白内障摘出术中脉络膜下爆发性出血的临床分析  

Clinical analysis of suprachriodal expulsive hemorrhage in cataract surgery

作　　者：刘琳[1] 邓金印[1] 易魁先[1] 

机构地区：[1]广州军区广州总医院眼科,广东广州510010

出　　处：《眼外伤职业眼病杂志》2009年第9期661-663,共3页Journal of Injuries and Occupational Diseases of the Eye with Ophthalmic Surgeries

基　　金：广东省科学技术研究基金资助(B2006118)

摘　　要：目的探讨白内障摘出术中发生脉络膜下爆发性出血的原因及其处理及预防方法。方法对我院2540例(2810眼)白内障摘出术中发生脉络膜下爆发性出血的3例(3眼):术中给予关闭切口,降低眼压、血压及镇静处理,必要时及时切开巩膜放血,术后给予止血、消炎、镇静及甘露醇静脉滴注,并进一步控制患者的眼压、血压。结果1例(1眼)由于术后视网膜脱离,而无光感。1例(1眼)经术中及时发现和果断处理而阻止了脉络膜下爆发性出血,从而获得了较好的术后视力,为0.3。最后1例(1眼)成功引流脉络膜下积血,也保留了部分视力,为0.1。结论眼球切开后,眼压迅速降低至零,脉络膜血管显著扩张后出现破裂是白内障手术中出现脉络膜下爆发性出血的直接原因,其相关因素有高度近视、高血压、高眼压、高血糖,咳嗽,哮喘及患者精神过度紧张等。在经过上述及时果断处理后大部分患者可治愈并保存一定的视力。Objective To analyze risk factors, management, and prevention of suprachriodal expulsive hemorrhage （SEH） during cataract surgery. Methods A retrospective study was done on the SEH in cataract surgery between 2003 and 2008. During this period, 2810 eyes of （2540 cases） cataract extractions （phacoemulsification and ECCE ） were performed, There were three patients who developed intraoperative SHE. The wound was immediately closed with sutures, intravenous mannitol and other drugs were administered to control the blood pressure and the intraocular pressure. Calmming drugs were also used to the patients. If necescry, intraoperative sclerostomy was performed, After surgery these drugs were also used to further control the blot^d pressure, the intraocular pressure, hemostasis and inflammation. Results After surgery, one patient had on light perception because of retina detachment; one case had the vision of 0, 3 because of discover in time and treatment decisively; the other one also remain the useful vision of 0.1 because of successful draining the blood. Conclusion The venous of choroid expanded significantly when the intraocnlar tension decreased to zero after the eyeball was incisied, this leaded to the vessel-wall rupture. The other risk factors for the development of intraoperative suprachoroidal hemorrhage were ： high myopia, glaucoma and systemic diseases （hypertetlsion, diabetes, cough, asthma, overstress ）, After above treatment, some patients reserved a part of vision.

关 键 词：白内障 脉络膜下爆发性出血 

分 类 号：R779.66[医药卫生—眼科]