinical characteristics of younger patients with primary angle-closure glaucoma (PACG). Methods Retrospective case control study. Twelve patients (22 eyes) aged 40 or younger with a confirmed diagnosis of PACG from January 2006 to July 2010 were investigated. At the time of the initial diagnosis, all patients were in the middle or late stageand did not feel significant pain. Eighteen eyes underwent surgical treatment. Full ophthalmic examinations were performed. They were compared to 217 older patients (236 eyes) with PACG who underwent trabeculectomy during the same period. The clinical characteristics, including clinical presentations,surgical results and complications were evaluated. Data were analyzed with a paired t test and a chi-square test. Results The mean age of the younger patients with PACG was (32.8±5.7)years.The majority of them were female (75％). The mean axial length was (21.1±1.9)mm. Plateau iris was the most common underlying etiology (91％), and only 1 case (2 eyes) was pupillary block. The mean follow-up period was (24.8±6.3)months. There was an (11.6±5.2)mmHg reduction in the final postoperative intraocular pressure (IOP) compared to preoperative IOP (t=6.456, P＜0.01). The main postoperative complications included shallow anterior chambers (44％) and malignant glaucoma (17％). The mean age of the older patients with PACG was (60.2±7.1)years. The majority of them were females (81％). The mean axial length was (21.5±2.7)mm. Pupillary block (81％) was the most common underlying etiology,and 19％ patients were Plateau iris. The differences of plateau iris and pupillary block were significant (x2=56.446, 14.303, P＜0.01). The incidence of postoperative shallow anterior chamber and postoperative malignant glaucoma was 10％ and 6％, respectively. There was a statistically significant difference in the incidence of postoperative shallow anterior chamber when younger patients were compared to older patients with PACG (x2=14.091, P＜0.01). Conclusion The younger PACG patients cannot be easily identified and diagnosed in the early stages. They can be effectively managed by trabeculectomy, but they have higher incidences of postoperative sustained shallow anterior chamber and malignant glaucoma.