目的。报告1例假晶状体女性恶性青光眼。没有青光眼病史,通过平坦部前部玻璃体切除术解决。案例介绍。一位80岁的女性患者在我们的急诊科就诊,她的左眼(LE)有五天的疼痛史。在最后一天,患者注意到明显的视力丧失和眼部疼痛。在她的LE中,视力是光感,高曼眼压是80mmHg。生物显微镜检查显示没有周围和中央前房(AC)和后房(PC)假晶状体。后段造影显示无玻璃体或脉络膜异常。进行了外围激光YAG虹膜切开术,并对患者进行了20%甘露醇静脉注射治疗,局部噻吗洛尔,局部溴莫尼定,和局部睫状肌麻痹。12小时后,尽管在LE眼中进行了虹膜切开术,眼内压(IOP)为55mmHg,无AC伴严重角膜水肿。诊断为假晶状体恶性青光眼,并进行了激光YAG囊切开术,症状和体征均未消退。24小时后,我们进行了平坦部前部玻璃体切除术。术后,交流深度增加,眼压降至20mmHg。一周后,患者出院时,手运动感知视力在她的LE,20mmHg眼压,角膜水肿减少,正常深度AC。一个月后,角膜水肿消退,视力为2/50,眼压为20mmHg,交流有一个正常的深度。结论。恶性青光眼是一种威胁视力的疾病,以假晶状体的眼睛报道。虽然,文献描述了通过睫状肌麻痹和激光YAG囊切开术解决的病例,我们的患者需要进行平坦部前部玻璃体切除术以缓解症状和体征.
Purpose. To report a
case of malignant glaucoma in a pseudophakic female patient, with no history of glaucoma, resolved through pars plana anterior vitrectomy.
Case presentation. An 80-year-old female patient presented in our Emergency Department after a five-day history of pain in her left eye (LE). In the last day, the patient noticed marked visual loss and ocular pain. Visual acuity was light perception and Goldman tonometry was 80 mmHg in her LE. The biomicroscopy revealed absent peripheral and central anterior chamber (AC) and posterior chamber (PC) pseudophakia. Posterior segment ecography showed no vitreous or choroidal abnormalities. A peripheral laser YAG iridotomy was made and the patient was treated with intravenous 20% mannitol, topical timolol, topical brimonidine, and topical cycloplegics. 12 hours later, despite a patent iridotomy in the LE eye, intraocular pressure (IOP) was 55 mmHg, absent AC with severe corneal edema. The diagnosis of pseudophakic malignant glaucoma was made and laser YAG capsulotomy was performed with no resolution of symptoms and signs. 24 hours later, we performed pars plana anterior vitrectomy. Postoperatively, the AC depth increased and the IOP decreased to 20mmHg. After a week, the patient was discharged with hand movement perception visual acuity in her LE, 20 mmHg IOP, reduced corneal edema, normal depth AC. After a month, the corneal edema resolved, the visual acuity was 2/50, IOP was 20mmHg, and the AC had a normal depth. Conclusion. Malignant glaucoma is a sight threatening condition, reported in pseudophakic eyes. Although, literature describes cases solved by cycloplegics and laser YAG capsulotomy, our patient needed pars plana anterior vitrectomy for the resolution of symptoms and signs.