Management of an Anteriorly Dislocated Crystalline Lens and Acute Secondary Angle-Closure Glaucoma by Endocapsular Phacoemulsification in the Anterior Chamber and Iris-Fixated Intraocular Lens Implant

突發性水晶體前房移位併發次發急性青光眼

羅英源(Andy Y Lo) ； 王嘉康(Jia-Kang Wang) ； 陳沛仁(Pei-Jen Chen) ； 胡兆宇(Chao-Yu Hu)

《中華民國眼科醫學會雜誌》 46卷1期 (2007/03) Pp. 77-82

https://doi.org/10.30048/ACTASOS.200703.0014

摘要

目的：報告一個在眼前房以囊內超音波晶體乳化術併虹彩人工水晶體固定術，來處理突發性水晶體前房移位並合併次發急性青光眼的病例。
方法：病例報告。
結果：一位44歲男性，因突發性右眼視力模糊合併疼痛感而至急診就醫。經裂細燈檢查發現，水晶體移位至前房並併發次發性青光眼，當時右眼最佳矯正視力為眼前可辨手動、眼壓為大於60毫米汞柱，經藥物治療無效後，病人接受眼前房囊內超音波晶體乳化術，於三個月後接受小傷口人工水晶體植入固定於虹彩，病人術後最佳矯正視力為0.8，在未使用降眼壓藥物控制下的眼壓為14毫米汞柱。
結論：使用眼前房囊內超音波晶體乳化術併虹彩人工水晶體固定術，來處理突發性水晶體前房移位是安全可行的方法。

並列摘要

Purpose: To report a case of an anteriorly dislocated crystalline lens and acute secondary angle-closure glaucoma
Method: A case report and review of literature
Result: A 44-year-old man experienced severe pain in his right eye for 24 h. Spontaneous anterior dislocation of the crystalline lens and acute secondary angle-closure glaucoma were diagnosed. Treatment with intravenous mannitol, oral acetazolamide, topical mydriatics, and antiglaucoma eye drops proved ineffective in controlling the elevated intraocular pressure (IOP). Therefore, we attempted removal of the dislocated lens through small corneal incisions. However, the hardness of the lenticular nucleus made its complete removal by vitrectomy difficult; hence, endocapsular phacoemulsification was performed in the anterior chamber. After the corneal edema subsided, the patient’s best- corrected visual acuity (BCVA) returned to its preoperative level of 0.7, and the IOP reduced to 12 mmHg without antiglaucoma mediations. After his ocular condition had stabilized for 3 months, a 3-piece soft acrylic iris-fixated intraocular lens (IOL) was implanted in his right eye through sutureless corneal incisions. His BCVA improved to 0.8 thereafter.
Conclusion: Small-incision clear cornea endocapsular phacoemulsification and iris-fixated IOL implantation are relatively safe techniques for managing an anteriorly dislocated crystalline lens. The use of small incisions in both these techniques not only prevents potentially devastating surgical complications but also decreases postoperative astigmatism.

並列關鍵字

crystalline lens dislocation ； ectopia lentis ； secondary angle-closure glaucoma ； iris-fixated intraocular lens