Phase contrast microscopy. Diagnosis of ghost cell glaucoma following cataract extraction

Ghost cell glaucoma may be suspected when intraocular pressure remains elevated following vitreous hemorrhage. Vitrectomy provides relief of the glaucoma and an improvement in vision. The vitrectomy specimen offers confirmation of the clinical diagnosis when examined by phase contrast microscopy.     

白内障囊外摘出及人工晶状体植入术后继发性青光眼

目的探讨白内障囊外摘出及人工晶状体植入术后继发性青光眼的原因。方法对11例术后继发性青光眼进行详细的观察分析。结果发现其主要原因为房角阻塞,瞳孔阻滞,手术创伤及血—房水屏障破坏等。结论术后继发性青光眼原因多种多样,大部分可以预防及药物治愈。     

A case of acute angle-closure glaucoma secondary to annular ciliochoroidal detachment after unsutured cataract surgery

BACKGROUND: We report a patient with acute angle-closure glaucoma secondary to annular ciliochoroidal detachment after unsutured cataract surgery. CASE: An 82-year-old man was diagnosed with bilateral shallow central anterior chamber depth, flat peripheral anterior chamber, and elevated intraocular pressure. One day previously he had undergone uncomplicated unsutured cataract surgery in the right eye and eight days previously, in the left eye. Ultrasound biomicroscopy revealed annular ciliochoroidal detachment in both eyes. Treatment with intravenous methyl prednisolone deepened the anterior chamber and reduced intraocular pressure. CONCLUSION: Annular ciliochoroidal detachment may lead to anterior rotation of the ciliary body and angle-closure. This clinical entity is indistinguishable from malignant glaucoma when the fundus cannot be visualized.     

原发性青光眼合并白内障患者白内障摘出术后影响眼压的因素

目的 探讨原发性青光眼合并白内障患者影响术后眼压的因素.方法 回顾性分析96例(96眼)行白内障手术的原发性青光眼合并白内障患者,48例为开角型青光眼,48例为闭角型青光眼,均行白内障摘出联合人工晶状体植入术.术后随访24个月.比较术前、术后眼压和降眼压药物应用情况,并对成功病例和失败病例术前一般情况进行比较,寻找与术后眼压控制相关的因素.结果 开角型青光眼失败29例患者中术前应用≥3种降眼压药物者26例(89.7%),术前最高眼压≥31mmHg(1 kPa=7.5 mmHg)者26例(89.7%);19例成功患者中16例(84.2%)术前应用降眼压药物<3种,且术前最高眼压<31mmHg-Hg者16例(84.2%),二者比较差异有统计学意义(P=0.001).闭角型青光眼48例患者中成功30例(62.5%),失败18例(37.5%).成功病例术前应用降眼压药物(1.5±0.4)种明显少于失败病例(2.6±0.8)种,二者比较差异有统计学意义(P=0.021).而且术前最高眼压(32.6±6.1)mmHg小于42mmHg,也明显低于失败病例(46.8±7.6)mmHg,二者比较差异也有统计学意义(P=0.015).结论 小切口白内障囊外摘出联合折叠型人工晶状体植入术是控制原发性青光眼合并白内障患者术后眼压的良好手术选择,术前眼压控制情况和应用抗青光眼药物情况是影响术后眼压的主要因素.     

青光眼白内障联合手术治疗白内障继发青光眼

目的探讨白内障继发青光眼进行白内障青光眼联合手术的效果。方法28例（28只眼）白内障继发青光眼完成了超声乳化吸出及人工晶状体植入联合巩膜瓣下小梁切除术。结果术前视力〈0．1者22只眼,0．1～0．3者6只眼。术后视力〈0．1者13只眼,0．1～1．0者15只眼。术前平均眼压（34．30±9．32）mmHg,术后平均眼压（16．42±5．36）mmHg（1mmHg=0．133kPa）。25眼眼压降至正常范围,3眼经药物治疗达到正常范围。并发症主要是角膜水肿和浅前房。术后随访3～6个月。结论超声乳化吸出及人工晶状体植入联合巩膜瓣下小梁切除术对于白内障继发青光眼是安全和有效的。     

Incision procedure in cataract extraction after filtering glaucoma operations

The authors report on 72 cataract extractions following filtering procedures for glaucoma. In 45 cases they performed a purely corneal incision in the upper part of the globe (in 17 cases the classical von Graefe knife incision was used; in 28 cases a three-plane incision ab externo using a razor blade and scissors was done). In the other 27 cases the globe was opened from the outer surface by performing a corneoscleral incision with a limbus-based conjunctival flap. With regard to postoperative intraocular pressure and intraoperative and postoperative complications the two techniques - the ab interno incision and the ab externo incision - produced equally good results. Moreover, a slightly higher residual astigmatism was observed after the purely corneal incisions. The advantages and disadvantages of the two techniques for opening the globe following a filtering procedure for glaucoma are discussed. Finally the authors describe the procedure they currently use, depending on the preoperative situs.     

外伤性白内障继发性青光眼伴前房消失的临床研究

目的 探讨眼球穿孔伤伴外伤性白内障后继发性青光眼引起前房消失的治疗方法.方法 对12例(12眼)眼球穿孔伤后外伤性白内障后继发青光眼伴前房消失,立即施行晶状体超声乳化和(或)前部玻璃体切除术,手术细心操作.术后随访6～ 24个月.结果 所有术眼术后前房形成良好,眼压控制理想,术后视力较术前明显提高,无角膜内皮失代偿等并发症.结论 眼球穿孔伤伴外伤性白内障后继发青光眼及前房消失,及时行白内障超声乳化手术,解除瞳孔阻滞,是前房形成的关键,从而可获得较好的结果.     

Pupillary membrane after cataract extraction with posterior chamber lens in glaucoma patients

Deposition of a fibrin-like material leading to a membrane in the pupillary opening is described in glaucoma patients following extracapsular cataract extraction and intraocular lens implantation. The fibrinoid reaction was observed in 4 out of 57 eyes (7%), all operated on within two years by the same surgeon (CTL). The fibrinoid reaction appeared 2 to 15 days postoperatively in glaucoma patients on whom iridoplasty or synechiolysis had been performed during surgery. It seems advisable to give such patients long-acting subconjunctival steroids at the end of the operation.     

Treatment of phacolytic glaucoma with extracapsular cataract extraction

The treatment of choice for phacolytic glaucoma has been intracapsular cataract extraction (ICCE). The current study was undertaken to determine the efficacy of extracapsular cataract extraction (ECCE) as a definitive treatment for phacolytic glaucoma. Five cases of phacolytic glaucoma that occurred between 1984 and 1986 were studied after a retrospective chart review; ECCE (with placement of a posterior chamber intraocular lens [PC IOL]) was performed without complication and was curative in all five eyes. All patients (100%) maintained intraocular pressures (IOPs) of less than 20 mmHg, without medical therapy. The best-corrected visual acuity for all cases was 20/50 or better (80%, greater than or equal to 20/40) with 5 months to 3 years follow-up. These results suggest that ECCE is an effective alternative for the treatment of phacolytic glaucoma and allows surgeons the freedom to choose the procedure with which they are most comfortable. Additionally, implantation of a PC IOL is a safe and efficacious procedure in restoring visual function in these patients.     

A case of postoperative Sphingomonas paucimobilis endophthalmitis after cataract extraction

PURPOSE: To report a case of an acute onset of delayed postoperative endophthalmitis that was caused by Sphingomonas paucimobilis. METHODS: This case demonstrates an acute onset of delayed postoperative endophthalmitis at 3 months after uneventful cataract extraction and posterior chamber intraocular lens implantation. We performed vitrectomy, intraocular lens and capsular bag removal, and intravitreal antibiotics injection. On the smear stains from the aspirated vitreous humor, gram-negative bacilli were detected and S. paucimobilis was found in culture. RESULTS: At three months after vitrectomy, the best corrected visual acuity was 20/300. Fundus examination showed mild pale color of optic disc and macular degeneration. CONCLUSIONS: Vitrectomy with intravitreal ceftazidime injection had contributed to the favorable result in case of an acute onset of delayed postoperatire endophthalmitis caused by S. paucimobilis.     

小切口白内障摘除联合小梁切除术治疗PACG合并白内障

目的：观察小切口白内障摘除人工晶状体植入联合小梁切除术治疗原发性闭角型青光眼(primary angle-closure glaucoma,PACG)合并白内障的疗效。

方法：选取44例52眼PACG合并白内障病例,均采用小切口白内障摘除人工晶状体植入联合小梁切除术,观察患者手术前后的视力、眼压及术后并发症情况。

结果：术后与术前相比,术后视力显著改善,眼压明显降低,结果具有统计学意义(P<0.05)。52眼手术均由同一术者完成,手术过程顺利,术后出现前房炎症细胞反应6眼,前房纤维素样渗出物3眼,经过散瞳、糖皮质激素及非甾体类眼药水滴眼治疗后吸收,浅前房2眼,经散瞳、加压包扎后恢复,未出现恶性青光眼、睫状体脱离等并发症。

结论：小切口白内障摘除人工晶状体植入联合小梁切除术治疗PACG合并白内障可靠性高,治疗效果好,手术方法简单易学,适合在基层推广应用。     

Efficacy of microcatheter-assisted trabeculotomy on secondary glaucoma after congenital cataract surgery

AIM: To evaluate efficacy of microcatheter-assisted trabeculotomy (MAT) in eyes with secondary glaucoma after congenital cataract surgery and explore its correlation with the different degree of trabeculotomy. METHODS: A retrospective analysis was conducted on patients who underwent the said procedure between September 2019 and September 2020. The patients were classified into two groups according to the degree of trabeculotomy (group 1: ≤240-degree; group 2: 240–360-degree). The intraocular pressure (IOP) and anti-glaucoma drugs before and after operation was collected during the 12-month follow-up. RESULTS: Totally 27 eyes of 25 patients were included: 11 (40.7%) eyes in group 1 and 16 (59.3%) eyes in group 2. The mean IOP of all patients was 34.67±9.18 mm Hg preoperatively and 8.74±4.32, 9.95±5.65, 14.39±5.30, 16.02±4.37, 15.82±3.28, and 16.19±3.56 mm Hg 1d, 1wk, 1, 3, 6, and 12mo after surgery, respectively. In all patients, there were significant differences in IOP at each time point (F=65.614, P<0.01). In each group, IOP after surgery was lower than that before surgery (all P<0.01), but there was no difference in the rate of IOP reduction between the two groups (P=0.246). Furthermore, the amount of anti-glaucoma medications reduced to 0.30±0.67 (0–2) at 12mo from 2.63±0.49 (2–3) preoperatively (P<0.01), and there was no difference between the two groups (P>0.05). At the end of follow-up, the partial success rate was 81.8% in group 1 vs 93.75% in group 2 (P=0.549). Various amount of intraoperative and postoperative hyphema occurred in all eyes, which spontaneously absorbed or cleaned through paracentesis and irrigation. No other serious complications was observed. CONCLUSION: MAT can effectively reduce IOP in patients with secondary glaucoma after congenital cataract surgery with a high success rate and safety. And it can be used as the first choice for the treatment of secondary glaucoma after surgery for congenital cataracts.     

One-stage extracapsular cataract extraction with sinusotrabeculotomy in patients with combined glaucoma and cataract

The paper deals with the question about surgical treatment of patients with glaucoma associated with cataract. A new technique of one-stage extracapsular cataract extraction with sinusotrabeculotomy is proposed. Its main point is a change in the sequence of stages: stage I--opening of anterior lens capsule, stage II--antiglaucomatous operation, stage III--extraction of lenticular nucleus and masses through a corneal incision. The operation was made in 30 patients (31 ages). The follow-up period was 2 years. Normalization of intraocular pressure was achieved in all patients, in one eye--miotics had to be used. All patients showed a rise of visual functions: in 21 of 31 eyes vision rose to 0.3 and higher. In one patient vision fell after a year because of progression of the glaucomatous process in the presence of normal intraocular pressure. One-stage extracapsular cataract extraction with sinusotrabeculotomy can be made at any stage of glaucoma. By the authors' data, contraindications can be a rise of intraocular pressure above 40.0 mm Hg as well as the presence of a single eye and severe course of hypertonic disease.     

Neovascular glaucoma after intracapsular and extracapsular cataract extraction in diabetic patients

A retrospective study of the rate of development of neovascular glaucoma after cataract extraction in 242 eyes of 186 diabetic patients identified neovascular glaucoma in 13 of 146 eyes (8.9%) after intracapsular extraction, in two of 17 eyes (11.8%) after extracapsular extraction with primary capsulotomy, and in zero of 53 eyes after extracapsular extraction without capsulotomy. The incidence of neovascular glaucoma was significantly lower in patients who underwent extracapsular extraction with preservation of an intact posterior capsule than in those undergoing intracapsular cataract extraction (P less than .01) or extracapsular cataract extraction with primary capsulotomy (P less than .05).     

Combined extracapsular cataract extraction with ahmed glaucoma valve implantation in phacomorphic glaucoma

PURPOSE: To report a retrospective analysis of a combined procedure of extracapsular cataract extraction (ECCE) with heparin surface modified (HSM) posterior chamber intraocular lens (PCIOL) implantation along with primary Ahmed glaucoma valve (AGV) implantation in an attempt to optimize visual acuity gains and intraocular pressure (IOP) control in patients with phacomorphic glaucoma. METHODS: ECCE with HSM PC IOL and AGV implantation was performed through two separate incisions in 15 patients diagnosed with phacomorphic glaucoma. Postoperative improvement in visual acuity and IOP control were monitored. RESULTS: A steady control of IOP was maintained in all patients with minimum anti-glaucoma medications. The average visual acuity was approximately 6/24 at 3 months. CONCLUSION: Superior preoperative IOP control and a shorter phacomorphic attack resulted in better postoperative vision. The successful maintenance of IOP within the desired range in this study suggests that the procedure should be performed under similar conditions.