malignant glaucoma
Introduction
Introduction to malignant glaucoma Malignant glaucoma is also known as ciliary block glaucoma. It is characterized by an increase in postoperative intraocular pressure, and the crystal iris is moved forward, causing all anterior chambers to become shallower or even disappear. Typical cases often occur several hours after surgery, days to months. The cause of the miotic agent is the contraction of the ciliary muscle, the ciliary ring block, the relaxation of the crystal suspensory ligament, the adhesion of the ciliary body to the equator of the crystal, the crystal behind the aqueous humor, the crystal and the iris move forward, and the iris appears. Highly bulging, the anterior chamber is generally shallow and the drainage of water is blocked. At this time, it can only be diverted to the rear. The vitreous body is detached and moved forward, so that the crystal is pushed forward more, the anterior chamber is shallower, and the angle of the anterior chamber is closed again to form a vicious circle, so that the ciliary ring blocks the closed angle glaucoma. basic knowledge Sickness ratio: 0.0001% Susceptible people: no special people Mode of infection: non-infectious Complications: cataract
Cause
Cause of malignant glaucoma
Anatomical defects (30%):
Variations and genetic defects in the normal range of anatomy, such as small eyeballs, small cornea, hyperopia, shallow anterior chamber, and high pleat red film, make the anterior chamber shallow angle narrow, leading to drainage of water.
Physiological changes (30%):
Pupil block, narrow anterior chamber angle, moderate dilated pupil is an important condition, coupled with the increase of age, the crystal grows with age, gradually close to the pupil edge, so that pupil formation between the iris and the crystal, The pressure in the posterior chamber is higher than the pressure in the anterior chamber, and the elasticity of the cornea and sclera is weakened, which has no compensatory ability to increase the pressure. Therefore, the iris is pushed forward, and the iris bulges to close the angle of the anterior chamber, resulting in increased intraocular pressure.
Emotional hormones (15%):
Central nervous system dysfunction, cerebral cortical excitation inhibition disorder, inter-brain intraocular pressure regulation central disorder, vasomotor neurological disorders make the pigmented membrane hyperemia, edema, sympathetic excitation, dilated pupils, can make the iris roots to Zhoulian, obstruction angle.
Other factors (10%):
The point is scattered and frozen, the dark room is tested or the movie is watched. The long time of the TV makes the pupil dilated, and the angle of the corner is blocked, resulting in an increase in intraocular pressure.
Prevention
Malignant glaucoma prevention
1, live a regular life, to avoid emotional fluctuations, maintain a psychological balance, try to watch TV less, let the eyes rest, diet should be light, do not eat spicy food, do not take drugs that have an effect on eye pressure. Once you have glaucoma symptoms, you must go to the hospital to consult an ophthalmologist and try to keep your eyesight.
2, can only eat boiled eggs, up to 3 per week do not use excessive force, because your blood vessels are inherently vulnerable. As long as a small blood vessel ruptures, it can lead to blindness. Try to avoid constipation. Don't do things with your head down, blood on your head is harmful to glaucoma patients.
Complication
Malignant glaucoma complications Complications cataract
Corneal opacity, posterior iris adhesion, pupillary atresia, pre-irisal adhesion, pupillary membrane closure, iris bulging, complicated cataract, fundus lesion, eyeball atrophy.
Symptom
Malignant glaucoma symptoms Common symptoms Green weak intraocular pressure increased red blood plane uveitis under the anterior chamber
Malignant glaucoma is a kind of intractable glaucoma with difficult diagnosis and difficult to control intraocular pressure. It is generally considered to be a serious complication after glaucoma surgery. It is characterized by elevated intraocular pressure and the crystal iris is moved forward, making all the former The room is obviously shallower or even disappears. Typical cases often occur several hours after surgery, several days or even months, but in some cases, there is no anti-glaucoma operation, and local drops of the use of miotic agents cause eye pressure rise or trauma. This disease occurs after uveitis, these are all transparent factors leading to contraction of the ciliary muscle, ciliary ring block.
This disease only occurs in closed-angle glaucoma, especially when performing surgery, although the intraocular pressure is low, but the angle of the occlusion is still occluded, often with both eyes onset, that is, after one eye has a malignant glaucoma, the other eye has a malignant effect due to the eyelash The possibility of glaucoma, if a prophylactic peripheral resection is performed at a glance, it can not only prevent the occurrence of malignant glaucoma, but also has the possibility of induction.
Examine
Examination of malignant glaucoma
1 Application of ultrasound biomicroscopy: This technique can dynamically and statically record the anatomical structure and physiological function of the anterior segment of the living human body in a non-interfering natural state, and can be quantitatively measured, especially for the morphology of the ciliary body and the surrounding iris. The posterior chamber morphology and physiological and pathological changes were recorded in real time.
2 Confocal laser scanning ophthalmoscope: This machine uses low-energy radiation scanning technology, real-time image recording and computer image analysis technology. Through the confocal laser fundus scanning, high-resolution, high-contrast retinal tomographic images can be obtained through the slightly opaque refractive interstitial, which can accurately record and quantitatively analyze the distribution of optic nerve fibers, the stereoscopic image of the optic disc, and simultaneously Examination of blood flow status in the optic papilla area and completion of local visual field and electrophysiological examination are of great value for early diagnosis, stage staging and prognosis analysis of glaucoma.
3 Quantitative static visual field, graphic visual evoked potential: When the typical visual field defect occurs in glaucoma, the loss of optic nerve fiber may have reached 50%. The computer automatic perimetry provides a basis for the earliest diagnosis of glaucoma by detecting changes in visual thresholds. Graphic visual electrophysiology PVEP, PE-RG examination, has certain sensitivity and specificity in glaucoma. If the above two tests are combined, the early detection rate of glaucoma can be significantly improved.
Diagnosis
Diagnosis and diagnosis of malignant glaucoma
This disease only occurs in closed-angle glaucoma, especially when performing surgery, although the intraocular pressure is low, but the angle of the occlusion is still occluded, often with both eyes onset, that is, after one eye has a malignant glaucoma, the other eye has a malignant effect due to the eyelash The possibility of glaucoma, if a prophylactic peripheral resection is performed at a glance, it can not only prevent the occurrence of malignant glaucoma, but also has the possibility of induction.
For suspicious patients, the intraocular pressure should first be measured. Intraocular pressure greater than 3.20kPA (24mmHg) is pathological high intraocular pressure, but high intraocular pressure can not diagnose glaucoma, and normal glaucoma can not rule out glaucoma. Because intraocular pressure fluctuates periodically within a day. The intraocular pressure fluctuation is greater than 1.07kPA (8mmHg) for pathological intraocular pressure. In normal people, the intraocular pressure of both eyes is close. For example, the pressure difference between eyes is greater than 0.67kPA (5mmHg), which is also pathological intraocular pressure. Secondly, the fundus should be examined to observe the change of optic disc. The optic disc change of glaucoma has certain peculiarities and has important clinical value. Often expressed as pathological depression, the ratio of the diameter of the depression to the diameter of the optic disc (C/D) is commonly used to indicate the size of the depression. C/D greater than 0.6 or binocular C/D difference greater than 0.2 is abnormal; the optic disc is thinned, often accompanied by unevenness and notch of the optic disc, indicating that the optic disc decreases along the number of optic nerve fibers; optic disc blood vessels change, manifested as the disc edge Bleeding, vascular overhead, nasal displacement of the optic disc and central pulsation of the central retina.
