Department of Ophthalmology and Vision Sciences, University of Toronto.
Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada.
J Glaucoma. 2018 Jun;27(6):e106-e109. doi: 10.1097/IJG.0000000000000957.
The purpose of this study was to report a case of phacomorphic glaucoma following retinal detachment repair with silicone oil (SO) in a pediatric patient.
Case report.
A chart review was conducted at St. Michael's Hospital and The Hospital for Sick Children (Toronto, Canada), where the patient received ophthalmic care from July 28, 2015 onwards.
A 14-year-old boy with a history of traumatic retinal detachment and proliferative vitreoretinopathy in the left eye, requiring 2 pars plana vitrectomies, membrane peel, and SO tamponade, presented with 1-day history of decreased vision in the left eye, severe headache, nausea, and vomiting. Visual acuity was hand motions; intraocular pressure (IOP) was 54 mm Hg; the pupil was middilated and minimally reactive with a reverse relative afferent pupillary defect. Slit-lamp examination revealed an injected eye with diffuse microcystic corneal edema, a shallow anterior chamber (AC), and an intumescent cataract. Gonioscopy demonstrated closed angles in 3 quadrants. Compared with his last examination 6 weeks prior, where only a mild posterior subcapsular cataract was noted, the patient's presentation was suggestive of rapid lens intumescence causing acute angle-closure glaucoma. He was given topical and systemic treatment, including intravenous mannitol, and his IOP reduced to 22 mm Hg after 7 hours. Urgent lensectomy was performed the following day. Preoperative ultrasound biomicroscopy revealed a greatly increased lens thickness of 5.12 mm and an AC depth of 1.12 mm. The integrity of both anterior and posterior lens capsules was confirmed intraoperatively, and SO remained confined to the posterior segment. Postoperatively, the iris returned to a normal configuration with open angles, and IOP was 16 mm Hg with no antiglaucoma medications at the last follow-up.
Acute angle-closure in children is a rare event. To our knowledge, this is the first reported case of phacomorphic glaucoma secondary to vitreoretinal surgery in the pediatric population. Although uncommon, ophthalmologists should be aware of this potential complication with the intraocular use of SO and administer urgent treatment accordingly.
本研究报告了一例儿童视网膜脱离修复术后硅油（SO）引起的青光眼。
病例报告。
在圣迈克尔医院和 Sick 儿童医院（加拿大多伦多）进行了病历回顾，该患者自 2015 年 7 月 28 日起在该院接受眼科治疗。
一名 14 岁男孩左眼曾有外伤性视网膜脱离和增生性玻璃体视网膜病变史，行 2 次经睫状体平坦部玻璃体切除术、膜剥除术和 SO 填充术，左眼视力下降 1 天，伴有严重头痛、恶心和呕吐。视力为手动；眼压（IOP）为 54mmHg；瞳孔中度扩大，反应轻微，伴有相对性传入性瞳孔障碍。裂隙灯检查显示眼部充血，弥漫性微囊状角膜水肿，浅前房（AC）和膨胀性白内障。房角镜检查显示 3 个象限的房角关闭。与他 6 周前的最后一次检查相比，当时仅发现轻度后囊下白内障，患者的表现提示晶状体迅速肿胀导致急性闭角型青光眼。他接受了局部和全身治疗，包括静脉注射甘露醇，IOP 在 7 小时后降至 22mmHg。次日紧急行晶状体切除术。术前超声生物显微镜显示晶状体厚度增加到 5.12mm，AC 深度为 1.12mm。术中证实前后晶状体囊完整，SO 仍局限于后段。术后虹膜恢复正常形态，房角开放，眼压为 16mmHg，最后一次随访时无需抗青光眼药物。
儿童急性闭角型青光眼较为罕见。据我们所知，这是首例儿童玻璃体视网膜手术后发生的青光眼。尽管不常见，但眼科医生应该意识到这种潜在的并发症，并相应地进行紧急治疗。
