Laroche Daniel, Nkrumah Gideon
New York Eye and Ear Infirmary, Icahn School of Medicine of Mount Sinai, 10003, USA.
Advanced Eyecare of New York, NY, USA.
Am J Ophthalmol Case Rep. 2020 Feb 5;18:100617. doi: 10.1016/j.ajoc.2020.100617. eCollection 2020 Jun.
To report a case of refractory open angle glaucoma (POAG) in an osteogenesis imperfecta patient who was successfully treated with combination microinvasive glaucoma surgery: combined kahook blade goniotomy and ciliary sulcus suprachoroidal microtube insertion.
A 57-year-old woman with a history of osteoporosis, breast cancer, osteogenesis imperfecta, with uncontrolled POAG in right more than left. Anterior segment examination revealed thin blue sclera, the optic nerve examination revealed glaucomatous cupping with cup to disc ration of 0.9 in right and 0.7 in left. Her IOP on six (6) medications was 26 mmHg in the right eye. After discussion of the risks and benefits, she agreed to undergo combined kahook blade goniotomy and ciliary sulcus suprachoroidal microtube insertion surgery to lower her intraocular pressure. Her IOP at 6 months follow up was 13 in the right eye and a decrease number of medications from six (6) to three.
Patients with OI have homogenously thinner sclera and conjunctiva which pose a challenge to traditional subconjunctival surgical methods. Combined kahook blade goniotomy and ciliary sulcus suprachoroidal microtube insertion surgery are bleb sparing operations that enhances aqueous outflow to the aqueous veins and supraciliary space to lower intraocular pressure.
报告1例成骨不全患者难治性开角型青光眼（POAG），其通过联合微创青光眼手术成功治疗：联合卡胡克刀片前房角切开术和睫状沟脉络膜上腔微管植入术。
一名57岁女性，有骨质疏松症、乳腺癌、成骨不全病史，右眼POAG控制不佳，较左眼严重。眼前节检查显示巩膜呈薄蓝色，视神经检查显示青光眼性视盘凹陷，右眼杯盘比为0.9，左眼为0.7。她使用六种药物治疗时右眼眼压为26 mmHg。在讨论风险和益处后，她同意接受联合卡胡克刀片前房角切开术和睫状沟脉络膜上腔微管植入手术以降低眼压。随访6个月时，她右眼眼压为13 mmHg，用药数量从六种减少至三种。
成骨不全患者的巩膜和结膜均匀变薄，这给传统的结膜下手术方法带来了挑战。联合卡胡克刀片前房角切开术和睫状沟脉络膜上腔微管植入手术是不形成滤过泡的手术，可增强房水向房水静脉和睫状体上腔的流出，以降低眼压。
