散瞳检查在诊治隐匿性晶状体半脱位继发青光眼中的重要性

目的　分析隐匿性晶状体半脱位继发青光眼的临床特点，强调术前散瞳检查的重要性，探讨合理有效的治疗方法。方法　回顾分析我院收治的２１例（２５眼）隐匿性晶状体半脱位继发青光眼患者的临床特点，术前散瞳检查并根据悬韧带断裂的部位和范围选择不同的手术方式，分析术后的眼压、视力及并发症。结果　２１例（２５眼）患者临床表现与原发性急性闭角型青光眼极其相似，但同时有虹膜震颤、发作眼前房深度较对侧眼明显变浅的重要体征。患眼前房深度为（１．１７±０．４８）ｍｍ，对侧眼为（２．５７±０．５２）ｍｍ，差异有统计学意义（Ｐ＜０．０５）。患眼散瞳后前房深度为（１．５３±０．２７）ｍｍ，与散瞳前比较差异有统计学意义（Ｐ＜０．０５）。ＵＢＭ检查显示１６眼（６４．０％）有晶状体悬韧带断裂，散瞳检查发现有２４眼（９６．０％）晶状体半脱位，散瞳检查对晶状体半脱位的检出率较ＵＢＭ高。术后随访３个月～２ａ，术后３个月所有患者眼压恢复正常为（１７．６５±２．７９）ｍｍＨｇ（１ｋＰａ＝７．５ｍｍＨｇ），与术前（４８．１２±３．１５）ｍｍＨｇ相比，差异有统计学意义（Ｆ＝３８．４６２，Ｐ＜００５）。术后６个月，２１眼（８４０％）眼压正常，４眼（１６．０％）需加用降眼压药控制，眼压为（２２．７４±３．１５）ｍｍＨｇ，与术前比较差异有统计学意义（Ｆ＝２６５４７，Ｐ＜０．０５）。术后２ａ除１眼因悬吊ＩＯＬ后药物无法控制眼压外，再次行抗青光眼手术，其余２４眼眼压均正常，所有患者眼压为（１８．９５±３．７４）ｍｍＨｇ，与术前比较差异有统计学意义（Ｆ＝１９．９３８，Ｐ＜０．０５）。结论　隐匿性晶状体半脱位继发青光眼时容易误诊；术前散瞳检查能提高晶状体半脱位的检出率，并能明确悬韧带断裂的部位及范围，从而选择合适的手术方式；小梁切除术不能完全根治此类青光眼，只有解除晶状体因素才能提高手术成功率。

Importance of mydriasis in diagnosis and treatment of secondary glaucoma due to lens subluxation

Objective To analyze the clinical characteristics in patients with secondary glaucoma due to atypical lens subluxation, analyze the importance of mydriasis in diagnosis and treatment.and find the safe and efficient treatment of these patients. Methods Twenty-five eyes of 21 patients with secondary glaucoma due to lens subluxation were examined. different operation was performed according to the degree of zonular dialysis. The postoperative ocular pressure ,visual acuity and complication were analyzed. Results The clinical characteristics of these 21 patients were very similar with primary acute angle closure glaucoma . but these 21 patients had tremor iris .seizure of anterior chamber depth( 1. 17 +0. 48) mm, which was shallower than that of the fellow eye ( 2. 57 + 0. 52) mm ( P < 0. 05 ) . Anterior chamber depth was deeper after mydriasis( 1. 53 + 0. 27 ) mm than before mydriasis (P < 0. 05 ) . and intraocular pressure decreased from( 48. 12 + 3. 15) mmHg ( I kPa = 7. 5 mmHg) to ( 17. 65 + 2. 79 ) mmHg ( F = 38. 462 ,P < 0. 05 ) . UBM showed 16 eyes ( 64. 0% ) with subluxated lens after mydriasis , 24 eyes( 96. 0% ) showed lens subluxation. The rate of mydriasis in lens subluxation was higher than UBM. On postoperative 6 months , the ocular pressure in 21 eyes ( 84. 0% ) were normal,4 eyes ( 16. 0% ) needed the drugs to control, which was ( 22. 74 + 3. 15 ) mmHg , there was statistical difference compared with pre-operation ( F = 26. 547 . P < 0. 05). At postoperative 2 years, except that ocular pressure in I eye could not controlled by drugs , other 24 eyes was normal. which was ( 18. 95 + 3. 74 ) mmHg , there was statistical difference compared with pre-operation ( F = 19. 938 ,P < 0. 05 ) . Conclusion Secondary glaucoma due to subluxated lens is easily misdiagnosed as primary acute angle-closure glaucoma. To low the rate of misdiagnosis ,we need the exact history and ocular exanunation. Mydriasis is important in diagnosis , and lens extraction is required in order to have satisfactory intraocular pressure in these patients.