Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Viale Risorgimento 80, Reggio Emilia, Italy.
Ophthalmology Unit, DIMES, Alma Mater Studiorum, University of Bologna and S. Orsola-Malpighi Teaching Hospital, 40138, Bologna, Italy.
BMC Ophthalmol. 2022 Feb 8;22(1):59. doi: 10.1186/s12886-022-02276-3.
To report a case of malignant glaucoma that developed after gonioscopy-assisted transluminal trabeculotomy (GATT).
An 85-year-old male pseudophakic patient affected by pseudoexfoliative glaucoma (PEXG), unresponsive to medical glaucoma treatment, underwent uneventful GATT surgery. On the first day after surgery, the eye showed a shallow central and peripheral anterior chamber (AC) with a raised intraocular pressure (IOP) measured at 55 mmHg. Optical coherence tomography and ultrasound biomicroscopy confirmed the diagnosis of malignant glaucoma. Laser iridotomy, posterior capsulotomy and hyaloidotomy were performed, and the patient was treated with atropine sulphate 1%, maximum topical and systemic ocular hypotensive drugs with no improvement in the IOP. Subsequently, the patient underwent pars plana anterior vitrectomy, resulting in deepening of the AC with opening of the iridocorneal angle and decrease of the IOP. No further postoperative complications were recorded, and the IOP remained controlled 12 months after surgery without antiglaucoma medications.
Despite the minimally invasive profile of GATT, malignant glaucoma may develop after this procedure. Early recognition and prompt treatment are mandatory for preventing permanent visual loss.
报告一例在房角镜辅助经巩膜小梁切开术（GATT）后发生恶性青光眼的病例。
一名 85 岁男性假晶状体患者患有剥脱性青光眼（PEXG），对药物治疗青光眼反应不佳，行 GATT 手术顺利。术后第一天，眼睛出现浅中央和周边前房（AC），眼压（IOP）升高至 55mmHg。光学相干断层扫描和超声生物显微镜证实了恶性青光眼的诊断。行激光虹膜切开术、后囊切开术和玻璃体切割术，患者使用硫酸阿托品 1%、最大剂量局部和全身降眼压药物，但 IOP 无改善。随后，患者行睫状体平坦部前段玻璃体切除术，导致 AC 加深，房角开放，IOP 降低。术后无其他并发症发生，IOP 在术后 12 个月仍得到控制，无需抗青光眼药物治疗。
尽管 GATT 具有微创性，但该手术后仍可能发生恶性青光眼。早期识别和及时治疗对于预防永久性视力丧失至关重要。
