内眼手术术中及术后暴发性脉络膜上腔出血的原因、处理和预后

发布时间：2018-04-11 23:00

本文选题：暴发性脉络膜上腔出血 + 内眼手术　；参考：《眼科新进展》2016年02期

【摘要】：目的分析与评价内眼手术及术中术后暴发性脉络膜上腔出血的原因、处理和预后。方法选取暴发性脉络膜上腔出血患者11例,术前5例合并高度近视,4例合并高眼压,2例有既往内眼手术史,2例患者发生二次出血。出血后采取保守或于出血后10~16 d(平均12.1 d)手术治疗。手术方法包括单纯后巩膜脉络膜上腔积血穿刺放液术,或联合玻璃体切割及硅油填充术。结果 11例患者中有7例发生于术中,4例发生在术后1~3 d,约占同期我科内眼手术的0.15%(11/7204)。11例患者中,2例保守治疗,4例行单纯后巩膜脉络膜上腔积血穿刺放液术,1例行玻璃体切割及后巩膜脉络膜上腔积血穿刺放液术,另外4例行玻璃体切割硅油填充及后巩膜脉络膜上腔积血穿刺放液术。平均随访8.2个月,术后7例患者视力改善,1例无变化,3例恶化。结论术前高眼压、高度近视及既往内眼手术史是暴发性脉络膜上腔出血的高危因素。通过术中迅速关闭切口,术后采取保守治疗,择机行后巩膜脉络膜上腔积血穿刺放液术,视网膜脱离时联合玻璃体切割术,可保留患者部分视力。
[Abstract]:Objective to analyze and evaluate the causes, treatment and prognosis of intraocular surgery and postoperative fulminant suprachoroidal hemorrhage.Methods 11 cases of fulminant suprachoroidal hemorrhage, 5 cases of high myopia and 4 cases of high intraocular pressure were selected. 2 cases had previous history of intraocular surgery and 2 cases had secondary hemorrhage.Surgical treatment was performed on 10 ~ 16 days (mean 12.1 days) after bleeding.Surgical procedures include simple posterior scleral and suprachoroidal hemorrhage puncture and drainage, or combined vitrectomy and silicone oil filling.Results of the 11 cases, 7 cases occurred at 1 and 3 days after operation, accounting for about 0.15% of the total of 11 / 7204 cases in the same period. 2 cases were conservatively treated and 4 cases were treated with simple posterior scleral and suprachoroidal cavity hematocentesis and drainage. 1 case was treated by puncture and drainage of posterior scleral and suprachoroidal cavity hematocele.Vitrectomy and posterior scleral suprachoroidal hemorrhage,Another 4 cases underwent vitrectomy with silicone oil filling and posterior scleral superior choroidal hemorrhage puncture and drainage.The average follow-up was 8.2 months. The visual acuity was improved in 1 case and deteriorated in 3 cases.Conclusion preoperative high intraocular pressure, high myopia and previous history of intraocular surgery are high risk factors for fulminant suprachoroidal hemorrhage.Through the quick closure of incision, the conservative treatment after operation, the choice of posterior scleral and suprachoroidal hemorrhage puncture and drainage, retinal detachment combined with vitrectomy, the partial visual acuity of the patients can be preserved.
【作者单位】：西安交通大学第二附属医院眼科;
【基金】：陕西省科学技术发展研究项目资助(编号:2012K19-05-05)~~
【分类号】：R779.6

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