Hosoda Yoshikatsu, Akagi Tadamichi, Yoshimura Nagahisa
Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Clin Ophthalmol. 2014 Apr 2;8:677-9. doi: 10.2147/OPTH.S60704. eCollection 2014.
Malignant glaucoma, which is characterized by a shallow or flat anterior chamber with high intraocular pressure, can usually be resolved by pars plana vitrectomy with anterior hyaloidectomy. We describe two cases in which malignant glaucoma was refractory to conventional treatment and complete vitrectomy. Case one an 88-year-old woman with pseudoexfoliation glaucoma underwent trabeculotomy and subsequently developed malignant glaucoma. Four months after transient recovery by pars plana vitrectomy, the malignant glaucoma recurred. She underwent peripheral iridectomy and local zonulectomy with successful control of her intraocular pressure. In case two, an 85-year-old man had a history of pseudoexfoliation glaucoma. Seven months after phacoemulsification and intraocular lens implantation, he developed malignant glaucoma that was refractory to pars plana vitrectomy. He underwent peripheral iridectomy, goniosynechialysis and trabectome surgery resulting in the successful control of his intraocular pressure. In rare cases of malignant glaucoma refractive to vitrectomy, peripheral iridectomy with or without local zonulectomy is a reasonable and minimally invasive surgical procedure.
恶性青光眼的特征是前房浅或扁平且眼压高，通常可通过玻璃体平坦部玻璃体切除术联合前段玻璃体切除术来解决。我们描述了两例恶性青光眼对传统治疗和完全玻璃体切除术均无效的病例。病例一，一名88岁患有假性剥脱性青光眼的女性接受了小梁切开术，随后发生了恶性青光眼。在通过玻璃体平坦部玻璃体切除术短暂恢复四个月后，恶性青光眼复发。她接受了周边虹膜切除术和局部晶状体悬韧带切开术，眼压得到成功控制。病例二，一名85岁男性有假性剥脱性青光眼病史。在白内障超声乳化吸除术和人工晶状体植入术后七个月，他发生了对玻璃体平坦部玻璃体切除术无效的恶性青光眼。他接受了周边虹膜切除术、房角粘连分离术和小梁切除术，眼压得到成功控制。在极少数对玻璃体切除术难治的恶性青光眼病例中，行周边虹膜切除术（伴或不伴局部晶状体悬韧带切开术）是一种合理且微创的手术方法。
