Discussion on the Therapeutic Effect of Secondary Glaucoma Characterized by Iris Atrophy
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目的： 分析以虹膜萎缩为特征的继发性青光眼的临床分类及疗效。 方法： 回顾性系列病例研究。收集2013年7月至2020年1月于石家庄市人民医院收治的以虹膜萎缩为特征的继发性青光眼患者60例（70眼），年龄26~67（50.0±10.4）岁，其中男32例（36眼），女28例（34眼）。随访12个月，观察患者最佳矫正视力（BCVA）、眼压、抗青光眼药物的变化，分析其临床分类及治疗效果。采用重复测量设计资料的方差分析、Wilcoxon符号秩和检验对数据进行分析。 结果： 70眼中，患有葡萄膜炎的有54眼，Fuchs综合征10眼，角膜内皮炎6眼；虹膜弥漫性萎缩44眼，局限性萎缩26眼；经房水检测的有30眼，其中10眼房水病毒IgG抗体呈阳性，20眼房水白细胞介素-6（IL-6）、白细胞介素-8（IL-8）、白细胞介素-10（IL-10）、血管内皮生长因子（VCAM）升高。本研究患者采用青光眼药物治疗的有20眼，采用YAG激光周边虹膜切除术治疗的有12眼，采用青光眼手术治疗的有38眼。随访12个月，70眼治疗前后BCVA差异具有统计学意义（F=24.04，P<0.001），治疗后1个月视力最好，治疗后3个月趋于平稳；治疗前后眼压差异具有统计学意义（F=445.16，P<0.001），治疗后1个月眼压最低，之后逐渐回升，治疗后3个月趋于平稳；治疗后抗青光眼药物明显减少，差异有统计学意义（Z=-7.28，P<0.001）。 结论： 病毒性葡萄膜炎仍是以虹膜萎缩为特征的继发性青光眼的主要病因。在积极控制眼内炎症及抗病毒的基础上，降眼压药物和（或）YAG激光周边虹膜切除术对于首次发作、虹膜粘连时间短者疗效显著；对于反复发作、青光眼性损害较重者行抗青光眼手术治疗。 Objective: To analyze the therapeutic effect of secondary glaucoma characterized by iris atrophy. Methods: In this case retrospective study, a total of 60 patients (70 eyes) with secondary glaucoma characterized by iris atrophy admitted to Shijiazhuang People's Hospital from July 2013 to January 2020 were collected and followed up for 12 months, including 32 males (36 eyes) and 28 females (34 eyes), aged 26-67 (50.0±10.4) years. The clinical classification and therapeutic effect were analyzed, and the changes of best corrected visual acuity, intraocular lens (IOP) and anti-glaucoma drugs were observed. Repeated measures analysis of variance, Wilcoxon signed-rank test were used to analyze the data. Results: There were 70 eyes of patients with secondary glaucoma characterized by iris atrophy, including uveitis in 54 eyes, Fuchs syndrome in 10 eyes and corneal endodermatitis in 6 eyes There were 44 eyes with diffuse iris atrophy and 26 eyes with localized atrophy In 30 eyes, 10 eyes were positive for IgG antibody of aqueous humor virus, and 20 eyes were elevated for interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10) and vascular cell adhesion molecule (VCAM). After active treatment with inflammation and antiviral therapy, there were 20 eyes treated with anti-glaucoma medications, 12 eyes were treated with YAG laser peripheral iridectomy, and 38 eyes were treated with anti-glaucoma surgery. After 12 months of follow-up, the best corrected visual acuity of 70 eyes before and after treatment had a statistically significant difference (F=24.04, P<0.001). The best visual acuity was found 1 month after treatment and leveled off 3 months after treatment. The IOP before and after treatment had a statistically significant difference (F=445.16, P<0.001), the IOP was the lowest 1 month after treatment, then rose gradually, and leveled off 3 months after treatment. Anti-glaucoma drugs decreased significantly after treatment, the difference was statistically significant (Z=-7.28, P<0.001). Conclusion: Viral uveitis is still the main cause of secondary glaucoma characterized by iris atrophy. Based on active control of intraocular inflammation and anti-viral therapy, anti-glaucoma medications and YAG peripheral iris laser perforation showed significant efficacy in the first attack, and short iris adhesion time. Glaucoma surgery is necessary for recurrent glaucoma and severe glaucoma damage.
Objective: To analyze the therapeutic effect of secondary glaucoma characterized by iris atrophy. Methods: In this case retrospective study, a total of 60 patients (70 eyes) with secondary glaucoma characterized by iris atrophy admitted to Shijiazhuang People's Hospital from July 2013 to January 2020 were collected and followed up for 12 months, including 32 males (36 eyes) and 28 females (34 eyes), aged 26-67 (50.0±10.4) years. The clinical classification and therapeutic effect were analyzed, and the changes of best corrected visual acuity, intraocular lens (IOP) and anti-glaucoma drugs were observed. Repeated measures analysis of variance, Wilcoxon signed-rank test were used to analyze the data. Results: There were 70 eyes of patients with secondary glaucoma characterized by iris atrophy, including uveitis in 54 eyes, Fuchs syndrome in 10 eyes and corneal endodermatitis in 6 eyes There were 44 eyes with diffuse iris atrophy and 26 eyes with localized atrophy In 30 eyes, 10 eyes were positive for IgG antibody of aqueous humor virus, and 20 eyes were elevated for interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10) and vascular cell adhesion molecule (VCAM). After active treatment with inflammation and antiviral therapy, there were 20 eyes treated with anti-glaucoma medications, 12 eyes were treated with YAG laser peripheral iridectomy, and 38 eyes were treated with anti-glaucoma surgery. After 12 months of follow-up, the best corrected visual acuity of 70 eyes before and after treatment had a statistically significant difference (F=24.04, P<0.001). The best visual acuity was found 1 month after treatment and leveled off 3 months after treatment. The IOP before and after treatment had a statistically significant difference (F=445.16, P<0.001), the IOP was the lowest 1 month after treatment, then rose gradually, and leveled off 3 months after treatment. Anti-glaucoma drugs decreased significantly after treatment, the difference was statistically significant (Z=-7.28, P<0.001). Conclusion: Viral uveitis is still the main cause of secondary glaucoma characterized by iris atrophy. Based on active control of intraocular inflammation and anti-viral therapy, anti-glaucoma medications and YAG peripheral iris laser perforation showed significant efficacy in the first attack, and short iris adhesion time. Glaucoma surgery is necessary for recurrent glaucoma and severe glaucoma damage.
iris atrophysecondary glaucomaanti-glaucoma surgery
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