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青光眼-4
作者:     更新日期: 2020-04-17     访问次数: 12

程某某,男,63岁

Mr.Cheng,male,63 years old

一、病例特点

General Information

病史

现病史:患者20年前无明显诱因发现右眼渐进性视物不清,伴间断眼疼、头疼。1月前在外院门诊检查,诊断为“右眼青光眼 右眼白内障”,给予派立明 卢美根局部点眼降眼压,效果不佳。遂入我院手术治疗。

既往史:上硬腭肿物切除术后3年。

查体:健康。

Medical history

Present history: The patient complained of vision decrease in the right eye for twenty years with occasional eye pain and headache. The  diagnosis of glaucoma cataract of the right eye was made in other hospital and he was administrated brinzolamide eye drops and lumigan eye drops, Unfortunately, the effect was not satisfactory. Then, he was admitted for further surgical therapy to lower the intraocular pressure.

Past history: The patient underwent the hard palate neoplasm resection three years ago.

Physical examination: Body state is in good condition generally.

眼科检查

右眼:远视力0.1,最佳矫正视力0.8(-2.75),眼压21.9mmHg。

左眼:远视力0.06,最佳矫正视力1.0(-6.00),左眼14.9 mmHg。双眼眼前节:晶状体核Ⅱ级,晶状体前囊下、皮质、后囊下混浊。双眼眼底视盘色可界清,C/D0.5,余结构正常。

OcularExamination:

 

OD

OS

VA

0.1

0.06

BCVA

0.8

1.0

IOP

NCT 21.9mmHg

NCT 14.9 mmHg

conjunctiva

Normal

normal

Cornea

Clear

clear

AC

Normal

Normal

Iris/Pupil

Normal

Normal

Lens

Opaque,

nuclear grade Ⅱ

Opaque,

nuclear grade Ⅱ

Vitreous

Opaque

Opaque

Retina

Pale optic disc,

C/D0.5

Pale optic disc,

C/D0.5

二、辅助检查

Auxiliary Examination

UBM:双眼前房深度2.20mm,全周房角开放,虹膜后膨隆。

CCT:双眼539?m

中心视野:双眼旁中心视野暗点

UBM: ACD 2.20mm(OU), the whole anterior chamber angle is open, with the iris bombed backwardly.

CCT: 539?m(OU)

Visual Field: Paracentral scotoma(OU)

三、初步诊断

Impression

双眼开角型青光眼

双眼老年性白内障

双眼屈光不正

Primary open angle glaucoma OU

Senile cataract OU

Ametropia OU

四、治疗

Treatment

手术

右眼白内障超声乳化联合人工晶状体植入术+EXPRESS引流钉植入术

术后

4周 引流钉在位,滤过泡弥散,前房深,术眼眼压14.2mmHg,人工晶状体在位,余正常。

Operation

The right eye underwent phacoemulsification and OPL implantation and EXPRESS drainage nail implantation.

At 4weeks after operation,

The filtering bleb was diffused, the position of the drainage nail was good, the anterior chamber was deep, ,the IOL was centered in the capsule, and the IOP was 14.2 mmHg.

五、病例相关知识

Relative knowledge

Ex-PRESS青光眼微型引流钉植入术是一种新型的眼外引流手术。引流钉是由不锈钢制作、无阀门、长约3mm.在结构上可分为引流管、短突、翼领。引流钉植入物面积小,对眼部肌肉和周围组织影响小,并且具有良好的组织相容性,适合于所有开角型青光眼。

Ex-PRESS引流钉降眼压机制基本与传统小梁切除术相同,均是将房水引流至结膜下间隙。植入手术方式有两种,一种直接置于结膜瓣下,另一种是置于巩膜瓣下。前者操作简单,但将其直接置于结膜瓣下,可导致早期持续性低眼压及晚期结膜糜烂。后者可减少术后低眼压,尤其对滤过性手术失败的高危患者。置于巩膜瓣下方式具体操作方法:做以穹窿部为基底的结膜瓣和巩膜瓣,在透明角膜移行区做角膜穿刺,将Ex-PRESS微型引流钉通过巩膜瓣下穿刺口插入到前房。恢复巩膜瓣,覆盖Ex-PRESS的凸缘,缝合巩膜瓣及结膜瓣。

Glaucoma miniature drainage nail implantation surgery is a new type of extraocular drainage operation. The drainage nail is made of stainless steel, has good histocompatibility, has no valve and the length is about 3mm. the drainage nail can be divided into drainage tube, short process, and wing collar in the structure. The area of the  drainage nail is small, which will disturb the extraocular muscles and surrounding tissues minimally. The drainage nail is suitable for all open angle glaucoma patients.

The mechanism of Ex-PRESS drainage nail is identical to the traditional trabeculectomy, with the aqueous humor flowed from anterior chamber to subconjunctival space. The nail can be placed directly under conjunctiva flap or under the scleral flap. The former is simple to operate, but can lead to early persistent low intraocular pressure and late conjunctival erosion. The latter can be reduce postoperative lower intraocular pressure rate, especially for patients with high risk for filtration surgery failure.




 
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