Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
Department of Ophthalmology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Middle East Afr J Ophthalmol. 2021 Sep 25;28(2):137-139. doi: 10.4103/meajo.meajo_19_21. eCollection 2021 Apr-Jun.
In aqueous misdirection, the interval between diagnosis and surgical intervention is inversely proportional to the success of the surgery. Here, we report a successful outcome of pars plana vitrectomy (PPV) with irido-zonulo-hyaloidectomy 4 years after the onset of the disease. A 34-year-old female, known to have primary angle closure glaucoma, underwent trabeculectomy with mitomycin C in the right eye for uncontrolled intraocular pressure (IOP). Six weeks after the surgery, the patient presented with a shallow anterior chamber centrally and peripheral iridocorneal touch along with a patent peripheral iridectomy. Ultrasound biomicroscopy showed a shallow AC centrally with peripheral iridocorneal touch, and the ciliary body was rotated forward confirming the diagnosis of aqueous misdirection. The patient refused surgical management and was managed medically, which was unsuccessful. Four years after the diagnosis, the patient underwent PPV with irido-zonulo-hyaloidectomy because of progressive shallowing of the AC and corneal edema. One month postoperatively, visual acuity improved from 20/200 to 20/60, and the AC maintained appropriate depth. In conclusion, PPV with irido-zonulo-hyaloidectomy may result in a complete resolution of a chronic low-grade form of aqueous misdirection.
在水性迷路中，从诊断到手术干预的时间间隔与手术的成功率成反比。在这里，我们报告了一例疾病发作 4 年后成功进行的扁平部玻璃体切除术（PPV）联合虹膜-睫状体-脉络膜切除术。一名 34 岁女性，已知患有原发性闭角型青光眼，右眼行小梁切除术联合丝裂霉素 C 治疗眼压控制不良。手术后 6 周，患者出现中央浅前房和周边虹膜角膜接触，同时存在周边虹膜切除术通畅。超声生物显微镜显示中央浅前房伴周边虹膜角膜接触，睫状体向前旋转，确诊为水性迷路。患者拒绝手术治疗，接受药物治疗，但效果不佳。诊断 4 年后，由于前房深度进一步变浅和角膜水肿，患者行 PPV 联合虹膜-睫状体-脉络膜切除术。术后 1 个月，视力从 20/200 提高到 20/60，前房深度维持合适。总之，PPV 联合虹膜-睫状体-脉络膜切除术可能导致慢性低度水性迷路的完全缓解。
