斜视矫正术后眼前段缺血综合征1例  

A case of anterior segment ischemic syndrome after the strabismus surgery

作　　者：朱文卿 姚静 赵晨 ZHU Wenqing;YAO Jing;ZHAO Chen(Department of Ophthalmology,Eye&ENT Hospital,Fudan University,Shanghai 200031,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院眼科,上海200031

出　　处：《中国眼耳鼻喉科杂志》2022年第S01期1-4,共4页Chinese Journal of Ophthalmology and Otorhinolaryngology

摘　　要：66岁男性,因“车祸伤后双眼视物重影1年余”就诊。视力:右眼裸眼视力0.05,矫正视力0.2;左眼裸眼视力0.02,矫正视力0.15。眼压:右眼12 mmHg(1 mmHg=0.133 kPa),左眼13 mmHg。眼位:角膜映光+30°,Krimsky法测斜视度>+100 PD。眼球运动:右眼外转受限﹣4,不能过中线。裂隙灯检查:左眼鼻侧翼状胬肉,瞳孔散大,直径5 mm,对光反应迟钝,余结构正常;右眼未发现明显异常。心电图提示陈旧性下壁心肌梗死;眼眶CT显示左眼眶内侧壁凹陷性骨折。该患者右眼第六对脑神经(展神经)麻痹的诊断明确,对其进行内直肌超长量后徙联合上下直肌肌腹颞侧转位术。术后眼位和眼球运动的恢复都比较理想,但术后1 d患者主诉右眼眼痛剧烈,视力HM/BE,出现角膜水肿,后弹力层皱褶,前房细胞(+++),瞳孔变形,散大,对光反应迟钝,晶状体混浊,眼底窥不清。诊断为眼前段缺血综合征,给予激素静脉滴注结合局部频点,丹参静脉滴注,加之局部使用抗生素滴眼液与角膜营养滴眼液;至术后1个月右眼矫正视力达到0.3,角膜透明,前房细胞(﹣),瞳孔散大变形,晶状体混浊,眼底未见明显异常。讨论体会:对于涉及多条眼外肌的斜视手术,术中精细操作,减少对睫状血管的破坏,术后严密监测出现眼前段缺血的可能,如果出现应及时规范化处理。A 66-year-old male presented with diplopia for more than 1 year after a traffic accident.His best corrected visual acuity was 0.2 in the right eye and 0.15 in the left.The intraocular pressure was 12 mmHg(OD)and 13 mmHg(OS).The alignment showed esotropia of 30°with corneal light reflection,and more than 100 PD by reverse Krimsky test.The right eye abduction was graded as﹣4(unable to cross the midline).Slit lamp examination of the left eye revealed nasal pterygium,mid-dilated pupil unsensitive to light,and no other positive signs.No obvious abnormality was found in the right eye.Electrocardiogram(ECG)showed previous inferior myocardial infarction.Orbital CT showed fracture of medial orbital wall in the left eye.The patient was diagnosed with sixth nerve palsy on the right side and underwent medial rectus recession combined with belly transposition of the superior and inferior rectus muscles.One day after the operation,almost orthophoria with improved abduction to﹣2 was shown.However,the patient suffered severe pain in the right eye.Physical examination of the right eye showed declined visual acuity(HM/BE),corneal edema,Descemet’s membrane folds,anterior chamber cells(+++),irregular and dilated pupil with weak light reaction,lens opacity and unclear fundus.The diagnosis of anterior segment ischemic syndrome of the right eye was then made.The patient was instantly treated with intravenous glucocorticoid and salvia miltiorrhiza,combined with topical dexamethasone drops and antibiotic eye drops.After one month of treatment,the best corrected visual acuity of the right eye improved to 0.3 with transparent cornea and free of anterior chamber cells,but the pupil irregularity persisted.For strabismus surgery involving multiple extraocular muscles,the operation should be carefully and delicately performed to reduce damage to ciliary vessels.The possibility of anterior segment ischemia should be closely monitored after operation.Once it occurs,the disease should be treated in a timely and standardized manner.

关 键 词：眼前段缺血 展神经麻痹 斜视矫正术 

分 类 号：R779.6[医药卫生—眼科]