双侧葡萄膜后复光眼伴瞳孔阻塞、前晶状体囊破裂、恶性青光眼激光周围虹膜切除术后的处理:病例报告及文献回顾。

IF 1.2 Q3 OPHTHALMOLOGY
Journal of Current Ophthalmology Pub Date : 2022-07-26 eCollection Date: 2022-04-01 DOI:10.4103/joco.joco_3_22
Khaled El Matri, Dhouha Gouider, Rim Limaiem, Ahmed Chebil, Meher Henchiri, Yousra Falfoul, Leila El Matri
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引用次数: 0

摘要

目的:报告一例年轻高度近视患者的双侧复杂性青光眼(UG)伴瞳孔阻滞、前晶状体囊破裂和恶性青光眼,并报告术前和术后的前段光学相干断层扫描(AS-OCT)结果。方法:21岁高度近视女性,有前葡萄膜炎伴广泛后粘连病史,双侧Nd: YAG激光周围虹膜切开术(LPI)后出现急性双侧眼痛、红肿和视力模糊。结果:视力仅限于双眼光感(OU),伴有扁平前房(AC)和晶状体碎片前脱位。眼内压(IOP)大于60mmhg。AS-OCT在平面AC内显示闭合角度和高反射异质物质。虹膜和晶状体碎片被镀在角膜内皮OU上。我们进行了紧急玻璃体切除合并晶状体切除术。在欧大,一切都平安无事。重复AS-OCT显示AC深,角度大开,无晶状体。眼压降至9 mmHg,视力改善至5/10。结论:在存在广泛后粘连的UG的情况下进行LPI可能是有害的,即使在高度近视的眼睛中,也可能导致复杂机制的青光眼伴水误导综合征,并伴有前晶状体脱位引起的瞳孔阻滞。为了防止双侧视力威胁并发症的发生,不应同时在裸眼,特别是在病理眼进行Nd: YAG LPI。AS-OCT有很大的帮助,可以在术前和术后对ACs和虹膜角膜角度进行简单而详细的超微结构评估。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Management of a Bilateral Post-Uveitic Complex Glaucoma with Pupillary Block, Rupture of the Anterior Lens Capsule, and Malignant Glaucoma following Laser Peripheral Iridotomies: Case Report and Literature Review.

Management of a Bilateral Post-Uveitic Complex Glaucoma with Pupillary Block, Rupture of the Anterior Lens Capsule, and Malignant Glaucoma following Laser Peripheral Iridotomies: Case Report and Literature Review.

Purpose: To report a case of a bilateral complex uveitic glaucoma (UG) with pupillary block, rupture of the anterior lens capsule, and malignant glaucoma in a young high-myopic patient and to report anterior segment optical coherence tomography (AS-OCT) findings initially and following surgery.

Methods: A 21-year-old high-myopic woman who had a history of anterior uveitis with extensive posterior synechiae, presented with acute bilateral ocular pain, redness, and blurred vision following bilateral Nd: YAG laser peripheral iridotomy (LPI).

Results: Visual acuity was limited to light perception in both eyes (OU), with a flat anterior chamber (AC) and anterior luxation of lens fragments. Intraocular pressure (IOP) was over 60 mmHg OU. AS-OCT showed closed angles and hyperreflective heterogeneous material within the flat AC. The iris and lens fragments were plated against the corneal endothelium OU. We performed an urgent pars plana vitrectomy associated with lensectomy. It was uneventful in OU. Repeated AS-OCT revealed a deep AC, widely open angles, and aphakia. IOP was lowered to 9 mmHg and visual acuity improved to 5/10 in OU.

Conclusion: Performing LPI might be harmful in the presence of UG with extensive posterior synechia, resulting in complex mechanism glaucoma with aqueous misdirection syndrome associated with a pupillary block due to anterior lens luxation, even in high-myopic eyes. Nd: YAG LPI should not be performed simultaneously in OU, especially in pathologic eyes, to prevent bilateral vision-threatening complications. AS-OCT was of great help, allowing easy and detailed ultrastructural assessment of the ACs, and iridocorneal angles before and after surgery.

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来源期刊
CiteScore
2.50
自引率
6.70%
发文量
45
审稿时长
8 weeks
期刊介绍: Peer Review under the responsibility of Iranian Society of Ophthalmology Journal of Current Ophthalmology, the official publication of the Iranian Society of Ophthalmology, is a peer-reviewed, open-access, scientific journal that welcomes high quality original articles related to vision science and all fields of ophthalmology. Journal of Current Ophthalmology is the continuum of Iranian Journal of Ophthalmology published since 1969.
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