El Matri Khaled, Gouider Dhouha, Limaiem Rim, Chebil Ahmed, Henchiri Meher, Falfoul Yousra, El Matri Leila
Department B, Institut Hedi Rais d'ophtalmologie de Tunis, Tunis, Tunisia.
Oculogenetic Laboratory, LR14SP01, Tunis, Tunisia.
J Curr Ophthalmol. 2022 Jul 26;34(2):260-263. doi: 10.4103/joco.joco_3_22. eCollection 2022 Apr-Jun.
To report a case of a bilateral complex uveitic glaucoma (UG) with pupillary block, rupture of the anterior lens capsule, and malignant glaucoma in a young high-myopic patient and to report anterior segment optical coherence tomography (AS-OCT) findings initially and following surgery.
A 21-year-old high-myopic woman who had a history of anterior uveitis with extensive posterior synechiae, presented with acute bilateral ocular pain, redness, and blurred vision following bilateral Nd: YAG laser peripheral iridotomy (LPI).
Visual acuity was limited to light perception in both eyes (OU), with a flat anterior chamber (AC) and anterior luxation of lens fragments. Intraocular pressure (IOP) was over 60 mmHg OU. AS-OCT showed closed angles and hyperreflective heterogeneous material within the flat AC. The iris and lens fragments were plated against the corneal endothelium OU. We performed an urgent pars plana vitrectomy associated with lensectomy. It was uneventful in OU. Repeated AS-OCT revealed a deep AC, widely open angles, and aphakia. IOP was lowered to 9 mmHg and visual acuity improved to 5/10 in OU.
Performing LPI might be harmful in the presence of UG with extensive posterior synechia, resulting in complex mechanism glaucoma with aqueous misdirection syndrome associated with a pupillary block due to anterior lens luxation, even in high-myopic eyes. Nd: YAG LPI should not be performed simultaneously in OU, especially in pathologic eyes, to prevent bilateral vision-threatening complications. AS-OCT was of great help, allowing easy and detailed ultrastructural assessment of the ACs, and iridocorneal angles before and after surgery.
报告一例年轻高度近视患者双侧复杂性葡萄膜炎性青光眼（UG）合并瞳孔阻滞、晶状体前囊破裂及恶性青光眼的病例，并报告术前及术后前段光学相干断层扫描（AS-OCT）结果。
一名21岁高度近视女性，有前葡萄膜炎伴广泛后粘连病史，在双侧钕：钇铝石榴石激光周边虹膜切开术（LPI）后出现双侧急性眼痛、眼红和视力模糊。
双眼视力均降至光感，前房扁平，晶状体碎片前脱位。双眼眼压均超过60 mmHg。AS-OCT显示前房角关闭，扁平前房内有高反射性异质物质。双眼虹膜和晶状体碎片贴附于角膜内皮。我们进行了紧急玻璃体切割联合晶状体切除术。双眼手术过程顺利。重复AS-OCT显示前房加深，房角广泛开放，无晶状体。眼压降至9 mmHg，双眼视力提高到5/10。
在存在广泛后粘连的UG患者中进行LPI可能有害，会导致复杂机制性青光眼，伴有因晶状体前脱位引起的瞳孔阻滞相关的房水错向综合征，即使在高度近视眼中也是如此。钕：钇铝石榴石激光LPI不应在双眼同时进行，尤其是在病理性眼中，以防止双侧视力威胁性并发症。AS-OCT有很大帮助，可轻松、详细地评估手术前后前房和虹膜角膜角的超微结构。
