Wang Jie, Du Ergang, Tang Jinfei
Department of Ophthalmology, Zhejiang Chinese Medical Hospital, Hangzhou, 31006, China.
Department of Ophthalmology, Zhejiang Provincial Traditional Chinese Medical Hospital, 54 Youdian Road, Hangzhou, 310006, China.
BMC Ophthalmol. 2018 Feb 23;18(1):54. doi: 10.1186/s12886-018-0714-5.
The management of eyes with nanophthalmos is a dilemma for ophthalmologists due to various complications, especial the eye with malignant glaucoma. We report a case of effective treatment for malignant glaucoma in nanophthalmos.
An 82-year-old man was performed phacoemulsification in the right eye with normal ocular pressure and nanophthalmos. The surgery was uneventful: an intraocular lens (IOL) was placed and centered in the capsular bag. 2 months later, the patient presented with malignant glaucoma, and the intraocular pressure fluctuated between 18.6 mmHg and 30.8 mmHg with antiglaucoma medications. The patient did not respond to surgical peripheral iridotomy and goniosynechialysis. Then a single treatment with laser peripheral lens posterior capsulotomy and vitreous anterior membranectomy was performed. The intraocular pressure normalized, and the anterior chamber deepened within 24 h. The patient's condition remained stable for 9 months with no further treatment, and his Snellen corrected distance visual acuity was 20/50. The left eye of this patient was treated by combined surgery including phacoemulsification, IOL implantation, anterior vitrectomy, surgical peripheral iridotomy (PI), and goniosynechialysis. No intraoperative or postoperative complications were observed.
This case suggests that it is essential to choose a suitable treatment for nanophthalmos patients to deal with malignant glaucoma and to reduce the incidence of malignant glaucoma.
由于各种并发症，尤其是恶性青光眼，眼科医生在处理小眼球患者的眼睛时面临两难境地。我们报告一例小眼球患者恶性青光眼的有效治疗病例。
一名82岁男性右眼眼压正常且为小眼球，接受了白内障超声乳化手术。手术过程顺利：人工晶状体（IOL）植入并固定于囊袋内。2个月后，患者出现恶性青光眼，使用抗青光眼药物后眼压在18.6 mmHg至30.8 mmHg之间波动。患者对手术周边虹膜切开术和房角粘连分离术无反应。随后进行了一次激光周边晶状体后囊切开术和玻璃体前膜切除术治疗。眼压在24小时内恢复正常，前房加深。患者未经进一步治疗病情稳定9个月，其Snellen矫正远视力为20/50。该患者左眼接受了包括白内障超声乳化、IOL植入、前部玻璃体切除术、手术周边虹膜切开术（PI）和房角粘连分离术在内的联合手术。未观察到术中或术后并发症。
该病例表明，为小眼球患者选择合适的治疗方法以应对恶性青光眼并降低恶性青光眼的发生率至关重要。
