Glaucoma青光眼青光眼青光眼的流行病学青光眼的流行病学l全球有6700万青光眼万青光眼病人（超过加拿大和澳大利亚人口总和）l有670万人因青光眼成为盲人盲人l我国有3.6万眼科医生（青光眼专业医生0.2 4）视盘表面线状出血 5）视网膜神经纤维层变薄或缺损 原发性开角性青光眼原发性开角性青光眼Diagnosis lGlaucomatous optic disk or field changeslElevated intraocular pressurelNormal-appearing open anterior chamber anglelRepeated tonometry may be necessary(approximately 25% of patients with primary open-angle glaucoma have a normal intraocular pressure when first examined) 眼压升高：24h眼压更有意义最高眼压水平30mmHg,波动又大于10mmHg-做出诊断最高眼压水平略高于正常，波动大于6mmHg-青光眼可疑 青光眼视盘损害 青光眼视野缺损 其中二项阳性,房角检查属开角即可诊断注意注意：正常眼压青光眼正常眼压青光眼(NTG)： 具有特征性青光眼视盘损害和视野缺损具有特征性青光眼视盘损害和视野缺损但眼压始终在统计学正常值范围内但眼压始终在统计学正常值范围内诊断诊断 （早期极易漏诊）（早期极易漏诊）原发性开角性青光眼原发性开角性青光眼Screening for glaucoma筛查筛查 lScreening is important lPrimary open-angle glaucoma is the absence of symptomslSuccessful treatment must be started early lA single intraocular pressure measurement is unreliabilitylRelying on optic disk or visual field changes is complex治疗治疗l药物降眼压l激光降眼压l手术降眼压l视神经保护常用的降眼压药常用的降眼压药 1. 拟副交感神经药(缩瞳剂)：1-2%匹罗卡品Mydriatics 2. -肾上腺能受体阻滞剂：0.5%噻吗心安Suppression of aqueous production 3. 肾上腺能受体激动剂： 阿法根（2受体激动剂）Suppression of aqueous production 4. 前列腺素衍生物：适利达、前列腺素衍生物：适利达、苏为坦坦开青首开青首选Facilitation of aqueous outflow 5. 碳酸酐酶抑制剂：醋氮酰胺Suppression of aqueous production 6. 高渗剂：20%甘露醇，50%甘油Reduction of vitreous volume Course & Prognosis 预后预后lWithout treatment- complete blindnesslNot suffered extensive glaucomatous damage controlled- prognosis is good lEarly detected- sucessfully manamged medically正常眼压性青光眼正常眼压性青光眼Normal tension glaucomalThe intraocular pressure consistently below 25mmHglCommon in JapanlAssociation with vasospasm(血管痉挛)lAmong patients diagnosed with NTG, only 50% have progressive visual field losslReduction of intraocular pressure is beneficial in patients with progressive visual field loss高眼压症高眼压症Ocular hypertensionlElevated intraocular pressure without disk of field abnormalitieslMore common than primary open-angle glaucomalRate at which such individuals develop glaucoma is approximately 5-10per 1000 per yearlThe risk- increasing age, greater optic disk cupping, a positive family history 慢性闭角型青光眼慢性闭角型青光眼Chronic-angle closure glaucomalAnatomic predispositon to anterior chamber angle no acute rise in intraocular pressurelBut a gradual rise in intraocular pressurelPresent in the same way as those with primary open-angle glaucoma Narrow anterior chamber angles Variable amounts of peripheral anterior synechiae(粘连)病例分析病例分析l某单位体检发现有四位同事，眼睛检查结果如下：小王：眼压(右眼19mmHg,左眼21 mmHg)，C/D（右眼0.3，左眼0.4） 小李：眼压(右眼11mmHg,左眼19 mmHg)，C/D（右眼0.3，左眼0.4）小赵：眼压(右眼23mmHg,左眼26 mmHg)，C/D（右眼0.6，左眼0.4）小周: 眼压(右眼15mmHg,左眼16 mmHg)，C/D（右眼0.7，左眼0.3）请分析哪位同事需要分析哪位同事需要进一步一步检查眼睛，眼睛，为什什么么病例病例2l一位72岁老太太，晚上由家人陪同到急诊，痛苦面容，右手捂住右侧头部，诉头痛、胃痛，恶心。l现病史：昨天晚饭后为孙子缝衣服，2小时后觉眼痛，头痛。以为疲劳，睡觉后无明显缓解，今日加重。l既往史：否认糖尿病、高血压、脑梗等，有胃病10年，时有胃痛，一直服用药物l眼部检查：l视力：右眼 手动/眼前，左眼 1.0l裂隙灯：右眼角膜雾状水肿，结膜睫状充血，瞳孔呈纵椭圆形散大，对光反射消失，虹膜部分脱色素，前房极浅。左眼角膜透明，瞳孔正常，前房浅l眼底：无法窥入l眼压：右眼 60mmHg,左眼14mmHg讨论：可能的：可能的诊断及理由？断及理由？处理原理原则？小结小结l介绍青光眼的基本概况l青光眼的定义和分类l眼内压，房水循环的途径l急性闭角型青光眼临床表现、诊断、鉴别、处理原则（虹膜萎缩，青光眼斑）l开角型青光眼的临床表现、诊断、处理l2个病例复习上课内容