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Hypotony Maculopathy after 23-Gauge Transconjunctival Sutureless Vitrectomy: A Case Report

23-Gauge經結膜不縫合玻璃體切除術後產生低眼壓性黃斑部病變:病例報告

摘要


目的:報告一例23-Gauge經結膜不縫合玻璃體切除術後產生低眼壓性黃斑部病變。 方法:病例報告。 結果:39歲男性因左眼穿刺傷造成鞏膜破裂、眼內異物、外傷性白內障、視網膜破洞及視網膜血管阻塞,先接受緊急鞏膜縫合、20-gauge玻璃體切除術及白內障摘除。十周後再接受23-gauge玻璃體切除術及人工水晶體植入。術前左眼最佳矯正視力為0.3,眼壓為8mmHg,但術後第6天眼壓降到4mmHg。眼底檢查顯示視網膜有血管扭曲及脈絡膜皺摺之現象。超音波顯示無脈絡膜滲出及無視網膜剝離。在手術後3星期眼壓自發性地回復到15mmHg。矯正視力於11星期後進步到1.0。 結論:不縫合玻璃體切除術後產生低眼壓性的情況並不少見,通常會自發性地回復,不會留下後遺症。年輕人及之前接受過玻璃體切除術為術後低眼壓性的危險因子。然而,術後發生低眼壓性黃斑部病變是少見的併發症。此病例接受不縫合玻璃體切除術後產生持續性低眼壓性合併低眼壓性黃斑部病變,接受保守性治療後自發性地復原。

關鍵字

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並列摘要


Purpose: To describe a case of hypotony maculopathy following 23-gauge transconjunctival sutureless vitrectomy. Methods: A case report and literature review. Results: A 39-year-old man had penetrating injury of his left eye by a piece of iron. Scleral perforation, intraocular foreign body, traumatic cataract, retinal break and retinal vessel occlusion were noted during initial examination. He received emergent surgery of the scleral wound, 20-gauge pars plana vitrectomy, lensectomy and removal of the intraocular foreign body, followed by 23-gauge sutureless vitrectomy and secondary intraocular lens implantation 10 weeks later. His preoperative best corrected visual acuity was 0.3 and the intraocular pressure (IOP) was 8 mmHg. However, IOP decreased to 4 mmHg on the postoperative day 6. Fundus examination showed retinal vascular tortuosity and choroidal folds. He was treated with prednisolone acetate 1% four times a day. The IOP spontaneously returned to 15 mmHg 3 weeks after the operation. His best corrected visual acuity gradually improved to 1.0 at the 11th week. Conclusions: Postoperative hypotony following sutureless vitrectomy is not uncommon, and usually resolves spontaneously without other complications. Young age and a previous vitrectomy are risk factors related to postoperative hypotony. However, postoperative hypotony maculopathy is an uncommon complication. Our patient had persistent hypotony following a 23-guage sutureless vitrectomy complicated by hypotony maculopathy. It resolved spontaneously after conservative treatment.

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