From the Dr. Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India (S. Gupta, Lakra, Beniwal, Chawla, V. Gupta); Iclinix Advanced Eye Care, New Delhi, India (Gogia).
J Cataract Refract Surg. 2021 Nov 1;47(11):e14-e18. doi: 10.1097/j.jcrs.0000000000000519.
The management of malignant glaucoma involves either anterior vitrectomy with zonulectomy and iridectomy or 3-port core pars plana vitrectomy (PPV) by retinal surgeons. The proposed modification can be performed with reasonable success rates. In this technique, synechiolysis and anterior chamber irrigation were performed through a limbal incision, and a single-port 23- or 25-gauge vitrector was introduced through PPV superotemporally to perform anterior vitrectomy and central posterior capsulotomy in pseudophakic eyes. The same procedure can be performed after cataract surgery in phakic eyes. Vitrectomy is continued until anterior chamber deepens, ensuring a conduit between anterior and posterior chambers through the posterior capsulotomy alone, bypassing the need for a posterior iridectomy/zonulectomy. In a series on 9 eyes, all achieved optimization of anterior chamber depth with intraocular pressure normalization in 8 of 9 eyes, without showing any signs of recurrence at a mean follow-up of 8.6 months.
恶性青光眼的治疗包括前部玻璃体切除术联合巩膜切开和虹膜切除术,或由视网膜外科医生进行 3 端口核心扁平部玻璃体切除术(PPV)。该改良术式可获得较高的成功率。在该技术中,通过角巩膜缘切口进行粘连松解和前房冲洗,并通过 PPV 上方引入单端口 23 或 25 号玻切头,在前房已经注满黏弹剂的白内障术后眼行前部玻璃体切除术和中央后囊切开术。在有晶状体眼行白内障手术后也可以进行同样的操作。持续进行玻璃体切除术,直至前房加深,通过后囊切开术单独在前房和后房之间建立一个通道,从而无需进行后房虹膜切除术/巩膜切开术。在一项针对 9 只眼的研究中,所有眼的前房深度均得到优化,9 只眼中的 8 只眼眼压恢复正常,平均随访 8.6 个月,均未见复发迹象。