第十一章青光眼中英文优质课件

第十一章青光眼中英文第十一章青光眼中英文1优选第十一章青光眼中英文版优选第十一章青光眼中英文版2Intraocularpressure(IOP):thepressureoftheeyecontenttotheeyewall眼压:眼球内容物作用于眼球内壁的压力NormalIOP:10—2lmmHgDoubleIOPdifference<5mmHgIOPcurvedayandnight<8mmHg正常眼压10—2lmmHg双眼压差＜5mmHg昼夜眼压曲线＜8mmHg。3Intraocularpressure(IOP):thPathologicalIOP:IOPisbeyondeyeballinternalorganization,especiallytheopticnervebearinglimit.Causeopticatrophyandvisualfielddefects病理眼压:超越眼球内部组织，特别是视神经承受限度的眼压。引起视神经萎缩和视野缺损4PathologicalIOP:IOPisbeyonOcularhypertension:IOPishigherthannormalIOPrange,butnodamageofthenerveandvisualfield.高眼压症:眼压高出正常眼压范围，但无视神经和视野损害。Normaltensionglaucoma:InthenormalrangeofIOP,theopticnerveandvisualfieldofthedamagethere.正常眼压性青光眼眼压在正常范围,但出现视神经和视野的损伤。55房水循环途径:Aqueouscycleway:Ciliaryprocessposteriorchamberpupil睫状突(产生房水)

后房

瞳孔

AnteriorchamberAngle

Anteriorchamber

前房角(排出房水)前房房水产生率房水排出率维持正常眼压大多数青光眼眼压升高的原因为房水排出受阻6房水循环途径:Ciliaryprocess77pathophysiologicalprocess

病理生理过程

AqueousproducingrateTrabecularmeshworkresistanceScleraveinpressure三个因素房水生成率小梁网阻力上巩膜静脉压aqueousoutflowresistanceIncreased大多数青光眼眼压升高的原因是房水外流阻力增高8pathophysiologicalprocess

病理生Classification

分类Primaryglaucoma:Angleclosureglaucoma:AcuteangleclosureglaucomaChronicangleclosureglaucomaOpenangleglaucoma:PrimaryopenangleglaucomanormaltensionglaucomaSecondaryglaucoma:Congenitalglaucoma:InfantileglaucomaJuvenileglaucomaCongenitalglaucomaaccompaniedbyothercongenitalanomalyglaucoma原发性闭角型:急性闭角型青光眼慢性闭角型青光眼

开角型原发性开角型青光眼正常眼压性青光眼继发性(眼病、全身)先天性婴幼儿型青少年型先天性青光眼伴有其他先天异常9Classification

分类Primarygla前房角的检查及分类前房角位于前房的最周边前房角的构成：

前壁—角巩膜缘

房角隐窝—睫状体前端

后壁—虹膜根部10前房角的检查及分类前房角位于前房的最周边101111第二节原发性青光眼原发性闭角型青光眼—眼压升高房角关闭Primaryangleclosureglaucoma

原发性开角型青光眼—眼压升高房角开放PrimaryOpenangleglaucoma12第二节原发性青光眼原发性闭角型青光眼—眼压升高房Primaryangleclosureglaucoma

一.原发性闭角型青光眼

Acuteangleclosureglaucoma（一）急性闭角型青光眼Etiology:geneticanatomyincentiveClinicalfeatures:age>50yfemalepainredeyevisionlosswithheadachenauseavomiting病因具有遗传倾向，解剖结构异常，常有诱因。临床特征年龄＞50岁，女性多见。主诉为眼胀痛．眼红，视力下降，伴头痛、恶心、呕吐。13Primaryangleclosureglaucoma

Clinicalstages

急性闭角型青光眼临床分期Preclinicalstage:Nosymptom,Shallowanteriorchamber,Oneeyegetdisease,theothereyewithnosymptom.1.临床前期没有自觉症状，具有浅前房，房角窄，虹膜膨隆。一眼发作，另眼没发作。Precursorstage:TransientEasefast2.先兆期一过性，多次小发作，自行缓解。14Clinicalstages

急性闭角型青光眼临床分期PrAcutestage:Symptom:eye:pain,photophobia,tears,severevisionloss.withheadaches,nauseaandvomiting.Sign:Eyelidedema,Conjunctivalcongestion,Cornealepitheliumedema,Anteriorchamberextremelyshallow,Thepupildilatedandlightreflectiondisappeared,Anteriorchamberangleclosed.Intraocularpressureincreased>50mmHg.3.急性发作期症状眼部眼痛、眼胀、畏光、流泪、严重视力下降。全身头痛、恶心、呕吐。体征眼睑水肿、结膜混合充血、角膜上皮水肿、角膜后色素沉着、前房极浅、虹膜严重缺血、房水浑浊、絮状渗出、瞳孔中等大、竖椭圆、光反射消失、局限后粘连、房角关闭、眼底不清、视网膜动脉搏动,眼压明显升高>50mmHg。15Acutestage:15Precursorstage:TransientEasefastIntraocularpressureincreasedgradually.临床症状年龄较急性为早、渐进性、可无明确发病史。Congenitalglaucoma:Infantileglaucoma临床特征年龄＞50岁，女性多见。DependingontheopticdiskdamageC/D>0.Congenitalglaucomaaccompaniedbyothercongenitalanomalyglaucoma双眼压差＜5mmHgPreclinicalstage:Nosymptom,Shallowanteriorchamber,Features:WhenIOPincreasedtheanteriorchamberanglekeepopening大多数青光眼眼压升高的原因为房水排出受阻Ageisearlier临床症状年龄较急性为早、渐进性、可无明确发病史。上巩膜静脉压（一）急性闭角型青光眼increasedaqueouseduction:myoticVisualacuitygetbetter临床前期没有自觉症状，具有浅前房，房角窄，虹膜膨隆。正常眼压性青光眼继发性(眼病、全身)闭角青光眼前房和前房角16Precursorstage:Transient急性闭角型青光眼发作17急性闭角型青光眼发作17Acuteonsetsequela:VisualacuitygetbetterKPIris:atrophy,pigmentationdefectsandlimitedstickyThepupilcan'treturntonormalCloudyglaucomaspotontheanteriorlenscapsuleAnteriorchamberAngleextensivestick急性发作后遗症视力好转角膜后色素沉着虹膜阶段性萎缩、色素脱失、局限后粘瞳孔不能恢复正常晶体前囊下片状白色混浊青光眼斑房角广泛粘连18Acuteonsetsequela:18Remissionstage:symptomstoeaseandanteriorchamberangleopenChronicstage:anteriorchamberangleextensivestickFinalstage:thecontinuoushighintraocularpressure,pooreyesightornolightfeeling.4间歇期小发作后自行缓解，房角开放，不用药或少量缩瞳药。

5慢性期房角广泛粘连>半周，眼压中度升高，视盘病理凹陷，视野缺损。6绝对期持续高眼压，视力极差或无光感。19Remissionstage:symptomsto诊断青光眼激发试验1.暗室试验2.俯卧试验3.暗室+俯卧试验20诊断青光眼激发试验20Differentialdiagnosis鉴别诊断Eyedisease:Conjunctivitis,AnterioruveitisSystemicdisease:gastrointestinaldisease,braindisease,hypertension,etc眼病结膜炎、前部葡萄膜炎。全身病胃肠道疾病、颅脑疾患、高血压病等。21Differentialdiagnosis21Treatmentofprimaryangleclosureglaucoma

原发性闭角型青光眼的治疗Drugs:increasedaqueouseduction:myoticinhibitaqueousgeneratedhighpermeabilityagentadjuvanttreatment:calmorsleeping,purge,hormonereduceinflammationresponse.Laser:Operation:药物:1.增加房水排出缩瞳剂2.抑制房水生成醋氮酰胺、塞吗酰安3.高渗剂20%甘露醇1一1.5g／kg、50%甘油2一3ml/kg4.辅助治疗镇静、安眠、通便、激素减轻炎反应。激光手术22TreatmentofprimaryangleclosChronicangleclosureglaucoma（二）、慢性闭角型青光眼

Clinicalsymptom:AgeisearlierProgressiveHavenoacutehistoryIntraocularpressureincreasedgradually.临床症状年龄较急性为早、渐进性、可无明确发病史。一般无急性发作史，房角粘连和眼压增高逐渐进展。眼压<50mmHg23ChronicangleclosureglaucomaSigns:OpticatrophyandphysiologicalconcaveexpandVisualfieldgraduallydamage.体征视神经萎缩，生理凹扩大，视野进行性损害。24Signs:Opticatrophyandphysi25252626Primaryopenangleg1aucoma

二、原发性开角型青光眼Features:WhenIOPincreasedtheanteriorchamberanglekeepopeningThetrabecularmeshworkorganizationstructureisabnormal特点眼压升高，房角开放。小梁网内组织结构异常27Primaryopenangleg1aucoma

二、Acuteonsetsequela:Thepupilcan'treturntonormalClinical:Noselfconscioussymptomandbefoundlate.晶体前囊下片状白色混浊青光眼斑50%甘油2一3ml/kgPrimaryangleclosureglaucoma正常眼压10—2lmmHgCongenitalglaucomaaccompaniedbyothercongenitalanomalyglaucoma临床症状年龄较急性为早、渐进性、可无明确发病史。优选第十一章青光眼中英文版原发性闭角型青光眼—眼压升高房角关闭Clinicalfeatures:age>50yfemalePrecursorstage:TransientEasefastNormalIOP:10—2lmmHg前房角(排出房水)前房purge,hormonereduceinflammationresponse.上巩膜静脉压前房角位于前房的最周边AgeisearlierIntraocularpressureincreasedwithangleopen眼压:眼球内容物作用于眼球内壁的压力Congenitalglaucoma:InfantileglaucomaClinical:Noselfconscioussymptomandbefoundlate.Acuteonsetsequela:主诉为眼胀痛．眼红，视力下降，Primaryangleclosureglaucoma前房角(排出房水)前房伴头痛、恶心、呕吐。Iris:atrophy,pigmentationdefectsandlimitedsticky大多数青光眼眼压升高的原因为房水排出受阻继发性(眼病、全身)Visualacuitygetbetter全身头痛、恶心、呕吐。大多数青光眼眼压升高的原因为房水排出受阻Sign:Eyelidedema,Conjunctivalcongestion,Cornealepitheliumedema,Anteriorchamberextremelyshallow,Thepupildilatedandlightreflectiondisappeared,Anteriorchamberangleclosed.小梁网内组织结构异常Clinical:Noselfconscioussymptomandbefoundlate.IntraocularpressureincreasedwithangleopenDependingontheopticdiskdamageC/D>0.6Visualfielddefects

临床无自觉症状，晚期发现。眼压升高，房角开放。视乳头损伤C/D>0.6或双眼差＞0.2(火焰状出血)视野缺损(旁中心暗点、鼻侧阶梯、弓形暗点、环形暗点、向心性性缩小、管状、颞侧视岛)28Acuteonsetsequela:purge,hor第十一章青光眼中英文第十一章青光眼中英文29优选第十一章青光眼中英文版优选第十一章青光眼中英文版30Intraocularpressure(IOP):thepressureoftheeyecontenttotheeyewall眼压:眼球内容物作用于眼球内壁的压力NormalIOP:10—2lmmHgDoubleIOPdifference<5mmHgIOPcurvedayandnight<8mmHg正常眼压10—2lmmHg双眼压差＜5mmHg昼夜眼压曲线＜8mmHg。31Intraocularpressure(IOP):thPathologicalIOP:IOPisbeyondeyeballinternalorganization,especiallytheopticnervebearinglimit.Causeopticatrophyandvisualfielddefects病理眼压:超越眼球内部组织，特别是视神经承受限度的眼压。引起视神经萎缩和视野缺损32PathologicalIOP:IOPisbeyonOcularhypertension:IOPishigherthannormalIOPrange,butnodamageofthenerveandvisualfield.高眼压症:眼压高出正常眼压范围，但无视神经和视野损害。Normaltensionglaucoma:InthenormalrangeofIOP,theopticnerveandvisualfieldofthedamagethere.正常眼压性青光眼眼压在正常范围,但出现视神经和视野的损伤。335房水循环途径:Aqueouscycleway:Ciliaryprocessposteriorchamberpupil睫状突(产生房水)

后房

瞳孔

AnteriorchamberAngle

Anteriorchamber

前房角(排出房水)前房房水产生率房水排出率维持正常眼压大多数青光眼眼压升高的原因为房水排出受阻34房水循环途径:Ciliaryprocess357pathophysiologicalprocess

病理生理过程

AqueousproducingrateTrabecularmeshworkresistanceScleraveinpressure三个因素房水生成率小梁网阻力上巩膜静脉压aqueousoutflowresistanceIncreased大多数青光眼眼压升高的原因是房水外流阻力增高36pathophysiologicalprocess

病理生Classification

分类Primaryglaucoma:Angleclosureglaucoma:AcuteangleclosureglaucomaChronicangleclosureglaucomaOpenangleglaucoma:PrimaryopenangleglaucomanormaltensionglaucomaSecondaryglaucoma:Congenitalglaucoma:InfantileglaucomaJuvenileglaucomaCongenitalglaucomaaccompaniedbyothercongenitalanomalyglaucoma原发性闭角型:急性闭角型青光眼慢性闭角型青光眼

开角型原发性开角型青光眼正常眼压性青光眼继发性(眼病、全身)先天性婴幼儿型青少年型先天性青光眼伴有其他先天异常37Classification

分类Primarygla前房角的检查及分类前房角位于前房的最周边前房角的构成：

前壁—角巩膜缘

房角隐窝—睫状体前端

后壁—虹膜根部38前房角的检查及分类前房角位于前房的最周边103911第二节原发性青光眼原发性闭角型青光眼—眼压升高房角关闭Primaryangleclosureglaucoma

原发性开角型青光眼—眼压升高房角开放PrimaryOpenangleglaucoma40第二节原发性青光眼原发性闭角型青光眼—眼压升高房Primaryangleclosureglaucoma

一.原发性闭角型青光眼

Acuteangleclosureglaucoma（一）急性闭角型青光眼Etiology:geneticanatomyincentiveClinicalfeatures:age>50yfemalepainredeyevisionlosswithheadachenauseavomiting病因具有遗传倾向，解剖结构异常，常有诱因。临床特征年龄＞50岁，女性多见。主诉为眼胀痛．眼红，视力下降，伴头痛、恶心、呕吐。41Primaryangleclosureglaucoma

Clinicalstages

急性闭角型青光眼临床分期Preclinicalstage:Nosymptom,Shallowanteriorchamber,Oneeyegetdisease,theothereyewithnosymptom.1.临床前期没有自觉症状，具有浅前房，房角窄，虹膜膨隆。一眼发作，另眼没发作。Precursorstage:TransientEasefast2.先兆期一过性，多次小发作，自行缓解。42Clinicalstages

急性闭角型青光眼临床分期PrAcutestage:Symptom:eye:pain,photophobia,tears,severevisionloss.withheadaches,nauseaandvomiting.Sign:Eyelidedema,Conjunctivalcongestion,Cornealepitheliumedema,Anteriorchamberextremelyshallow,Thepupildilatedandlightreflectiondisappeared,Anteriorchamberangleclosed.Intraocularpressureincreased>50mmHg.3.急性发作期症状眼部眼痛、眼胀、畏光、流泪、严重视力下降。全身头痛、恶心、呕吐。体征眼睑水肿、结膜混合充血、角膜上皮水肿、角膜后色素沉着、前房极浅、虹膜严重缺血、房水浑浊、絮状渗出、瞳孔中等大、竖椭圆、光反射消失、局限后粘连、房角关闭、眼底不清、视网膜动脉搏动,眼压明显升高>50mmHg。43Acutestage:15Precursorstage:TransientEasefastIntraocularpressureincreasedgradually.临床症状年龄较急性为早、渐进性、可无明确发病史。Congenitalglaucoma:Infantileglaucoma临床特征年龄＞50岁，女性多见。DependingontheopticdiskdamageC/D>0.Congenitalglaucomaaccompaniedbyothercongenitalanomalyglaucoma双眼压差＜5mmHgPreclinicalstage:Nosymptom,Shallowanteriorchamber,Features:WhenIOPincreasedtheanteriorchamberanglekeepopening大多数青光眼眼压升高的原因为房水排出受阻Ageisearlier临床症状年龄较急性为早、渐进性、可无明确发病史。上巩膜静脉压（一）急性闭角型青光眼increasedaqueouseduction:myoticVisualacuitygetbetter临床前期没有自觉症状，具有浅前房，房角窄，虹膜膨隆。正常眼压性青光眼继发性(眼病、全身)闭角青光眼前房和前房角44Precursorstage:Transient急性闭角型青光眼发作45急性闭角型青光眼发作17Acuteonsetsequela:VisualacuitygetbetterKPIris:atrophy,pigmentationdefectsandlimitedstickyThepupilcan'treturntonormalCloudyglaucomaspotontheanteriorlenscapsuleAnteriorchamberAngleextensivestick急性发作后遗症视力好转角膜后色素沉着虹膜阶段性萎缩、色素脱失、局限后粘瞳孔不能恢复正常晶体前囊下片状白色混浊青光眼斑房角广泛粘连46Acuteonsetsequela:18Remissionstage:symptomstoeaseandanteriorchamberangleopenChronicstage:anteriorchamberangleextensivestickFinalstage:thecontinuoushighintraocularpressure,pooreyesightornolightfeeling.4间歇期小发作后自行缓解，房角开放，不用药或少量缩瞳药。

5慢性期房角广泛粘连>半周，眼压中度升高，视盘病理凹陷，视野缺损。6绝对期持续高眼压，视力极差或无光感。47Remissionstage:symptomsto诊断青光眼激发试验1.暗室试验2.俯卧试验3.暗室+俯卧试验48诊断青光眼激发试验20Differentialdiagnosis鉴别诊断Eyedisease:Conjunctivitis,AnterioruveitisSystemicdisease:gastrointestinaldisease,braindisease,hypertension,etc眼病结膜炎、前部葡萄膜炎。全身病胃肠道疾病、颅脑疾患、高血压病等。49Differentialdiagnosis21Treatmentofprimaryangleclosureglaucoma

原发性闭角型青光眼的治疗Drugs:increasedaqueouseduction:myoticinhibitaqueousgeneratedhighpermeabilityagentadjuvanttreatment:calmorsleeping,purge,hormonereduceinflammationresponse.Laser:Operation:药物:1.增加房水排出缩瞳剂2.抑制房水生成醋氮酰胺、塞吗酰安3.高渗剂20%甘露醇1一1.5g／kg、50%甘油2一3ml/kg4.辅助治疗镇静、安眠、通便、激素减轻炎反应。激光手术50TreatmentofprimaryangleclosChronicangleclosureglaucoma（二）、慢性闭角型青光眼

Clinicalsymptom:AgeisearlierProgressiveHavenoacutehistoryIntraocularpressureincreasedgradually.临床症状年龄较急性为早、渐进性、可无明确发病史。一般无急性发作史，房角粘连和眼压增高逐渐进展。眼压<50mmHg51ChronicangleclosureglaucomaSigns:OpticatrophyandphysiologicalconcaveexpandVisualfieldgraduallydamage.体征视神经萎缩，生理凹扩大，视野进行性损害。52Signs:Opticatrophyandphysi53255426Primaryopenangleg1aucoma

二、原发性开角型青光眼Features:WhenIOPincreasedtheanteriorchamberanglekeepopeningThetrabecularmeshworkorganizationstructureisabnormal