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目的分析原发性窄角型开角型青光误诊的原因、临床表现及治疗方法。方法收集2001年12月至2005年8月我院收治的被误诊为急性闭角型青光眼的原发性窄角型开角型青光眼15例(17眼)的临床资料,进行回顾性总结,分析其临床特点、误诊的原因和治疗效果。结果1.眼压:入院时的眼压43.38～81.78mmHg,平均为(51.66±5.46)mmHg;手术后的两年随访,在没有用降眼压药物的情况下,眼压在10mmHg以下有2例,10～15mmHg有4例,15～20mmHg有7例,20～25mmHg有2例,平均为(15.92±4.55)mmHg。经统计学处理,手术前后的眼压差异有显著性(p<0.001);2.视力:手术前的视力在0.3～1.0,手术后视力0.4～1.2,手术前后视力差异无显著性(p>0.05)。3.误诊原因:7例病人根本无房角检查情况,4例病人房角检查情况因为医师经验不足而有误,4例病人是手术前没有停用降眼压药物,其中有1例手术前匹罗卡品眼药水每小时点眼一次,而单单根据眼压控制,房角开放而采用周边虹膜切除。4.误诊情况:误诊为急性闭角型青光眼急发作的4例(4眼),误诊为急性闭角型青光眼慢性期的7例(9眼),已行周边虹膜切除后残余性青光眼4例(4眼)。结论原发性窄角型开角型青光眼可以有急性闭角型青光眼发作的临床表现,临床的确诊要靠房角检查,治疗要按照开角型青光眼进行处理。
Objective To analyze the causes, clinical manifestations and treatment of primary narrow-angle open-angle glaucoma misdiagnosis. Methods The clinical data of 15 cases (17 eyes) of primary narrow-angle open-angle glaucoma who were misdiagnosed as acute angle-closure glaucoma from December 2001 to August 2005 in our hospital were retrospectively summarized and analyzed Its clinical features, causes of misdiagnosis and therapeutic effect. Intraocular pressure at admission: 43.38 ~ 81.78mmHg, with an average of (51.66 ± 5.46) mmHg; after two years of follow-up, there was no significant difference in intraocular pressure under 10mmHg Cases, 10 ~ 15mmHg in 4 cases, 15 ~ 20mmHg in 7 cases, 20 ~ 25mmHg in 2 cases, with an average of (15.92 ± 4.55) mmHg. There was significant difference in intraocular pressure before and after operation (p <0.001); 2. Visual acuity: visual acuity was 0.3-1.0 before surgery and 0.4-1.2 after surgery. There was no significant difference in visual acuity between before and after surgery (p> 0.05). 3. Misdiagnosis reasons: 7 cases of patients with no room angle examination, 4 cases of patients with room examination due to lack of experience of doctors and errors, 4 cases of patients before surgery was not stopped lowering intraocular pressure drugs, including 1 case before surgery Pilocarpine eye drops eye drops once an hour, but based solely on intraocular pressure control, angle opening and the use of peripheral iris resection. 4. Misdiagnosis: misdiagnosed as acute angle-closure glaucoma in 4 cases (4 eyes), misdiagnosed as acute angle-closure glaucoma in 7 cases (9 eyes), after peripheral iridotomy residual glaucoma in 4 cases (4 eyes). Conclusions Primary narrow-angle open-angle glaucoma may have the clinical manifestation of acute angle-closure glaucoma. The clinical diagnosis depends on the angle of the angle and the treatment should be treated according to open-angle glaucoma.