The Role Of Disjointed Lens On The Mechanism Of Malignant Glaucoma

The first part The relations between the locations of lens ofbody eyes and the ciliary ringThe phenomenon of lens disjoint is common in clinical work, whichrefers to the lens moved forward from normal anatomic position, and thesuspensory ligament is not broken.It is different from the lens dislocation.For ophthalmologists, as a result of the iris block, as well as the slit lampmicroscope, B ultrasonic, gonioscope, technology of optical imaging, CT andMRI examination has their certain limitations, the relationship between ciliaryprocesses and equatorial of lens has always been a difficult problem.Objective:To measure the relationship between the locations of lens and the ciliaryring on body eyeballs.Methods:Collect four fresh eyeballs from donations of adults with no obviousdisease, then fix them48h by using conventional10%formalin, rinse out10min with distilled water, froze for24h by SANYO refrigerator in-78degrees.Cut them under the fixed mould.The cutting position is choosen to be the linebetween3point and9point,which is the position of the medial rectus muscleand external rectus muscle of the eyeball, then use sharp dental stainless steelsaw to cut them into halves. Take photos of eyeballs with a digital camera,then use Image-ProPlus professional Image analysis software to measure thediameter of ciliary ring and the lens, and compare both.Results:The measurment of body eyeballs shows:The anterior chamber depth ison an average of2.27mm, lens diameter is on an average of8.25mm,lens thickness is on an average of5.04mm,ciliary ring diameter is on an average of8.19mm, ciliary ring diameter is0.06mm smaller than lens diameter, thepossibility of lens disjoint can be confirmed.Conclusion:The lens diameter is greater than the ciliary ring diameter.Disjointed lenshas the posibility to be blocked in ciliary ring. The second part The relations between the locations of lensand the ciliary ring on maglinant glaucoma patients by usingUBMAs early as in1961, Von Graefe puts forward the concept of malignantglaucoma, he found that some patients with acute angle-closure glaucoma hasshallow anterior chamber after peripheral iridectomy and elevated intraocularpressure, and the development progressively, traditional glaucoma medicationand surgery treatment is invalid, the prognosis is poor.Scholars generallyagree that at present, when any causes of aqueous humor discharge forward isblocked, aqueous humor was forced to flow into vitreous chamber，thenanterior chamber becomes shallow or disappear, and intraocular pressureelevate，this is called malignant glaucoma.Malignant glaucoma were dividedinto many types，such as the typical ciliary block glaucoma, no crystal eyeciliary block glaucoma, artificial crystal ciliary eye block glaucoma, ciliaryblock glaucoma causing by shrinkage pupil drug and ciliary block glaucomaassociated with inflammation.One typical type often occurs in the crystal acuteangle-closure glaucoma patients, most of whom has crowded anterior segmentstructure,such as small cornea, shallow anterior chamber, narrow corner, thicklens and forward position, thick ciliary process and it moved forward, and thesmall ciliary ring, etc.Viral surgery may be a cause of malignantglaucoma.There are a variety of hypothesis of the pathogenesis of malignantglaucoma, but no consistent conclusion.Due to malignant glaucoma is a rareand serious complication, the exact pathogenesis is still unclear, it is still adifficult problem for ophthalmologist.Objective:The relationship between the locations of lens and the ciliary ring ofmaglinant glaucoma patients with glaucoma on living conditions. The subjects:1Patients after trabeculectomy with high intraocular pressure: Toobserve948cases of angle-closure glaucoma patients from October in2011toOctober in2013in the Department of Ophthalmology of the Second Hospitalof Hebei Medical University,there are832cases of patients taketrabeculectomy, among whom11eyes of9patient with anterior chambershallow or disappear and high intraocular pressure.8cases of10eyes fromfemales,1case of1eye from men. Age from38to80, the average is62.78.2The control group: From October in2011to October in2013in theDepartment of Ophthalmology of the Second Hospital of Hebei MedicalUniversity，42cases of58normal eyes were chosen.33case of44eye frommales,9cases of14eyes from female.Age from18to83, the average is43.57..All subjects received ophthalmologic examination (vision examination, slitlamp examination, fundus examination) and refractive check, ruling out thesubjects with eye diseases and above moderate refractive errors,diopterbetween+1.50and-1.50D.Methods:1Patients after trabeculectomy with shallow anterior chamber or highintraocular pressure:Photos of eyeballs’anterior segment,anterior chamberdistance，1ens thickness，relative lens position，ciliary body thickness，ciliaryprocesses thickness，the ciliary body height (T)，the distance between theciliary body and the lens equator department，trabecular-ciliary processesdistance（TCPD）,angle opening distance, trabecular-iris angle, sclera-ciliaryprocess angle, the measurement of eye axial length by using IOL-Master(A-ultrasound biometry).2Eyes of normal human: Routine inspection of ophthalmology (vision,slit lamp examination, fundus examination, optometry), anterior chamberdistance，1ens thickness，relative lens position，ciliary body thickness，ciliaryprocesses thickness， the ciliary body height (T)，the distance between theciliary body and the lens equator department，trabecular-ciliary processesdistance（TCPD），angle opening distance, trabecular-iris angle, sclera-ciliaryprocess angle，the measurement of eye axial length by using IOL-Master (A-ultrasound biometry).Results:1Compared with normal eyes，malignant glaucoma patients has short eyeaxis，shallow anterior chamber, oedema and thick ciliary processes, thick lens，small relative lens position，small distance between the ciliary body and theequator of lens，lower Ciliary body height.2After peripheral iris resection or trabeculectomy，the anterior chamberpressure drop, posterior chamber pressure increase,the pressure balance of theanterior and posterior chamber disrupt，the iris lens diaphragm go forward,clinical manifestations will be shallow anterior chamber or anterior chamberdisappear.After glaucoma, ciliary body edema, ciliary ring was reduced,disjointed lens can be blocked in ciliary ring.Aqueous humor flow into thebody cavity glass, the pressure of posterior chamber was further increased,then vicious cycle.Conclusion:The disjointed lens blocked in ciliary ring is a key factor in theoccurrence and development of malignant glaucoma.