phacolytic glaucoma
Introduction
Introduction to lens dissolved glaucoma In the mature or over-mature cataract, inflammatory glaucoma caused by lens protein leakage through the lens capsule, called phacolytic glaucoma or lensprotein glaucoma, is a secondary opening. Angle glaucoma. basic knowledge The proportion of illness: 0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications: edema
Cause
The cause of lens-soluble glaucoma
(1) Causes of the disease
In the cataract of over-ripening period, the lens capsule permeability increases or spontaneously ruptures, and the liquefied lens cortex overflows into the anterior chamber.
(two) pathogenesis
Under normal circumstances, the lens capsule can protect the lens protein from leaking into the aqueous humor. The lens capsule permeability of the cataract in the over-mature period increases or spontaneously ruptures. The lens cortical liquefaction penetrates into the aqueous humor and is swallowed by macrophages. After the phagocytic cells phagocytose the lens cortex, they swell and become round, gather in the iris crypt, trabecular mesh, block the drainage channel of the aqueous humor, and increase the intraocular pressure. Another theory is that the polymer soluble lens protein is discharged to the aqueous humor. Direct obstruction can also cause elevated intraocular pressure. It has been found that the lens in infants lacks this protein. Adolescents aged 5 to 20 years old account for less than 1% of the soluble protein of the lens, and then gradually increase with age. 70 The content of the elderly over the age of 5% to 15%, the content of cataract patients increased significantly with the course of the disease, 2 to 3 times the same age group, the content of lens dissolved glaucoma aqueous humor is higher.
Therefore, soluble lens protein leaks from the lens capsule of over-mature cataract, and severe obstruction of aqueous humor drainage is its main pathogenesis. The role of macrophages in lens-soluble glaucoma is mainly to clear the lens material in the anterior chamber. And the removal of protein in the aqueous drainage channel does not play a major role in the increase in intraocular pressure.
Prevention
Lens-dissolving glaucoma prevention
Early removal of mature cataracts.
Complication
Lens-soluble glaucoma complications Complications edema
Corneal edema, etc.
Symptom
Lens-soluble glaucoma symptoms Common symptoms Congestive green weak calcified intraocular pressure increased eye pain edema nausea and vomiting lens capsule wall rupture anterior chamber swelling...
symptom
1. redness, pain, headache, nausea and vomiting;
2. Eye congestion, corneal edema, deep anterior chamber, open angle, and sharp increase in intraocular pressure;
3. The anterior chamber water is turbid, visible crystals and emulsified crystal cortex;
4. The cataract is over-cooked.
The disease is more common in the elderly aged 60 to 70 years old, with a history of long-term cataract with vision loss, sudden onset, eye pain, conjunctival congestion, sharp vision loss, ipsilateral headache, accompanied by systemic symptoms such as nausea, vomiting, and intraocular pressure Rapid rise, often 30 ~ 50mmHg, some patients up to 80mmHg or more, the cornea is usually diffuse edema, sometimes microcapsule-like edema, aqueous cells and flashover reaction is very significant, no corneal posterior wall deposits (KP ), the corners are always open and there are no observable anomalies.
The cell debris in the anterior chamber is layered at the corner of the anterior chamber. In rare cases, anterior chamber empyema is sometimes seen. White granules (aggregated lens protein) can be seen in the anterior chamber with the volume of the lens after release of the lens material. Reduced maturity caused by anterior capsule shrinkage, over-mature or cystic cataract (Morgagnian cataract), lens-soluble glaucoma is rare in immature cataracts, such as immature cataract glaucoma acute episodes are not obvious, intraocular pressure Not very high, rare cases of lens-soluble glaucoma may be accompanied by spontaneous or traumatic lens dislocation to the vitreous.
Inflammatory deposits such as scattered cells or aggregated KP may or may not appear on the corneal endothelium, and the cellular response in the anterior chamber is very low, generally moderate.
The lens is completely gray-white turbid, and typical white small calcification spots or yellow-brown spots can be seen on the surface of the anterior capsule. This may be caused by the deposition of macrophages at the fine pores on the lens capsule. The common lens cortex is liquefied and milky. The nucleus sinking is brownish yellow, and the angle of the anterior chamber is an open angle. At the root of the iris, the scleral process, and the trabecular surface, scattered grayish white or brownish yellow spots and flaky deposits are visible. These changes are primary and primary. Important signs of acute angle-closure glaucoma differentiation.
For typical cases, according to medical history and clinical features, such as decreased vision, history of cataract progression, sudden acute episodes of intraocular pressure, a series of symptoms similar to acute angle-closure glaucoma, but the anterior chamber is deep or normal, The corner of the room is open, and there are grayish white or brownish yellow spots on the aqueous humor and iris cornea. It floats or floats on the anterior capsule of the lens. It can be diagnosed by grayish white or brownish yellow spots.
Examine
Examination of lens-soluble glaucoma
For atypical cases, the following laboratory tests should be performed to assist in the diagnosis.
1. Aqueous cytology examination
The anterior chamber puncture aspirate the aqueous humor, drop 1 drop on the slide, fix it with pure methanol for 10 min, air dry, then stain with Giemsa solution for 1 h, then fade with 95% ethanol, dry and then light microscopy, if found to be typical transparent Expanded macrophages contribute to the diagnosis of this disease.
2. Determination of high molecular weight soluble lens protein
The differential fractionation precipitation method was used to separate and purify the high molecular weight soluble lens protein, and the content was determined.
3. Lens protein intradermal test
The prepared standard lens protein solution was intradermally injected, and the result was negative, and the lens protein allergic glaucoma was positive.
Iris keratoscopy suggests an open angle and the presence of scattered gray-white or brown-yellow spots and flaky deposits on the roots of the iris, sclera and trabecular surfaces.
Diagnosis
Diagnostic identification of lens dissolved glaucoma
The disease should be differentiated from glaucoma caused by cataract in the swelling period, lens protein allergic glaucoma and primary acute angle-closure glaucoma.
Glaucoma caused by cataract during swelling
Because the lens is swollen, the volume is increased, the anterior and posterior diameters are increased, the anterior chamber is extremely shallow, the pupil opening is fixed, the photoreaction disappears, the anterior capsule of the lens is closely attached to the pupillary margin, and the angle of the chamber is mostly or completely closed. A small amount of pigment can be seen in the water, and the anterior chamber of the disease is deep, the angle of the anterior chamber is open, the pupil is mild or moderately dilated, and the aqueous humor and iris corneal corners are grayish or brownish yellow floating or sinking.
2. Lens protein allergic glaucoma
There are extracapsular cataract extraction, cataract surgery or a history of crystal external injury, iris congestion and swelling, extensive post-adhesion, small pupil, disappearance of light response, anterior chamber can be shallow, water flashes obviously, with more polymorphism White blood cells, even visible anterior chamber empyema, often have anterior adhesion around the iris, and there is a residual lens cortex on the anterior chamber, vitreous or trabecular surface.
3. Lens granular glaucoma
There is a history of cataract surgery or a history of in vitro trauma, the anterior chamber is deep, the angle of the anterior chamber is still open, the aqueous humor is obvious, the anterior chamber contains a large amount of swollen lens cortical particles, and contains a small amount of large macrophages and small white blood cells. It can be seen that the front of the iris is stuck.
4. Primary acute angle-closure glaucoma
The visual acuity suddenly drops or even no light perception, the intraocular pressure rises sharply, the anterior chamber is shallow, the angle of the anterior chamber is closed, and the lens glaucoma and iris segmental atrophy are visible. The pupil is elliptical and straight, and the photoreaction disappears.
