Compound trabeculectomy for treatment of traumatic lens subluxation secondary glaucoma
【Abstract】 Objective: To explore the compound
trabeculectomy for treatment of traumatic lens subluxation secondary glaucoma results. Methods: The scope of traumatic
lens subluxation does not exceed two quadrants, lens opacity lighter, drugs are difficult to control secondary glaucoma, select the non-lens dislocation and vitreous incarceration quadrant purposes of compound trabeculectomy. Results: The
follow-up 6 ~ 16mo, 7 cases of six cases of patients with secondary glaucoma after intraocular pressure <21mmHg (1mmHg = 0.133kPa), 1 patients with local control of normal intraocular pressure medication, 3 cases of visual acuity was improved. Conclusion: Select non-implementation of vitreous
incarceration compound quadrant trabeculectomy is the treatment of traumatic lens subluxation secondary glaucoma an effective manner.
Key words ocular trauma-shaped body subluxation glaucoma
trabeculectomy
0 Introduction
Traumatic lens subluxation is often caused by secondary glaucoma. In recent years, along with phacoemulsification and vitrectomy technology matures, can be used
phacoemulsification, the application of capsular tension ring and intraocular lens implantation, lens cutting, vitrectomy [1] and many other surgical techniques methods. As for lens subluxation does not extend to more than 2 quadrants, lens opacity lighter, drugs more difficult to control, in particular, beyond the control of local drug secondary
glaucoma, we have chosen to no lens dislocation and vitreous
incarceration of the quadrant, the purposes of compound trabeculae resection and achieved good results are reported as follows.
An object and method
1.1 Object 2002-06/2004-04 were treated in our hospital
from traumatic lens subluxation, range does not exceed two quadrants, lighter lens opacity seven cases of secondary glaucoma 7. 6 male and 1 female. Age 31 to 73 (mean 58) years old. Right eye in 4 cases, left eye in 3 patients. Dislocation
to the operation time was 15d ~ 2mo. Preoperative intraocular pressure 33 ~ 69mmHg (1mmHg = 0.133kpa) between the four comprehensive drug reduced intraocular pressure greater than 21mmHg. Preoperative visual acuity: Index 1, 0.05 ~ 0.1 in 3
eyes, 0.1 ~ 0.4 3. Lens dislocation is located in the nose, upper temporal quadrant in 5 cases, temporal quadrant in 1 case, partial nasal inferior quadrant in 1 case. All patients had a clear vitreous incarceration, the merger vitreous
hemorrhage in 2 cases.
1.2 Methods integrated drug reduced intraocular pressure before surgery. Including intravenous mannitol, oral acetazolamide, Pui special eye drops and other treatment. 3 patients after treatment returned to normal intraocular
pressure, elevation of intraocular pressure after the closure and 4 patients with drug-lowering intraocular pressure greater than 21mmHg, up to 40mmHg. Choose lens subluxation in the opposite quadrant of the purposes of trabeculectomy. Use of peribulbar anesthesia, as in the basement vault of the
conjunctival flap, doing 3mm × 4mm × 4mm trapezoidal scleral
flap, thick 1 / 2 or 1 / 3. With containing 0.4g / L mitomycin C (MMC) piece of cotton placed under the conjunctival flap 4 ~ 5min, placed beneath the scleral flap 2 ~ 3min, and then 20mL
saline flush. To do 3:00 or 9 points are clear corneal incision, removal of 1.5mm × 2mm, including the deep
corneoscleral trabecular meshwork of the organization, doing significantly larger than the corresponding trabecular
incision peripheral iris removed trapezoidal scleral flap corners using adjustable-song Xie suture, end of a thread to
remain in the conjunctival sac in Qionglong Bu. According to the anterior chamber depth of water from the corneal incision to restore anterior chamber depth. Tightly suture conjunctival flap to require shallow angle with edge Gong organization,
conjunctival flap slightly forward, packet cover part of the transparent cornea, conjunctiva back place to prevent postoperative bleb leaks. Point of tobradex eye drops after
eye, depending on the circumstances or the ghost of scattered pupil. Found that poor filtration surgery, IOP greater than 15mmHg in time for one or two removable adjustable suture. If postoperative IOP less than 15mmHg, delayed until after 3wk
extracted exposed adjustable suture. After try not to massage the eye to prevent the increasing dislocation of lens.
2 Results
6 cases of postoperative intraocular pressure were reduced to normal range, 1 cases with vitreous hemorrhage of
the intraocular pressure of 28mmHg, plus a special intraocular pressure control with the shell in the normal range. All patients were free of shallow anterior chamber and bleb leaks, leaking bubble dispersion. Follow-up of 6 ~ 16mo, no
significant change in intraocular pressure, no significant increase of lens opacity, visual acuity was 0.05 in 1 eye, 0.1 ~ 0.3 3, 0.3 ~ 0.5 in 3 eyes.
3 Discussion
Traumatic lens dislocation include lens subluxation, lens dislocation (anterior chamber or vitreous). After the
lens dislocation caused by common causes of glaucoma include: pupillary block; pupil and anterior chamber angle at the same time block; vitreous caused by pupillary block. Of traumatic lens subluxation, lens and sclera, vitreous relative position
change. As the vitreous incarceration before and after the atrial lead to blockage of water channels, angle contusion caused by blockage of aqueous discharge channel, as well as dislocation of the lens to the ciliary body aqueous humor of
the mechanical stimulation led to causes such as elevation of intraocular pressure is generated [2,3] . Lens dislocation caused by one of the most serious complications of secondary glaucoma, long-term ocular hypertension, will result in
permanent visual impairment such as optic atrophy. Reposted elsewhere in the paper for free download http://
Lens dislocation secondary glaucoma, often due to patients not treated early or surgical design is not correct, not only the postoperative intraocular pressure is not
controlled by, or require multiple operations, but may also result in decreased or loss of vision [4]. In recent years, with the gradual improvement of medical equipment and surgical techniques continue to improve, so that lens dislocation after
the surgical treatment of secondary glaucoma has been developed rapidly and its after effects are significantly improved [5]. As the lens out of the scope of the different parts, different levels of secondary glaucoma, take a different surgical techniques: all off into the anterior
chamber of nuclear lens, can be used directly to set a snare; all off into the anterior chamber of a nuclear-free lens, can
be the first puncture aspiration of cortical lens capsule, the capsule folder out of the extraocular; lens into the vitreous
in all off should be after vitrectomy, perfluorocarbon liquid used to remove the lens; lens subluxation range, lens opacity obvious, there is vitreous incarceration, the can be applied to the vitreous cutter at the same time the lens removal
combined vitrectomy, or combined glaucoma valve applications [6]; the lens out of range of small, lens opacity significantly and there is vitreous incarceration, the can be used phacoemulsification joint capsule bag tension ring applications, intraocular lens implantation [7,8]. The
patients as a lens opacity light, out of the range of less than 2 quadrant of secondary glaucoma, ocular situation was relatively quiet, the patient still part of the vision, secondary glaucoma is mainly due to pupil block, if we adopt
the lens or vitreous surgery, is bound to increase the eye damage, using a relatively simple trabeculectomy solve the problem of secondary glaucoma [9,10].
Mitomycin C (MMC) as an anti-metabolism drugs, can
inhibit the proliferation of fibroblasts, and therefore the application of MMC filtration surgery can reduce scar formation and improve refractory glaucoma surgery success rate. For lens subluxation for refractory glaucoma secondary glaucoma, conventional trabeculectomy high failure rate, we
have chosen the opposite quadrant for the dislocation of the surgical site to avoid the organization due to break into the anterior chamber of vitreous blocking filtration mouth. At the same time compound trabeculectomy with intraoperative
mitomycin C and adjustable scleral flap sutures, significantly improved the success rate of surgery [11,12]. MMC can inhibit the proliferation of surrounding tissue bleb, this group of patients under the MMC in the conjunctiva flap placed 4 ~
5min, so that it can clearly reflect the role of combat proliferation. Use of the needle from the conjunctival fornix adjustable suture method, reduce the risk of postoperative foreign bodies in eye irritation and decreased vision due to corneal astigmatism Erzhi much better than Wilson method [13].
Slightly larger than the mouth of peripheral iris filtration removed, lifting the pupillary block, and prevent adhesion of the lens before and after the shift. Postoperative intraocular pressure according to the situation, timely and accurate
removal of adjustable sutures, effectively maintain bleb function, no need to massage the eye, to avoid adding to lens damage, so that patients in the smallest eye injury, the lower the financial burden of to resolve the problem of secondary
glaucoma, save useful vision. Due to fewer cases of this group were followed up for short time, to adapt to a limited range, its effectiveness remains to be explored further. But still can not master the technique of phacoemulsification, vitrectomy can not be carried out grass-roots hospitals, is an
effective treatment.
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