Hu Rongrong, Wang Xiaoyu, Wang Yang, Sun Yang
Department of Ophthalmology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China Byers Eye Institute, Department of Ophthalmology at Stanford University, CA, USA.
Medicine (Baltimore). 2017 Mar;96(10):e6255. doi: 10.1097/MD.0000000000006255.
Laser peripheral iridotomy (LPI) is commonly performed as a primary treatment for acute primary angle closure glaucoma after administration of anti-glaucoma medications or for prevention of this condition. Minor complications may occur following LPI and most of them do not have deleterious consequences. We report a rare case of lens subluxation that has a possible relationship with LPI treatment.
A 54-year-old female patient was initially referred for surgical treatment of medication-uncontrollable angle closure glaucoma in her left eye. The patient had undergone Neodymium:YAG LPI at an outside hospital 2 months prior to the presentation due to an episode of elevated intraocular pressure (IOP). About 5 days after the LPI, she had spontaneous blurred vision, redness, and pain in the left eye. Her IOP was found to re-rise and was not controlled well even with maximum tolerated anti-glaucoma medications during the following 2 months. On slit-lamp examination, the significant shallowing of both peripheral and central anterior chamber was noted in the left eye. Ultrasound biomicroscopy examination revealed the lens tilting towards the iris and the inferior zonular dehiscence corresponding to the iridotomy site.
Lens subluxation secondary to LPI treatment in the left eye.
Phacoemulsification combined with in-the-bag intraocular lens implantation was performed in the left eye. The zonular weakness corresponding to the iridotomy site was further confirmed during surgery.
The patient's IOP remained stable in the first postoperative 3 months without additional anti-glaucoma medications.
Laser peripheral iridotomy may cause structural zonular damage, and ophthalmologists should be aware of this potential complication and proceed with caution.
激光周边虹膜切开术（LPI）通常作为抗青光眼药物治疗后急性原发性闭角型青光眼的主要治疗方法，或用于预防这种情况。LPI术后可能会出现轻微并发症，且大多数并发症并无有害后果。我们报告一例罕见的晶状体半脱位病例，其可能与LPI治疗有关。
一名54岁女性患者最初因左眼药物无法控制的闭角型青光眼而被转诊接受手术治疗。该患者在就诊前2个月因一次眼压升高在外地医院接受了钕：钇铝石榴石激光周边虹膜切开术。LPI术后约5天，她左眼出现自发视物模糊、眼红和疼痛。在接下来的2个月里，她的眼压再次升高，即使使用最大耐受量的抗青光眼药物也无法得到很好的控制。裂隙灯检查发现左眼周边和中央前房均明显变浅。超声生物显微镜检查显示晶状体向虹膜倾斜，与虹膜切开部位对应的下方晶状体悬韧带断裂。
左眼LPI治疗继发晶状体半脱位；
对左眼实施了白内障超声乳化吸除联合囊袋内人工晶状体植入术。术中进一步证实了与虹膜切开部位对应的悬韧带薄弱。
术后3个月内，患者眼压保持稳定，无需额外使用抗青光眼药物。
激光周边虹膜切开术可能会导致晶状体悬韧带结构损伤，眼科医生应意识到这种潜在并发症并谨慎操作。
