Konareva-Kostianeva Marieta, Kostianeva-Zhelinska Snezhina, Stoyanova Nina
Medical University of Plovdiv, Plovdiv, Bulgaria.
Folia Med (Plovdiv). 2019 Dec 31;61(4):506-511. doi: 10.3897/folmed.61.e48259.
To present 5 cases of late choroidal detachment occurring spontaneously in pseudophakic glaucomatous eyes with previous trabeculectomy before cataract surgery. We discuss the causes, risk factors, frequency, diagnostic methods, differential diagnosis, and treatment of this disease.
In the presented 5 cases the choroidal effusion is proved by ophthalmoscopy and echography. Late choroidal detachment occurs after phacoemulsification 6 months at the earliest and 9 years at the latest (mean period 2.5 years) in glaucomatous eyes with previous trabeculectomy. To prove choroidal detachment we accomplished routine ophthalmological examination including medical history, visual acuity, tonometry, examination of anterior segment (AS) and fundus. We have done B-scan echography using А/В Ocular Ultrasound Aviso Quantel Medical.
One of the patients had hemorrhagic detachment confirmed by B-scan echography, the other four patients had serous detachment. The examined patients had the glaucomatous disease for 10.4±6.11 years (mean±SD). Mean age at the time of choroidal effusion diagnosis was 76.8±7.6 years (68-87 years). The period between the trabeculectomy and the following phacoemulsification was 6±3.08 years (from 1 to 9 years). All patients received anti-glaucomatous topical therapy, including carbonic anhydrase inhibitors, before the occurrence of the effusion. In all cases conservative treatment with corticosteroids and cycloplegics was enough to overcome the detachment and restore visual acuity.
Late choroidal effusion after phacoemulsification in eyes with previous trabeculectomy is associated with an application of unjustified powerful hypotensive topical medications after cataract surgery associated with an additional reduction of intraocular pressure in most cases.
介绍5例在白内障手术前行小梁切除术的人工晶状体性青光眼眼中自发发生的晚期脉络膜脱离病例。我们讨论了这种疾病的病因、危险因素、发生率、诊断方法、鉴别诊断和治疗。
在这5例病例中，脉络膜积液通过检眼镜检查和超声检查得以证实。晚期脉络膜脱离最早在小梁切除术后6个月、最晚在9年（平均2.5年）发生于曾行小梁切除术的青光眼眼中。为证实脉络膜脱离，我们完成了包括病史、视力、眼压测量、眼前节检查和眼底检查在内的常规眼科检查。我们使用Quantel Medical公司的A/B型眼科超声Aviso进行了B超检查。
1例患者经B超检查确诊为出血性脱离，另外4例患者为浆液性脱离。所检查的患者患青光眼10.4±6.11年（平均±标准差）。脉络膜积液诊断时的平均年龄为76.8±7.6岁（68 - 87岁）。小梁切除术与后续白内障超声乳化术之间的间隔为6±3.08年（1至9年）。所有患者在积液发生前均接受了包括碳酸酐酶抑制剂在内的抗青光眼局部治疗。在所有病例中，使用皮质类固醇和睫状肌麻痹剂进行保守治疗足以克服脱离并恢复视力。
在曾行小梁切除术的眼中，白内障超声乳化术后的晚期脉络膜积液与白内障手术后不合理地使用强效降眼压局部药物有关，在大多数情况下这会导致眼压进一步降低。
