Etiology and Management of Raised Intraocular Pressure following Posterior Chamber Phakic Intraocular Lens Implantation in Myopic Eyes.
Etiology and Management of Raised Intraocular Pressure following Posterior Chamber Phakic Intraocular Lens Implantation in Myopic Eyes.
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DOI：
10.1371/journal.pone.0165469
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Garudadri CS
中科院分区：
文献类型：
--
作者：
Senthil S;Choudhari NS;Vaddavalli PK;Murthy S;Reddy JC;Garudadri CS
目的探讨有晶状体眼植入式透镜（ICL）术后高眼压的原因及处理方法。2009年至2015年期间，359例屈光性近视受试者的638只眼接受了V4 b和V4 c（CentraFLOW）型号ICL植入术。高眼压（OHT）定义为两次IOP ≥ 22 mm Hg，IOP升高伴相应的视盘或视野损伤定义为青光眼。在30例受试者的33只眼（33/638; 5.17%）中观察到IOP升高≥ 22 mm Hg。IOP升高受试者的中位年龄为26岁（四分位距（IQR）：22，29），中位屈光误差为-16屈光度（-19.5，-13）。中位随访时间为7.8个月（IQR：0.3，17.6），术后IOP升高的中位时间为12天（IQR：2，24）。眼压升高的各种病因是21只眼的类固醇反应（64%; V4 b 10眼，V4 c 11眼），5眼（15%）残留粘弹剂（V4 b 3例，V4 c 2例），4只眼瞳孔阻滞（12%; V4 b组3例，V4 c组1例），1只眼恶性青光眼（3%，V4 b组），2只眼未发现既存青少年开角型青光眼（JOAG）（6%，V4 b组）。31只眼眼压升高经保守治疗后消退。一只眼（centraFLOW设计）用粘弹剂阻断中央水通道，需要AC冲洗，一只眼患有恶性青光眼，需要进行睫状体玻璃体切除术和玻璃体切开术。10只眼需要长期（>2个月）抗青光眼药物（AGM）控制IOP。除两眼JOAG外，无视盘和视野损伤。在我们的系列中，接受V4 b和V4 c模型ICL植入的眼中，OHT发生率为4.85%，青光眼发生率为0.3%。观察到多种病因，类固醇诱导的高眼压是IOP升高的最常见原因，其次是残留粘弹性和瞳孔阻滞。这些眼睛中有三分之一需要长期AGM来控制IOP。
To evaluate the etiology and management of elevated intraocular pressure (IOP) following posterior chamber phakic implantable collamer lens (ICL) surgery. Between 2009 and 2015, 638 eyes of 359 subjects with refractive myopia, underwent V4b and V4c (CentraFLOW) model ICL implantation. Ocular hypertension (OHT) was defined as IOP of ≥ 22 mm Hg on two separate occasions and elevated IOP with corresponding optic disc or visual field damage was defined as glaucoma. Elevated IOP ≥ 22 mm Hg was noted in 33 eyes of 30 subjects (33/638; 5.17%). Median age of subjects with raised IOP was 26 years (Inter quartile range (IQR):22, 29) and median refarctive error was -16 diopters (-19.5, -13). The median follow up was 7.8 months (IQR:0.3, 17.6) and median time for postoperative IOP rise was 12 days, (IQR:2, 24). The various etiologies for elevated IOP were steroid response in 21 eyes (64%; 10 eyes with V4b, 11 eyes with V4c), retained viscoelastic in 5 eyes (15%) (3 with V4b, 2 with V4c), pupillary block in four eyes (12%; 3 with V4b, 1 with V4c), malignant glaucoma in one eye (3%, V4b), and missed pre-existing Juvenile open angle glaucoma (JOAG) in two eyes (6% with V4b). Elevated IOP in 31 eyes resolved with conservative management. One eye (centraFLOW design) with central aquaport block by viscoelastic, needed AC wash and one eye with malignant glaucoma needed parsplana vitrectomy and hyaloidotomy. Ten eyes required longterm (>2 months) antiglaucoma medications (AGM) for IOP control. Except the two eyes with JOAG, none had disc and field damage. In our series, OHT was seen in 4.85% and glaucoma in 0.3% eyes that underwent V4b and V4c model ICL implantation. Multiple etiologies were noted and steroid induced ocular hypertension was the most common cause of elevated IOP followed by retained viscoelastic and pupillary block. One third of these eyes required longterm AGM for IOP control.