青光眼---(中英文版)

1GLAUCOMAChapter11第十一章青光眼2第—节概述Definition:Glaucomaisagroupofcharacteristicinopticatrophyandvisualfielddefectsasthecommoncharacteristicdisease.Pathologicintraocularpressureheightenisoneofthemainriskfactors.青光眼定义：是一类以特征性视神经萎缩和视野缺损为共同特征的疾病.病理性眼压增高是其主要的危险因素.3Intraocularpressure(IOP):thepressureoftheeyecontenttotheeyewall眼压:眼球内容物作用于眼球内壁的压力NormalIOP:10—2lmmHgDoubleIOPdifference5mmHgIOPcurvedayandnight8mmHg正常眼压：10—2lmmHg双眼压差＜5mmHg昼夜眼压曲线＜8mmHg。4PathologicalIOP:IOPisbeyondeyeballinternalorganization,especiallytheopticnervebearinglimit.Causeopticatrophyandvisualfielddefects病理眼压:超越眼球内部组织，特别是视神经承受限度的眼压。引起视神经萎缩和视野缺损5Ocularhypertension:IOPishigherthannormalIOPrange,butnodamageofthenerveandvisualfield.高眼压症:眼压高出正常眼压范围，但无视神经和视野损害。Normaltensionglaucoma:InthenormalrangeofIOP,theopticnerveandvisualfieldofthedamagethere.正常眼压性青光眼：眼压在正常范围,但出现视神经和视野的损伤。6房水循环途径:Aqueouscycleway:Ciliaryprocessposteriorchamberpupil睫状突(产生房水)后房瞳孔AnteriorchamberAngleAnteriorchamber前房角(排出房水)前房房水产生率房水排出率维持正常眼压大多数青光眼眼压升高的原因为房水排出受阻78pathophysiologicalprocess病理生理过程：AqueousproducingrateTrabecularmeshworkresistanceScleraveinpressure三个因素：房水生成率小梁网阻力上巩膜静脉压aqueousoutflowresistanceIncreased大多数青光眼眼压升高的原因是房水外流阻力增高9Classification分类Primaryglaucoma:Angle-closureglaucoma:Acuteangle-closureglaucomaChronicangle-closureglaucomaOpen-angleglaucoma:PrimaryopenangleglaucomanormaltensionglaucomaSecondaryglaucoma:Congenitalglaucoma:InfantileglaucomaJuvenileglaucomaCongenitalglaucomaaccompaniedbyothercongenitalanomalyglaucoma原发性：闭角型:急性闭角型青光眼慢性闭角型青光眼开角型：原发性开角型青光眼正常眼压性青光眼继发性：(眼病、全身)先天性：婴幼儿型青少年型先天性青光眼伴有其他先天异常10前房角的检查及分类前房角位于前房的最周边前房角的构成：前壁—角巩膜缘房角隐窝—睫状体前端后壁—虹膜根部11第二节原发性青光眼原发性闭角型青光眼—眼压升高房角关闭Primaryangle-closureglaucoma原发性开角型青光眼—眼压升高房角开放PrimaryOpen-angleglaucoma1213Primaryangle-closureglaucoma一.原发性闭角型青光眼Acuteangle-closureglaucoma（一）急性闭角型青光眼Etiology:geneticanatomyincentiveClinicalfeatures:age50yfemalepainredeyevisionlosswithheadachenauseavomiting病因：具有遗传倾向，解剖结构异常，常有诱因。临床特征：年龄＞50岁，女性多见。主诉为眼胀痛．眼红，视力下降，伴头痛、恶心、呕吐。14Clinicalstages急性闭角型青光眼临床分期Preclinicalstage:Nosymptom,Shallowanteriorchamber,Oneeyegetdisease,theothereyewithnosymptom.1.临床前期：没有自觉症状，具有浅前房，房角窄，虹膜膨隆。一眼发作，另眼没发作。Precursorstage:TransientEasefast2.先兆期：一过性，多次小发作，自行缓解。15Acutestage:Symptom:eye:pain,photophobia,tears,severevisionloss.withheadaches,nauseaandvomiting.Sign:Eyelidedema,Conjunctivalcongestion,Cornealepitheliumedema,Anteriorchamberextremelyshallow,Thepupildilatedandlightreflectiondisappeared,Anteriorchamberangleclosed.Intraocularpressureincreased50mmHg.3.急性发作期：症状：眼部：眼痛、眼胀、畏光、流泪、严重视力下降。全身：头痛、恶心、呕吐。体征：眼睑水肿、结膜混合充血、角膜上皮水肿、角膜后色素沉着、前房极浅、虹膜严重缺血、房水浑浊、絮状渗出、瞳孔中等大、竖椭圆、光反射消失、局限后粘连、房角关闭、眼底不清、视网膜动脉搏动,眼压明显升高50mmHg。16闭角青光眼前房和前房角17急性闭角型青光眼发作18Acuteonsetsequela:VisualacuitygetbetterKPIris:atrophy,pigmentationdefectsandlimitedstickyThepupilcan'treturntonormalCloudy-glaucomaspotontheanteriorlenscapsuleAnteriorchamberAngleextensivestick急性发作后遗症：视力好转角膜后色素沉着虹膜阶段性萎缩、色素脱失、局限后粘瞳孔不能恢复正常晶体前囊下片状白色混浊---青光眼斑房角广泛粘连19Remissionstage:symptomstoeaseandanteriorchamberangleopenChronicstage:anteriorchamberangleextensivestickFinalstage:thecontinuoushighintraocularpressure,pooreyesightornolightfeeling.4间歇期：小发作后自行缓解，房角开放，不用药或少量缩瞳药。5慢性期：房角广泛粘连半周，眼压中度升高，视盘病理凹陷，视野缺损。6绝对期：持续高眼压，视力极差或无光感。诊断青光眼激发试验：1.暗室试验2.俯卧试验3.暗室+俯卧试验2021Differentialdiagnosis鉴别诊断Eyedisease:Conjunctivitis,AnterioruveitisSystemicdisease:gastrointestinaldisease,braindisease,hypertension,etc眼病：结膜炎、前部葡萄膜炎。全身病：胃肠道疾病、颅脑疾患、高血压病等。22Treatmentofprimaryangle-closureglaucoma原发性闭角型青光眼的治疗Drugs:increasedaqueouseduction:myoticinhibitaqueousgeneratedhighpermeabilityagentadjuvanttreatment:calmorsleeping,purge,hormonereduceinflammationresponse.Laser:Operation:药物:1.增加房水排出：缩瞳剂2.抑制房水生成：醋氮酰胺、塞吗酰安3.高渗剂：20%甘露醇1一1.5g／kg、50%甘油2一3ml/kg4.辅助治疗：镇静、安眠、通便、激素减轻炎反应。激光：手术：23Chronicangle-closureglaucoma（二）、慢性闭角型青光眼Clinicalsymptom:AgeisearlierProgressiveHavenoacutehistoryIntraocularpressureincreasedgradually.临床症状：年龄较急性为早、渐进性、可无明确发病史。一般无急性发作史，房角粘连和眼压增高逐渐进展。眼压50mmHg24Signs:OpticatrophyandphysiologicalconcaveexpandVisualfieldgraduallydamage.体征：视神经萎缩，生理凹扩大，视野进行性损害。252627Primaryopenangleg1aucoma二、原发性开角型青光眼Features:WhenIOPincreasedtheanteriorchamberanglekeepopeningThetrabecularmeshworkorganizationstructureisabnormal特点：眼压升高，房角开放。小梁网内组织结构异常28Clinical:Noself-conscioussymptomandbefoundlate.IntraocularpressureincreasedwithangleopenDependingontheopticdiskdamageC/D0.6Visualfielddefects临床：无自觉症状，晚期发现。眼压升高，房角开放。视乳头损伤C/D0.6或双眼差＞0.2(火焰状出血)视野缺损(旁中心暗点、鼻侧阶梯、弓形暗点、环形暗点、向心性性缩小、管状、颞侧视岛)29Diagnosis:HighIOPOpticdiskdamageVisualfielddefects2ofthe3signs+anteriorchamberangleopeningOthers:electricphysiologyexam,familyhistory,etc.Treatment:Drugtherapy:Lasertherapy:Operation:诊断：眼压高、视乳头损害、视野缺损其中两项+房角宽其他：电生理、家族史等。治疗：药物治疗：前列腺素衍生物激光治疗：手术治疗：滤过性手术30Ocularhypertension第三节高眼压症Definition:Intraocularpressureishigherthannormal,withouttheopticdiskandvisionfielddamage.Anteriorchamberanglekeepopening.Regularlyreturnvisit:Tominimizeriskfactors.概念:眼压高于正常上限,无视盘和视野损害,房角开放。定期随访:使危险因素降到最小。31Secondaryglaucoma第四节继发性青光眼GlaucomatocycliticsyndromeCorticosteroidsglaucoma:TraumaticglaucomaCatarac