在青光眼手术后采用体外脉络膜液引流术、玻璃体旁切除术和眼底填塞术治疗持续性眼压过低。

IF 1.8 4区 医学 Q3 OPHTHALMOLOGY
Journal of Ophthalmology Pub Date : 2024-07-29 eCollection Date: 2024-01-01 DOI:10.1155/2024/5323632
Susanna Friederike Koenig, Efstathios Vounotrypidis, Christian Maximilian Wertheimer, Armin Wolf
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引用次数: 0

摘要

背景:持续性严重浆液性脉络膜脱离是青光眼手术后的罕见并发症。通过巩膜切口引流脉络膜液的手术治疗是此类病例的一种选择。将这种手术与玻璃体旁切除术和气体内填塞术结合使用具有潜在的优势。下面将介绍一小部分患者在这种手术方案下的围手术期情况:这是一项回顾性队列研究,研究了在用尽所有保守治疗方案后,对六名患者的六只眼睛进行持续性浆液性脉络膜脱离(≥4 周)体外引流术,并结合玻璃体旁切除术和气体内填塞术的术后过程。纳入标准是因药物无法控制的青光眼而接受眼压(IOP)降低手术后,出现持续低眼压和严重浆液性脉络膜脱离。根据脉络膜脱离的消退情况、眼压和视力(VA)的变化、引流后并发症以及是否需要进一步手术对眼球进行评估:手术前,所有患者均表现为前房平坦、视力下降和持续性脉络膜脱离。手术本身并无大碍,但由于病例的复杂性,需要根据每位患者的需求量身定制手术方案。5只眼睛的脉络膜渗出在1个月前完全消除,1只眼睛在第3个月前完全消除,平均眼压从术前的5 (±2.1) mmHg升至11.3 (±3.7) mmHg,视力从1.7 (±0.8) logMAR升至1.2 (±0.6) logMAR。六名患者中有五名需要再次手术,主要是为了进一步提高眼压,尽管脉络膜脱离已经解决:结论:脉络膜腔外液体引流结合玻璃体旁切除术和气体内填塞似乎是治疗持续性眼压过低的一种有效而安全的方法。虽然可能需要反复手术,但必须进行大规模的前瞻性研究以提供确凿证据。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Ab Externo Choroidal Fluid Drainage, Pars Plana Vitrectomy, and Endotamponade for the Management of Persistent Hypotony following Glaucoma Surgery.

Background: Persistent severe serous choroidal detachment is a rare complication after glaucoma surgery. Surgical treatment with choroidal fluid drainage through a scleral incision is an option in these cases. Combining this procedure with pars plana vitrectomy and gas endotamponade has potential advantages. In the following, the perioperative course of this surgical option in a small cohort will be presented.

Methods: This is a retrospective cohort study of the postoperative course of ab externo drainage of persistent serous choroidal detachment (≥4 weeks) in combination with pars plana vitrectomy and gas endotamponade in six eyes of six patients after exhausting all conservative treatment options. Inclusion criterion was persistent hypotony with severe serous choroidal detachment after intraocular pressure (IOP) lowering surgery due to medically uncontrolled glaucoma. Eyes were evaluated according to resolution of choroidal detachment, change in IOP and visual acuity (VA), postdrainage complications, and need for further surgeries.

Results: Before surgery, all patients presented with flat anterior chamber, decreased vision, and persistent choroidal detachment. The surgery itself was uneventful, but due to the complexity of the cases, tailoring the procedure to each patient's needs was required. Complete resolution of choroidal effusion was achieved by one month in 5 eyes and in 1 eye by month 3. There was an increase in average IOP from 5 (±2.1) mmHg before surgery to 11.3 (±3.7) mmHg and in VA from 1.7 (±0.8) to 1.2 (±0.6) logMAR. Five out of six patients required additional surgery, mainly to further increase the IOP even though choroidal detachment had already resolved.

Conclusion: Ab externo choroidal fluid drainage combined with pars plana vitrectomy and gas endotamponade seems to be an effective and safe treatment option in persistent ocular hypotony. Although repeated surgeries might be necessary, large-scale prospective studies must be undertaken to provide corroborative evidence.

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来源期刊
Journal of Ophthalmology
Journal of Ophthalmology MEDICINE, RESEARCH & EXPERIMENTAL-OPHTHALMOLOGY
CiteScore
4.30
自引率
5.30%
发文量
194
审稿时长
6-12 weeks
期刊介绍: Journal of Ophthalmology is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies related to the anatomy, physiology and diseases of the eye. Submissions should focus on new diagnostic and surgical techniques, instrument and therapy updates, as well as clinical trials and research findings.
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