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女，12岁，色素性青光眼病例

2020-06-29 正医生 病例网

色素性青光眼
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患者2天前出现右眼红伴轻度视物模糊症状，自点氯霉素滴眼液未见好转。

[患者姓名]：
[患者年龄]：12
[性别]：女
[科室]：眼科

【主诉】

因右眼红、视物模糊2天入院。

【现病史】

患者2天前出现右眼红伴轻度视物模糊症状，自点氯霉素滴眼液未见好转。

【体格检查】

VOD0.5~1.5DS=1.0，VOS0.4~1.25DS=1.0，眼压：右81mmHg，左20mmHg。右眼混合性充血(+)，右眼角膜后表面中下部垂直梭形色素沉着，前房浮游色素颗粒(+-)，颞上方瞳孔缘见机化膜伴虹膜后粘连，中周部虹膜后凹，10点至1点钟位中周部虹膜萎缩，10点钟虹膜透照缺损，晶状体前囊色素沉着，眼底杯盘比0.4。左眼角膜清晰，中央前房深度正常，中周部虹膜后凹，瞳孔圆，对光反射灵敏，晶状体透明，眼底杯盘比0.3。

【辅助检查】

散瞳查：晶状体前后表面及悬韧带色素颗粒沉附。房角镜检查：房角为宽角，小梁网均匀一致色素颗粒沉着，(Scheie分级右眼Ⅳ级，左眼Ⅲ级)，周边部虹膜后凹。

【初步诊断】

右眼色素性青光眼

【治疗】

给予布林佐胺滴眼液、倍他洛尔滴眼液及妥布霉素地塞米松滴眼液点右眼治疗，临时给予甘露醇注射液125ml快速静脉滴注。入院第2日测右眼眼压35mmHg，再次给予甘露醇注射液125ml快速静脉滴注1次。入院第3日测右眼眼压23mmHg，患者自觉症状消失，右眼充血减轻，前房浮游色素颗粒消失。入院第4日降至16mmHg，入院第5~7日右眼眼压15~17mmHg。住院7天期间，左眼眼压17～19mmHg。建议行激光周边虹膜切开术，患者父母拒绝手术，要求带药出院，出院后随访至今1个月眼压正常。

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1811018, encodeId=00b0181101815, content=<a href='/topic/show?id=3e2786e100c' target=_blank style='color:#2F92EE;'>#色素性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86710, encryptionId=3e2786e100c, topicName=色素性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e87d405, createdName=Homburg, createdTime=Mon May 17 05:16:50 CST 2021, time=2021-05-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1680677, encodeId=7b8e16806e7d0, content=<a href='/topic/show?id=9e5c86e0712' target=_blank style='color:#2F92EE;'>#色素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86707, encryptionId=9e5c86e0712, topicName=色素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=343027846633, createdName=sunylz, createdTime=Wed Sep 30 18:16:50 CST 2020, time=2020-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=803183, encodeId=a071803183d4, content=这个病人应该坚持主动随访, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=277c5401256, createdName=ms2000000193134695, createdTime=Sat Jul 18 11:26:43 CST 2020, time=2020-07-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1540528, encodeId=23f8154052824, content=<a href='/topic/show?id=fbbce2786cc' target=_blank style='color:#2F92EE;'>#眼病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72786, encryptionId=fbbce2786cc, topicName=眼病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b85c13256921, createdName=pps20023, createdTime=Wed Jul 01 01:16:50 CST 2020, time=2020-07-01, status=1, ipAttribution=)]
    2021-05-17 Homburg

    #色素性#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1811018, encodeId=00b0181101815, content=<a href='/topic/show?id=3e2786e100c' target=_blank style='color:#2F92EE;'>#色素性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86710, encryptionId=3e2786e100c, topicName=色素性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e87d405, createdName=Homburg, createdTime=Mon May 17 05:16:50 CST 2021, time=2021-05-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1680677, encodeId=7b8e16806e7d0, content=<a href='/topic/show?id=9e5c86e0712' target=_blank style='color:#2F92EE;'>#色素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86707, encryptionId=9e5c86e0712, topicName=色素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=343027846633, createdName=sunylz, createdTime=Wed Sep 30 18:16:50 CST 2020, time=2020-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=803183, encodeId=a071803183d4, content=这个病人应该坚持主动随访, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=277c5401256, createdName=ms2000000193134695, createdTime=Sat Jul 18 11:26:43 CST 2020, time=2020-07-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1540528, encodeId=23f8154052824, content=<a href='/topic/show?id=fbbce2786cc' target=_blank style='color:#2F92EE;'>#眼病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72786, encryptionId=fbbce2786cc, topicName=眼病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b85c13256921, createdName=pps20023, createdTime=Wed Jul 01 01:16:50 CST 2020, time=2020-07-01, status=1, ipAttribution=)]
    2020-09-30 sunylz

    #色素#

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1811018, encodeId=00b0181101815, content=<a href='/topic/show?id=3e2786e100c' target=_blank style='color:#2F92EE;'>#色素性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86710, encryptionId=3e2786e100c, topicName=色素性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e87d405, createdName=Homburg, createdTime=Mon May 17 05:16:50 CST 2021, time=2021-05-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1680677, encodeId=7b8e16806e7d0, content=<a href='/topic/show?id=9e5c86e0712' target=_blank style='color:#2F92EE;'>#色素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86707, encryptionId=9e5c86e0712, topicName=色素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=343027846633, createdName=sunylz, createdTime=Wed Sep 30 18:16:50 CST 2020, time=2020-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=803183, encodeId=a071803183d4, content=这个病人应该坚持主动随访, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=277c5401256, createdName=ms2000000193134695, createdTime=Sat Jul 18 11:26:43 CST 2020, time=2020-07-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1540528, encodeId=23f8154052824, content=<a href='/topic/show?id=fbbce2786cc' target=_blank style='color:#2F92EE;'>#眼病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72786, encryptionId=fbbce2786cc, topicName=眼病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b85c13256921, createdName=pps20023, createdTime=Wed Jul 01 01:16:50 CST 2020, time=2020-07-01, status=1, ipAttribution=)]
    2020-07-18 ms2000000193134695

    这个病人应该坚持主动随访

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1811018, encodeId=00b0181101815, content=<a href='/topic/show?id=3e2786e100c' target=_blank style='color:#2F92EE;'>#色素性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86710, encryptionId=3e2786e100c, topicName=色素性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e87d405, createdName=Homburg, createdTime=Mon May 17 05:16:50 CST 2021, time=2021-05-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1680677, encodeId=7b8e16806e7d0, content=<a href='/topic/show?id=9e5c86e0712' target=_blank style='color:#2F92EE;'>#色素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86707, encryptionId=9e5c86e0712, topicName=色素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=343027846633, createdName=sunylz, createdTime=Wed Sep 30 18:16:50 CST 2020, time=2020-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=803183, encodeId=a071803183d4, content=这个病人应该坚持主动随访, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=277c5401256, createdName=ms2000000193134695, createdTime=Sat Jul 18 11:26:43 CST 2020, time=2020-07-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1540528, encodeId=23f8154052824, content=<a href='/topic/show?id=fbbce2786cc' target=_blank style='color:#2F92EE;'>#眼病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72786, encryptionId=fbbce2786cc, topicName=眼病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b85c13256921, createdName=pps20023, createdTime=Wed Jul 01 01:16:50 CST 2020, time=2020-07-01, status=1, ipAttribution=)]
    2020-07-01 pps20023

    #眼病#

    0