25号玻璃体旁切除术治疗黄斑孔后继发急性闭角型青光眼:病例报告。

IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL
Shigefumi Takahashi, Suguru Nakagawa, Kiyoshi Ishii
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引用次数: 0

摘要

背景:虹膜后膜裂孔很少在玻璃体旁切除术后引起继发性闭角型青光眼,主要见于术后炎症较重的病例。由于瞳孔相对阻滞,面朝下体位加气体填塞可导致法眼急性闭角型青光眼。本报告介绍了一例罕见的假性法眼并继发急性闭角型青光眼的病例,患者因黄斑孔而接受了25号玻璃体旁切除术和长期玻璃体气体填塞术:一名 61 岁的日本女性患者主诉右侧视力受损,且已持续数月。裂隙灯检查发现双眼均有深前房和中度核硬化性白内障。眼轴长度为右眼 23.53 毫米,左眼 24.05 毫米,眼底检查发现右眼有一个全厚黄斑孔(3 期)。患者同时接受了白内障手术和玻璃体旁切除术,并植入了直径 7 毫米的三片式单焦人工晶体,剥离了内限制膜,并进行了空气填塞。手术期间没有出现并发症。由于黄斑裂孔没有闭合,13 天后进行了第二次玻璃体旁切除术,同时进行了内限制膜倒瓣和 SF6 气体填塞。两次手术后患者都保持面朝下的姿势,第二次手术后 6 天,眼压升高至 53 mmHg,诊断为右眼急性闭角型青光眼伴虹膜弹出。患者接受了激光周边虹膜切开术,术后前房加深,眼压恢复正常,黄斑孔闭合:本病例是一例罕见的假性视网膜眼在接受25号微创玻璃体旁切除术和SF6气体填塞治疗黄斑孔后继发急性闭角型青光眼的病例。其原因被推测为虹膜后合或玻璃体气体前推囊内晶状体导致的相对瞳孔阻滞。如果重复手术仍无法实现黄斑孔闭合,需要长期面朝下体位,玻璃体气体长期滞留,或植入大直径眼内晶状体,则应考虑继发性急性闭角型青光眼。即使进行25号玻璃体旁切除术不是为了治疗侵袭性极强的增殖性糖尿病视网膜病变,而是为了修复黄斑裂孔,尤其是如果患者是假性视网膜病变眼,也应考虑到这一点。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Secondary acute angle closure glaucoma after 25-gauge pars plana vitrectomy for a macular hole: a case report.

Background: Posterior synechiae of the iris rarely cause secondary angle-closure glaucoma after pars plana vitrectomy, mainly reported in cases with high postoperative inflammation. The face-down position with gas tamponade can cause acute angle-closure glaucoma in phakic eyes owing to relative pupillary block. This report presents a rare case of pseudophakic eye with secondary acute angle-closure glaucoma after 25-gauge pars plana vitrectomy and long-term vitreous gas tamponade for a macular hole.

Case presentation: A 61-year-old Japanese female patient presented with a chief complaint of right-sided visual impairment that had persisted for several months. Slit-lamp examination revealed deep anterior chamber and moderate nuclear sclerotic cataracts in both eyes. The axial length of the eye was 23.53 mm right eye and 24.05 mm left eye, and the fundus examination revealed a full-thickness macular hole (stage 3) in the right eye. The patient underwent simultaneous cataract surgery and pars plana vitrectomy with 7-mm diameter 3-piece monofocal intraocular lens implantation, internal limiting membrane peeling, and air tamponade. There were no complications during surgery. Due to non-closure of the macular hole, a second pars plana vitrectomy with internal limiting membrane inverted flap and SF6 gas tamponade was performed 13 days later. The patient maintained face-down position after both surgeries, and 6 days after the second surgery, intraocular pressure was elevated to 53 mmHg, and acute angle-closure glaucoma with iris bombe was diagnosed in the right eye. A laser peripheral iridotomy was performed, resulting in a deepened anterior chamber, normalized intraocular pressure, and a closed macular hole.

Conclusions: This case presents a rare occurrence of secondary acute angle-closure glaucoma in a pseudophakic eye after 25-gauge minimally invasive pars plana vitrectomy and SF6 gas tamponade for macular hole. The cause was presumed to be posterior synechiae of the iris or relative pupillary block due to forward pushing of the intracapsular intraocular lens by vitreous gas. In cases where surgery is repeated without achieving macular hole closure, necessitating long-term face-down position, where vitreous gas is retained for an extended period, or when a large-diameter intraocular lens is implanted, secondary acute angle-closure glaucoma should be considered. This applies even when the 25-gauge pars plana vitrectomy is performed not for a highly invasive proliferative diabetic retinopathy but for macular hole repair, especially if the patient has a pseudophakic eye.

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来源期刊
Journal of Medical Case Reports
Journal of Medical Case Reports Medicine-Medicine (all)
CiteScore
1.50
自引率
0.00%
发文量
436
期刊介绍: JMCR is an open access, peer-reviewed online journal that will consider any original case report that expands the field of general medical knowledge. Reports should show one of the following: 1. Unreported or unusual side effects or adverse interactions involving medications 2. Unexpected or unusual presentations of a disease 3. New associations or variations in disease processes 4. Presentations, diagnoses and/or management of new and emerging diseases 5. An unexpected association between diseases or symptoms 6. An unexpected event in the course of observing or treating a patient 7. Findings that shed new light on the possible pathogenesis of a disease or an adverse effect
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