Flaum Eye Institute, University of Rochester, Rochester, NY, USA.
J Refract Surg. 2010 Dec;26(12):991-4. doi: 10.3928/1081597X-20100521-01. Epub 2010 Jun 1.
To report a case of bilateral non-pupillary block angle closure glaucoma after Visian Implantable Collamer Lens (ICL, STAAR Surgical) surgery.
A 35-year-old woman with high myopia, white-to-white measurements of 11.8 mm in the right eye and 11.9 mm in the left eye, and anterior chamber depths >3 mm in both eyes underwent simultaneous bilateral ICL implantation with 13.2-mm lenses.
Persistent, bilateral acute angle closure developed despite multiple patent peripheral iridotomies and iridectomies. Visante anterior segment optical coherence tomography (AS-OCT, Carl Zeiss Meditec) revealed profound vaulting of the ICLs and angle closure. Both ICLs were explanted. After explantation, ultrasound biomicroscopy demonstrated a sulcus-to-sulcus diameter of 10.8 mm in the right eye and 11.2 mm in the left eye.
The correlation between white-to-white and sulcus-to-sulcus measurements were poor in this patient, resulting in extreme vaulting of the ICL and angle closure from a non-pupillary block mechanism. Proper identification of the mechanism of angle closure is aided by AS-OCT. For non-pupillary block mechanisms, ICL extraction is necessary.
报告一例 Visian 可植入式 Collamer 透镜（ICL，STAAR Surgical）手术后双侧非瞳孔阻滞性闭角型青光眼。
一名 35 岁女性，高度近视，右眼和左眼的白到白测量值分别为 11.8mm 和 11.9mm，双眼前房深度均>3mm，行双侧 ICL 植入术，植入 13.2mm 晶状体。
尽管进行了多次房角切开术和虹膜切除术，但仍持续出现双侧急性闭角型青光眼。Visante 眼前节光学相干断层扫描（AS-OCT，卡尔蔡司 Meditec）显示 ICL 明显隆起和房角关闭。两个 ICL 均被取出。取出后，超声生物显微镜显示右眼和左眼的巩膜嵴到巩膜嵴直径分别为 10.8mm 和 11.2mm。
本例患者的白到白和巩膜嵴到巩膜嵴测量值相关性较差，导致 ICL 明显隆起和非瞳孔阻滞性房角关闭。AS-OCT 有助于正确识别房角关闭的机制。对于非瞳孔阻滞性机制，需要进行 ICL 取出术。
