经睫状体扁平部超声粉碎治疗青光眼滤过术后V级核白内障一例  

Pars Plana Vitrectomy with Fragmentation in Emery V Cataract after Glaucoma Filtering Surgery: A Case Report

作　　者：刘国军 邴丽英 李成芳 杜敏晖 

机构地区：[1]青岛市中医医院(市海慈医院)眼科,山东 青岛

出　　处：《眼科学》2019年第4期169-172,共4页Hans Journal of Ophthalmology

摘　　要：青光眼滤过术后合并硬核白内障,同时角膜内皮细胞密度低,前房条件差,经典白内障手术风险大,并发症发生率高,我们收治1例,经后路超声粉碎摘除白内障,一期植入后房型人工晶体,术后效果良好,患者不仅脱盲而且脱残,现与同仁分享。患者,女,76岁,主诉:右眼青光眼滤过术后10余年,视力下降5年加重2年。眼科检查:视力:右0.01,矫正无助,左无光感,眼压:右10.3 mmHg,左10.8 mmHg。右眼上方球结膜见扁平滤过泡,前房中央深度约2.5 CT,周边约1/4 CT,前房上方周切口附近见半透明胶样组织堆积,且局限性虹膜前粘连,瞳孔缘见机化膜,4:00~5:00后粘连,晶状体皮质及核棕黑色混浊,眼底窥不入。右眼角膜内皮细胞计数751个/mm2,B超示玻璃体轻度混浊伴后脱离。诊断:1) 白内障OD;2) 青光眼滤过术后OU。常规术前准备,于2019年3月28在神经阻滞麻醉下行右眼瞳孔成形联合经后路晶状体超声粉碎吸除及后房型人工晶体植入术,手术顺利。术后抗生素及糖皮质激素滴眼液点眼预防感染、减轻炎症反应。术后第四天右眼视力0.3,眼压13 mmHg,角膜透明,人工晶体位正,治愈出院。术后6月随诊,右眼视力0.25,矫正视力0.4,眼压12 mmHg,角膜透明,人工晶体位正,复查角膜内皮细胞计数740个/mm2。结论:青光眼滤过术后合并V级核白内障,同时角膜内皮少,Emery V cataract surgery after glaucoma filtering operation, with low corneal endothelial cells density and poor anterior chamber conditions, has great difficulty and increased postoperative complications (POC). We treated such a patient by Pars Plana Vitrectomy (PPV) with Fragmentation combined intraocular lens (IOL) implantation, and the patient obtained a wonderful effect. Now we share the case with colleagues. The patient, a 76-year-old woman, complained of blurred right vision for 5 years which increased for 2 years 10 years after glaucoma filtering surgery. Ophthalmic examination: Visual acuity was 0.01 in the right eye and NLP in the left eye;intra ocular pressure (IOP) was OD 10.3 mmHg and OS 10.8 mmHg. Flat filtering bleb can be observed in the right eye. The central depth of the anterior chamber was about 2.5 CT, and the periphery was about 1/4 CT. Translucent gelatinous tissue accumulation and anterior synechia of the iris was observed near iris hole above at 12 o’clock. The fibrosis membrane was observed around pupillary edge, and the iris adhereed backwards to the anterior capsule of the lens at 4:00-5:00.The lens is blakish brown, and fundus cannot be observed. The number of corneal endothelial cells in the right eye was 751/mm2, and B-type ultrasonography revealed vitreous floaters and posterior vitreous detachment. The patient is diagnosed with cataract OD, after glaucoma filtering operation OU. We performed PPV with fragmentation (23-gauge 3-port PPV + pars plana ultrasonic fragmentation) combined IOL implantation. Levofloxacin eye drops and tobramycin dexamethasone eye drops were used in the following days. In the fourth day, the right visual acuity was 0.3, and the intra ocular pressure is normal. Slit-lamp microscopy reveals right eye cornea clear and IOL sulcus implant. At 6 months after surgery, the best corrected visual acuity (BCVA) was of the right eye 0.4, and the intraocular pressure was 12 mmHg. The cornea was transparent. Corneal endothelial cells density was calculated 740/mm2 by s

关 键 词：硬核 白内障 经后路晶状体超声粉碎 青光眼 角膜内皮 

分 类 号：R47[医药卫生—护理学]