Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji.
Department of Ophthalmology, Ishinkai Niimi Eye Clinic, Akashi.
J Glaucoma. 2018 Mar;27(3):e64-e67. doi: 10.1097/IJG.0000000000000872.
We report a case of glaucoma implant tube lumen obstruction visualized with anterior segment optical coherence tomography (ASOCT) and present its surgical management. The patient was a 66-year-old man with refractory glaucoma associated with traumatic aphakia in the right eye after trabeculectomy, several bleb needling procedures, and scleral fixation of the intraocular lens with pars plana vitrectomy. Finally, we performed Baerveldt implantation at the pars plana of the temporal inferior quadrant with a several Sherwood slit. However, his intraocular pressure (IOP) was >30 mm Hg despite maximum medication for several weeks. We attempted second vitrectomy and completely removed vitreous around the tube tip; however, his IOP remained around 40 mm Hg for several days after the surgery. Therefore, we suspected tube obstruction at the extraocular point of the tube lumen and used ASOCT for assessment. ASOCT revealed material in the tube lumen. We pulled out the tube and then crushed and extruded the obstructing material from the tube tip. We then refixed the tube at the same place and achieved good IOP control after the surgery. Our findings indicate that ASOCT is useful for diagnosing glaucoma implant tube lumen obstruction and surgical decision-making.
我们报告了一例前节光学相干断层扫描（ASOCT）可见的青光眼植入管管腔阻塞病例，并介绍了其手术治疗方法。患者为 66 岁男性，右眼因小梁切除术后、多次小梁切开术和巩膜固定眼内晶状体伴睫状体平坦部玻璃体切除术导致创伤性无晶状体，并伴有难治性青光眼。最终，我们在颞下象限的睫状体平坦部行 Baerveldt 植入术，并进行 Sherwood 缝切。然而，尽管使用了数周的最大剂量药物，他的眼内压（IOP）仍高于 30mmHg。我们尝试了第二次玻璃体切除术，并完全清除了管尖端周围的玻璃体；然而，手术后几天，他的 IOP 仍维持在 40mmHg 左右。因此，我们怀疑管在眼球外的管腔处阻塞，并使用 ASOCT 进行评估。ASOCT 显示管腔内有物质。我们拔出管子，然后从管尖端挤压并挤出阻塞物。然后，我们将管子重新固定在同一位置，手术后眼压得到良好控制。我们的发现表明，ASOCT 可用于诊断青光眼植入管管腔阻塞，并为手术决策提供依据。
