白内障术后1 d发生恶性青光眼1例报道

黄煜薇　　杨芳　　余锦强

[摘要] 恶性青光眼（Malignant glaucoma，MG）是一类发作迅速、症状重、治疗难度大的继发性青光眼，多发生于青光眼滤过术后[1]，目前已有许多相关病案报道。然而白内障超乳晶体植入术后发生恶性青光眼的报道却并不多见。短眼轴是MG的独立危险因素[2]，前房浅、房角狭窄、晶状体较厚并且前移的特点[3-5]，与原发性闭角型青光眼（Primary angle-closure glaucoma，PACG）眼前节形态的高度相似性，使得合并短眼轴的PACG的术后风险性更大。该文记录了1例慢性闭角型青光眼患者行白内障术后1 d发生MG的相关情况。

[关键词] 短眼轴;恶性青光眼;白内障超乳晶状体植入术;慢性闭角型青光眼

[中图分类号] R779.6          [文献标识码] C          [文章编号] 1673-9701（2021）21-0155-03

A case report of malignant glaucoma occurred one day after cataract surgery

HUANG Yuwei1   YANG Fang1， 2   YU Jinqiang1， 2

1.Postgraduate Training Base， Jinzhou Medical University， Hubei University of Medicine，  Shiyan   442000， China; 2. Department of Ophthalmology， Shiyan Renmin Hospital， Shiyan   442000， China

[Abstract] Malignant glaucoma （MG） is a kind of secondary glaucoma with rapid onset， severe symptoms and difficult treatment， which mostly occurs after glaucoma filtration surgery. At present， there are many reported related medical records. However， there are few reports of MG caused by phacoemulsification. Short eye axial length is an independent risk factor for MG， which has the features of shallow anterior chamber， narrow angle， thick lens and forward movement. It is highly similar to the shape of anterior segment of primary angle-closure glaucoma （PACG）. Therefore， the postoperative risk of PACG with complicated short eye axial length is higher. In this paper， the incidence of MG in a patient with chronic angle-closure glaucoma one day after cataract surgery was recorded.

[Key words] Short eye axis; Malignant glaucoma; Implantation of phacoemulsification lens for cataract; Chronic angle-closure glaucoma

1 病例介紹

61岁女性患者，2020年9月25日因“右眼视物不清5年余”入院。既往体健，无特殊病史。入院专科检查：视力：右眼0.2，左眼0.4，双眼角膜透明，中央前房深度可，周边深度浅（右眼周深<1/4 CT;左眼周深<1/5 CT），瞳孔圆，直径（Diameter，D）约3 mm，光反射存在，晶体混浊（右眼C1N1P4 左眼C1N1P2），小瞳下眼底见视盘界清，色淡红，C/D约0.3，后极部网膜平伏，无出血及渗出，眼压：右眼25 mmHg/左眼14 mmHg。入院诊断：双眼后囊下型老年性白内障、双眼慢性闭角型青光眼可疑？完善辅助检查：医学验光：右眼-1.50DC×90=0.4，左眼+2.00DS/+1.50DC×10=0.9+;眼部生物测量：（右眼）眼轴（Axial length，AL）21.52 mm、中央角膜厚度（Cenreal corneal thickness，CCT）481 μm、前房深度（Anterior chamber depth，ACD）1.68 mm、晶状体厚度（Lens thickness，LT）4.99 mm，（左眼）AL21.53 mm、CCT484 μm、ACD2.21 mm、LT4.92 mm;光学相干断层扫描（Optical Coherence Tomography，OCT）显示右眼房角狭窄，甚至关闭（图1）。视盘OCT（图2）：右眼视神经纤维层（Retinal nerve fiber layer，RNFL）厚度未见明显变薄。视野检查：右眼鼻侧阶梯（图3），左眼未见明显异常。房角镜检查：右眼全周匍匐样粘连，静态观察全周窄IV，动态观察下方开放 余方位关闭;左眼房角点状粘连，静态观察上方窄III鼻侧窄IV余方位宽角，动态观察鼻侧关闭余方位开方。综合以上检查结果，考虑双眼慢性闭角型青光眼早期。