Schlote T, Mielke J, Zierhut M, Jean B, Thiel H J
Abteilung I: Allgemeine Augenheilkunde mit Poliklinik, Universitäts-Augenklinik Tübingen.
Klin Monbl Augenheilkd. 1998 Nov;213(5):306-8. doi: 10.1055/s-2008-1034992.
A 60-year-old female patient presented with recurrent anterior, necrotizing scleritis with inflammation and a newly developed secondary glaucoma in the right eye. Anterior uveitis occurred some years before. Severe scleral thinning was circumferentially present and focal scleral ectasia was found. Physical examination revealed no systemic association of scleritis. Immunosuppressive therapy with metotrexate was initiated and control of scleritis achieved. Intraocular pressure elevation persisted and was refractory to glaucoma medication. Diurnal pressure curve showed IOP-values of 40 mm Hg despite the use of systemic carbonic anhydrase inhibitors. Visual acuity was 20/50 in the right and 20/25 in the left eye.
Diode laser cyclophotocoagulation (Oculight SLx 810 nm, Iris Medical Instruments Inc. California, USA) was performed under general anaesthesia using reduced parameters for application (12 laser spots, 1 second, 1.25 W). No complications occurred during and after laser application. Postoperatively, intraocular pressure was within normal range between 14 and 18 mm Hg. No reactivation of scleritis or uveitis was seen.
In our experience, diode laser cyclophotocoagulation is effective and safe in treating secondary glaucoma associated with anterior, necrotizing scleritis with inflammation and uveitis using reduced parameters for application.
一名60岁女性患者，右眼出现复发性前部坏死性巩膜炎伴炎症以及新发生的继发性青光眼。前部葡萄膜炎在数年前出现。巩膜严重变薄呈环形，且发现有局限性巩膜扩张。体格检查未发现巩膜炎与全身疾病相关。开始使用甲氨蝶呤进行免疫抑制治疗，巩膜炎得到控制。眼压持续升高，对青光眼药物治疗无效。昼夜眼压曲线显示，尽管使用了全身碳酸酐酶抑制剂，眼压仍为40毫米汞柱。右眼视力为20/50，左眼视力为20/25。
在全身麻醉下使用降低的参数（12个激光点，1秒，1.25瓦）进行二极管激光睫状体光凝术（Oculight SLx 810纳米，美国加利福尼亚州虹膜医疗仪器公司）。激光治疗期间及之后未发生并发症。术后眼压在14至18毫米汞柱的正常范围内。未观察到巩膜炎或葡萄膜炎复发。
根据我们的经验，使用降低的参数进行二极管激光睫状体光凝术治疗与前部坏死性巩膜炎伴炎症和葡萄膜炎相关的继发性青光眼是有效且安全的。
