急性闭角型青光眼1例

A case of acute angle-closure glaucoma

60岁男性,因“左眼胀痛12天,右眼胀痛5天”来诊。患者发病数天前曾用双手反复拍打头面部,无其余眼病史、用药史和全身疾病史。最佳矫正视力:右眼HM/眼前,左眼0.1;眼压:右眼41 mmHg(1 mmHg=0.133 kPa),左眼14.3 mmHg。双眼角膜水肿,前房极浅(中央前房深度=1.5 CT;角膜厚度,corneal thickness,CT),房角全周关闭,虹膜萎缩,青光眼斑,晶状体混浊。诊断为双眼继发性急性闭角型青光眼,双眼外伤性晶状体半脱位(悬韧带松弛),双眼老年性白内障。右眼由于药物治疗无效,先行前房穿刺术快速缓解眼压。随后,双眼均行周边虹膜切除术+经平坦部前段玻璃体切除术+白内障超声乳化吸除术+张力环植入术+人工晶状体植入术+房角分离术。双眼手术后前房明显加深;右眼术后眼压需使用抗青光眼药物才能控制,左眼术后眼压控制良好。讨论体会:双眼青光眼同时急性发作伴前房极浅的患者,应考虑继发因素的存在;若眼压保守治疗后无法控制,在排除恶性青光眼的前提下,可考虑急性期先行前房穿刺术控制眼压;白内障超声乳化吸除术术中联合前段玻璃体切除术有助于术中加深前房。

A 60-year-old man presented to our clinic,complaining of severe ocular pain in the left eye(OS)for 12 days and in the right eye(OD)for 5 days.The patient had repeatedly patted his head and face with the palm of his hand several days before the onset of the disease,and had no history of other ocular diseases,medications,or systemic diseases.The best corrected visual acuity(VA)was hand motion(HM)/before eye(BE)in OD and 0.1 in OS,and the intraocular pressure(IOP)was 41mmHg OD and 14.3 mmHg OS.Corneal edema,extremely shallow anterior chamber(the central anterior chamber depths=1.5corneal thickness(CT)),angle closure for 360 degrees,iris atrophy,glaucomatous fleck,and lens opacity showed in both eyes.Diagnosis of secondary acute angle-closure glaucoma,traumatic lens subluxation(relaxation of the suspensory ligament of the lens),and senile cataract in both eyes were made.An anterior chamber paracentesis was performed in OD to lower the IOP after ineffective drug therapy.Consequently,the combination of peripheral iridectomy,anterior vitrectomy,phacoemulsification,capsular tension ring(CTR)implantation,intraocular lens(IOL)implantation,and goniosynechialysis was performed for both eyes.The depth of the anterior chamber significantly deepened,and the IOP was controlled after surgery in both eyes,but the right eye required multiple anti-glaucoma medications.In conclusion,secondary factors should be considered in patients with bilateral simultaneous acute angle-closure glaucoma,especially when accompanied by extremely shallow anterior chamber.If the IOP cannot be controlled after conservative treatment,with the premise excluding malignant glaucoma,anterior chamber paracentesis can be considered for control of IOP during the acute phase.Anterior vitrectomy was useful for deepening the anterior chamber during phacoemulsification.