第十一章青光眼中英文優(yōu)質(zhì)課件

第十一章青光眼中英文第十一章青光眼中英文1優(yōu)選第十一章青光眼中英文版優(yōu)選第十一章青光眼中英文版2Intraocularpressure(IOP):thepressureoftheeyecontenttotheeyewall眼壓:眼球內(nèi)容物作用于眼球內(nèi)壁的壓力NormalIOP:10—2lmmHgDoubleIOPdifference<5mmHgIOPcurvedayandnight<8mmHg正常眼壓10—2lmmHg雙眼壓差＜5mmHg晝夜眼壓曲線＜8mmHg。3Intraocularpressure(IOP):thPathologicalIOP:IOPisbeyondeyeballinternalorganization,especiallytheopticnervebearinglimit.Causeopticatrophyandvisualfielddefects病理眼壓:超越眼球內(nèi)部組織，特別是視神經(jīng)承受限度的眼壓。引起視神經(jīng)萎縮和視野缺損4PathologicalIOP:IOPisbeyonOcularhypertension:IOPishigherthannormalIOPrange,butnodamageofthenerveandvisualfield.高眼壓癥:眼壓高出正常眼壓范圍，但無視神經(jīng)和視野損害。Normaltensionglaucoma:InthenormalrangeofIOP,theopticnerveandvisualfieldofthedamagethere.正常眼壓性青光眼眼壓在正常范圍,但出現(xiàn)視神經(jīng)和視野的損傷。55房水循環(huán)途徑:Aqueouscycleway:Ciliaryprocessposteriorchamberpupil睫狀突(產(chǎn)生房水)

后房

瞳孔

AnteriorchamberAngle

Anteriorchamber

前房角(排出房水)前房房水產(chǎn)生率房水排出率維持正常眼壓大多數(shù)青光眼眼壓升高的原因為房水排出受阻6房水循環(huán)途徑:Ciliaryprocess77pathophysiologicalprocess

病理生理過程

AqueousproducingrateTrabecularmeshworkresistanceScleraveinpressure三個因素房水生成率小梁網(wǎng)阻力上鞏膜靜脈壓aqueousoutflowresistanceIncreased大多數(shù)青光眼眼壓升高的原因是房水外流阻力增高8pathophysiologicalprocess

病理生Classification

分類Primaryglaucoma:Angleclosureglaucoma:AcuteangleclosureglaucomaChronicangleclosureglaucomaOpenangleglaucoma:PrimaryopenangleglaucomanormaltensionglaucomaSecondaryglaucoma:Congenitalglaucoma:InfantileglaucomaJuvenileglaucomaCongenitalglaucomaaccompaniedbyothercongenitalanomalyglaucoma原發(fā)性閉角型:急性閉角型青光眼慢性閉角型青光眼

開角型原發(fā)性開角型青光眼正常眼壓性青光眼繼發(fā)性(眼病、全身)先天性嬰幼兒型青少年型先天性青光眼伴有其他先天異常9Classification

分類Primarygla前房角的檢查及分類前房角位于前房的最周邊前房角的構成：

前壁—角鞏膜緣

房角隱窩—睫狀體前端

后壁—虹膜根部10前房角的檢查及分類前房角位于前房的最周邊101111第二節(jié)原發(fā)性青光眼原發(fā)性閉角型青光眼—眼壓升高房角關閉Primaryangleclosureglaucoma

原發(fā)性開角型青光眼—眼壓升高房角開放PrimaryOpenangleglaucoma12第二節(jié)原發(fā)性青光眼原發(fā)性閉角型青光眼—眼壓升高房Primaryangleclosureglaucoma

一.原發(fā)性閉角型青光眼

Acuteangleclosureglaucoma（一）急性閉角型青光眼Etiology:geneticanatomyincentiveClinicalfeatures:age>50yfemalepainredeyevisionlosswithheadachenauseavomiting病因具有遺傳傾向，解剖結構異常，常有誘因。臨床特征年齡＞50歲，女性多見。主訴為眼脹痛．眼紅，視力下降，伴頭痛、惡心、嘔吐。13Primaryangleclosureglaucoma

Clinicalstages

急性閉角型青光眼臨床分期Preclinicalstage:Nosymptom,Shallowanteriorchamber,Oneeyegetdisease,theothereyewithnosymptom.1.臨床前期沒有自覺癥狀，具有淺前房，房角窄，虹膜膨隆。一眼發(fā)作，另眼沒發(fā)作。Precursorstage:TransientEasefast2.先兆期一過性，多次小發(fā)作，自行緩解。14Clinicalstages

急性閉角型青光眼臨床分期PrAcutestage:Symptom:eye:pain,photophobia,tears,severevisionloss.withheadaches,nauseaandvomiting.Sign:Eyelidedema,Conjunctivalcongestion,Cornealepitheliumedema,Anteriorchamberextremelyshallow,Thepupildilatedandlightreflectiondisappeared,Anteriorchamberangleclosed.Intraocularpressureincreased>50mmHg.3.急性發(fā)作期癥狀眼部眼痛、眼脹、畏光、流淚、嚴重視力下降。全身頭痛、惡心、嘔吐。體征眼瞼水腫、結膜混合充血、角膜上皮水腫、角膜后色素沉著、前房極淺、虹膜嚴重缺血、房水渾濁、絮狀滲出、瞳孔中等大、豎橢圓、光反射消失、局限后粘連、房角關閉、眼底不清、視網(wǎng)膜動脈搏動,眼壓明顯升高>50mmHg。15Acutestage:15Precursorstage:TransientEasefastIntraocularpressureincreasedgradually.臨床癥狀年齡較急性為早、漸進性、可無明確發(fā)病史。Congenitalglaucoma:Infantileglaucoma臨床特征年齡＞50歲，女性多見。DependingontheopticdiskdamageC/D>0.Congenitalglaucomaaccompaniedbyothercongenitalanomalyglaucoma雙眼壓差＜5mmHgPreclinicalstage:Nosymptom,Shallowanteriorchamber,Features:WhenIOPincreasedtheanteriorchamberanglekeepopening大多數(shù)青光眼眼壓升高的原因為房水排出受阻Ageisearlier臨床癥狀年齡較急性為早、漸進性、可無明確發(fā)病史。上鞏膜靜脈壓（一）急性閉角型青光眼increasedaqueouseduction:myoticVisualacuitygetbetter臨床前期沒有自覺癥狀，具有淺前房，房角窄，虹膜膨隆。正常眼壓性青光眼繼發(fā)性(眼病、全身)閉角青光眼前房和前房角16Precursorstage:Transient急性閉角型青光眼發(fā)作17急性閉角型青光眼發(fā)作17Acuteonsetsequela:VisualacuitygetbetterKPIris:atrophy,pigmentationdefectsandlimitedstickyThepupilcan'treturntonormalCloudyglaucomaspotontheanteriorlenscapsuleAnteriorchamberAngleextensivestick急性發(fā)作后遺癥視力好轉(zhuǎn)角膜后色素沉著虹膜階段性萎縮、色素脫失、局限后粘瞳孔不能恢復正常晶體前囊下片狀白色混濁青光眼斑房角廣泛粘連18Acuteonsetsequela:18Remissionstage:symptomstoeaseandanteriorchamberangleopenChronicstage:anteriorchamberangleextensivestickFinalstage:thecontinuoushighintraocularpressure,pooreyesightornolightfeeling.4間歇期小發(fā)作后自行緩解，房角開放，不用藥或少量縮瞳藥。

5慢性期房角廣泛粘連>半周，眼壓中度升高，視盤病理凹陷，視野缺損。6絕對期持續(xù)高眼壓，視力極差或無光感。19Remissionstage:symptomsto診斷青光眼激發(fā)試驗1.暗室試驗2.俯臥試驗3.暗室+俯臥試驗20診斷青光眼激發(fā)試驗20Differentialdiagnosis鑒別診斷Eyedisease:Conjunctivitis,AnterioruveitisSystemicdisease:gastrointestinaldisease,braindisease,hypertension,etc眼病結膜炎、前部葡萄膜炎。全身病胃腸道疾病、顱腦疾患、高血壓病等。21Differentialdiagnosis21Treatmentofprimaryangleclosureglaucoma

原發(fā)性閉角型青光眼的治療Drugs:increasedaqueouseduction:myoticinhibitaqueousgeneratedhighpermeabilityagentadjuvanttreatment:calmorsleeping,purge,hormonereduceinflammationresponse.Laser:Operation:藥物:1.增加房水排出縮瞳劑2.抑制房水生成醋氮酰胺、塞嗎酰安3.高滲劑20%甘露醇1一1.5g／kg、50%甘油2一3ml/kg4.輔助治療鎮(zhèn)靜、安眠、通便、激素減輕炎反應。激光手術22TreatmentofprimaryangleclosChronicangleclosureglaucoma（二）、慢性閉角型青光眼

Clinicalsymptom:AgeisearlierProgressiveHavenoacutehistoryIntraocularpressureincreasedgradually.臨床癥狀年齡較急性為早、漸進性、可無明確發(fā)病史。一般無急性發(fā)作史，房角粘連和眼壓增高逐漸進展。眼壓<50mmHg23ChronicangleclosureglaucomaSigns:OpticatrophyandphysiologicalconcaveexpandVisualfieldgraduallydamage.體征視神經(jīng)萎縮，生理凹擴大，視野進行性損害。24Signs:Opticatrophyandphysi25252626Primaryopenangleg1aucoma

二、原發(fā)性開角型青光眼Features:WhenIOPincreasedtheanteriorchamberanglekeepopeningThetrabecularmeshworkorganizationstructureisabnormal特點眼壓升高，房角開放。小梁網(wǎng)內(nèi)組織結構異常27Primaryopenangleg1aucoma

二、Acuteonsetsequela:Thepupilcan'treturntonormalClinical:Noselfconscioussymptomandbefoundlate.晶體前囊下片狀白色混濁青光眼斑50%甘油2一3ml/kgPrimaryangleclosureglaucoma正常眼壓10—2lmmHgCongenitalglaucomaaccompaniedbyothercongenitalanomalyglaucoma臨床癥狀年齡較急性為早、漸進性、可無明確發(fā)病史。優(yōu)選第十一章青光眼中英文版原發(fā)性閉角型青光眼—眼壓升高房角關閉Clinicalfeatures:age>50yfemalePrecursorstage:TransientEasefastNormalIOP:10—2lmmHg前房角(排出房水)前房purge,hormonereduceinflammationresponse.上鞏膜靜脈壓前房角位于前房的最周邊AgeisearlierIntraocularpressureincreasedwithangleopen眼壓:眼球內(nèi)容物作用于眼球內(nèi)壁的壓力Congenitalglaucoma:InfantileglaucomaClinical:Noselfconscioussymptomandbefoundlate.Acuteonsetsequela:主訴為眼脹痛．眼紅，視力下降，Primaryangleclosureglaucoma前房角(排出房水)前房伴頭痛、惡心、嘔吐。Iris:atrophy,pigmentationdefectsandlimitedsticky大多數(shù)青光眼眼壓升高的原因為房水排出受阻繼發(fā)性(眼病、全身)Visualacuitygetbetter全身頭痛、惡心、嘔吐。大多數(shù)青光眼眼壓升高的原因為房水排出受阻Sign:Eyelidedema,Conjunctivalcongestion,Cornealepitheliumedema,Anteriorchamberextremelyshallow,Thepupildilatedandlightreflectiondisappeared,Anteriorchamberangleclosed.小梁網(wǎng)內(nèi)組織結構異常Clinical:Noselfconscioussymptomandbefoundlate.IntraocularpressureincreasedwithangleopenDependingontheopticdiskdamageC/D>0.6Visualfielddefects

臨床無自覺癥狀，晚期發(fā)現(xiàn)。眼壓升高，房角開放。視乳頭損傷C/D>0.6或雙眼差＞0.2(火焰狀出血)視野缺損(旁中心暗點、鼻側階梯、弓形暗點、環(huán)形暗點、向心性性縮小、管狀、顳側視島)28Acuteonsetsequela:purge,hor第十一章青光眼中英文第十一章青光眼中英文29優(yōu)選第十一章青光眼中英文版優(yōu)選第十一章青光眼中英文版30Intraocularpressure(IOP):thepressureoftheeyecontenttotheeyewall眼壓:眼球內(nèi)容物作用于眼球內(nèi)壁的壓力NormalIOP:10—2lmmHgDoubleIOPdifference<5mmHgIOPcurvedayandnight<8mmHg正常眼壓10—2lmmHg雙眼壓差＜5mmHg晝夜眼壓曲線＜8mmHg。31Intraocularpressure(IOP):thPathologicalIOP:IOPisbeyondeyeballinternalorganization,especiallytheopticnervebearinglimit.Causeopticatrophyandvisualfielddefects病理眼壓:超越眼球內(nèi)部組織，特別是視神經(jīng)承受限度的眼壓。引起視神經(jīng)萎縮和視野缺損32PathologicalIOP:IOPisbeyonOcularhypertension:IOPishigherthannormalIOPrange,butnodamageofthenerveandvisualfield.高眼壓癥:眼壓高出正常眼壓范圍，但無視神經(jīng)和視野損害。Normaltensionglaucoma:InthenormalrangeofIOP,theopticnerveandvisualfieldofthedamagethere.正常眼壓性青光眼眼壓在正常范圍,但出現(xiàn)視神經(jīng)和視野的損傷。335房水循環(huán)途徑:Aqueouscycleway:Ciliaryprocessposteriorchamberpupil睫狀突(產(chǎn)生房水)

后房

瞳孔

AnteriorchamberAngle

Anteriorchamber

前房角(排出房水)前房房水產(chǎn)生率房水排出率維持正常眼壓大多數(shù)青光眼眼壓升高的原因為房水排出受阻34房水循環(huán)途徑:Ciliaryprocess357pathophysiologicalprocess

病理生理過程

AqueousproducingrateTrabecularmeshworkresistanceScleraveinpressure三個因素房水生成率小梁網(wǎng)阻力上鞏膜靜脈壓aqueousoutflowresistanceIncreased大多數(shù)青光眼眼壓升高的原因是房水外流阻力增高36pathophysiologicalprocess

病理生Classification

分類Primaryglaucoma:Angleclosureglaucoma:AcuteangleclosureglaucomaChronicangleclosureglaucomaOpenangleglaucoma:PrimaryopenangleglaucomanormaltensionglaucomaSecondaryglaucoma:Congenitalglaucoma:InfantileglaucomaJuvenileglaucomaCongenitalglaucomaaccompaniedbyothercongenitalanomalyglaucoma原發(fā)性閉角型:急性閉角型青光眼慢性閉角型青光眼

開角型原發(fā)性開角型青光眼正常眼壓性青光眼繼發(fā)性(眼病、全身)先天性嬰幼兒型青少年型先天性青光眼伴有其他先天異常37Classification

分類Primarygla前房角的檢查及分類前房角位于前房的最周邊前房角的構成：

前壁—角鞏膜緣

房角隱窩—睫狀體前端

后壁—虹膜根部38前房角的檢查及分類前房角位于前房的最周邊103911第二節(jié)原發(fā)性青光眼原發(fā)性閉角型青光眼—眼壓升高房角關閉Primaryangleclosureglaucoma

原發(fā)性開角型青光眼—眼壓升高房角開放PrimaryOpenangleglaucoma40第二節(jié)原發(fā)性青光眼原發(fā)性閉角型青光眼—眼壓升高房Primaryangleclosureglaucoma

一.原發(fā)性閉角型青光眼

Acuteangleclosureglaucoma（一）急性閉角型青光眼Etiology:geneticanatomyincentiveClinicalfeatures:age>50yfemalepainredeyevisionlosswithheadachenauseavomiting病因具有遺傳傾向，解剖結構異常，常有誘因。臨床特征年齡＞50歲，女性多見。主訴為眼脹痛．眼紅，視力下降，伴頭痛、惡心、嘔吐。41Primaryangleclosureglaucoma

Clinicalstages

急性閉角型青光眼臨床分期Preclinicalstage:Nosymptom,Shallowanteriorchamber,Oneeyegetdisease,theothereyewithnosymptom.1.臨床前期沒有自覺癥狀，具有淺前房，房角窄，虹膜膨隆。一眼發(fā)作，另眼沒發(fā)作。Precursorstage:TransientEasefast2.先兆期一過性，多次小發(fā)作，自行緩解。42Clinicalstages

急性閉角型青光眼臨床分期PrAcutestage:Symptom:eye:pain,photophobia,tears,severevisionloss.withheadaches,nauseaandvomiting.Sign:Eyelidedema,Conjunctivalcongestion,Cornealepitheliumedema,Anteriorchamberextremelyshallow,Thepupildilatedandlightreflectiondisappeared,Anteriorchamberangleclosed.Intraocularpressureincreased>50mmHg.3.急性發(fā)作期癥狀眼部眼痛、眼脹、畏光、流淚、嚴重視力下降。全身頭痛、惡心、嘔吐。體征眼瞼水腫、結膜混合充血、角膜上皮水腫、角膜后色素沉著、前房極淺、虹膜嚴重缺血、房水渾濁、絮狀滲出、瞳孔中等大、豎橢圓、光反射消失、局限后粘連、房角關閉、眼底不清、視網(wǎng)膜動脈搏動,眼壓明顯升高>50mmHg。43Acutestage:15Precursorstage:TransientEasefastIntraocularpressureincreasedgradually.臨床癥狀年齡較急性為早、漸進性、可無明確發(fā)病史。Congenitalglaucoma:Infantileglaucoma臨床特征年齡＞50歲，女性多見。DependingontheopticdiskdamageC/D>0.Congenitalglaucomaaccompaniedbyothercongenitalanomalyglaucoma雙眼壓差＜5mmHgPreclinicalstage:Nosymptom,Shallowanteriorchamber,Features:WhenIOPincreasedtheanteriorchamberanglekeepopening大多數(shù)青光眼眼壓升高的原因為房水排出受阻Ageisearlier臨床癥狀年齡較急性為早、漸進性、可無明確發(fā)病史。上鞏膜靜脈壓（一）急性閉角型青光眼increasedaqueouseduction:myoticVisualacuitygetbetter臨床前期沒有自覺癥狀，具有淺前房，房角窄，虹膜膨隆。正常眼壓性青光眼繼發(fā)性(眼病、全身)閉角青光眼前房和前房角44Precursorstage:Transient急性閉角型青光眼發(fā)作45急性閉角型青光眼發(fā)作17Acuteonsetsequela:VisualacuitygetbetterKPIris:atrophy,pigmentationdefectsandlimitedstickyThepupilcan'treturntonormalCloudyglaucomaspotontheanteriorlenscapsuleAnteriorchamberAngleextensivestick急性發(fā)作后遺癥視力好轉(zhuǎn)角膜后色素沉著虹膜階段性萎縮、色素脫失、局限后粘瞳孔不能恢復正常晶體前囊下片狀白色混濁青光眼斑房角廣泛粘連46Acuteonsetsequela:18Remissionstage:symptomstoeaseandanteriorchamberangleopenChronicstage:anteriorchamberangleextensivestickFinalstage:thecontinuoushighintraocularpressure,pooreyesightornolightfeeling.4間歇期小發(fā)作后自行緩解，房角開放，不用藥或少量縮瞳藥。

5慢性期房角廣泛粘連>半周，眼壓中度升高，視盤病理凹陷，視野缺損。6絕對期持續(xù)高眼壓，視力極差或無光感。47Remissionstage:symptomsto診斷青光眼激發(fā)試驗1.暗室試驗2.俯臥試驗3.暗室+俯臥試驗48診斷青光眼激發(fā)試驗20Differentialdiagnosis鑒別診斷Eyedisease:Conjunctivitis,AnterioruveitisSystemicdisease:gastrointestinaldisease,braindisease,hypertension,etc眼病結膜炎、前部葡萄膜炎。全身病胃腸道疾病、顱腦疾患、高血壓病等。49Differentialdiagnosis21Treatmentofprimaryangleclosureglaucoma

原發(fā)性閉角型青光眼的治療Drugs:increasedaqueouseduction:myoticinhibitaqueousgeneratedhighpermeabilityagentadjuvanttreatment:calmorsleeping,purge,hormonereduceinflammationresponse.Laser:Operation:藥物:1.增加房水排出縮瞳劑2.抑制房水生成醋氮酰胺、塞嗎酰安3.高滲劑20%甘露醇1一1.5g／kg、50%甘油2一3ml/kg4.輔助治療鎮(zhèn)靜、安眠、通便、激素減輕炎反應。激光手術50TreatmentofprimaryangleclosChronicangleclosureglaucoma（二）、慢性閉角型青光眼

Clinicalsymptom:AgeisearlierProgressiveHavenoacutehistoryIntraocularpressureincreasedgradually.臨床癥狀年齡較急性為早、漸進性、可無明確發(fā)病史。一般無急性發(fā)作史，房角粘連和眼壓增高逐漸進展。眼壓<50mmHg51ChronicangleclosureglaucomaSigns:OpticatrophyandphysiologicalconcaveexpandVisualfieldgraduallydamage.體征視神經(jīng)萎縮，生理凹擴大，視野進行性損害。52Signs:Opticatrophyandphysi53255426Primaryopenangleg1aucoma

二、原發(fā)性開角型青光眼Features:WhenIOPincreasedtheanteriorchamberanglekeepopeningThetrabecularmeshworkorganizationstructureisabnormal