玻璃体切割手术中突发单纯性浆液渗出性脉络膜脱离的影响因素的分析

发布时间：2018-11-20 10:33

【摘要】：目的：探讨玻璃体切割手术中突发单纯性浆液渗出性脉络膜脱离的主要影响因素。探讨手术中发生单纯浆液渗出性脉络膜脱离的正确诊断和有效治疗的意义。方法：回顾分析2010年12月至2012年12月间我组收治的在玻璃体切割手术中突发单纯性浆液渗出性脉络膜脱离的患者5眼，5个病例在手术前都经过全科病例会诊及眼科相关辅助检查、眼底检查等，手术前不存在脉络膜脱离征象。包括视网膜脱离患者1眼，糖尿病性视网膜病变Ⅳ期患者1眼，糖尿病视网膜病变Ⅵ期患者1眼（已行另一只眼睛玻璃体切割手术），外伤性脉络膜裂伤伴睫状体脱离患者1眼，高血压玻璃体积血患者1眼。分析其临床资料及相关检查，查阅相关文献，总结患者突发单纯性浆液渗出性脉络膜脱离主要因素、有效治疗方法以及曲安奈德在手术过程中的应用及其作用。并分别从短期和长期的视力（visual acuity VA）、眼压（intraocular pressure IOP）评价术中处理的效果。结果：玻璃体切割手术中突发单纯性浆液渗出性脉络膜脱离极为少见。其发生与患者术中血压的升高、眼内压的改变、手术方式、该患眼近期行过眼内手术、另一只眼的手术、患者应用地高辛等药物治疗、经睫状体平坦部玻璃体切割手术等有关。回顾分析这5例患者，发现其术中血压均有不同程度的升高。手术中发生的单纯浆液渗出性脉络膜脱离的眼底表现是切割中轴和周边玻璃体时发生的主要累及全视网膜的棕红色半球形隆起，可以是一个半球形隆起，也可以是两个或多个同时发生。其中4例在手术时即被确诊，立即给予升高眼内压至90cmH2O以上、降低血压、玻璃体腔内注射曲安奈德、静待等处理渗出在半小时至一个小时内基本消失，完成玻璃体切割手术，另一例患者因怀疑有出血性脉络膜脱离，在手术中直接关闭切口，第二天眼底检查无明显脉络膜上腔出血征象时完成玻璃体切割手术。随访半年，，糖尿病视网膜病变Ⅵ期患者视力小于0.1，其余4例患者视力在0.2至0.8之间，所有患者眼压均在正常范围内。结论：（1）对于玻璃体切割手术过程中发生的单纯浆液性脉络膜脱离，采取静待、提高眼内压力、降低血压、局部应用皮质类固醇激素促使脉络膜下方的液体自行吸收,渗出未进一步发展，以上处理稳定了病变，愈后良好。术后视力与原病变程度相关，研究表明术中突发的单纯性渗出性脉络膜脱离只要处理得当并不影响术后视力。（2）向玻璃体腔内注入曲安奈德可减少渗出，稳定病变。（3）调节患者的全身状况、平稳术中血压波动可以减少发生几率。(4)术中眼压变化过快可增加发生的几率。
[Abstract]:Objective: to investigate the main influencing factors of burst simple serous exudative choroidal detachment during vitrectomy. To investigate the correct diagnosis and effective treatment of simple serous exudative choroidal detachment. Methods: from December 2010 to December 2012, 5 eyes of patients with sudden exudative choroidal detachment during vitrectomy in our group were retrospectively analyzed. All the 5 cases underwent general patient consultation, ophthalmological examination and fundus examination before operation, and there were no signs of choroidal detachment before operation. These include 1 eye with retinal detachment, 1 eye with stage IV diabetic retinopathy, 1 eye with stage VI diabetic retinopathy (another eye has undergone vitrectomy), Traumatic choroidal laceration with ciliary body detachment in 1 eye, hypertensive vitreous hemorrhage in 1 eye. The clinical data and related examination were analyzed, and the related literature was reviewed to summarize the main factors, effective treatment methods and the application and role of triamcinolone acetonide in the course of operation in patients with burst simple serous exudative choroidal detachment. The effect of intraoperative management was evaluated by short-term and long-term (visual acuity VA), intraocular pressure (intraocular pressure IOP). Results: sudden simple serous exudative choroidal detachment was rare in vitrectomy. Its occurrence is related to the increase of blood pressure, the change of intraocular pressure, the operation mode, the operation of the other eye, the treatment of digoxin and vitrectomy through the flat part of the ciliary body, etc. A retrospective analysis of these 5 patients showed that their blood pressure increased in varying degrees during operation. The fundus manifestation of the simple serous exudative choroidal detachment that occurs during surgery is the brown-red hemispherical bulge of the entire retina that occurs during the cutting of the central axis and the surrounding vitreous body, and may be a hemispherical eminence. It can also be two or more at the same time. Four of them were diagnosed at the time of operation. They were immediately given elevated intraocular pressure above 90cmH2O, lower blood pressure, intravitreal injection of triamcinolone acetonide, and intravitreal injection of triamcinolone acetonide. The exudation disappeared within half an hour to one hour after vitrectomy, and vitrectomy was completed. The other patient, suspected of haemorrhagic choroidal detachment, closed the incision directly during the operation, and completed vitrectomy on the second day when there were no obvious signs of suprachoroidal hemorrhage in the fundus examination. The visual acuity of the patients with diabetic retinopathy stage VI was less than 0.1, and the visual acuity of the other 4 patients was between 0.2 and 0.8. The IOP of all the patients was within the normal range. Conclusion: (1) for the simple serous choroidal detachment during vitrectomy, we should take static treatment, increase intraocular pressure, lower blood pressure, and local use of corticosteroids to promote the spontaneous absorption of the fluid beneath the choroid. No further development of exudation, the above treatment stabilized the lesion, good after recovery. Postoperative visual acuity is related to the degree of primary lesion. Studies have shown that the intraoperative burst of simple exudative choroidal detachment does not affect the postoperative visual acuity as long as it is properly treated. (2) injecting triamcinolone acetonide into the vitreous cavity can reduce the exudation. Stable lesions. (3) regulating the whole body of patients, stable intraoperative blood pressure fluctuations can reduce the probability of occurrence. (4) intraoperative intraocular pressure changes too fast can increase the probability of occurrence.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R779.6

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