【摘要】 病例1为35岁健康男性，因“右眼胀痛伴头痛3个月余”就诊。右眼已无光感，眼压：右眼48.9 mmHg(1 mmHg=0.133 kPa)，左眼23.4 mmHg。右眼见虹膜新生血管，眼底杯盘比(C/D)为1.0，见动脉白鞘，静脉稍扩张，周边视网膜可见点状出血，颞侧血管呈白线。左眼眼前节和眼底均未见异常，C/D为0.3。右眼全周房角关闭，左眼全周房角开放。颈动脉超声未见异常。追问病史，患者3年前诊断为双眼原发性开角型青光眼，用药不规律，未定期随访，右眼长时间眼压控制欠佳。该病例考虑为原发性青光眼长期高眼压造成视网膜低灌注，继而发生新生血管性青光眼。病例2为61岁男性，糖尿病7年，因“右眼视物模糊半个月”就诊，视力右眼眼前手动，左眼0.2。眼压：右眼34 mmHg，左眼22 mmHg。右眼见大量虹膜新生血管，双眼眼底C/D为0.9，杯凹深，动脉偏细，静脉稍扩张，视网膜见散在点状出血，未见渗出，左眼鼻侧动脉可见白线。右眼大部分房角关闭，左眼全周房角开放。颈动脉超声亦未见异常。该病例考虑为在糖尿病视网膜病变造成视网膜缺血的基础上，原发性开角型青光眼可能加重视网膜缺血。讨论体会：晚期原发性青光眼可以发生视网膜缺血，甚至可能导致新生血管性青光眼。更多还原

【Abstract】 Case 1: A 35-year-old healthy male was admitted with complaints of pain and headache in his right eye for over three months. His right eye had no light perception. His intraocular pressure was 48.9 mmHg in the right eye and 23.4 mmHg in the left eye. The right eye showed neovascularization of the iris and cup to disc ratio(C/D) of 1.0, with white sheaths on the arteries, slightly dilated veins, scattered punctate hemorrhages in the peripheral retina, and white arterioles in the temporal vessels. The anterior segment and fundus in his left eye were normal, with C/D 0.3. The right eye had a closed angle in all quadrants, while the left eye had an open angle. No abnormalities were found in the carotid artery ultrasound. Upon further inquiry, the patient was diagnosed with primary open angle glaucoma in both eyes three years ago, but he did not follow the medication regimen regularly and did not have periodic follow-ups. The intraocular pressure in the right eye had not been controlled well for a long time. Neovascular glaucoma in this case is considered retinal hypoperfusion due to long-term high intraocular pressure caused by primary glaucoma. Case 2: A 61-year-old male with seven years of diabetes was admitted with complaints of blurred vision in the right eye for half a month. His visual acuity was hand motion in the right eye and 0.2 in the left eye. The intraocular pressure was 34 mmHg in the right eye and 22 mmHg in the left eye. The right eye showed extensive neovascularization of the iris. Both eyes had C/D 0.9 with deep cupping, thin arteries, slightly dilated veins, and scattered punctate hemorrhages without exudation in the retina. White arteries were seen in the nasal retina of the left eye. The right eye had a closed angle in most quadrants, while the left eye had an open angle. No abnormalities were found in the carotid artery ultrasound. Primary open angle glaucoma possibly exacerbates retinal ischemia on the basis of diabetic retinopathy. Summary: Advanced primary glaucoma can cause retinal ischemia and may even lead to neovascular glaucoma.更多还原