Nuzzi Raffaele, Monteu Francesca
Eye Clinic Section, University of Turin, Ophthalmic Hospital, Turin, Italy.
Case Rep Ophthalmol. 2017 Mar 7;8(1):170-172. doi: 10.1159/000461573. eCollection 2017 Jan-Apr.
We describe the case of an 86-year-old patient, pseudophakic in both eyes and with high myopia, who had previously had a 25-G vitrectomy with 20% C3F8 used as a tamponade due to a total retinal detachment with choroidal hemorrhages and macular hole. At the postoperative 4-month follow-up, we found 360° iridocorneal synechiae with elevated intraocular pressure due to angle closure in all sectors, with an adherent retina and in the absence of choroidal hemorrhage/detachment and of corneal edema or endothelial damage. The patient was, therefore, hospitalized to receive 360° anterior synechiolysis with a single opening to the corneal limbus, like in paracentesis, with topical anesthesia. We have tried to study the possible causes of this case history. However, it should be recognized that the development of iridocorneal synechiae and the rise of intraocular pressure can be a possible complication of air/C3F8 vitrectomy, which cannot be managed with medical therapy. It will be essential to monitor the situation and to hospitalize the patient for surgical synechiolysis to restore the normal anatomy and physiology and to correct the ocular hypertension. During the vitrectomy, we will have to introduce in advance an adequate amount of viscoelastic material in the anterior chamber and to perform a preventive surgical iridectomy, even if the iridocorneal angle is open in all sectors.
我们描述了一名86岁患者的病例，该患者双眼植入人工晶状体且患有高度近视，此前因视网膜全脱离伴脉络膜出血和黄斑裂孔接受了25G玻璃体切除术，术中使用20%的C3F8作为填充剂。术后4个月随访时，我们发现患者出现360°虹膜角膜粘连，所有象限房角关闭导致眼压升高，视网膜粘连，且无脉络膜出血/脱离、角膜水肿或内皮损伤。因此，患者住院接受了类似于前房穿刺的360°前粘连松解术，通过角膜缘单一开口进行，采用表面麻醉。我们试图研究该病例的可能病因。然而，应认识到虹膜角膜粘连的形成和眼压升高可能是空气/C3F8玻璃体切除术的一种并发症，药物治疗无法处理这种情况。监测病情并让患者住院接受手术粘连松解术以恢复正常解剖结构和生理功能并纠正高眼压至关重要。在玻璃体切除术中，即使所有象限的虹膜角膜角均开放，我们也必须提前在前房内注入适量的粘弹剂并进行预防性手术虹膜切除术。
