开放角光眼和富士缩症的眼睛
Thomas W Samuelson1, Mark D Larson, Analisa Arosemena
1Minneapolis, Minnesota.
Journal of cataract and refractive surgery
|July 10, 2024
概括
本案例研究讨论了经过Descemet剥离内皮角膜成形术 (DSEK) 后管理不受控制的眼内压力 (IOP) 的情况,该患者有开角玻璃眼 (OAG) 的病史. 它探讨了手术选择和类固醇管理,以保持视力.
科学领域:
- 眼科医生 眼科 眼科
- 视光眼管理 视光眼管理
- 角膜外科手术 角膜外科手术
背景情况:
- 一名62岁的女性有开角青光眼 (OAG) 的病史和之前的眼切除术,在Descemet剥离内皮角膜整形术 (DSEK) 后三个月内,左眼的眼内压力 (IOP) 失控.
- 该患者正在接受IOP的最大耐受性药物治疗,包括乙胺,布里莫尼丁,多胺和蒂莫洛尔,并且还在最近的DSEK中服用处方类固醇.
- 眼科病史包括中度近视,福克斯缩症和假定的类固醇反应,右眼在没有药物治疗的情况下保持低内血压.
研究的目的:
- 确定最近接受了Descemet剥离内皮角膜整形手术 (DSEK) 的患者左眼中失控眼内压 (IOP) 的最佳管理策略.
- 评估停止类固醇治疗对IOP控制的潜在影响,以及进一步进行绿眼瘤手术的必要性.
- 考虑患者在青光眼发病时的年龄和之前的手术对选择DSEK后的手术干预的影响.
主要方法:
- 临床检查包括视力敏度,戈德曼平面测音仪,瞳孔评估,视野,裂灯生物显微镜和 fundus 评估.
- 用视网膜神经纤维层 (RNFL) 的光学连贯性断层 (OCT) 和轴长度测量进行前段成像.
- 对患者病史的审查,包括以前的玻璃眼外科手术 (垂眼切除术),角膜手术 (DSEK) 和目前的IOP医疗管理.
主要成果:
- 尽管进行了最大的医疗治疗,但左眼内压力为25mmHg,而右眼内压力为12mmHg.
- 视力敏度在20/30 (右) 和20/40 (左) 稳定;OCT在两只眼睛中显示稳定中度RNFL稀释.
- 结膜显示痕,但重复带切除术或Xen Gel支架植入似乎是可行的;角度是开的.
结论:
- 管理需要平衡IOP控制的必要性与DSEK后进一步的玻璃眼外科手术的风险,考虑到正在进行的类固醇使用.
- 可以考虑停止使用类固醇来降低内脏压力,但这种决定必须与角膜外科医生对移植存活的建议进行权衡.
- 诸如重复管切除术或Xen Gel支架之类的手术选择可能是可行的,而手术选择可能会受到患者早期光瘤病史和之前的手术的影响.
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