Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania.
Medicina (Kaunas). 2018 Sep 5;54(4):65. doi: 10.3390/medicina54040065.
Despite established common risk factors, malignant glaucoma (MG) remains a rare condition with challenging management. We aimed to analyze differences in risk factors for MG after different surgeries and outcomes after pars plana vitrectomy (PPV). This retrospective study included cases of MG treated with PPV between January 2005 and December 2015 in the Department of Ophthalmology, Lithuanian University of Health Sciences, Kaunas, Lithuania. A total of 39 cases were analyzed: 23 (59%) after cataract surgery, 13 (33.3%) after trabeculectomy, and 3 (7.7%) after other interventions. Characteristics among the groups did not differ. Intraocular lens refractive power was significantly higher in the cataract group, in which intraocular pressure (IOP) before MG was significantly greater in the affected eye. Normotension was achieved in 92.3%, and a normal anterior chamber in 75%. Additional measures included eye drops ( = 24), trabeculectomy ( = 5), bleb revision ( = 2), synechiotomy ( = 4), and cyclophotocoagulation ( = 1). The proportion of drop-free patients significantly increased after PPV compared with that before MG development (38.5% versus 15.4%). Complications were observed in 11 cases: choroidal detachments with spontaneous resolution ( = 2); retinal detachment ( = 1); constant mydriasis ( = 1), neovascular glaucoma ( = 1); obstruction of filtrating zone by iris ( = 1) and by blood clot ( = 1); posterior synechia formation causing IOP rise ( = 4 (all resolved after synechiotomy)). The cataract group experienced significantly fewer complications than the trabeculectomy group (17.4% vs. 53.8%, respectively). There were no differences in the risk of MG among the different surgeries. However, higher IOP in the predisposed eye (versus contra-lateral eye) could indicate additional risk of MG after cataract surgery. PPV afforded reliable treatment for MG and the possibility for glaucoma patients to discontinue topical treatment.
尽管存在已确立的共同危险因素，但恶性青光眼 (MG) 仍然是一种罕见的疾病，其治疗具有挑战性。我们旨在分析不同手术后 MG 的危险因素差异以及经睫状体平坦部玻璃体切除术 (PPV) 治疗后的结果。本回顾性研究包括 2005 年 1 月至 2015 年 12 月在立陶宛卫生科学大学考纳斯眼科系接受 PPV 治疗的 MG 病例。共分析了 39 例病例：23 例（59%）白内障手术后，13 例（33.3%）小梁切除术后，3 例（7.7%）其他手术后。各组之间的特征无差异。晶状体屈光力在白内障组中明显更高，MG 前受影响眼中的眼内压（IOP）明显更高。92.3%达到正常眼压，75%恢复正常前房。其他措施包括滴眼液（=24）、小梁切除术（=5）、滤过泡修正术（=2）、虹膜分离术（=4）和光凝术（=1）。与 MG 发生前相比，PPV 后无需滴药的患者比例明显增加（38.5%对 15.4%）。11 例出现并发症：脉络膜脱离伴自发缓解（=2）；视网膜脱离（=1）；持续散瞳（=1）、新生血管性青光眼（=1）；虹膜（=1）和血凝块（=1）阻塞滤过区；后粘连导致眼压升高（=4（均经虹膜分离术缓解））。白内障组的并发症发生率明显低于小梁切除术组（分别为 17.4%和 53.8%）。不同手术的 MG 风险无差异。然而，预先存在的眼（与对侧眼相比）的 IOP 升高可能表明白内障手术后发生 MG 的风险增加。PPV 为 MG 提供了可靠的治疗方法，使青光眼患者有可能停止局部治疗。
