Kocak I, Altintas A G, Yalvac I S, Nurozler A, Kasim R, Duman S
Glaucoma Section, Ankara Hospital, Department of Ophthalmology, Turkey.
Int Ophthalmol. 1996;20(1-3):107-11. doi: 10.1007/BF00212955.
To evaluate the criteria of diagnosis and management of secondary glaucoma in young nanophthalmic patients.
Considering the anatomic features and clinical characteristics, 22 eyes of 11 patients were identified as bilateral nanophthalmos. Intraocular pressures (IOP) were checked with Goldmann applanation or Keeler pulse-air 2000 tonometer, and Nd-Yag laser was used for iridotomies. Prophylactic V-shaped unsutured sclerectomies over the pars plana were combined with trabeculectomy, and Mitomycin C (MMC) in 0.2 mg/ml concentration was applied.
Among 22 eyes of bilateral nanophthalmic patients 8 eyes had secondary angle-closure glaucoma. Laser iridotomies were performed in 6 eyes. Laser iridotomy and supplemental medical therapy were sufficient in 4 out of 6 eyes. Mean IOP dropped from 26.4 to 14.5 mmHg in these patients. Due to continuous increase of IOP in the other patients, they underwent trabeculectomy with V-shaped sclerostomy and intraoperative MMC application. Mean IOP dropped from 39.3 mmHg to 19.3 mmHg. Postoperative uveal effusion on other major complications were not observed. Mean age of these patients was 14.6 years during treatment.
Management of glaucoma in nanophthalmus is complicated. Initial treatment is medical. If it is insufficient, laser iridotomies and V-shaped sclerostomies with filtration surgery can be performed at any age.
评估年轻小眼球患者继发性青光眼的诊断标准和治疗方法。
根据解剖特征和临床特点，11例患者的22只眼被确诊为双侧小眼球。使用Goldmann压平眼压计或Keeler脉搏空气眼压计2000测量眼压，并使用Nd-Yag激光进行虹膜切开术。在睫状体平坦部进行预防性V形未缝合巩膜切除术并联合小梁切除术，应用浓度为0.2mg/ml的丝裂霉素C（MMC）。
在双侧小眼球患者的22只眼中，8只眼患有继发性闭角型青光眼。6只眼进行了激光虹膜切开术。6只眼中有4只眼通过激光虹膜切开术和辅助药物治疗即可。这些患者的平均眼压从26.4mmHg降至14.5mmHg。由于其他患者的眼压持续升高，他们接受了V形巩膜造口小梁切除术并在术中应用MMC。平均眼压从39.3mmHg降至19.3mmHg。未观察到术后葡萄膜渗漏或其他主要并发症。这些患者治疗期间的平均年龄为14.6岁。
小眼球青光眼的治疗较为复杂。初始治疗为药物治疗。如果药物治疗不足，可在任何年龄进行激光虹膜切开术和V形巩膜造口滤过手术。
