Kounatidou Nefeli Eleni, Filippopoulos Theodoros, Palioura Sotiria
National and Kapodistrian University of Athens Medical School, Athens, Greece.
Glaucoma Division, Athens Vision Eye Institute, Athens, Greece.
Int Med Case Rep J. 2022 Oct 11;15:563-568. doi: 10.2147/IMCRJ.S382810. eCollection 2022.
To describe the case of a monocular patient with ocular mucous membrane pemphigoid (MMP) and open angle glaucoma refractory to medical treatment, who was successfully managed with ab interno goniotomy at the time of cataract surgery.
A 63-year-old woman with a history of severe MMP presented with exacerbation of the disease in both eyes. Vision was 20/80 in the right eye and light perception in the left eye. Symblepharon formation, trichiasis and forniceal foreshortening were present in the right eye, while the cornea of the left eye was completely conjunctivalized. Following aggressive systemic immunosuppressive therapy with corticosteroids and cyclophosphamide, the disease was brought under control. However, the patient developed a mature cataract and high intraocular pressure (IOP) of 28 mmHg on maximal medical therapy. Due to the high risk of ocular MMP exacerbation with glaucoma filtration surgery, the decision was made to proceed with cataract extraction combined with ab interno goniotomy with the Kahook Dual Blade.
There were no intraoperative complications. The IOP has remained in the 12-14 mmHg range without any topical glaucoma medications over a total follow up of 3.5 years.
Ab interno goniotomy using the Kahook Dual Blade can significantly reduce IOP and medication burden in MMP cases, where any type of conjunctival incisional surgery could induce disease flare up. In this case, it represented a safe and effective surgical procedure for ocular MMP with concomitant refractory open angle glaucoma.
描述一例患有眼黏膜类天疱疮（MMP）且药物治疗无效的开角型青光眼单眼患者，其在白内障手术时通过内路房角切开术成功得到治疗。
一名63岁有严重MMP病史的女性双眼疾病加重。右眼视力为20/80，左眼仅有光感。右眼存在睑球粘连形成、倒睫和穹窿部缩短，而左眼角膜完全被结膜化。在使用皮质类固醇和环磷酰胺进行积极的全身免疫抑制治疗后，病情得到控制。然而，患者出现了成熟白内障，在最大药物治疗下眼压高达28 mmHg。由于青光眼滤过手术导致眼MMP病情加重的风险很高，决定采用Kahook双刃刀进行白内障摘除联合内路房角切开术。
术中无并发症。在总共3.5年的随访中，眼压一直保持在12 - 14 mmHg范围内，无需任何局部青光眼药物治疗。
使用Kahook双刃刀进行内路房角切开术可显著降低MMP病例的眼压和药物负担，因为任何类型的结膜切开手术都可能引发疾病发作。在该病例中，它是伴有难治性开角型青光眼的眼MMP的一种安全有效的手术方法。
