Glaucoma congénito

青光眼
  • 文章类型: Journal Article
    目的:使用静态章鱼视野检查对原发性先天性青光眼(PCG)患者的视野(VF)缺陷进行检测和表征,并确定VF的质量和持续时间。
    方法:纳入诊断为PCG的70例患者88只眼。使用章鱼900进行评估,并使用趋势导向视野(G-TOP)算法评估每只眼睛。收集定量VF数据:质量数据(假阳性和阴性反应,和持续时间)以及平均偏差(MD)和损失方差平方根(sLV)的结果。收集了定性数据:弥漫性和局部缺陷的存在,使用Aulhorn和Karmeyer分类的受影响的半球和缺陷等级。分析了周边结果与临床变量之间的相关性。
    结果:中位年龄为11(8-17)岁。65.9%(58/88)的PCG眼出现VF缺损。在10/58眼中观察到弥漫性缺陷(16.94%)(平均MD=23.92[SD:2.52])dB,在48/58眼中观察到局部缺陷(82.75%)。最常见的缺陷是斑点样/中风样/初期的中央旁暗点(n=15),鼻台阶(n=8),添加弧形缺陷(n=2),半环形(n=13)和同心缺陷与中心岛(n=9)。最常见的视觉半场是下半场。平均测试持续时间为2分钟12秒(SD:21.6秒)。MD和sLV值与最佳矫正视力(BCVA)相关,杯盘比和抗青光眼手术次数(均P<.001)。
    结论:在PCG患者中使用章鱼视野检查发现大量弥漫性和局部缺陷。最常见的缺陷是中央旁暗点,下半场受影响最大。
    OBJECTIVE: To detect and characterise visual field (VF) defects using static Octopus perimetry in patients with primary congenital glaucoma (PCG) and to determine VF quality and time duration.
    METHODS: Eighty-eight eyes of 70 patients diagnosed with PCG were included. Assessments were performed using an Octopus 900 and each eye was assessed with the tendency-oriented perimetry (G-TOP) algorithm. Quantitative VF data were collected: quality data (false positive and negative response, and time duration) and results of mean deviation (MD) and square root of loss variance (sLV). Qualitative data were collected: the presence of diffuse and localized defects, the affected hemifield and grade of defects using the Aulhorn and Karmeyer classification. Correlations between perimetric results and clinical variables were analysed.
    RESULTS: Median age was 11 (8-17) years. 65.9% (58/88) of PCG eyes showed VF defects. Diffuse defects were observed in 10/58 eyes (16.94%) (mean MD = 23.92 [SD: 2.52]) dB) and localized defects in 48/58 eyes (82.75%). The most frequent defect was spot-like/stroke-like/incipient paracentral scotoma (n = 15), nasal step (n = 8), adding arcuate defect (n = 2), half ring-shaped (n = 13) and concentric defect with a central island (n = 9). And the most frequent affected visual hemifield was inferior hemifield. Mean test duration was 2 min 12 s (SD: 21.6 s). MD and sLV values were correlated with best corrected visual acuity (BCVA), cup to disc ratio and number of antiglaucoma surgeries (all P < .001).
    CONCLUSIONS: A high number of diffuse and localized defects were identified using Octopus perimetry in PCG patients. The most frequent defect was paracentral scotoma and inferior hemifield was the most affected.
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  • 文章类型: Journal Article
    Aniridia is a congenital bilateral ocular disorder with dominant autosomal inheritance. More than 50% of patients will develop aniridic glaucoma (AG) during their lives. Open angle glaucoma is more common in aniridia, but a closed angle mechanism has been described in relation with anterior rotation of the rudimentary iris, occluding trabecular meshwork. Diagnosis and follow-up of AG is difficult in relation with the presence of keratopathy, nystagmus and foveal hypoplasia. Central corneal thickness usually measures more than 600 microns, which prevents achieving a reliable value of intraocular pressure. Medical treatment of AG is no different from the rest of glaucoma. It is recommended to use preservative free formulations, and combined therapy is often required. Surgical treatment is needed in many cases. There is no consensus on the first line surgery for AG, but in open angle AG, angle surgery is usually first choice, and glaucoma drainage devices are the next preferred surgical technique. In closed angle AG glaucoma drainage devices are usually the first choice, with trabeculectomy as the second preferred surgical technique.
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  • 文章类型: Journal Article
    无虹膜是一种先天性双侧眼部疾病,具有显性常染色体遗传。超过50%的患者将在其一生中发展为无虹膜青光眼(AG)。开角型青光眼更常见于无虹膜,但是已经描述了与基本虹膜的前旋转有关的闭合角度机制,阻塞小梁网。AG的诊断和随访与角膜病变的存在有关是困难的,眼球震颤和中央凹发育不全。中央角膜厚度通常大于600微米,这阻碍了实现可靠的眼内压值。AG的药物治疗与其他青光眼没有区别。建议使用不含防腐剂的配方,通常需要联合治疗。在许多情况下需要手术治疗。对于AG的一线手术没有共识,但在开角AG中,角度手术通常是首选,青光眼引流装置是下一个首选的手术技术。在闭角AG青光眼引流装置通常是首选,小梁切除术是第二种首选手术技术。
    Aniridia is a congenital bilateral ocular disorder with dominant autosomal inheritance. More than 50% of patients will develop aniridic glaucoma (AG) during their lives. Open angle glaucoma is more common in aniridia, but a closed angle mechanism has been described in relation with anterior rotation of the rudimentary iris, occluding trabecular meshwork. Diagnosis and follow-up of AG is difficult in relation with the presence of keratopathy, nystagmus and foveal hypoplasia. Central corneal thickness usually measures more than 600 microns, which prevents achieving a reliable value of intraocular pressure. Medical treatment of AG is not different from the rest of glaucoma. It is recommended to use preservative free formulations, and combined therapy is often required. Surgical treatment is needed in many cases. There is no consensus on the first line surgery for AG, but in open angle AG, angle surgery is usually first choice, and glaucoma drainage devices are the next preferred surgical technique. In closed angle AG glaucoma drainage devices are usually the first choice, with trabeculectomy as the second preferred surgical technique.
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  • 文章类型: Case Reports
    The neonate has a horizontal diameter of the cornea, usually up to 10mm with growth up to 2mm in the first 2 years of life. We report a case of megalocornea, a rare, recessive, X-linked disorder in a 3-month-old child, seeking to review what the medical literature brings information about the condition, as well as diagnostic and follow-up parameters, of its main differential diagnoses.
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