glaucomaНациональный журнал ГлаукомаNational Journal glaucoma2078-41042311-6862Federal State Budgetary Institution of Science “Krasnov Research Institute of Eye Diseases”10.53432/2078-4104-2023-22-4-52-59glaucoma-489Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESОстрый приступ глаукомы на фоне коронавирусной инфекции (клинический случай)Acute glaucoma attack in a patient recovered from coronavirus infection (case report)https://orcid.org/0009-0000-9396-8210СоколовскаяТ. В.SokolovskayaT. V.

к.м.н., ведущий научный сотрудник отдела хирургии глаукомы

127486, Москва, Бескудниковский бульвар, 59а

Cand. Sci. (Med.), Lead Researcher at the Glaucoma Surgery Department

59a Beskudnikovskiy blvd., Moscow, 127486

https://orcid.org/0000-0003-2465-5610ГутникВ. Н.GutnikV. N.

Гутник Валерия Николаевна, к.м.н., врач-офтальмолог

127486, Москва, Бескудниковский бульвар, 59а

Cand. Sci. (Med.), ophthalmologist

59a Beskudnikovskiy blvd., Moscow, 127486

dr.gutnik@mail.ruhttps://orcid.org/0000-0001-5319-4898КрасноваЕ. О.KrasnovaЕ. О.

клинический ординатор

127486, Москва, Бескудниковский бульвар, 59а

clinical resident

59a Beskudnikovskiy blvd., Moscow, 127486

ФГАУ «НМИЦ «МНТК «Микрохирургия глаза» имени акад. С.Н. Фёдорова» Минздрава РФРоссияS.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery"Russian Federation2023071220232245259Copyright © Соколовская Т.В., Гутник В.Н., Краснова Е.О., 20232023Соколовская Т.В., Гутник В.Н., Краснова Е.О.Sokolovskaya T.V., Gutnik V.N., Krasnova Е.О.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.glaucomajournal.ru/jour/article/view/489

Распространенность офтальмологических проявлений среди пациентов с COVID-19 колеблется в пределах 2%...32%. Наиболее распространенным глазным заболеванием при COVID-19 является вирусный конъюнктивит, также имеются сообщения о случаях эписклерита, увеита, окклюзий центральной артерии и вены сетчатки, ретинопатии, глаукомы, синдрома сухого глаза, о редких нейроофтальмологических проявлениях, таких как диплопия, офтальмоплегия и нистагм. Нами описан клинический случай двустороннего острого приступа закрытоугольной глаукомы на фоне тяжелой пневмонии, вызванной COVID-19.

ЦЕЛЬ

ЦЕЛЬ. Определить причины возникновения и развития острого приступа глаукомы на фоне пневмонии, вызванной COVID-19 и оценить эффективность лазерной иридэктомии и трансцилиарного дренирования задней камеры (ТДЗК) глаза при двустороннем остром приступе закрытоугольной глаукомы, возникшем на фоне COVID-19.

МЕТОДЫ

МЕТОДЫ. Под наблюдением находилась пациентка с ранее перенесенной пневмонией, вызванной COVID-19, с диагнозом OU Первичная закрытоугольная IIIС глаукома (состояние после острого приступа), гиперметропия слабой степени, осложненная катаракта. С целью нормализации офтальмотонуса и восстановления зрительных функций была проведена лазерная иридэктомия на обоих глазах по стандартной технологии, выполнена хирургическая антиглаукомная операция — ТДЗК на обоих глазах, затем — факоэмульсификация с имплантацией интраокулярной линзы.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ. После лазерной иридэктомии и ТДЗК на обоих глазах достигнуты снижение уровня ВГД до «давления цели» без использования гипотензивных препаратов и стабилизация глаукомного процесса. Вторым этапом выполнена факоэмульсификация катаракты с имплантацией ИОЛ, что позволило значительно повысить остроту зрения обоих глаз.

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ. COVID-19 может привести к потере зрения и инвалидизации, поэтому необходимо обязательно контролировать внутриглазное давление у пациентов, которые длительно находятся в положении лежа на животе (прон-позиция) и системно получают стероидные препараты, особенно при предрасположенности к развитию глаукомы или при ранее установленной глаукоме.

The prevalence of ophthalmic manifestations in COVID-19 ranges from 2 to 32%. The most common ophthalmic disease associated with COVID-19 is viral conjunctivitis, but there are also reports of cases with episcleritis, uveitis, occlusions of the central retinal artery and vein, retinopathy, glaucoma, dry eye syndrome, as well as rare neuroophthalmological manifestations such as diplopia, ophthalmoplegia and nystagmus. This study reports a case of bilateral acute angle-closure glaucoma attack in a patient recovered from severe COVID-19 pneumonia.

PURPOSE

PURPOSE. To determine the causes of bilateral acute angle-closure glaucoma attack associated with COVID-19 pneumonia, and to evaluate the effectiveness of laser iridotomy and transciliary drainage of the posterior chamber of the eye.

METHODS

METHODS. Bilateral acute angle closure glaucoma attack was observed in a female patient recovered from COVID-19 pneumonia. Low hypermetropia and co-existing cataract were diagnosed in both eyes. In order to normalize the IOP and restore visual acuity, laser iridotomy was performed in both eyes, followed by surgical treatment of glaucoma with transciliary drainage of the posterior chamber in both eyes. After that the patient underwent phacoemulsification with implantation of intraocular lenses (IOL) in both eyes.

RESULTS

RESULTS. Laser iridotomy and transciliary drainage of the posterior chamber was performed in both eyes. The target IOP without topical therapy and stabilization of glaucoma were achieved in both eyes. The second step was phacoemulsification with implantation of IOL, which significantly improved visual acuity of both eyes.

CONCLUSION

CONCLUSION. COVID-19 can lead to vision loss and disability, therefore IOP should be monitored in patients that remain in prone position for ventilation for extended periods of time and receive systemic steroid medications. This is especially relevant for patients with a predisposition to glaucoma or with diagnosed glaucoma.

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The authors declare that there are no conflicts of interest present.