PDF(Pubmed)
Abstract：
Predicting the visual outcome after cataract extraction can be challenging in glaucoma patients who develop cataracts. Here, we demonstrate the case of a patient with advanced glaucoma and a mild-to-moderate cataract at initial presentation, who demonstrated remarkable improvement in visual acuity following a period of controlled intraocular pressure (IOP) and the removal of a matured cataract at the time of surgery. A 64-year-old Haitian woman with severe mixed-mechanism glaucoma and hand motion vision in both eyes (OU) presented with intraocular pressures of 38 mmHg OD (oculus dexter/right eye) and 41 mmHg OS (oculus sinister/left eye) while on three IOP-lowering agents. Her medications were escalated to six IOP-lowering medications, and she underwent bilateral transscleral laser cyclophotocoagulation with both micropulse and continuous wave probes simultaneously. Postoperatively, IOPs dropped to 7 and 9 mmHg in the right and left eyes, respectively, and remained at or below target on three topical agents for the remainder of her follow-up. Contrastingly, the patient\'s cataract had progressed, and the decision was made to undergo cataract extraction OU sequentially. The subsequent clinical course demonstrated progressive visual improvement with 20/80 best-corrected visual acuity OU and increased independence with activities of daily living. This case illustrates the potential for visual improvement in an advanced glaucoma patient after removing a matured cataract despite limited prior expectations. Ocular comorbidities complicate but do not necessarily preclude appropriate interventions that may improve patients\' vision-related quality of life.
摘要：
在发生白内障的青光眼患者中，预测白内障摘除后的视觉结果可能具有挑战性。这里,我们在初次就诊时演示了一例晚期青光眼和轻度至中度白内障的患者，在控制眼压（IOP）一段时间并在手术时摘除成熟的白内障后，视力显着改善。一名64岁的海地妇女，患有严重的混合机制性青光眼，双眼（OU）的手运动视力（OU），眼压为38mmHgOD（眼孔/右眼）和41mmHgOS（眼孔/左眼）。使用三种降低IOP的药物。她的药物被升级为六种降低IOP的药物，她接受了双侧经巩膜激光睫状体光凝术，同时使用微脉冲和连续波探头。术后,右眼和左眼的IOP下降到7和9mmHg，分别,在其余的随访中，三种外用药物保持在或低于目标。相反，病人的白内障有进展，并决定依次进行白内障摘除术。随后的临床过程显示出具有20/80最佳矫正视力OU的渐进性视力改善，并且增加了日常生活活动的独立性。这种情况说明了尽管先前的期望有限，但在去除成熟的白内障后，晚期青光眼患者的视力改善的潜力。眼部合并症复杂，但不一定排除适当的干预措施，可以改善患者的视力相关生活质量。
