Multiple patterns of angle closure mechanisms in primary angle closure glaucoma in Chinese

Transcription

1 Chin J Ophthalmol, January 2000, Vol 36, No. 1 ( ), (ultrasound biomicroscopy,ubm) 126 (126 ) UBM, (48,48,38. 1 %), (9,9,7. 1 %), (69,69,54. 8 %), ;,, ;, () (),, ; ; Multiple patterns of angle closure mechanisms in primary angle closure glaucoma in Chinese WANG Ningli 3 ( gzsums. edu. cn ), OUYANG Jie, ZHOU Wenbing, et al. 3 Zhongshan Ophthalmic Center, Sun Yat2sen University of Medical Sciences, Guangzhou , China Abstract Objective The mechanism of primary angle closure glaucoma (PACG) in Chinese is studied to establish a new classification system based on the etiology and mechanism of angle closure. Methods The anterior chamber angle s configuration and the anatomic structures related to the angle in 126 cases with PACG were observed with ultrasound biomicroscope (UBM), and the mechanisms of angle closure were analyzed by diagnostic treatment. Results Based on the configuration of the angle and anatomic structures related to the angle as well as the mechanisms of angle closure, PACG could be divided into following subtypes : pure pupillary block angle closure glaucoma [ PPB, 48 cases (38. 1 %) ] ; pure non2pupillary angle closure glaucoma [ PNP, 9 cases (7. 1 %) ] ; multiple mechanism angle closure glaucoma [MM, 69 cases (54. 8 %) ]. PPB manifested that the relative position of pupillary margin was located anteriorly, the peripheral iris bombwas due to the pupillary block, and the angle closure was not related to the location and shape of the peripheral iris and ciliary body. PNP showed that the relative position of pupil margin was located posteriorly, the angle closure was not caused by the pupillary block, but caused by anterior located ciliary body and/ or thick and anterior located peripheral iris. MM pattern was caused by both pupillary block and non2pupilary block, and most of the cases manifested creeping angle closure. Conclusions The angle closure mechanisms of PACG in Chinese are of multiple patterns. Based on the different mechanisms of angle closure in PACG, a new classification system should be established to improve the diagnosis and treatment of PACG. Key words Glaucoma, angle2closure ; Classification ; Ultrasound biomicroscopy ( ) A, :510060, [ ( gzsums. edu. cn) ] ; ( ) ; ( ), ;, Pavlin

2 Chin J Ophthalmol, January 2000, Vol 36, No (ultrasound biomicroscopy,ubm),, (3,4) ;,,, , 126, (712) (126 ), 21 :, : (1), ( ; (2) ; (3) ),, 1, : (1) : UBM ( ) ( ), 62 (62 ), 64 (64 ) ; 3868, (49 18), 58 (58 ),, 68 (68 ) 11 : Zeiss/ Humphery 840 ( ) ( ) 50 mhz,, 5 mm 5 mm, 50m 8 / s 21UBM : Pavlin : 500, UBM m, ( ) ( ),, UBM ( ) (15) (4) :,PCX,, UBM image CAD,,, (5,6), () ( ) (13) (2) : UBM ( ), (14) (3) UBM ( + 1 ) (0 ) ( - 1 ) (16,17) 11 :UBM ( ),,,,, ( 1,2) ( ), ( ) 31UBM :47 (47 ) UBM, UBM,

3 Chin J Ophthalmol, January 2000, Vol 36, No. 1 ( ), 4. 0 % ;, 4 (4 ), ( ), 17 ( ) 3. 2 %,, 1 47 (47 ), 126 (126 ) UBM, (117 ) UBM, %, UBM 48 (48 ), % 69 (69 ), % 9 (9 ) UBM, ( ), 7. 1 % ; 5 (5 ) ;, (126 ) ( ) (47 ) ( )

4 Chin J Ophthalmol, January 2000, Vol 36, No. 1 49,,, UBM, S,, PBF = (D + E) cos+ Scos, PBF,D, E,S, (D + E), 18 (PBF),,, UBM,,,, (, 2) [1-3 ],, 21 :UBM,, Mapstone [9 ] Kondo Miura [10 ],, 60 %,,, 40 % UBM ( ), [428 ] ( 36), (plateau iris ), [11 11 : ],, Mapstone [9 ] Kondo, Miura [10 ] PBF = (D + E) cos+ UBM, Scos (18) 18 ( ),,UBM,,,, ( ), 3/ 4 (1), UBM

5 Chin J Ophthalmol, January 2000, Vol 36, No. 1 ( UBM, ), UBM,, ( UBM, ),,,, (712), (5),,,,, (6) : (1) ; (2) 2 ( ) ; (3), ( ) ; (4) UBM, I ( ),UBM,, (3) 11 : UBM,,,, UBM,, UBM (4),, ( ),,,, UBM, 2, UBM 31 :,, UBM ;,,, 21 : ( ), (),, ; +, +, + +, UBM UBM,,, UBM,,, UBM [2, ] ; UBM,,

6 Chin J Ophthalmol, January 2000, Vol 36, No ,, ( 116 5,6 ),.., 1993, 29 : Hung PT. Aetiology and mechanism of angle closure glaucoma. Asia Pac J Ophthalmol, 1990,2 : Lowe RF. Treatment for primary creeping chronic angle closure glaucoma. Asia Pac J Ophthalmol, 1990,2 : ,,,.. 1,,,..,1995,31 : ,1998,34 : Mapstone R. Closed2angle glaucoma : theoretical considerations. Br J 2,,,. Ophthalmol, 1974,58 :36..,1999,35 : Kondo T, Miura M. A method of measuring pupil2blocking force in the 3 Pavlin CJ, Harasiewicz K, Foster FS, et al. Ultrasound biomicroscopy human eye. Arch Clin Exp Ophthalmol,1987,225 : of anterior segment structures in normal and glaucomatous eyes. Am J 11 Pavlin CJ, Ritch R, Forster FS, et al. Ultrasound biomicroscopy in Ophthalmol,1992,113 : plateau iris syndrome. Am J Ophthalmol,1992,113 : ,.., ( : ) 1985,21 : ( : ) ,110 ; 149, :, ; Nd : YAG,, : (1) :, (2) :,,,,, ( ), Alcon( ) Topcon( ), : (1),,A/ B,,, (2),,, (3),,,,,,,,, : 18 C 2110,, : (0532) , , (0532) BP : : ( )

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