Особенности диагностики глаукомы на миопических глазах в отдаленные сроки после кераторефракционной хирургии (клинический случай)

Abstract

Purpose. Demonstration of a clinical case of diagnosis and dynamic observation of glaucoma in a patient after LASIK. Material and methods. Patient A., 58 years old. Complaints about decreasing in vision of the right eye into the distance during the last year. In 2004, LASIK was performed for moderate myopia with astigmatism. In 2018, for the first time, asymmetry of the parameters of the optic nerve head (the ratio of the maximum excavation size to the diameter of the disk (E/D)) was revealed for the first time: up to 0.7 in the right eye; on the left eye – up to 0.5. At the same time, the level of intraocular pressure (IOP) according to Maklakov was 22 mm Hg. Installations of prostaglandin analogues (APG) (0.005% solution of latanoprost) once are recommended. In subsequent years, the patient was on the «D» register at the place of residence, the level of IOP according to Maklakov varied from 18 to 20 mm Hg. After 4 years, the level of IOP according to Maklakov (on the previous hypotensive regimen): OD – 18 mm Hg; OS – 21 mm Hg. Ophthalmoscopically OD: E/D – 0.85–0.9; on OS: E/D – 0.9 with a breakthrough of the neuroretinal rim from below. SAP: OD – with absolute scotoma in the Bjerrum’s zone 5–15° from the fixation point, OS – blind spot expansion. Based on this, the diagnosis was formulated: primary open-angle glaucoma III A of the right eye, II A of the left eye. Results. Selective laser trabeculoplasty was performed. But due to the lack of complete stabilization of the IOP level, the hypotensive regimen was strengthened in the form of installations of APG and alpha-agonists. Despite this, the progression of glaucoma optic neuropathy was noted, and a decision was made to perform antiglaucoma surgery. Conclusion. Despite Maklakov’s IOP levels within the average statistical norm, in patients after LASIK, it is important to assess carefully the condition of the structures of the optic nerve head. Keywords: keratorefractive operations, myopia, glaucoma, ophthalmotonometry