人工晶状体眼硅油瞳孔阻滞性青光眼
Silicone oil pupil block glaucoma in a pseudophakic eye.
作者信息
Yusuf Imran H, Fung Timothy H M, Salmon John F, Patel Chetan Kantibhai
机构信息
Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK.
出版信息
BMJ Case Rep. 2014 Sep 23;2014:bcr2014205018. doi: 10.1136/bcr-2014-205018.
Intravitreal silicone oil achieves an effective endotamponade in patients with complex retinal detachments. Silicone oil displacement into the anterior chamber risks glaucoma and endothelial failure. We describe a 52-year-old patient with pseudophakia with silicone oil endotamponade presenting with visual loss and intraocular pressure of 60 mm Hg. Inferior YAG iridotomy was undertaken to repatriate silicone oil to the posterior segment. Despite normal intraocular pressure, acute corneal oedema occurred postiridotomy, resolving spontaneously over 2 weeks. Pupil block glaucoma secondary to silicone oil requires a management approach based on an understanding of silicone oil fluidics. Careful selection of inferior laser iridotomy site is critical to effectively reverse pupil block. Anterior migration of silicone oil in patients with pseudophakia is rare. We offer an hypothesis to explain unanticipated transient corneal oedema following silicone oil displacement from the anterior chamber. Clinicians must discuss the possibility of transient or permanent endothelial failure preoperatively in this patient group.
玻璃体内硅油在复杂性视网膜脱离患者中可实现有效的眼内填充。硅油进入前房有导致青光眼和内皮功能衰竭的风险。我们描述了一名52岁的人工晶状体植入患者，其接受硅油眼内填充后出现视力丧失和眼压60 mmHg。进行了下方YAG虹膜切开术，以将硅油送回眼后段。尽管眼压正常，但虹膜切开术后发生了急性角膜水肿，在2周内自行消退。硅油继发的瞳孔阻滞性青光眼需要基于对硅油流体动力学的理解来采取管理方法。仔细选择下方激光虹膜切开术部位对于有效逆转瞳孔阻滞至关重要。人工晶状体植入患者中硅油向前房迁移的情况很少见。我们提出一个假说来解释硅油从前房移位后意外出现的短暂性角膜水肿。临床医生必须在术前与该患者群体讨论短暂或永久性内皮功能衰竭的可能性。
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