El Helwe Hani, Ingram Zoë, Liebman Daniel, Falah Henisk, Solá-Del Valle David A
Ophthalmology, Harvard Medical School, Boston, USA.
Glaucoma, Massachusetts Eye and Ear, Boston, USA.
Cureus. 2023 Sep 4;15(9):e44683. doi: 10.7759/cureus.44683. eCollection 2023 Sep.
Predicting the visual outcome after cataract extraction can be challenging in glaucoma patients who develop cataracts. Here, we demonstrate the case of a patient with advanced glaucoma and a mild-to-moderate cataract at initial presentation, who demonstrated remarkable improvement in visual acuity following a period of controlled intraocular pressure (IOP) and the removal of a matured cataract at the time of surgery. A 64-year-old Haitian woman with severe mixed-mechanism glaucoma and hand motion vision in both eyes (OU) presented with intraocular pressures of 38 mmHg OD (oculus dexter/right eye) and 41 mmHg OS (oculus sinister/left eye) while on three IOP-lowering agents. Her medications were escalated to six IOP-lowering medications, and she underwent bilateral transscleral laser cyclophotocoagulation with both micropulse and continuous wave probes simultaneously. Postoperatively, IOPs dropped to 7 and 9 mmHg in the right and left eyes, respectively, and remained at or below target on three topical agents for the remainder of her follow-up. Contrastingly, the patient's cataract had progressed, and the decision was made to undergo cataract extraction OU sequentially. The subsequent clinical course demonstrated progressive visual improvement with 20/80 best-corrected visual acuity OU and increased independence with activities of daily living. This case illustrates the potential for visual improvement in an advanced glaucoma patient after removing a matured cataract despite limited prior expectations. Ocular comorbidities complicate but do not necessarily preclude appropriate interventions that may improve patients' vision-related quality of life.
对于患有白内障的青光眼患者，预测白内障摘除术后的视觉效果可能具有挑战性。在此，我们展示了一例初诊时患有晚期青光眼和轻度至中度白内障的患者病例，该患者在眼压得到控制一段时间后，以及手术时摘除成熟白内障后，视力有了显著改善。一名64岁的海地女性，患有严重的混合型青光眼，双眼手动视力，在使用三种降眼压药物时，右眼眼压为38 mmHg，左眼眼压为41 mmHg。她的药物增加到六种降眼压药物，并同时使用微脉冲和连续波探头进行了双侧经巩膜激光睫状体光凝术。术后，右眼和左眼眼压分别降至7 mmHg和9 mmHg，在后续随访的剩余时间里，使用三种局部用药时眼压保持在目标眼压或以下。相反，患者的白内障病情进展，因此决定依次对双眼进行白内障摘除术。随后的临床过程显示视力逐步改善，双眼最佳矫正视力达到20/80，日常生活活动的独立性增强。该病例表明，尽管此前预期有限，但晚期青光眼患者摘除成熟白内障后仍有视力改善的潜力。眼部合并症会使情况复杂化，但不一定会妨碍采取可能改善患者视力相关生活质量的适当干预措施。
