青光眼(中英文版)PPT幻灯片.ppt

1、1,GLAUCOMA 青光眼,2,第节 概述,Definition: Glaucoma is a group of characteristic in optic atrophy and visual field defects as the common characteristic disease. Pathologic intraocular pressure heighten is one of the main risk factors. 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.,3,Intraocular pressure(

2、IOP) : the pressure of the eye content to the eye wall 眼压:眼球内容物作用于眼球内壁的压力 Normal IOP: 102l mmHg Double IOP difference5mmHg IOP curve day and night8mmHg 正常眼压： 102lmmHg 双眼压差5mmHg 昼夜眼压曲线8mmHg。,4,Pathological IOP: IOP is beyond eyeball internal organization, especially the optic nerve bearing limit. Cau

3、se optic atrophy and visual field defects 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,5,Ocular hypertension: IOP is higher than normal IOP range, but no damage of the nerve and visual field. 高眼压症:眼压高出正常眼压范围，但无视神经和视野损害。 Normal tension glaucoma: In the normal range of IOP, the optic nerve and visual fie

4、ld of the damage there. 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: Aqueous cycle way:,Ciliary process posterior chamber pupil 睫状突(产生房水) 后房 瞳孔 Anterior chamber Angle Anterior chamber 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,7,8,pathophysiological process病理生理过程：,Aqueous producing rate Trabe

5、cular meshwork resistance Sclera vein pressure 三个因素：房水生成率 小梁网阻力 上巩膜静脉压 aqueous outflow resistance Increased 大多数青光眼眼压升高的原因是房水外流阻力增高,9,Classification分 类,Primary glaucoma: Angle-closure glaucoma: Acute angle-closure glaucoma Chronic angle-closure glaucoma Open-angle glaucoma: Primary open angle glaucom

6、a normal tension glaucoma Secondary glaucoma: Congenital glaucoma: Infantile glaucoma Juvenile glaucoma Congenital glaucoma accompanied by other congenital anomaly glaucoma 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

7、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 Primary angle-closure glaucoma 原发性开角型青光眼眼压升高 房角开放 Primary Open-angle glaucoma,12,13,Primary angle-closure glaucoma一.原发性闭角型青光眼,Acute angle-closure glaucoma （一） 急性闭角型青光眼 Etiology: genetic anatomy incentive Clinical features: age50y female pain red

8、eye vision loss with headache nausea vomiting 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。,14,Clinical stages急性闭角型青光眼临床分期,Preclinical stage: No symptom, Shallow anterior chamber, One eye get disease, the other eye with no symptom . 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。 Prec

9、ursor stage: Transient Ease fast 2.先兆期：一过性，多次小发作，自行缓解。,15,Acute stage: Symptom: eye: pain, photophobia, tears, severe vision loss. with headaches, nausea and vomiting. Sign: Eyelid edema, Conjunctival congestion, Corneal epithelium edema, Anterior chamber extremely shallow, The pupil dilated and lig

10、ht reflection disappeared, Anterior chamber angle closed. Intraocular pressure increased 50 mmHg. 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,18,Acute ons

11、et sequela: Visual acuity get better KP Iris: atrophy, pigmentation defects and limited sticky The pupil cant return to normal Cloudy-glaucoma spot on the anterior lens capsule Anterior chamber Angle extensive stick 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,19,Remissio

12、n stage : symptoms to ease and anterior chamber angle open Chronic stage: anterior chamber angle extensive stick Final stage: the continuous high intraocular pressure, poor eyesight or no light feeling. 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

13、试验： 1.暗室试验 2.俯卧试验 3.暗室+俯卧试验,20,21,Differential diagnosis 鉴别诊断 Eye disease: Conjunctivitis, Anterior uveitis Systemic disease: gastrointestinal disease, brain disease, 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。,22,Treatment of primary angle-closure glaucoma 原发性闭角型青光眼的治疗,Drugs: increased a

14、queous eduction : myotic inhibit aqueous generated high permeability agent adjuvant treatment: calm or sleeping, purge, hormone reduce inflammation response. 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1一1.5gkg、 50%甘油2一3ml/kg 4.辅助治疗：镇静、安眠、 通便、激素减轻炎反应。 激光： 手术：,23,Chronic angle-cl

15、osure glaucoma （二）、慢性闭角型青光眼 Clinical symptom: Age is earlier Progressive Have no acute history Intraocular pressure increased gradually. 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50mmHg,24,Signs: Optic atrophy and physiological concave expand Visual field gradually damage. 体征： 视神经萎缩，生理凹扩大，

16、 视野进行性损害。,25,26,27,Primary open angle g1aucoma二、原发性开角型青光眼,Features: When IOP increased the anterior chamber angle keep opening The trabecular meshwork organization structure is abnormal 特点：眼压升高，房角开放。 小梁网内组织结构异常,28,Clinical: No self-conscious symptom and be found late. Intraocular pressure increased

17、with angle open Depending on the optic disk damage C/D0.6 Visual field defects 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),29,Diagnosis: High IOP Optic disk damage Visual field defects 2 of the 3 signs +anterior chamber angle opening Others: electri

18、c physiology exam, family history, etc. Treatment: Drug therapy: Laser therapy: 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,30,Ocular hypertension第三节 高眼压症,Definition : Intraocular pressure is higher than normal, without the optic disk and vision field damage. Anterior chamber angle keep opening. Regularly return visit: To minimize risk factors. 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。,31,Secondary glaucoma 第四节继发性青光眼,Glaucomatocyclitic syndrome Corticosteroids glaucoma: Traumatic glaucoma Cataract expansion glaucoma Anterior uveal inflam