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首页> 外文期刊>Journal of glaucoma >Secondary Glaucoma due to Iridescent Crystalline Particles Masquerading as Refractory Hypertensive Uveitis in an Eye With Irradiated Iris Melanoma
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Secondary Glaucoma due to Iridescent Crystalline Particles Masquerading as Refractory Hypertensive Uveitis in an Eye With Irradiated Iris Melanoma

机译：由于伪装为令人难治性高血压葡萄膜炎，透射虹膜逆血性葡萄膜炎引起的次级青光眼

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Purpose:We report a previously unrecognized mechanism of secondary glaucoma due to iridescent crystalline particles released from an irradiated iris melanoma. It masqueraded as refractory hypertensive uveitis following uncomplicated phacoemulsification.Materials and Methods:A 58-year-old gentleman had an iris melanoma that underwent successful regression following irradiation with proton beam radiotherapy. Three years later an uncomplicated phacoemulsification with intraocular lens implant was performed and subsequently the patient presented with apparently refractory hypertensive uveitis. Closer examination identified unique iridescent crystalline particles originating from a disintegrating tumor and dispersing within the anterior chamber and drainage angle. The patient developed a unilateral secondary open-angle glaucoma attributable to these particles. Ultrasound biomicroscopy of the anterior segment confirmed absence of tumor recurrence or intrascleral spread and systemic investigations ruled out distant metastases.Results:The intraocular pressure was refractory to maximal medical treatment, but was eventually controlled with trans-scleral diode laser cyclo-photocoagulation.Conclusions:This is the first report of a secondary glaucoma attributable to trabecular blockage with iridescent crystalline particulate material released from a disintegrating, previously irradiated, iris melanoma. Proton beam radiotherapy and possibly phacoemulsification may have played a role in triggering the release of these previously undescribed particles from the atrophied tumor surface. This unique mechanism of secondary glaucoma needs to be kept in mind in such rare cases. Trans-scleral cyclodiode laser may be used as a good initial option in such cases to minimize potential risk of tumor seeding with incisional glaucoma surgery.
机译：目的：由于从辐照的虹膜黑色素瘤释放的虹彩结晶颗粒，我们报告了先前未被识别的二次青光眼机制。它伪装成难治性高血压葡萄膜炎，这种情况下不复杂的噬乳化。材料和方法：一位58岁的绅士有一个虹膜黑色素瘤，在用质子束放射照射后进行了成功的回归。三年后，进行了一种简单的单乳化与眼内晶状体植入物，随后患有明显难治性高血压葡萄炎的患者。接近检查源自崩解肿瘤的独特虹彩结晶颗粒并分散在前室内和排水角度。该患者开发了归因于这些颗粒的单侧二级开口荧光眼。前段的超声波生物镜检查确认没有肿瘤复发或胃肠杆菌涂抹，并排除了远处转移的系统性调查。结果：对半岩体的药物治疗的难治性是难以解决的，但最终用反式巩膜二极管激光环光电凝固。结论：这是具有透析释放，先前照射的虹膜黑色素膜的虹吸结晶颗粒材料的次要青光眼的第一次报告。质子束放射疗法和可能的沉淀乳化可能在触发从萎缩的肿瘤表面释放这些先前未签号的颗粒的释放中起作用。在如此罕见的情况下，需要牢记二次青光眼的这种独特的机制。在这种情况下，反式巩膜环偶激光可以用作良好的初始选项，以最大限度地减少肿瘤播种的潜在风险。

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