Wang Min, Tan Qian, Jiang Haibo, Xia Xiaobo, Wang Pingbao, Jiang Jian, Liu Dan
Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha 410008, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2015 May;40(5):543-8. doi: 10.11817/j.issn.1672-7347.2015.05.015.
To explore the risk factors, the ciliary body anatomy structures, the therapeutic methods and the prognosis for malignant glaucoma through retrospectively collecting the clinical data from primary angle-closure glaucoma (PACG) patients.
Clinical data in 1183 patients (1456 eyes) with PACG were collected between July, 2010 and May, 2014 from Xiangya Hospital, Central South University. Thirty patients (38 eyes) were diagnosed as malignant glaucoma. According to symptom, these patients were divided into a PACG group (1418 eyes) and a malignant glaucoma group (38 eyes); according to age, they were divided into a 3-40 years old group (171 eyes), a 41-70 years old group (1016 eyes) and a ≥71 years old group (269 eyes); according to therapeutic methods, they were divided into a drug therapy group (5 eyes), a lens extraction group (6 eyes) and a vitrectomy surgery group (27 eyes); according to the different method of surgery, they were divided into a vitrectomy group (27 eyes), a nonvitrectomy group (11 eyes). The age, sex, anterior chamber depth (ACD), axial length (AL), lens thickness (LT), visual acuity, intraocular pressure, therapeutic methods and surgery history were recorded. Meanwhile, the ciliary body thickness (CBT), trabecular ciliary process angle (TCA) and lens diameter were measured by ultrsound biomicroscopy (UBM).
Male and female ratio was 1:2 in the malignant glaucoma group. The average age [(51.87±12.92) years] in the malignant glaucoma group was less than that in the PACG group (57.87±8.78) years. Malignant glaucoma was more likely to occur in the first 3 months after PACG trabeculectomy with a rate of 85.7%. The LT [(4.33±0.67) mm], AL[(21.44±1.18) mm] and ACD [(2.12±0.41) mm] in the malignant glaucoma group were less than those in the PACG group [(4.81±0.50), (22.17±0.97) and (2.49±0.48) mm, respectively](all P<0.05). The CBT0, CBT1, CBTmax, TCA and lens diameter in the malignant glaucoma group were less than those in the PACG group (all P<0.05).
Female PACG patients, with short axial length, shallow anterior chamber, thin lens, thin ciliary body, small trabecular ciliary process angle and short lens diameter, are more likely to suffer from malignant glaucoma. Vitrectomy can significantly reduce intraocular pressure.
通过回顾性收集原发性闭角型青光眼（PACG）患者的临床资料，探讨恶性青光眼的危险因素、睫状体解剖结构、治疗方法及预后。
收集2010年7月至2014年5月中南大学湘雅医院1183例（1456眼）PACG患者的临床资料。其中30例（38眼）被诊断为恶性青光眼。根据症状，将这些患者分为PACG组（1418眼）和恶性青光眼组（38眼）；根据年龄，分为3～40岁组（171眼）、41～70岁组（1016眼）和≥71岁组（269眼）；根据治疗方法，分为药物治疗组（5眼）、晶状体摘除组（6眼）和玻璃体切割手术组（27眼）；根据不同手术方式，分为玻璃体切割组（27眼）、非玻璃体切割组（11眼）。记录患者的年龄、性别、前房深度（ACD）、眼轴长度（AL）、晶状体厚度（LT）、视力、眼压、治疗方法及手术史。同时，采用超声生物显微镜（UBM）测量睫状体厚度（CBT）、小梁睫状体夹角（TCA）及晶状体直径。
恶性青光眼组男女比例为1∶2。恶性青光眼组平均年龄[（51.87±12.92）岁]低于PACG组[（57.87±8.78）岁]（P<0.05）。恶性青光眼多发生在PACG小梁切除术后的前3个月，发生率为85.7%。恶性青光眼组的LT[（4.33±0.67）mm]、AL[（21.44±1.18）mm]和ACD[（2.12±0.41）mm]均小于PACG组[分别为（4.81±0.50）、（22.17±0.97）和（2.49±0.48）mm]（均P<0.05）。恶性青光眼组的CBT0、CBT1、CBTmax、TCA及晶状体直径均小于PACG组（均P<0.05）。
女性PACG患者，眼轴短、前房浅、晶状体薄、睫状体薄、小梁睫状体夹角小及晶状体直径短，更易发生恶性青光眼。玻璃体切割术可显著降低眼压。
