目的:探讨青光眼术后脉络膜脱离患者睫状体脱离的发生率及其对临床病程的影响。管理,和预后。
方法:前瞻性观察性病例系列研究。纳入2018-2019年青光眼手术后脉络膜脱离的患者。所有患者均接受了完整的眼科检查和超声生物显微镜检查,以评估睫状体脱离的存在和程度。随访检查包括超声生物显微镜扫描在1周,1个月,3个月,和6个月。
结果:纳入8例患者(8只眼),4男4女,平均年龄72岁(范围60-83)。5例患者行丝裂霉素C小梁切除术(0.02%),其中1例联合超声乳化白内障摘除术;2例接受了Ahmed青光眼瓣膜植入术,1例接受了丝裂霉素C(0.02%)的ab-internoXen45凝胶支架植入。术前平均眼压为26.0±7.65mmHg,术后第一天降至6.9±2.64mmHg。从手术到诊断脉络膜脱离的平均时间为11.6±5.73天。所有患者均通过超声生物显微镜检查发现睫状体脱离,介于一到四个象限之间。所有患者均接受局部类固醇和环麻痹药治疗;三人(37.5%)接受口服类固醇。未显示脉络膜或睫状体脱离的手术干预。
结论:在这项现实世界的前瞻性研究中,在青光眼手术后出现脉络膜脱离的所有患者中均发现并发睫状体脱离.这一观察结果可能会加深我们对青光眼手术后常见的低眼压机制的理解。
OBJECTIVE: To examine the rate of ciliary body detachment in patients with choroidal detachment following glaucoma surgery and its effect on the clinical course, management, and prognosis.
METHODS: A prospective observational case-series study. Patients with choroidal detachment following glaucoma surgery in 2018-2019 were included. All underwent complete ophthalmological examination and ultrasound biomicroscopy for evaluation of the presence and extent of ciliary body detachment. Follow-up examinations including ultrasound biomicroscopy scans were performed at 1 week, 1 month, 3 months, and 6 months.
RESULTS: Eight patients (8 eyes) were enrolled, 4 male and 4 female, of mean age 72 years (range 60-83). Five patients underwent trabeculectomy with mitomycin C (0.02%), which was combined with phacoemulsification cataract extraction in one; two underwent Ahmed glaucoma valve implantations, and one underwent ab-interno Xen45 gel stent implantation with mitomycin C (0.02%). The mean intraocular pressure was 26.0 ± 7.65 mmHg preoperatively, dropping to 6.9 ± 2.64 mmHg on first postoperative day one. Mean time from surgery to diagnosis of choroidal detachment was 11.6 ± 5.73 days. Ciliary body detachment was identified by ultrasound biomicroscopy in all patients, ranging between one and four quadrants. All patients were treated with topical steroids and cycloplegics; three (37.5%) received oral steroids. No surgical intervention for the choroidal or ciliary body detachments was indicated.
CONCLUSIONS: In this real-world prospective study, concurrent ciliary body detachment was identified in all patients who presented with choroidal detachment following glaucoma surgery. This observation may deepen our understanding of the mechanism underlying the hypotony that is often seen after glaucoma surgery.