Glaucoma due to vitreous and retinal detachment surgery
Introduction
Introduction to glaucoma caused by vitreous and retinal detachment surgery Vitreous and retinal detachment surgery glaucoma (glaucomaassoiatedwithvitreousandretinalsurgery) can occur on the first day after surgery, mostly elevated intraocular pressure, can also occur more than half a year after surgery, showing occult or chronic elevated intraocular pressure. basic knowledge The proportion of sickness: 0.01% - 0.015% Susceptible people: no specific people Mode of infection: non-infectious Complications: suppurative uveitis
Cause
Causes of glaucoma caused by vitreous and retinal detachment surgery
Causes:
It is related to the surgical methods and operation skills of the vitreous and retina.
Pathogenesis:
The main cause of glaucoma after vitreous and retinal detachment surgery is that the outflow of aqueous humor is blocked, which can be divided into two aspects: the disturbance of the aqueous circulation path and the influence of auxiliary materials for surgical application.
1. Intraocular inflammation and venous return disorder caused by angle-closure glaucoma surgery can cause the ciliary body to become congested, swollen and/or detached, rotate forward with the scleral process as a fulcrum, push the peripheral iris forward to close the anterior horn; choroid Edema, exudation and hemorrhage, and choroidal detachment involve the ciliary body, causing the edema of the ciliary body to gyrus, making the anterior chamber shallow, leading to complete or partial anterior chamber closure, common in retinal detachment scleral cerclage, outside the sclera Pressurization or more than two types of combined surgery, as well as total retinal photocoagulation, especially in the range of extrascleral pressure and located in the deep and compression or injury of the vortex vein, histopathological findings of all scleral compression After acute angle-closure glaucoma, there are unequal amounts of bloody or serous fluid in the suprachoroidal space. The gas injection in the retinal vitreous surgery is too fast, especially the inflation gas, which can push the entire lens-iris compartment. Move forward, close the corner of the room; silicone oil injection can inject too much silicone oil to push the entire lens-iris compartment forward, or silicone oil in the avitron-free vitreous cavity can directly cause pupillary block; Perfluorocarbon liquid remaining in the anterior chamber of the aphakic eye after surgery can also block the peripheral iridotomy hole at 6 o'clock, causing pupillary block. Long-term uveal inflammation after retinal vitreous surgery is also one of the factors that cause pre-irisal adhesion. Can lead to secondary angle-closure glaucoma, in addition, the preoperative anatomical features of the angle-closure glaucoma eye, postoperative dilation and maintenance of prone position, similar to glaucoma stimulation test caused by angle closure or anterior chamber shallow It can induce a large attack of acute angle-closure glaucoma.
2. Open-angle glaucoma alone vitrectomy, elevated intraocular pressure may be related to the release of prostaglandins, red blood cell lysis and inflammatory vitreous opacity obstruction of trabecular meshwork; silicone oil emulsified into the anterior chamber, histological examination see trabecular meshwork Blocked by tiny silicone oil foam, pigment cells and macrophages filled with silicone oil, it can block the outflow of aqueous humor through the trabecular meshwork; postoperative inflammation makes the trabecular meshwork dysfunctional, and the original eye with the original open-angle glaucoma The intraocular pressure is more likely to increase; the rhegmatogenous retinal detachment increases the aqueous drainage of the uveoscleral pathway. When the retina is repositioned, the retinal tear and the uveal scleral efflux are rapidly closed, and the trabecular mesh drainage volume increases. Can cause elevated intraocular pressure; postoperative long-term use of corticosteroids is also one of the factors of open-angle glaucoma after vitreoretinal surgery. In addition, some scholars believe that the use of transforming growth factor-2 in macular hole surgery can increase the formation of aqueous humor, causing Increased intraocular pressure.
Prevention
Prevention of glaucoma caused by vitreous and retinal detachment surgery
According to clinical experience, certain measures can be taken to prevent the increase of intraocular pressure and glaucoma after vitreous and retinal detachment surgery, such as scleral cerclage and external compression, to avoid post-location; minimum required amount during surgery, low concentration Inflated gas, such as 18% to 20% SF6 or 12% to 16% C3F8; master the amount of silicone oil injection; minimize retinal condensation, photocoagulation range, etc., postoperative active and reasonable anti-inflammatory treatment.
Complication
Glaucoma complications caused by vitreous and retinal detachment surgery Complications, purulent uveitis
Uveal inflammation, adhesion of the anterior chamber, reddening of the iris, glaucoma optic disc disease.
Symptom
Vitreous and retinal detachment surgery caused by glaucoma symptoms Common symptoms High intraocular pressure hunchback aphakic eye rainbow eye pressure increased nausea retinal detachment
1. Risk factors The anatomical features of the primary angle-closure glaucoma, or the family history of glaucoma, or the pre-operative "basal" intraocular pressure, and aphakic eyes, diabetic patients, are retinal vitreous The increase of intraocular pressure and the risk factors related to glaucoma after operation, the injury caused by surgical operation is an important factor for postoperative increase of intraocular pressure and glaucoma. As mentioned above, retinal detachment surgery scleral cerclage is too tight, sclera plus The pressure block is too wide, the position is too deep, etc., the amount and concentration of inflation gas in the vitreous resection and intraocular filling, the amount of silicone oil injected and the molecular weight, etc., as well as the extent and extent of retinal condensation, photocoagulation, etc. Postural position such as prolonged prone position, squat position, inappropriate treatment such as not taking timely anti-inflammatory treatment, or long-term application of corticosteroid anti-inflammatory treatment, can cause elevated intraocular pressure and glaucoma risk factors.
2. The clinical manifestations are higher than those in the afternoon of the first day after surgery. The symptoms are similar to those of primary acute angle-closure glaucoma. Sometimes it is considered to be an inflammatory reaction after retinal surgery, especially in response to general anesthesia. Confused, not easy to be found, mild cases are more easily overlooked, generally due to corneal edema can not see the fundus began to see elevated intraocular pressure, its anterior chamber shallow and pupillary block caused by primary acute angle closure The shape of glaucoma is somewhat different: the surface of the iris is not arched forward with a typical uniform iris hunchback, but the middle part is slightly flat, the depth of the anterior chamber is slightly deeper, the patient is nausea, vomiting, eye pain, and generally no rainbow Vision can only be light or even light, eyelid swelling, eye congestion, corneal epithelial edema or posterior elastic layer wrinkles, anterior chamber shallow or normal, open or closed angle, sometimes difficult to distinguish from vitreoretinal surgery. Using an applanation tonometer or Tono-pen tonometer to measure intraocular pressure rise 22mmHg can help differential diagnosis, but should pay attention to postoperative eyelid swelling and corneal epithelial defect, edema, significant astigmatism, etc. Effect of accurate measurement of non-contact tonometer accurate measurement of intraocular pressure after vitreoretinal surgery are not suitable, Schiötz tonometer susceptible to changes in hardness of the sclera after vitreoretinal surgery.
Glaucoma can occur early after silicone oil or inflation gas filling, often within a few hours after the end of surgery, can be a transient increase in intraocular pressure or sustained high intraocular pressure, early in the silicone-free filling in the aphakic eye It was found that the 6-point iris perforation was closed by the exudation membrane, and a dense membrane was formed in the pupil area. It was also found that the pupil was dilated, the silicone oil was filled with the anterior chamber, and the late stage was characterized by silicone oil emulsification, corner adhesion or iris red change, and fundus characteristics. The glaucoma optic disc disease, the intraocular pressure continues to rise and so on.
Examine
Examination of glaucoma caused by vitreous and retinal detachment surgery
Cytological and biochemical examination of aqueous humor and vitreous.
Intraocular pressure measurement was performed using Tono-pen or flattening tonometer; B-ultrasound examination confirmed the condition of vitreous and visual network application; the history and clinical manifestations of keratomileus keratoscopic examination can be clearly diagnosed.
Diagnosis
Diagnosis and diagnosis of glaucoma caused by vitreous and retinal detachment surgery
Diagnosis can be confirmed based on the history of the surgery and clinical manifestations.
