Li Yan, Zhong Xin, Ma Di
Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, 515041, Guangdong, China.
Int Ophthalmol. 2025 May 5;45(1):173. doi: 10.1007/s10792-025-03527-0.
To review the clinical characteristics and managements of severe corneal ulcers in patients with end-stage glaucoma.
Retrospectively reviewed the medical records of patients diagnosed with severe corneal ulcers who had a history of end-stage glaucoma, including demographic profiles, medical histories, clinical features, and treatments.
Thirty patients (30 eyes) were included. The median age at presentation was 73.00 years (interquartile range [IQR]: 64.25-77.25 years). The majority of patients were previously diagnosed with primary angle-closure glaucoma (11/30, 36.67%). Nineteen patients (63.33%) were still using antiglaucoma medications within 6 months before the onset of corneal ulcer. Visual acuity was already severely impaired in these patients before the onset of corneal ulcer. At last visit before the onset, 20 eyes (66.67%) had intraocular pressure (IOP) greater than 21 mmHg. Corneal perforation occurred in 13 eyes (43.33%). Eleven eyes (36.67%) underwent debridement of corneal ulcer and conjunctival flap covering surgery, while 13 eyes (43.33%) eventually underwent evisceration. Patients without corneal perforation had received a greater variety of surgical or laser treatments in the past compared to those with corneal perforation (P = 0.047). A significantly larger proportion of patients with corneal perforation underwent evisceration (9/13 vs 4/17, P = 0.012).
Severe corneal ulcers in patients with end-stage glaucoma were characterized by advanced age, long-term use of topical antiglaucoma medications and poor IOP control. Nearly half of the patients lost their eyes. Active treatment of underlying diseases and careful attention to ocular surface condition are crucial in preventing corneal perforation and improving prognosis.
回顾终末期青光眼患者严重角膜溃疡的临床特征及治疗方法。
回顾性分析诊断为严重角膜溃疡且有终末期青光眼病史患者的病历，包括人口统计学资料、病史、临床特征及治疗情况。
纳入30例患者（30只眼）。就诊时的中位年龄为73.00岁（四分位间距[IQR]：64.25 - 77.25岁）。大多数患者既往诊断为原发性闭角型青光眼（11/30，36.67%）。19例患者（63.33%）在角膜溃疡发病前6个月内仍在使用抗青光眼药物。这些患者在角膜溃疡发病前视力已严重受损。在发病前的最后一次就诊时，20只眼（66.67%）眼压高于21 mmHg。13只眼（43.33%）发生角膜穿孔。11只眼（36.67%）接受了角膜溃疡清创及结膜瓣覆盖手术，13只眼（43.33%）最终接受了眼球摘除术。与角膜穿孔患者相比，无角膜穿孔患者过去接受的手术或激光治疗种类更多（P = 0.047）。角膜穿孔患者接受眼球摘除术的比例显著更高（9/13对4/17，P = 0.012）。
终末期青光眼患者的严重角膜溃疡具有年龄大、长期使用局部抗青光眼药物及眼压控制不佳的特点。近一半患者失明。积极治疗基础疾病并密切关注眼表状况对于预防角膜穿孔及改善预后至关重要。
