Pavlin C J, Easterbrook M, Harasiewicz K, Foster F S
Department of Ophthalmology, Princess Margaret Hospital, Toronto, Ontario, Canada.
Am J Ophthalmol. 1993 Sep 15;116(3):341-5. doi: 10.1016/s0002-9394(14)71351-0.
Immunoglobulin A nephropathy is a common glomerulonephritis of unknown cause. Episcleritis, scleritis, anterior uveitis, and keratoconjunctivitis sicca have been associated with this disease. We diagnosed angle-closure glaucoma secondary to ciliochoroidal effusion in a patient with IgA nephropathy confirmed by biopsy. High-frequency ultrasound biomicroscopy was used to determine internal relationships of angle structures and to follow changes with treatment. Supraciliary effusion undetected by B-scan ultrasound and retinal examination was easily imaged by ultrasound biomicroscopy. Glaucoma mechanisms included forward rotation of the ciliary processes, which caused direct angle closure in a manner similar to plateau iris. Ultrasound biomicroscopy showed that cycloplegia improved this mechanism by retracting the ciliary processes, but angle closure secondary to forward iris bowing from pupil block remained. Iridectomy was performed and immediately opened the angle. Ultrasound biomicroscopy proved a useful method of defining mechanisms and a helpful guide to treatment in this type of glaucoma.
免疫球蛋白A肾病是一种病因不明的常见肾小球肾炎。巩膜外层炎、巩膜炎、前葡萄膜炎和干燥性角结膜炎与该疾病有关。我们诊断出一名经活检确诊为IgA肾病的患者继发于睫状体脉络膜积液的闭角型青光眼。高频超声生物显微镜用于确定房角结构的内部关系并跟踪治疗后的变化。B超和视网膜检查未发现的睫状体上腔积液通过超声生物显微镜很容易成像。青光眼的机制包括睫状体向前旋转，这以类似于高原虹膜的方式导致直接房角关闭。超声生物显微镜显示，睫状肌麻痹通过使睫状体后移改善了这种机制，但瞳孔阻滞导致虹膜向前膨隆继发的房角关闭仍然存在。进行了虹膜切除术并立即打开了房角。超声生物显微镜被证明是定义机制的有用方法，也是这类青光眼治疗的有用指南。
