crystallin allergic glaucoma
Introduction
Introduction of lens protein allergic glaucoma The phacoanaphylactic glaucoma, which is clinically rare, is caused by an allergic reaction caused by lens protein after cataract surgery or lens injury, and is also known as glaucomainendophthalmitisphacoanaphilactica. basic knowledge The proportion of illness: 0.003% Susceptible people: no special people Mode of infection: non-infectious Complications: glaucoma
Cause
Lens protein allergic glaucoma cause
Cause:
The lens protein escapes into the aqueous humor or vitreous.
(two) pathogenesis
Normally, the lens protein cannot enter the aqueous humor through the intact lens capsule, so it does not cause an allergic reaction to the ocular tissue. When the lens capsule is ruptured (after surgery or trauma) or the permeability changes, the lens protein can Entering the aqueous humor or vitreous, the lens is the body's own hidden antigen, mainly -crystallin, with corresponding immunologically active cells. The disease is related to type III and IV allergic reactions, and the lens cortex overflows into the anterior chamber or vitreous. By immunocompetent cells, they can be selectively stimulated to produce antibodies or sensitized lymphocytes, causing an immune response, and granulomatous uveitis occurs. As long as the residual lens protein antigen is present, the immune response will continue. If the trabecular trabecular meshwork of the iris is involved, it will cause an obstacle to the drainage of the aqueous humor and an increase in intraocular pressure.
Prevention
Lens protein allergic glaucoma prevention
Timely removal of mature cataracts.
Complication
Lens protein allergic glaucoma complications Complications glaucoma
Lens protein allergic uveitis and the like.
Symptom
Lens protein allergic glaucoma symptoms common symptoms elevated intraocular pressure retinal edema edema lens iron crystal lens protein escape lens capsule wall rupture lens glaucoma anterior chamber swelling ...
Clinical manifestations vary, most patients present with moderate anterior chamber response, with KP on the corneal endothelium of the edema and on the anterior surface of the lens, in addition to low-grade vitreitis, pre-irisal adhesion or posterior adhesion formation and anterior chamber It may be found that residual lens material is examined in the clinic by ophthalmology, and it is often difficult to diagnose lens allergy. It can be diagnosed by histopathological examination after eyeball removal.
Patients with this disease have a history of residual intraocular lens cortex or cataract surgery, especially residual cortical and vitreous, which is more likely to occur. Generally, after 24 to 14 days of incubation, uveitis occurs. Symptoms, mostly anterior uveitis, anterior chamber inflammatory reaction, a large number of inflammatory cells exudation, occasionally visible anterior chamber empyema, a large amount of sheep fat deposits on the posterior wall of the cornea, swelling of the iris, new life can occur later Blood vessels, pupils shrink, dilated agents are not easy to make the pupils dilated, if the posterior uveitis inflammation is severe, you can find the yellow light reflection in the pupil area, the intraocular pressure is low in acute inflammation, when the inflammation involves the angle of the anterior chamber, trabecular meshwork When the pathological changes of the tissue are caused, the intraocular pressure can be increased, resulting in secondary glaucoma.
Examine
Examination of lens protein allergic glaucoma
1. Intradermal test The intraocular test is carried out with a lens leaching solution to produce a delayed skin allergic reaction.
2. Immunological examination of elevated serum immunoglobulin IgA and IgM, the determination of lens protein antibodies in serum is helpful for diagnosis.
3. Atrial cytology examination of diagnostic anterior chamber puncture, removal of aqueous humor for cytology, such as the discovery of small lymphocytes and macrophages, is helpful in determining allergic reactions.
4. Biochemical examination of aqueous humor showed that the high molecular weight soluble lens protein content in aqueous humor was extremely low, which can be considered as reliable evidence for the identification of lens-soluble glaucoma.
5. Histopathological examination revealed extensive polymorphonuclear granulocyte infiltration in the injured lens, as well as granulomatous inflammation bands formed by lymphocytes, epithelioid cells and giant cells. No special auxiliary inspection.
Diagnosis
Diagnostic identification of lens protein allergic glaucoma
Diagnostic criteria
Clinically, according to the medical history, there are residual lens cortex in the eye, accompanied by severe uveal inflammation and elevated intraocular pressure to make a diagnosis. In fact, it is difficult to make timely and correct diagnosis of this disease in clinical practice. It is often diagnosed after pathological examination after eyeball removal.
Diagnostic criteria for the diagnosis of allergic glaucoma:
1 Polymorphonuclear granulocytes must be present in aqueous or vitreous specimens.
There is a certain amount of lens protein or lens substance in the 2 room water, which can explain the occurrence of glaucoma. Therefore, the lens allergy is accompanied by an increase in intraocular pressure, which is called phacoanaphylactic glaucoma.
Differential diagnosis
1. Glaucoma caused by cataract in the swelling period: due to the swelling of the lens, the volume increases, the anterior and posterior diameters are increased, the anterior chamber is extremely shallow, the pupil opening is fixed, the photoreaction disappears, and the anterior capsule of the lens is closely attached to the pupillary margin. Most or all of the corners are closed, a small amount of pigment is visible in the aqueous humor, and the anterior chamber is deep, the angle of the anterior chamber is open, the pupil is mild or moderately dilated, and the aqueous humor and iris cornea are grayish or brownish yellow. calm.
2. Lens granular glaucoma: a history of cataract surgery or a history of crystalline external injury, the anterior chamber is deep, the angle of the anterior chamber is still open, the aqueous humor is obvious, and the anterior chamber contains a large amount of swollen lens cortical granules, and contains a small amount of large Macrophages and small white blood cells can be seen in the anterior adhesion of the iris.
3. Primary acute angle-closure glaucoma: sudden decline in visual acuity or even no light perception, sharp increase in intraocular pressure, shallow anterior chamber, closed angle of the anterior chamber, visible lens glaucoma and iris segmental atrophy, pupils are elliptical and strong Big, the light reaction disappears.
