Kéroub C, Hyams S W
Arch Ophtalmol (Paris). 1976 Aug-Sep;36(8-9):575-8.
A patient suffering from open angle glaucoma was treated with topical phospholine iodide and epinephrine. Before treatment the anterior chamber was deep and the angle wide open in both eyes. Two weeks after beginning treatment there was an acute elevation of pressure to 52 mm hg in the right eye accompanied by myopia, shallowing of the anterior chamber and closure of the angle. These findings were dramatically reversed by the instillation of one drop of tropicamide and one drop of cyclopentolate. Simultaneous contraction of the dilator and sphincter muscles of the iris in this case probably caused pupillary block and closure of the anterior chamber angle, in spite of the initially wide open angle. Phospholine iodide may also have caused a spasm of the ciliary muscle and a forward movement of the lens, in a manner similar to that thought to occur in malignant glaucoma. Strong miotics together with epinephrine should be used cautiously in the treatment of glaucoma even when the initial examination shows a wide open angle.
一名开角型青光眼患者接受了局部使用碘化磷酰硫胆碱和肾上腺素的治疗。治疗前，双眼前房深，房角开放。开始治疗两周后，右眼眼压急性升高至52 mmHg，伴有近视、前房变浅和房角关闭。滴入一滴托吡卡胺和一滴环喷托酯后，这些表现显著逆转。尽管最初房角是开放的，但在这种情况下，虹膜开大肌和括约肌同时收缩可能导致瞳孔阻滞和前房角关闭。碘化磷酰硫胆碱也可能引起睫状肌痉挛和晶状体前移，其方式类似于恶性青光眼的发生机制。即使初始检查显示房角开放，在青光眼治疗中，强效缩瞳剂与肾上腺素联合使用时也应谨慎。
