背景:有报道对后部多形性角膜营养不良(PPCD)的眼睛进行安全的白内障手术;然而,根据我们的知识,在患有PPCD的眼中没有微创青光眼手术(MIGS)的报道。在这里,我们报告一例术中能见度差的房角镜检查,术后角膜水肿,小梁微旁路支架联合白内障手术治疗PPCD的角膜散光。
■一名78岁的男子因MIGS被转诊到我们医院。患者出现双侧角膜内皮囊泡改变和带状病变。内皮细胞密度为2983/2871细胞/mm2(右/左眼),中央角膜厚度为581μm/572μm,最佳矫正视力值(相当于Snellen)为20/32(右)和20/100(左),右眼角膜散光为-2.7D,左眼为-2.5D。
■白内障超声乳化术和人工晶状体植入术后,双眼角膜切口为2.4毫米,尽管房角镜检查术中可见性差,但小梁微旁路支架仍成功插入。手术后一周,中央角膜厚度为614μm/609μm,观察到Descemet膜褶皱和轻度角膜水肿。右眼的最佳校正十进制视敏度为20/40,左眼为20/50。在左眼,总角膜散光从-2.5D增加到-5.5D角膜散光和水肿逐渐改善。
结论:虽然有报告显示白内障手术可以安全地在PPCD患者眼中进行,患有PPCD的眼睛中的MIGS可能需要注意术中可见性以及术后早期的前角镜检查和视觉功能。
BACKGROUND: There are
reports of safe cataract surgery in eyes with posterior polymorphous corneal dystrophy (PPCD); however, to our knowledge, there are no
reports of minimally invasive glaucoma surgery (MIGS) in eyes with PPCD. Herein, we report a
case of poor intraoperative visibility with gonioscopy, postoperative corneal edema, and corneal astigmatism in eyes with PPCD treated with trabecular micro-bypass stent combined with cataract surgery.
UNASSIGNED: A 78-year-old man was referred to our hospital for MIGS. He presented with bilateral corneal endothelial vesicular changes and band lesions. Endothelial cell density was 2983/2871 cells/mm2 (right/left eye), central corneal thickness was 581 μm/572 μm, best-corrected visual acuity values (Snellen equivalent) were 20/32 (right) and 20/100 (left), and corneal astigmatism was -2.7D in the right eye and -2.5D in the left eye.
UNASSIGNED: After phacoemulsification and aspiration with intraocular lens implantation with a 2.4-mm corneal incision in both eyes, trabecular micro-bypass stents were inserted successfully despite the poor intraoperative visibility with gonioscopy. One week after surgery, the central corneal thickness was 614 μm/609 μm, and Descemet\'s membrane folds and mild corneal edema were observed. Best-corrected decimal visual acuity was 20/40 for the right eye and 20/50 for the left eye. In the left eye, total corneal
astigmatism increased from -2.5D to -5.5D. Corneal
astigmatism and edema showed gradual improvement.
CONCLUSIONS: Although reports have shown that cataract surgery can be safely performed in eyes with PPCD, MIGS in eyes with PPCD may require caution regarding intraoperative visibility with gonioscopy and visual function in the early postoperative period.