Gizzi Corrado, Costa Giacomo, Servadei Roberto, Abed Edoardo, Ning Brigid, Sharma Anant, Barton Keith
Ospedale Morgagni-Pierantoni, Forlì, Italy.
Moorfields Eye Hospital, NHS Trust, London, UK.
Eur J Ophthalmol. 2022 Jul;32(4):NP115-NP119. doi: 10.1177/11206721211003492. Epub 2021 Mar 18.
To describe a case of malignant glaucoma following insertion of a Preserflo™ MicroShunt in a patient with primary open angle glaucoma (POAG).
Case report.
A 46-year-old Caucasian man with medically uncontrolled POAG developed malignant glaucoma 1 day after an uncomplicated insertion of a mitomycin C (MMC) augmented Preserflo MicroShunt (PMS).
Initial medical treatment with aqueous suppressants and atropine 1% resulted in temporary resolution of the episode, although partial occlusion of the PMS with iris required a Nd:YAG laser iridotomy to open the inlet of the device. However, the malignant glaucoma recurred 6 days later. Temporary resolution was subsequently achieved with an Nd:YAG laser peripheral irido-zonulo-hyaloidotomy in combination with topical atropine, though a subsequent PMS revision was required due to bleb encapsulation. Unfortunately, the revision procedure was followed 2 days later, by a further recurrence of malignant glaucoma which was eventually resolved by left pars plana vitrectomy (PPV) in combination with clear lens extraction (CLE) and surgical irido-zonulo-hyaloidectomy. Subsequently, the eye remained stable, with a deep anterior chamber (AC), a partially functioning bleb, and an intraocular pressure (IOP) of 14 mmHg on one topical IOP-lowering agent, 8 months after the last procedure.
The management of malignant glaucoma after PMS insertion and its subsequent clinical course is described. Apart from the propensity for a small tube such as the PMS to obstruct with iris when the AC is shallow, management is similar to other scenarios in which malignant glaucoma may develop.
描述1例原发性开角型青光眼（POAG）患者植入Preserflo™微型分流器后发生恶性青光眼的病例。
病例报告。
1例46岁白种男性，药物治疗无法控制的POAG患者，在未发生并发症的情况下植入丝裂霉素C（MMC）增强型Preserflo微型分流器（PMS）1天后发生恶性青光眼。
最初使用房水抑制剂和1%阿托品进行药物治疗使病情暂时缓解，尽管虹膜部分阻塞PMS需要进行Nd:YAG激光虹膜切开术以打开装置入口。然而，6天后恶性青光眼复发。随后通过Nd:YAG激光周边虹膜-晶状体悬韧带-玻璃体膜切开术联合局部使用阿托品暂时缓解了病情，不过由于滤过泡包裹，随后需要对PMS进行修复。不幸的是，修复手术后2天，恶性青光眼再次复发，最终通过左眼玻璃体切除术（PPV）联合透明晶状体摘除术（CLE）及手术性虹膜-晶状体悬韧带-玻璃体膜切除术得以解决。此后，在最后一次手术后8个月，患眼保持稳定，前房深，滤过泡部分功能良好，使用一种局部降眼压药物时眼压为14 mmHg。
描述了PMS植入后恶性青光眼的处理及其后续临床过程。除了在浅前房时PMS这类小管径装置有被虹膜阻塞的倾向外，其处理与可能发生恶性青光眼的其他情况相似。
