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中国人闭角型青光眼房角关闭机制的研究

Multiple patterns of angle closure mechanisms in primary angle closure glaucoma in Chinese

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【作者】 王宁利欧阳洁周文炳赖铭莹叶天才曾明兵陈静嫦

【Author】 WANG Ningli * (Email: wnlz @ gzsums.edu.cn), OUYANG Jie, ZHOU Wenbing, et al. Zhongshan Ophthalmic Center, Sun Yat sen University of Medical Sciences, Guangzhou 510060,China

【机构】 中山医科大学中山眼科中心福建医学院附属协和医院眼科深圳市眼科医院

【摘要】 目的 对中国人原发性闭角型青光眼 (闭青 )房角关闭机制进行研究 ,为按发病机制分类提供依据。方法 采用超声生物显微镜 (ultrasoundbiomicroscopy,UBM)和诊断性的治疗方法对 12 6例 (12 6只眼 )原发性闭青的房角及房角相关解剖结构进行活体、实时、定性及半定量观察分析。结果根据UBM房角及房角相关解剖结构的观察 ,可将原发性闭青房角关闭机制分为单纯性瞳孔阻滞型(48例 ,48只眼 ,占 38.1% ) ,单纯性非瞳孔阻滞型 (9例 ,9只眼 ,占 7.1% ) ,多种机制共存型 (6 9例 ,6 9只眼 ,占 5 4.8% )。单纯性瞳孔阻滞型闭青瞳孔缘相对位置靠前 ,周边虹膜因瞳孔阻滞而膨隆 ,房角关闭与虹膜根部附着点位置及睫状体位置无关 ;单纯性非瞳孔阻滞型闭青瞳孔缘相对位置靠后 ,无瞳孔阻滞因素参与 ,房角关闭与前位的睫状体及附着靠前的周边虹膜肥厚堆积有关 ;多种机制共存型闭青除有瞳孔阻滞因素参与外 ,大多数患者具有虹膜根部附着点靠前和 (或 )睫状体前位和 (或 )周边虹膜肥厚等非瞳孔阻滞因素参与 ,结果形成特殊的爬行性房角关闭。结论 中国人原发性闭青房角关闭机制呈多样性。建议建立以房角关闭不同机制为基础的青光眼分类体系。

【Abstract】 Objective The mechanism of primary angle closure glaucoma (PACG) in Chinese is studied to establish a new classification system based on the etiology and mechanism of angle closure. Methods The anterior chamber angle’s configuration and the anatomic structures related to the angle in 126 cases with PACG were observed with ultrasound biomicroscope (UBM), and the mechanisms of angle closure were analyzed by diagnostic treatment. Results Based on the configuration of the angle and anatomic structures related to the angle as well as the mechanisms of angle closure, PACG could be divided into following subtypes: pure pupillary block angle closure glaucoma [PPB, 48 cases (38.1%)]; pure non pupillary angle closure glaucoma [PNP, 9 cases (7.1%)]; multiple mechanism angle closure glaucoma [MM, 69 cases (54.8%)]. PPB manifested that the relative position of pupillary margin was located anteriorly, the peripheral iris bombé was due to the pupillary block, and the angle closure was not related to the location and shape of the peripheral iris and ciliary body. PNP showed that the relative position of pupil margin was located posteriorly, the angle closure was not caused by the pupillary block, but caused by anterior located ciliary body and/or thick and anterior located peripheral iris. MM pattern was caused by both pupillary block and non pupilary block, and most of the cases manifested creeping angle closure. Conclusions The angle closure mechanisms of PACG in Chinese are of multiple patterns. Based on the different mechanisms of angle closure in PACG, a new classification system should be established to improve the diagnosis and treatment of PACG.

【关键词】 青光眼,闭角型; 分类法; 超声生物显微镜;

【Key words】 Glaucoma, angle closure; Classification; Ultrasound biomicroscopy;

【分类号】R775.2;R322.91;R446.8;

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