Ciliary ring block glaucoma

Introduction to ciliary ring block glaucoma Ciliary block glaucoma (ciliary blockglaucoma) is a rare and serious type of closed-angle glaucoma, which can cause blindness in one or both eyes. The exact pathogenesis is not clear. For ophthalmologists, the disease is still a difficult clinical practice. problem. basic knowledge The proportion of illness: 0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: ocular hypertension

Cause of ciliary ring block glaucoma

(1) Causes of the disease

1. Ciliary body - lens or ciliary body - vitreous block

Many studies have found that there are some anatomical abnormalities in the eyes of malignant glaucoma, that is, the anatomical relationship between the ciliary process, the lens and the vitreous anterior membrane (the horizontal region of the ciliary ring) is abnormal.

Classical malignant glaucoma almost always occurs after primary angle-closure glaucoma with anterior segment anatomical abnormalities (such as presbyopia, small eyeballs, and shallow anterior chamber), whether it is relatively crowded in the anterior segment (stenotic anterior chamber and A thick, forward-moving lens) also has a relatively narrow ciliary annulus.

Abnormal anatomical relationship between the ciliary process, the lens and the vitreous anterior membrane may be the main cause of aqueous humor reflux and the formation of water sac in the vitreous cavity. Once induced by surgery, trauma, inflammation or miotic agents, this Anomalous anatomical relationships become very significant and manifest as a vicious cycle, and the important role of the vitreous (especially the anterior vitreous) should not be underestimated while emphasizing the ciliary body or direct lens block.

2. Lens zonal ligament relaxation

The lens-iris compartment advancement in patients with malignant glaucoma may be due to abnormal relaxation of the lens suspensory ligament, fragility and compression from the vitreous. Clinically, the application of mydriatic ciliary muscle numbness in the treatment of malignant glaucoma is achieved by tightening the sling To improve the advancement of the lens-iris compartment, the relaxation of the lens suspensory ligament may be due to severe, long-term closure of the angle of the anterior chamber, or due to surgery, miotic agents, inflammation, trauma and some unclear causes of ciliary tendon, edema As a result of the advancement, these risk factors cause the equator of the lens to directly push the surrounding iris and close the angle of the anterior chamber. This concept was once called "direct lens block glaucoma", and now it is recognized that these conditions are more common in so-called Non-traditional malignant glaucoma or similar malignant glaucoma should be identified with certain known causes of the disease, such as ciliary body-choroidal leakage, lens relaxation syndrome or undiagnosed lens subluxation.

In conclusion, malignant glaucoma is a multifactorial, multi-mechanism disease, with or without abnormal eye anatomy, multiple pathogenic factors and multiple pathogenesis mentioned above participate in this pathological cycle, however, The subtle changes in the "blind zone" of the vitreous and ciliary bodies in the periphery, as well as the initial events that cause an increase in the volume of the vitreous (the occurrence of high pressure in the posterior vitreous) remain unclear. The pathogenesis of true malignant glaucoma requires more basic information and Reliable evidence, regardless of the various pathogenic factors and mechanisms of malignant glaucoma, is the last common pathway for vitreous self-expansion.

(two) pathogenesis

There is currently no recognized pathogenesis for malignant glaucoma. The following are some of the more popular theories.

1. The theory of "water bag" formation in the vitreous

This theory was first proposed by Shaffer and later accepted by many scholars. It is assumed that the aqueous humor remains in the vitreous and then detaches, causing the iris-lens or iris-vitret to move forward, causing the anterior chamber to become shallower and aggravating physiological pupillary block. Even causing occlusion of the angle of the anterior chamber, resulting in elevated intraocular pressure, the use of ultrasound examination, can prove the existence of water bags in the vitreous cavity, leading to the mechanism of lateral water transfer is still unclear, the largest possible due to ciliary body-crystal block To.

2. Ciliary body - lens (or ciliary body - vitreous) block theory

It has been observed that the anterior rotation of the ciliary process in patients with malignant glaucoma oppresses the anterior vitreous of the lens in the lens or the anterior vitreous membrane of the aphakic eye, which blocks the passage of aqueous humor to the front, so it is advocated to refer to malignant glaucoma. In order to replace malignant glaucoma, the cause of mechanical blockage in aqueous humor circulation may be related to anatomical factors such as small eyeball, small cornea, shallow anterior chamber, lens thickness and short visual axis in patients with typical malignant glaucoma. Coupled with the trapping agent, trauma, surgery and uveitis and other incentives, the ciliary body edema or spasm, and promote the ciliary body and the lens (or vitreous) further close, resulting in increased intraocular pressure.

3. Vitreous and vitreous anterior membrane block theory

The vitreous anterior membrane may be involved in the formation of malignant glaucoma. It is believed that the vitreous and vitreous anterior membrane membrane permeability of the malignant glaucoma is reduced, which affects the forward drainage of the fluid. The perfusion experiment shows that the fluid flow resistance through the vitreous is increased when the intraocular pressure is increased. It also increases, thus causing a decrease in the liquid moving through the vitreous gel. This increase in resistance may be due to the concentration of the vitreous and its forward displacement, so that the anterior peripheral vitreous is in the same position as the ciliary body and the lens equatorial portion, reducing the vitreous body. The anterior membrane can pass through the effective area of the liquid, further aggravating the resistance of the liquid in the vitreous gel to move forward. Due to the pressure difference between the anterior and posterior vitreous bodies, the concentrated vitreous gel is displaced forward, resulting in a shallow anterior chamber.

4. Lens ligament relaxation theory

The lens-iris advancement of malignant glaucoma may be due to the relaxation or weakness of the lens ligament and the pressure of the vitreous. Other scholars also advocate this theory, and believe that the lens ligament relaxation is due to the result of continuous angle occlusion or due to surgery As a result of ciliary tendon caused by sputum, inflammation, trauma or other unexplained causes, the anterior and posterior diameter of the lens increases due to the relaxation of the lens ligament, and the lens-iris compartment moves forward, resulting in shallow anterior chamber.

Ciliary ring block glaucoma prevention

Slit lamp microscopy is needed several hours after surgery. If the anterior chamber is found to be extremely shallow or disappearing and the intraocular pressure is increased, the standard medication for standard malignant glaucoma should be started immediately. Malignant glaucoma often occurs in dismantling or loosening the scleral valve. When the line is used, the scleral flap should not be removed too quickly, and the ciliary muscle paralysis should not be stopped prematurely.

Ciliary ring block glaucoma complications Complications, high ocular hypertension

Severe inflammatory response in the anterior chamber, post-irisal adhesions, and high intraocular pressure fundus damage.

Ciliary ring block glaucoma symptoms Common symptoms High intraocular pressure paralysis Congestive trauma Uveitis Intraocular pressure increased abscess edema without lens

The clinical types of malignant glaucoma (ciliary ring-blocking glaucoma) syndrome are divided into two categories: traditional (classical) and non-traditional (similar or related to malignant glaucoma). Domestic scholars advocate multiple classifications. Secondary secondary, primary occurs in primary angle-closure glaucoma with eye susceptibility anatomical abnormalities, which may include: classic malignant glaucoma after glaucoma surgery, classic malignant glaucoma lens removal After aphakic or intraocular lens malignant glaucoma, malignant glaucoma caused by miotic or laser treatment before surgery, and divided into three types of malignant glaucoma with lens, no lens or intraocular lens, this classification method It is helpful to understand the role of vitreous in the pathogenesis of malignant glaucoma. Considering the current international tendency to gradually dilute the primary and secondary classification of glaucoma classification, it also considers that the concept of modern malignant glaucoma includes a group and water. Countercurrent is associated with the clinical situation, therefore, the following representative names will be used to describe the various clinical categories of the syndrome. type:

1. Classical malignant glaucoma

This is the most common type of syndrome in this group, typically occurring after primary incision glaucoma with a lens, chronic angle-closure glaucoma is more common than acute angle-closure glaucoma, primary Closed-angle glaucoma itself has abnormal anatomical structures, such as a small cornea, a shallow anterior chamber (especially asymmetrical), a narrow angle, a relatively thick lens and a forward position (low lowe coefficient), and a ciliary thick and anterior The ciliary spur of the lens is near the equator (<0.5mm, small ciliary ring) and other features of the anterior segment of the eye. These factors may be the basis of malignant glaucoma, anti-glaucoma surgery (peripheral iridotomy, filtering surgery) Or ciliary body separation may be the cause of malignant glaucoma, domestic report of filtering surgery accounted for 56.5%, of which trabeculectomy is less common, long-term high intraocular pressure, preoperative high intraocular pressure drugs can not be controlled, or intraoperative Sudden increase in intraocular pressure (the anterior chamber disappears, the iris-lens compartment is moved forward, and the ciliary valgus is in the incision) is also considered to be the cause of malignant glaucoma. Most researchers have suggested the type of surgery and preoperative operation of the disease. Intraocular pressure water Irrelevant, if the iris corneal angle is still partially or completely closed during surgery, the risk of this disease increases significantly regardless of whether the intraocular pressure is reduced before surgery. If the angle is completely open during surgery, the disease usually does not occur in peripheral iridotomy. Malignant glaucoma can occur during surgery, several days, weeks, months or quite any time after surgery, some cases occur when the dilated ciliary muscle paralysis agent is discontinued, or when the miotic agent is used, if Malignant glaucoma occurs at a glance, and the contralateral eye will also occur.

Typical clinical manifestations of malignant glaucoma: the iris-lens compartment is extremely advanced, the anterior chamber is generally shallow or disappears (from the center to the periphery), and the acute or subacute intraocular pressure is elevated (up to 5.33 to 8.0 kPa, 40~) 60mmHg), in a few cases, the intraocular pressure can be normal, usually the peripheral iris resection hole exists, the treatment of inguinal decompression is ineffective or worse, dilated ciliary muscle paralysis may be effective, traditional glaucoma surgery can not reverse the disease process, postoperative classic malignant glaucoma It needs to be differentiated from choroidal leakage, suprachoroidal hemorrhage and postoperative pupillary block glaucoma.

2. Aphakic malignant glaucoma occurs in:

1 classic malignant glaucoma after the removal of the lens, malignant glaucoma persisted;

2 malignant glaucoma after conventional cataract extraction without glaucoma history; intracapsular cataract extraction, extracapsular cataract extraction can occur, but if the operation is accompanied by loss of vitreous, it will not occur.

(1) Clinical manifestations: After cataract extraction, the anterior chamber becomes shallow or disappears universally, the intraocular pressure is elevated or normal, the peripheral iris resection is present, and the anterior chamber is often accompanied by severe inflammatory reaction. The pupil and the iris are adhered and thickened. The posterior capsule of the lens adheres to the vitreous anterior membrane (after dilated); UBM examination reveals thickening of the ciliary process, anterior rotation, ciliary process and adhesion to the vitreous anterior membrane or posterior lens capsule, and the iris-vitreous compartment is extremely advanced. .

(2) Pathogenesis includes:

1 significant vitreous hemorrhoids make the vitreous anterior membrane close to the ciliary body and iris;

2 Surgical trauma and residual lens cortex cause severe inflammation of the anterior segment of the eye, causing adhesion between the posterior capsule of the lens, the anterior membrane of the vitreous and the ciliary process, causing ciliary process-vitrary blockade for two reasons, and the aqueous humor is backwards and Accumulation in the vitreous cavity, which causes the iris-vitreous compartment to move forward extremely and the angle of the anterior chamber to close. The aphakic malignant glaucoma is cured by the deep incision of the vitreous anterior membrane, supporting the vitreous and its anterior membrane in its pathogenesis. importance.

3. Intraocular lens of malignant glaucoma

Malignant glaucoma can also occur after cataract extraction and intraocular lens implantation. These eyes may or may not have a history of glaucoma and history of filtering surgery. Clinical manifestations: cataract extraction combined with intraocular lens implantation (or combined trabeculectomy) The anterior chamber becomes shallow or disappears. The anterior chamber intraocular lens contacts the corneal endothelium or the iris-posterior chamber intraocular lens is extremely advanced. The intraocular pressure is elevated or normal (1.33 kPa). The anterior chamber intraocular lens should be alert to the occurrence of malignant glaucoma. Malignant glaucoma, it is speculated that the intraocular lens may push the iris backward to make it close to the vitreous anterior membrane, and the aqueous flow of the posterior chamber is blocked. The posterior chamber intraocular lens malignant glaucoma, in addition to the above-mentioned aphakic glaucoma In addition, the intact thickened posterior capsule and anterior border membrane and intraocular lens may act as a barrier to prevent the aqueous flow forward; at the same time, the surgical wound causes the vitreous base to separate from the flat part of the ciliary body, which may cause the aqueous humor to flow back into the glass. In the body cavity, a case of posterior chamber intraocular lens malignant glaucoma has been reported, and its pathogenesis may be short and the eye axis is planted. Into the posterior chamber intraocular lens of the large optical surface (diameter 7mm), so these patients should be treated with extra care when implanting the posterior chamber intraocular lens.

4. Malignant glaucoma caused by miotic drugs

The earliest report in the eyes of primary angle-closure glaucoma, preoperative application of miotic drugs to induce malignant glaucoma attacks, which can be regarded as a pre-existing manifestation of classic malignant glaucoma, and the episode of classic malignant glaucoma often begins After the application of miotic drugs, these all suggest a causal link between them, similar cases occur in open-angle glaucoma, or in the application of amniotic drugs after open-angle glaucoma filtration surgery, domestic report Malignant glaucoma induced by miotic drugs accounted for 24.7% of all malignant glaucoma, while malignant glaucoma induced by post-operative use of miotic drugs accounted for 14.12%. The pathogenesis of the drug was sputum sputum for ciliary tendon anterior rotation, lens suspensory ligament Relaxation, the position of the lens is relatively advanced, and the ciliary ring is reduced.

5. Malignant glaucoma associated with trauma

Eyeball blunt trauma can cause ciliary body congestion and edema or flat leakage, ciliary process anterior rotation, lens suspensory ligament relaxation and lens advancement, ciliary ring reduction, thereby inducing clinical manifestations similar to malignant glaucoma, perhaps more often in The anterior segment of the eye has a narrow structure on the affected eye.

6. Malignant glaucoma associated with inflammation

Anterior and posterior uveitis can induce clinical manifestations of malignant glaucoma, such as uveal inflammation in rheumatism and Harada disease, its pathogenesis and inflammation-induced ciliary body congestion and edema, flat leakage and ciliary process Related to the infection, malignant glaucoma has also been reported in fungal keratopathy and acute fungal endophthalmitis, called "fungal malignant glaucoma", similarly seen in atypical (no spore actinomycetes) stars Nocardia bacterial endophthalmitis, iris lens adhesion and vitreous abscess make the anterior chamber shallow, leading to aqueous humor countercurrent, histology also confirmed the existence of fungal mass barrier between the iris and lens, thus supporting the infection-related malignant glaucoma The pathogenesis is aqueous countercurrent rather than pupillary block. Due to the similar malignant glaucoma caused by endophthalmitis and vitreous abscess, flat vitreous surgery should be taken early.

7. Malignant glaucoma associated with retinal diseases

(1) Central retinal vein occlusion: After the central retinal vein occlusion, the iris-lens compartment is transiently advanced, the anterior chamber is shallow and the intraocular pressure is elevated. They suggest that the fluid leaks from the blocked retinal vein into the vitreous or vitreous. The cavity and aqueous retention caused the iris-lens to move forward. Through the fundus fluorescein angiography, it was confirmed that there was significant leakage in the retina and in the vitreous. The corneal process was found by the gonioscopic examination, so the pathogenesis was proposed. The ciliary body is swollen and related to the frontal rotation.

(2) Extensive retinal photocoagulation: After extensive retinal photocoagulation for diabetic fundus lesions, most of the anterior chamber of the eye will become shallow, about 31% of which have angle closure, and the intraocular pressure can sometimes reach 7.33 kPa (55 mmHg). The treatment is ineffective. Under the ophthalmoscope, edema or leakage of the choroid and ciliary body can be found. Ultrasound measurement of the ciliary body becomes thicker. It is speculated that the pathogenesis is due to ciliary body congestion and edema, and the frontal rotation and ciliary ring become smaller. Or because the choroidal exudate enters the vitreous cavity or the annular choroid detaches, causing the iris-lens to move forward.

(3) Retinopathy of prematurity: 30% of retinopathy of premature infants will have angle closure in the eye, the pathogenesis of which is the adhesion of the posterior fibrous tissue mass to the ciliary body, and the iris-lens compartment advances and the room when contracted. The angle is closed, the iridotomy around the disease is ineffective, and the dilated ciliary muscle paralysis can be improved. It is advocated to use lens removal.

(4) Retinal detachment surgery: patients with retinal detachment undergoing scleral shortening or scleral buckling surgery may have clinical manifestations similar to malignant glaucoma, suggesting that ciliary choroidal leakage causes the ciliary body to anteriorly rotate and abut the peripheral iris, Weiss 1 case of retinal detachment was performed 2 days after scleral buckling, the anterior chamber became shallow, the intraocular pressure increased and the choroidal detachment, the anterior chamber was shallower after the sputum sputum, and the drip sputum ciliary muscle palsy was slightly improved, drainage The choroidal effusion also failed to control the condition, and finally the posterior scleral incision, lens removal and iridotomy were performed. During the operation, the anterior ciliary process was found to be tightly covered on the equator of the lens.

8. Spontaneous malignant glaucoma

Clinical manifestations similar to malignant glaucoma can also occur in patients with no history of surgery, no application of miotic agents, or no other apparent causes.

Examination of ciliary ring block glaucoma

Mainly using ultrasound and UBM examination.

1. Clinical features of classic malignant glaucoma before attack

(1) Both eyes have narrow anatomical features of the anterior segment of the eye: the depth of the central anterior chamber is often less than 1.6mm or 1.8mm; especially the depth of the central anterior chamber of the eyes is asymmetrical, and the intraocular pressure is higher and the drug reaction is more likely to occur; The lens is thicker and the position is relative to the anterior position (Lowe's coefficient is often less than 0.18); the axial length is shorter.

(2) UBM examination revealed that the ciliary body of the affected eye was thicker than the anterior position (close to the surrounding iris), but it may be normal, the iris-lens was moved forward, and the distance between the ciliary process and the equator of the lens (ciliary ring) ) Smaller.

2. Early features of classic malignant glaucoma

UBM examination revealed that the iris-lens compartment was extremely advanced, and the iris was attached to the corneal endothelium from the root to the pupillary margin. The ciliary process was very close to the equator of the lens or only the fissure-like distance, the posterior chamber disappeared, and the ciliary body edema thickened. The ciliary process is anteriorly rotated and placed against the peripheral iris. If we can identify it in the early stage of malignant glaucoma or make a correct judgment early in the attack, we can quickly interrupt or alleviate the vicious cycle through a separate medical treatment. Avoid further surgery.

Diagnosis and diagnosis of ciliary ring block glaucoma

The diagnosis of typical (conventional) malignant glaucoma can be considered according to the following factors: in patients with acute or chronic angle-closure glaucoma, after peripheral iridotomy or trabeculectomy, the intraocular pressure is elevated and the anterior chamber is generally shallow. Or disappear, there is a clear lens Iris interval forward, treatment with miotic drugs will make the disease worse, with dilated ciliary muscle paralysis can ease the disease deepening the anterior chamber, open angle of the eye pressure drop, the disease is binocular disease, Under the same incentive, malignant glaucoma will also occur in the contralateral eye, and the anterior chamber becomes shallower after the contralateral unoccupied eye drops and the intraocular pressure is elevated, and the diagnosis can be confirmed.

Differential diagnosis

Postoperative malignant glaucoma should be identified with the following three postoperative complications with elevated or normal intraocular pressure and shallow or disappeared anterior chamber.

Pupil block

Before making a diagnosis of malignant glaucoma, it is first necessary to rule out the anterior chamber shallowing and elevated intraocular pressure due to the persistence of postoperative pupillary block, which can be judged by the following methods:

(1) anterior chamber morphology: the central anterior chamber of the pupillary block is asymmetrical with the surrounding anterior chamber. Usually, the central anterior chamber still retains a medium depth, but the peripheral iris anterior arch bulging and the surrounding anterior chamber are significantly shallower, malignant glaucoma The entire iris-lens septum or iris-vitreous compartment is generally advanced, and the central anterior chamber is significantly lighter or disappears.

(2) Peripheral iris resection and its patency: If the resection is clearly visible, there is no possibility of pupillary block; if the resection is unproven or suspected to be occluded, it can be re-made by laser or surgery. Peripheral iris resection.

(3) UBM examination: When the pupillary block is present, the UBM image shows the peripheral iris bulging forward, the posterior chamber exists, and the peripheral iris resection is absent or blocked. Usually, the lens is moved forward or the ciliary process is not obvious. There is still a distance between the equatorial portion of the lens.

(4) Intravenous injection of fluorescein: 10 ml of 5% sodium fluorescein solution was injected from the cubital vein, and then the appearance of fluorescein in the anterior chamber was observed under a slit lamp microscope to determine whether communication between the posterior chamber and the anterior chamber existed. Under normal circumstances, fluorescein can enter the anterior chamber from the pupil at about 30s after injection (like a solitary stream). Although the fluorescein in the anterior chamber is reduced when the pupil is blocked, even in the presence of complete pupillary block, the anterior chamber remains. Fluorescein can be found. In malignant glaucoma, fluorescein only appears behind the lens (with the lens), behind the vitreous anterior membrane (intraocular lens) or behind the inflammatory membrane (no lens).

Causes of obstruction of the peripheral iris resection:

1 The iris tissue is only partially excised and the intact pigment epithelial layer tissue remains, and the pupillary block can be removed by laser cutting the pigment epithelium;

2 The angled incision is too far behind (beyond the sclera), not only does not cut to the surrounding iris or root iris, and will cause bleeding due to the removal of the ciliary body tissue. The prevention method is to familiarize with the anatomical landmarks and incisions of the limbal surgery. Should be located before the scleral process;

3 peripheral iris resection is ciliary process, vitreous anterior membrane, vitreous, posterior elastic membrane, lens equator, residual lens cortex, clot, inflammatory exudate (machined), intraocular lens obstruction, etc. There are phakic eyes, aphakic eyes or intraocular lens. When the pupillary block is suspected, through the new peripheral iris resection, if the anterior chamber is deepened, the decrease of intraocular pressure can confirm the existence of pupillary block mechanism.

Iris-vitrethesis has been considered to be the pathogenesis of malignant glaucoma in aphakic or intraocular lens, but Shrader et al believe that the aqueous humor countercurrent in the intraocular lens is another form of pupillary block, namely iris-vitricular block, Iris-vitrex-blocked intraocular lens in the eye, although there is a full-thickness peripheral iris resection, iris bulging can still occur, some eyes undergo laser laser iridotomy to temporarily relieve pupillary block, but subsequent sustained remission often Need to use Nd:YAG laser to open the posterior lens capsule, vitreous anterior membrane or both, laser capsulotomy can also be done through the positioning hole of the intraocular lens, iris-vitrary block is also seen in the aphakic body, especially no planting Intracapsular cataract extraction after intraocular lens implantation may be caused by adhesion of the vitreous anterior membrane to the posterior iris, resulting in obstruction of free communication of aqueous humor from the posterior chamber into the anterior chamber, and laser iris incision and Nd:YAG laser vitreous. Anterior membrane incision can alleviate the support of this block, and some scholars believe that iris-vitraction block and pathophysiology of malignant glaucoma The mechanism is different. The latter lacks communication from the posterior chamber to the anterior chamber. The aqueous humor flows backwards and falls into the vitreous cavity. Simple iris resection and vitreous anterior membrane incision do not alleviate the malignant process; iris-vitraction block It is caused by the advancement of the vitreous anterior membrane in the same position behind the iris or adhesion to the posterior iris and the iris resection (inflammation). It is not necessary to use vitrectomy to treat this blockage because most Laser iridotomy or vitreous anterior membrane incision can alleviate this block.

2. Superior choroidal hemorrhage

Similar to malignant glaucoma, postoperative suprachoroidal hemorrhage may have a clinical feature of shallow or disappearing anterior chamber, elevated intraocular pressure or normal, bleeding may occur during surgery, hours or days after surgery (usually 1 week) Internal), especially after anti-glaucoma surgery, typical manifestations of eye pain and elevated intraocular pressure, eye inflammation and hyperemia (usually more serous choroidal leakage), anterior chamber shallow or disappear, visible around the fundus Single or multiple choroidal bulges, the size and location of the suprachoroidal hemorrhage bulge is similar to choroidal leakage, but the color appears dark brown or dark reddish brown (choroidal leakage is light brown), when viewing the fundus is difficult, Ultrasound examination is used to assist diagnosis. The treatment of suprachoroidal hemorrhage is similar to choroidal leakage. The choroidal fluid is drained through the two posterior sclera, and the anterior chamber is reconstructed with saline or viscoelastic agent. If the liquid is liquefied. Or partially liquefied dark red to black blood to confirm the diagnosis of bleeding; if the drainage liquid is a pale yellow transparent liquid, it is serous choroidal leakage, however The fluid from the upper collateral hemorrhage is occasionally mixed with a pale yellow transparent liquid mixed with liquefied blood with red or black. It is rare that intrachoroidal hemorrhage does not penetrate into the suprachoroidal space, and it is impossible from the suprachoroidal space. Drainage is obtained, followed by spontaneous absorption of the bleeding.

3. Choroidal leakage (disengagement)

This is a serous choroid-ciliary body detachment, which is often associated with glaucoma filtration surgery, and is associated with wound leakage (Seidel sign positive) and ultrafiltration (large filter bleb), and the anterior chamber of the eye becomes shallow or Disappearing is easily confused with malignant glaucoma, but its intraocular pressure is typically low (<1.33 kPa). When the anterior chamber disappears, the value measured by a Goldmann applanation tonometer, a pneumatic tonometer or a Tono-Pen tonometer is used. It is not reliable, that is, low intraocular pressure tends to overestimate and high intraocular pressure tends to underestimate, resulting in the inability to rely solely on intraocular pressure to judge whether it is ultrafiltration or malignant glaucoma. Ophthalmoscopy is the most diagnostic value. The method usually finds a light brown bulge in the peripheral choroid. If the visibility of the fundus is poor or detached from the shallow and flat, ultrasonic examination (B-ultrasound and UBM) is required. Most of the serous choroidal leakage of the eye will spontaneously absorb, and the choroidal bulge Disappearing; for a continuous low ocular pressure shallow anterior chamber or a large detachment with central contact, two posterior scleral incisions are required to drain the choroidal superior cavity fluid in the lower quadrant, such as the liquid drained from the suprachoroidal space is characteristic. Color liquid, then the diagnosis of serous choroidal leakage can be established, after which the fluid should be drained as much as possible and the anterior chamber should be reconstructed with saline or viscoelastic agent. The choroid or ciliary body of the eye of malignant glaucoma is rare. Fluid, but the presence of choroidal leakage does not rule out the possibility of aqueous humor flowing back into the vitreous cavity.

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