白內障術后1 d發生惡性青光眼1例報道

黃煜薇　　楊芳　　余錦強

[摘要] 惡性青光眼（Malignant glaucoma，MG）是一類發作迅速、癥狀重、治療難度大的繼發性青光眼，多發生于青光眼濾過術后[1]，目前已有許多相關病案報道。然而白內障超乳晶體植入術后發生惡性青光眼的報道卻并不多見。短眼軸是MG的獨立危險因素[2]，前房淺、房角狹窄、晶狀體較厚并且前移的特點[3-5]，與原發性閉角型青光眼（Primary angle-closure glaucoma，PACG）眼前節形態的高度相似性，使得合并短眼軸的PACG的術后風險性更大。該文記錄了1例慢性閉角型青光眼患者行白內障術后1 d發生MG的相關情況。

[關鍵詞] 短眼軸;惡性青光眼;白內障超乳晶狀體植入術;慢性閉角型青光眼

[中圖分類號] R779.6? ? ? ? ? [文獻標識碼] C? ? ? ? ? [文章編號] 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歲女性患者，2020年9月25日因“右眼視物不清5年余”入院。既往體健，無特殊病史。入院專科檢查：視力：右眼0.2，左眼0.4，雙眼角膜透明，中央前房深度可，周邊深度淺（右眼周深<1/4 CT;左眼周深<1/5 CT），瞳孔圓，直徑（Diameter，D）約3 mm，光反射存在，晶體混濁（右眼C1N1P4 左眼C1N1P2），小瞳下眼底見視盤界清，色淡紅，C/D約0.3，后極部網膜平伏，無出血及滲出，眼壓：右眼25 mmHg/左眼14 mmHg。入院診斷：雙眼后囊下型老年性白內障、雙眼慢性閉角型青光眼可疑？完善輔助檢查：醫學驗光：右眼-1.50DC×90=0.4，左眼+2.00DS/+1.50DC×10=0.9+;眼部生物測量：（右眼）眼軸（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、晶狀體厚度（Lens thickness，LT）4.99 mm，（左眼）AL21.53 mm、CCT484 μm、ACD2.21 mm、LT4.92 mm;光學相干斷層掃描（Optical Coherence Tomography，OCT）顯示右眼房角狹窄，甚至關閉（圖1）。視盤OCT（圖2）：右眼視神經纖維層（Retinal nerve fiber layer，RNFL）厚度未見明顯變薄。視野檢查：右眼鼻側階梯（圖3），左眼未見明顯異常。房角鏡檢查：右眼全周匍匐樣粘連，靜態觀察全周窄IV，動態觀察下方開放 余方位關閉;左眼房角點狀粘連，靜態觀察上方窄III鼻側窄IV余方位寬角，動態觀察鼻側關閉余方位開方。綜合以上檢查結果，考慮雙眼慢性閉角型青光眼早期。