内眼手术中发生驱逐性脉络膜上腔出血的临床观察

Abstract

目的：分析发生在内眼手术中驱逐性脉络膜上腔出血的原因和治疗转归。方法：收集内眼手术中发生驱逐性脉络膜上腔出血患者11例，男性6例，女性5例，分析其原发病种类，手术类型，治疗方法和治疗效果。结果：在11例患者中手术前合并高眼压7例，其中2例是玻璃体切割术后；4例眼压正常。手术类型分别是小梁切除术3例，青光眼白内障联合手术4例，白内障手术2例，II期人工晶体植入2例。4例实施了玻璃体切割硅油填充 + 后巩膜放液手术，7例保守治疗。随访6~12个月，2例眼球萎缩，3例无光感，光感1例，2例手动，最佳矫正视力：3例0.02~0.1，1例0.2，1例0.4。结论：手术前高眼压是内眼手术中发生驱逐性脉络膜上腔出血的高危因素；对于出血严重患者行玻璃体切割联合引流脉络膜上腔积血是处理驱逐性脉络膜上腔出血的有效方法。 Objective: To analyze the causes and therapeutic outcome of expulsive suprachoroidal hemorrhage during surgery. Methods: This study collected 11 cases (6 male and 5 female, 11 eyes) with expulsive suprachoroida hemor- rhage during intraocular surgery. The primary disease type, surgery type, intraocular pressure, and therapeutic methods and effect were analyzed. Results: Pre-surgery high intraocular pressure occurred in 7 eyes. In 11 eyes, 3 eyes were performed trabeculectomy, 4 eyes were performed cataract extraction combined with trabeculectomy, 2 eyes were per- formed cataract surgery, and 2 eyes were performed phase II IOL implantation. In 11 cases, 4 cases underwent secondary surgical intervention with radial sclerotomies combined with vitrectomy and silicone oil filling, and the rest cases underwent conservative treatment. These cases were followed up for 6 to 12 months, and finally atrophy occurred in 2 eyes, no light sensor occurred in 3 eyes, light sensors occurred in 1 eye, hand move occurred in 2 eyes, best corrected vision acuity (BCVA) 0.02 to 0.1 occurred in 3 eyes, BCVA 0.2 occurred in 1 eye, and BCVA 0.4 occurred in 1 eye. Conclusion: Preoperative high intraocular pressure is a risk factor for expulsive suprachoroidal hemorrhage during sur- gery. Radial sclerotomy combined vitrectomy and silicone oil filling can effectively treat severe expulsive suprachor- oidal hemorrhage.