Luo Jihan, Liu Zhen, Zhao Lin, Zhou Yi, Kong Li, Sun Yang
Department of Ophthalmology, Chongqing General Hospital, University of Chinese Academy of Science, CGH, UCAS, Chongqing, China.
Chongqing Aier Eye Hospital, No.2, Huatang Road, Jiangbei District, Chongqing, China.
BMC Ophthalmol. 2021 Jan 7;21(1):16. doi: 10.1186/s12886-020-01743-z.
Ultrasound cycloplasty (UCP) is a non-invasive procedure for glaucoma treatment. Using high-intensity focused ultrasound to work on the ciliary body, the generation of aqueous humor can be reduced and the drainage of aqueous humor through the uveoscleral pathway can be enhanced. Recently, this therapy is gradually gaining clinical recognition. We report a case of a patient with glaucoma who accepted UCP in another hospital, but because of a worsening of a preexistent cataract and an insufficient IOP lowering effect, finally underwent cataract surgery in both eyes in our hospital, during the surgery we observed the unusual opacities probably due to UCP mistreatment.
Patient was diagnosed as chronic angle closure glaucoma and catacract, accepted UCP on both eyes in another hospital 4 months ago. After the UCP therapy, the pupil was vertical ellipse, the UCP didn't have a sufficient effect on IOP and forced us to do cataract surgery to lower IOP. During the cataract surgery, some unusual white opacities in the peripheral cortex with clear boundary were found. Inaccurate WtW measurement was the most likely cause of the injury, which resulted in the use of the small-size UCP probe and the downward movement of the UCP probe.
UCP should not be a first line treatment in a patient with cataract and angle closure glaucoma, cataract extraction is a better choice. The appropriate case selection needs to be more strict and the preoperative indexes measurements need to be more accurate.
超声睫状体成形术（UCP）是一种用于青光眼治疗的非侵入性手术。利用高强度聚焦超声作用于睫状体，可减少房水生成，并增强房水经葡萄膜巩膜途径的引流。近来，该疗法逐渐获得临床认可。我们报告一例青光眼患者，其在另一家医院接受了UCP治疗，但因原有白内障病情恶化且眼压降低效果不佳，最终在我院接受了双眼白内障手术，术中我们观察到可能因UCP操作不当所致的异常混浊。
患者被诊断为慢性闭角型青光眼合并白内障，4个月前在另一家医院接受了双眼UCP治疗。UCP治疗后，瞳孔呈垂直椭圆形，UCP对眼压的降低效果不佳，迫使我们进行白内障手术以降低眼压。白内障手术过程中，发现周边皮质有一些边界清晰的异常白色混浊。眼轴长度测量不准确很可能是损伤的原因，这导致使用了小尺寸UCP探头以及UCP探头向下移动。
对于合并白内障和闭角型青光眼的患者，UCP不应作为一线治疗方法，白内障摘除术是更好的选择。病例选择应更加严格，术前指标测量应更加准确。
