Spontaneous filtering bleb with subsequent secondary glaucoma June consultation #1

医学 眼科 房角镜 眼压 青光眼 视力 眼底(子宫) 无虹膜 化脓 眼科检查 小梁切除术 巩膜 外科 生物化学 化学 基因
作者
Jefferson Berryman,Thomas W. Samuelson
出处
期刊:Journal of Cataract and Refractive Surgery [Lippincott Williams & Wilkins]
卷期号:47 (7): 965-965 被引量:1
标识
DOI:10.1097/j.jcrs.0000000000000696
摘要

A 32-year-old previously healthy woman was referred for evaluation and management of newly diagnosed hypotony in the right eye. Her ocular history was significant only for moderate myopia and an idiopathic Horner syndrome in the left eye diagnosed at age 13. The patient endorsed a history of fluctuating and decreasing vision in the right eye over the past 6 months. She denied any ocular pain, previous ocular surgery, or recent trauma. The patient was otherwise healthy and denied any previous autoimmune disease or systemic infection. She wore soft, daily disposable contact lenses and reported no abnormalities on previous routine eye examinations. At presentation, the patient's uncorrected distance visual acuity was 20/25 in the right eye and 20/200 in the left. Lensometry revealed a previous refraction of -3.00 + 0.50× 150 in the right eye and -4.00 + 1.75× 174 in the left. Intraocular pressures (IOPs) were 4 mm Hg and 15 mm Hg by applanation, and central corneal thicknesses were 573 μm and 564 μm in the right and left eyes, respectively. Slitlamp examination revealed an area of scleral thinning near the limbus in the right eye from 5 to 7 o'clock with mild overlying chemosis (Figure 1JOURNAL/jcrs/04.03/02158034-202107000-00023/figure1/v/2021-06-26T110826Z/r/image-tiff). Gonioscopy showed an open angle with mild trabecular meshwork pigmentation in both eyes without any cyclodialysis clefts, peripheral anterior synechiae (PAS), or other abnormalities. Dilated fundus examination was significant for mild optic nerve edema and chorioretinal folds in the right eye. Optical coherence tomography (OCT) of the optic nerve confirmed mild disc edema (Figure 2JOURNAL/jcrs/04.03/02158034-202107000-00023/figure2/v/2021-06-26T110826Z/r/image-tiff) and OCT of the macula confirmed mild chorioretinal folds. Anterior segment OCT (AS-OCT) and ultrasound biomicroscopy failed to show any other abnormalities. The patient was initially observed without treatment and presented urgently approximately 1 month later with decreased vision and ocular discomfort. Repeat examination revealed an IOP of 31 mm Hg and a focal area of PAS to the previous area of scleral thinning (Figure 3JOURNAL/jcrs/04.03/02158034-202107000-00023/figure3/v/2021-06-26T110826Z/r/image-tiff). In one respect, the newly elevated IOP was considered transiently therapeutic to help reverse the hyperopic shift, disc edema, and hypotony-related maculopathy. However, the situation quickly became more worrisome when shortly thereafter the IOP elevated to 55 mm Hg at subsequent follow-up, and multiple IOP-lowering medications were initiated. Over numerous additional visits, the patient's IOPs ranged from 30 to 39 mm Hg in the right eye despite rapidly advancing to maximally tolerated medical therapy including acetazolamide. She was noted to have a new relative afferent pupillary defect of the right eye, and Humphrey visual fields showed early arcuate defects (Figure 4JOURNAL/jcrs/04.03/02158034-202107000-00023/figure4/v/2021-06-26T110826Z/r/image-tiff). What would be your approach to managing this healthy, young, myopic woman who presented with hypotony due to a spontaneous, perilimbal filtration bleb that later occluded with PAS, resulting in intractably elevated IOP and field loss? What is the differential diagnosis? Would you perform a systemic workup for her initial scleral thinning, and if so, what would you check? Would you intervene for her elevated IOP in the right eye? If so, what would be your surgical approach?
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
萌萌哒完成签到,获得积分10
刚刚
小龅牙吖完成签到,获得积分10
刚刚
Propitious完成签到,获得积分10
1秒前
徐先生1106完成签到,获得积分10
1秒前
Epiphany完成签到,获得积分10
2秒前
舒心的久完成签到 ,获得积分10
2秒前
闻巷雨完成签到 ,获得积分10
4秒前
北风完成签到,获得积分10
5秒前
xliiii完成签到,获得积分10
5秒前
时光倒流的鱼完成签到,获得积分10
6秒前
LL完成签到,获得积分10
6秒前
李李完成签到,获得积分20
6秒前
雨无意完成签到,获得积分10
7秒前
盛宇大天才完成签到,获得积分10
9秒前
游戏人间完成签到 ,获得积分10
10秒前
11秒前
科研通AI5应助淡淡的忆彤采纳,获得10
11秒前
早日毕业完成签到,获得积分10
11秒前
Billie完成签到,获得积分10
12秒前
积极行天完成签到,获得积分10
12秒前
98完成签到,获得积分10
13秒前
nkmenghan完成签到,获得积分20
14秒前
韶邑完成签到,获得积分10
14秒前
penzer完成签到 ,获得积分10
15秒前
suwan完成签到,获得积分10
16秒前
张瀚文完成签到 ,获得积分10
19秒前
不吃香菜完成签到 ,获得积分10
21秒前
何日完成签到,获得积分10
23秒前
明天完成签到,获得积分10
23秒前
rrrick完成签到,获得积分10
23秒前
XF发布了新的文献求助10
24秒前
结实乐曲完成签到,获得积分10
24秒前
24秒前
25秒前
顺利紫山完成签到,获得积分10
26秒前
liaodongjun完成签到,获得积分10
27秒前
28秒前
ma完成签到,获得积分10
28秒前
GOW完成签到,获得积分10
29秒前
淡淡的忆彤完成签到,获得积分10
30秒前
高分求助中
【提示信息,请勿应助】关于scihub 10000
Les Mantodea de Guyane: Insecta, Polyneoptera [The Mantids of French Guiana] 3000
徐淮辽南地区新元古代叠层石及生物地层 3000
The Mother of All Tableaux: Order, Equivalence, and Geometry in the Large-scale Structure of Optimality Theory 3000
Handbook of Industrial Diamonds.Vol2 1100
Global Eyelash Assessment scale (GEA) 1000
Picture Books with Same-sex Parented Families: Unintentional Censorship 550
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 4038303
求助须知:如何正确求助?哪些是违规求助? 3576013
关于积分的说明 11374210
捐赠科研通 3305780
什么是DOI,文献DOI怎么找? 1819322
邀请新用户注册赠送积分活动 892672
科研通“疑难数据库(出版商)”最低求助积分说明 815029