单眼新生血管性青光眼1例

A case of unilateral neovascular glaucoma

59岁男性,因"发现右眼视糊伴眼压升高2周"入院。双眼最佳矫正视力:右眼0.03,左眼0.6。裂隙灯检查见右眼角膜KP(+),Tyndall(+),虹膜新生血管,晶状体轻度混浊,视盘新生血管,视网膜见棉绒斑、中周部有微血管瘤,静脉扩张、动脉纤细;房角镜下见右眼全周房角关闭。左眼无殊。眼压:右眼30.8mmHg(1 mmHg=0.133 kPa),左眼18.8 mmHg。初步诊断为右眼新生血管性青光眼。病因鉴别主要包括葡萄膜炎继发青光眼和眼缺血综合征。患者入院后先行右眼玻璃体腔注射抗血管内皮生长因子(VEGF),后行减压阀植入;术后转诊血管外科行颈内动脉支架植入术。术后随访眼压控制良好,血供改善。讨论体会:当新生血管性青光眼眼压不太高时,要考虑缺血的可能。房角状态决定了患者颈内动脉狭窄再通后的眼压预后。双侧颈内动脉狭窄的眼缺血综合征风险大,应尽快转诊血管外科。

A 59-year-old male was admitted with a 2-week blurred vision and increased intraocular pressure in the right eye.Best corrected visual acuity was 0.03 in the right eye and 0.6 in the left.The right eye was revealed under slit lamp to be with KP(+),Tyn(+),neovascularized iris and mild cataract in the anterior segment,while cotton-wool spots and microaneurysms in the mid-peripheral retina with dilated venules and fine arterioles in both eyes,but only new vessels on the right disc.Gonioscopy showed a 360-degree closed anterior chamber angle in the right eye and fully open in the left.IOP:OD 30.8mmHg,OS 18.8mmHg.The initial diagnosis was neovascular glaucoma,the cause of which has to be differentiated between uveitis and ocular ischemic syndrome(OIS).The patient was given an intravitreal anti-VEGF injection followed by a successful Ahmed valve implantation,after which the internal carotid artery stenting was performed.During the ophthalmic follow-up,the IOP has been controlled well and the ophthalmic blood flow was improved.It must be born in mind that when neovascular glaucoma comes with a normal or mildly increased IOP,ischemia should be considered.Secondly,the prognosis of IOP depends on the range of angle closure before carotid artery surgery.OIS with bilateral severe internal carotid artery stenosis should be referred to vascular surgeon as soon as possible.