Nakao Isao, Mine Tadashi, Sakaguchi Mika, Enaida Hiroshi
Department of Ophthalmology, Faculty of Medicine, Saga University, Saga, 849-8501, Japan.
J Med Case Rep. 2019 Aug 11;13(1):249. doi: 10.1186/s13256-019-2186-5.
Gonioscopy-assisted transluminal trabeculectomy is a novel and useful technique for ab interno trabeculotomy. However, gonioscopy-assisted transluminal trabeculectomy is difficult to perform in patients with corneal opacity or in patients with sequelae of cerebral infarction and cervical osteoarthritis with severe limitation of spinal mobility. This is because observing Schlemm's canal during surgery using gonioscopy is difficult. In this report, we introduce a new and beneficial surgical technique of transluminal trabeculotomy for these patients, using an ophthalmic endoscope for cases in which normal gonioscopy-assisted transluminal trabeculectomy is difficult.
Our patient was a 65-year-old Japanese man with cervical osteoarthritis with severe limitation of spinal mobility who showed primary open-angle glaucoma of the right eye. He had limited conversion of his head during surgery because of complications. Therefore, we performed transluminal trabeculotomy using an ophthalmic endoscope. Finally, ab interno trabeculotomy of 200 degrees was achieved by this method, and an average reduction in ocular pressure of 60% from baseline was achieved after surgery, with no major complications.
This surgical technique may be useful as an alternative method for normal gonioscopy-assisted transluminal trabeculectomy in difficult cases.
前房角镜辅助经腔小梁切除术是一种用于内路小梁切开术的新颖且有用的技术。然而，对于角膜混浊患者或患有脑梗死后遗症和颈椎骨关节炎且脊柱活动严重受限的患者，前房角镜辅助经腔小梁切除术很难实施。这是因为在手术过程中使用前房角镜观察施莱姆管很困难。在本报告中，我们介绍一种新的、有益的经腔小梁切开手术技术，对于正常前房角镜辅助经腔小梁切除术难以实施的病例，使用眼科内窥镜为这些患者进行手术。
我们的患者是一名65岁的日本男性，患有颈椎骨关节炎且脊柱活动严重受限，右眼患有原发性开角型青光眼。由于并发症，他在手术过程中头部转动受限。因此，我们使用眼科内窥镜进行经腔小梁切开术。最终，通过该方法实现了200度的内路小梁切开，术后眼压平均较基线降低了60%，且无重大并发症。
在困难病例中，这种手术技术作为正常前房角镜辅助经腔小梁切除术的替代方法可能是有用的。
