{"title":"角膜屈光手术后青光眼患者长期充分评估眼压的技术难点(附临床病例)","authors":"N. A. Kuleshova, O. V. Kolenko, E. L. Sorokin","doi":"10.53432/2078-4104-2023-22-1-76-84","DOIUrl":null,"url":null,"abstract":"PURPOSE. To demonstrate a clinical case involving difficulties in adequate assessment of intraocular pressure (IOP) in a patient with glaucoma in the long term after LASIK.METHODS. The study describes the case of patient M. of 58 years old with complaints about decreased distance vision in the right eye during the last year. In 2004 the patient underwent LASIK for moderate myopia. In 2018, asymmetry in the parameters of optic nerve head (size of the optic cup to the optic disc ratio (C/D ratio) was revealed: in the right eye — up to 0.7, narrowing of the visual field from nasal to fixation point; in the left eye — 0.5, visual fields without abnormalities. The IOP measured using the Maklakov method in both eyes corresponded to the average statistical norm — 22 mm Hg. The following diagnosis was established: IIA primary open-angle glaucoma in the right eye, IA primary open-angle glaucoma in the left eye. One-time instillations of latanoprost 0.005% eye drops solution was indicated for both eyes. In subsequent years the IOP was 18–20 mm Hg. After 4 years, the IOP according to the Maklakov method: OD — 18 mm Hg; OS — 21 mm Hg (on the hypotensive regimen — instillations of latanoprost 0.005% eye drops solution). In the right eye: C/D ratio 0.85–0.9 with absolute scotoma in the Bjerrum area 5–15° from fixation; in the left eye: C/D ratio 0.9 with neuro retinal rim loss from below, with absolute scotoma in the blind spot area. The stages of primary open-angle glaucoma were ascertained: IIIA in the right eye, IIA in the left eye.RESULTS. Selective laser trabeculoplasty was performed. Brimonidine 0.1% solution was added due to the lack of complete stabilization of the IOP level on a single instillation of latanoprost 0.005%, after that IOP decreased to 19 mm Hg in both eyes.CONCLUSION. It is necessary to carefully assess the condition of the structures of the optic nerve head in patients after LASIK, regardless of the statistically normal IOP values.","PeriodicalId":129515,"journal":{"name":"National Journal glaucoma","volume":"9 2","pages":"0"},"PeriodicalIF":0.0000,"publicationDate":"2023-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Technical difficulties of adequate assessment of intraocular pressure in a patient with glaucoma in the long term after corneal refractive surgery (clinical case)\",\"authors\":\"N. A. Kuleshova, O. V. Kolenko, E. L. Sorokin\",\"doi\":\"10.53432/2078-4104-2023-22-1-76-84\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"PURPOSE. To demonstrate a clinical case involving difficulties in adequate assessment of intraocular pressure (IOP) in a patient with glaucoma in the long term after LASIK.METHODS. The study describes the case of patient M. of 58 years old with complaints about decreased distance vision in the right eye during the last year. In 2004 the patient underwent LASIK for moderate myopia. In 2018, asymmetry in the parameters of optic nerve head (size of the optic cup to the optic disc ratio (C/D ratio) was revealed: in the right eye — up to 0.7, narrowing of the visual field from nasal to fixation point; in the left eye — 0.5, visual fields without abnormalities. The IOP measured using the Maklakov method in both eyes corresponded to the average statistical norm — 22 mm Hg. The following diagnosis was established: IIA primary open-angle glaucoma in the right eye, IA primary open-angle glaucoma in the left eye. One-time instillations of latanoprost 0.005% eye drops solution was indicated for both eyes. In subsequent years the IOP was 18–20 mm Hg. After 4 years, the IOP according to the Maklakov method: OD — 18 mm Hg; OS — 21 mm Hg (on the hypotensive regimen — instillations of latanoprost 0.005% eye drops solution). In the right eye: C/D ratio 0.85–0.9 with absolute scotoma in the Bjerrum area 5–15° from fixation; in the left eye: C/D ratio 0.9 with neuro retinal rim loss from below, with absolute scotoma in the blind spot area. The stages of primary open-angle glaucoma were ascertained: IIIA in the right eye, IIA in the left eye.RESULTS. Selective laser trabeculoplasty was performed. Brimonidine 0.1% solution was added due to the lack of complete stabilization of the IOP level on a single instillation of latanoprost 0.005%, after that IOP decreased to 19 mm Hg in both eyes.CONCLUSION. It is necessary to carefully assess the condition of the structures of the optic nerve head in patients after LASIK, regardless of the statistically normal IOP values.\",\"PeriodicalId\":129515,\"journal\":{\"name\":\"National Journal glaucoma\",\"volume\":\"9 2\",\"pages\":\"0\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-03-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"National Journal glaucoma\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.53432/2078-4104-2023-22-1-76-84\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"National Journal glaucoma","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.53432/2078-4104-2023-22-1-76-84","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
目的。展示一个临床病例,涉及在lasik术后长期对青光眼患者的眼压(IOP)进行充分评估的困难。该研究描述了58岁的患者m在去年抱怨右眼远处视力下降的病例。2004年,患者因中度近视接受了LASIK手术。2018年,视神经头参数(视杯尺寸与视盘比(C/D比))的不对称性被发现:右眼-高达0.7,视野从鼻腔到注视点变窄;左眼- 0.5,视野无异常。采用Maklakov法测得双眼IOP符合平均统计标准- 22 mm Hg。诊断:右眼IIA原发性开角型青光眼,左眼IA原发性开角型青光眼。双眼一次性滴注0.005%拉坦前列素滴眼液。随后数年眼压为18 - 20 mm Hg, 4年后按Maklakov法眼压:OD - 18 mm Hg;OS - 21 mm Hg(在降压方案中-滴注0.005%拉坦前列素滴眼液)。右眼:C/D比值0.85-0.9,距固定位置5-15°处有绝对暗斑;左眼:C/D比值0.9,神经视网膜边缘从下而下丧失,盲区出现绝对暗斑。确定原发性开角型青光眼的分期:右眼为IIIA,左眼为IIA。行选择性激光小梁成形术。由于单次滴注0.005%拉坦前列素眼压水平未完全稳定,双眼眼压降至19 mm Hg后,加入0.1%的溴莫尼定溶液。对于LASIK术后患者,无论其IOP值是否正常,都需要仔细评估视神经头的结构状况。
Technical difficulties of adequate assessment of intraocular pressure in a patient with glaucoma in the long term after corneal refractive surgery (clinical case)
PURPOSE. To demonstrate a clinical case involving difficulties in adequate assessment of intraocular pressure (IOP) in a patient with glaucoma in the long term after LASIK.METHODS. The study describes the case of patient M. of 58 years old with complaints about decreased distance vision in the right eye during the last year. In 2004 the patient underwent LASIK for moderate myopia. In 2018, asymmetry in the parameters of optic nerve head (size of the optic cup to the optic disc ratio (C/D ratio) was revealed: in the right eye — up to 0.7, narrowing of the visual field from nasal to fixation point; in the left eye — 0.5, visual fields without abnormalities. The IOP measured using the Maklakov method in both eyes corresponded to the average statistical norm — 22 mm Hg. The following diagnosis was established: IIA primary open-angle glaucoma in the right eye, IA primary open-angle glaucoma in the left eye. One-time instillations of latanoprost 0.005% eye drops solution was indicated for both eyes. In subsequent years the IOP was 18–20 mm Hg. After 4 years, the IOP according to the Maklakov method: OD — 18 mm Hg; OS — 21 mm Hg (on the hypotensive regimen — instillations of latanoprost 0.005% eye drops solution). In the right eye: C/D ratio 0.85–0.9 with absolute scotoma in the Bjerrum area 5–15° from fixation; in the left eye: C/D ratio 0.9 with neuro retinal rim loss from below, with absolute scotoma in the blind spot area. The stages of primary open-angle glaucoma were ascertained: IIIA in the right eye, IIA in the left eye.RESULTS. Selective laser trabeculoplasty was performed. Brimonidine 0.1% solution was added due to the lack of complete stabilization of the IOP level on a single instillation of latanoprost 0.005%, after that IOP decreased to 19 mm Hg in both eyes.CONCLUSION. It is necessary to carefully assess the condition of the structures of the optic nerve head in patients after LASIK, regardless of the statistically normal IOP values.