2017年 · 第53卷第04期

This issue focuses on the clinical and basic research of cataract and intraocular lens. Professor Bao Yongzhen, Department of Ophthalmology, Peking University People's Hospital, is responsible for the planning, composition and review of this issue.

Trabeculectomy is the most important surgical method in the treatment of glaucoma. Postoperative complications were mainly related to the tightness of scleral flap suture. If the suture is loose, the filtration volume will be large and the intraocular pressure reduction effect will be good, but the incidence of complications such as shallow anterior chamber, low intraocular pressure, anterior chamber hemorrhage, choroidal leakage and hypotensive maculopathy after operation will be high. If the suture is tight, the filtration volume will be small. Although there are few early postoperative complications, the aqueous humor outflow resistance will be large, and the filtration tract will be easily scarred, resulting in operation failure. How to regulate postoperative filtration and reduce the occurrence of postoperative scarring has become the key point of success of trabeculectomy.

The occurrence of glaucoma is closely related to the pressure gradient of intraocular pressure and intracranial pressure^[1,2,3]。 At present, the detection methods of intracranial pressure are mainly invasive, and are prone to complications such as bleeding and infection. Therefore, it is of great significance to find a non-invasive and accurate method to monitor intracranial pressure in the diagnosis and treatment of glaucoma. Noninvasive measurement of intracranial pressure and transsieve pressure gradient based on MRI has been used in clinical practice^[4]Among them, the method with the diameter of the optic nerve subarachnoid space as the main parameter has attracted much attention and has potential clinical application value^[5]。

True microphthalmos refers to a rare eye disease in which the volume of the eyeball is significantly smaller than normal after the embryo cleft is closed, without other ocular deformities^[1,2]Although the disease is clinically rare, its harm is very serious. Patients often have increased intraocular pressure and are difficult to control, which is likely to lead to choroidal leakage, expulsive bleeding, retinal detachment, persistent shallow anterior chamber and malignant glaucoma during or after internal eye surgery. Complications such as malignant glaucoma, but cases of acute non-arteritic anterior ischemic optic neuropathy (NAION) after internal eye surgery are rarely reported in China. The author once treated a patient with typical true microphthalmos, uveal leakage in both eyes, and NAION after exudative retinal detachment in the right eye. The clinical diagnosis and treatment are analyzed and reported as follows.

The patient was a 65-year-old female. The visual acuity of the left eye suddenly decreased 20 days after cataract extraction and IOL implantation, and he was seen in the Department of Ophthalmology of Bethune First Hospital of Jilin University. Eye examination, left eye corrected visual acuity 0.3 (+7.0+4.0 DC ×180°); The conjunctiva was not obviously congested, the cornea was transparent, the intraocular pressure was normal, and no IOL was seen in the pupil area. B-ultrasound examination: strong linear anterior retinal echo in the posterior pole of the left eye. Retcam-Ⅱ examination: IOL shedding can be seen in the dilated pupil of the left eye, located at the posterior pole of the fundus, moving with body position; No obvious abnormalities were observed in the optic disc, retina and blood vessels (Quintessence Picture 1）。 Clinical diagnosis: Left eye cataract extraction after IOL implantation; IOL dislocation in left eye.