一名冠状病毒感染康复患者的急性青光眼发作(病例报告)

T. V. Sokolovskaya, V. N. Gutnik, Е. О. Krasnova
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摘要

在COVID-19中,眼部表现的患病率为2%至32%。与COVID-19相关的最常见的眼科疾病是病毒性结膜炎,但也有报道的病例有外巩膜炎、葡萄膜炎、视网膜中央动静脉闭塞、视网膜病变、青光眼、干眼综合征,以及罕见的眼科神经表现,如复视、眼麻痹和眼球震颤。本研究报告1例重症COVID-19肺炎患者急性闭角型青光眼发作。目的探讨新型冠状病毒肺炎合并双侧急性闭角型青光眼发作的原因,并评价激光虹膜切开术和经睫状体后房引流术的疗效。报告1例女性新冠肺炎患者急性闭角型青光眼发作。双眼均诊断为低度远视并并发白内障。为使眼压恢复正常,恢复视力,对双眼行激光虹膜切开术,术后行青光眼手术治疗,双眼经睫状体后房引流。术后行双眼超声乳化术并人工晶状体植入术。双眼均行激光虹膜切开术及经睫状体后房引流术。两眼均达到目标性眼压,且青光眼稳定。第二步行超声乳化术联合人工晶状体植入术,可明显提高双眼视力。COVID-19可导致视力丧失和残疾,因此,对于长时间保持俯卧位通气并接受全身类固醇药物治疗的患者,应监测IOP。这对青光眼易感性或诊断为青光眼的患者尤其重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Acute glaucoma attack in a patient recovered from coronavirus infection (case report)
The prevalence of ophthalmic manifestations in COVID-19 ranges from 2 to 32%. The most common ophthalmic disease associated with COVID-19 is viral conjunctivitis, but there are also reports of cases with episcleritis, uveitis, occlusions of the central retinal artery and vein, retinopathy, glaucoma, dry eye syndrome, as well as rare neuroophthalmological manifestations such as diplopia, ophthalmoplegia and nystagmus. This study reports a case of bilateral acute angle-closure glaucoma attack in a patient recovered from severe COVID-19 pneumonia.PURPOSE. To determine the causes of bilateral acute angle-closure glaucoma attack associated with COVID-19 pneumonia, and to evaluate the effectiveness of laser iridotomy and transciliary drainage of the posterior chamber of the eye.METHODS. Bilateral acute angle closure glaucoma attack was observed in a female patient recovered from COVID-19 pneumonia. Low hypermetropia and co-existing cataract were diagnosed in both eyes. In order to normalize the IOP and restore visual acuity, laser iridotomy was performed in both eyes, followed by surgical treatment of glaucoma with transciliary drainage of the posterior chamber in both eyes. After that the patient underwent phacoemulsification with implantation of intraocular lenses (IOL) in both eyes.RESULTS. Laser iridotomy and transciliary drainage of the posterior chamber was performed in both eyes. The target IOP without topical therapy and stabilization of glaucoma were achieved in both eyes. The second step was phacoemulsification with implantation of IOL, which significantly improved visual acuity of both eyes.CONCLUSION. COVID-19 can lead to vision loss and disability, therefore IOP should be monitored in patients that remain in prone position for ventilation for extended periods of time and receive systemic steroid medications. This is especially relevant for patients with a predisposition to glaucoma or with diagnosed glaucoma.
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