微创玻璃体切割术后短暂性视力无光感的临床观察  

Clinical Observations of Transitory Amaurosis Following Minimally Invasive Vitrectom

作　　者：赵军 田超伟 赵润泽 桑迪 张自峰 王雨生 Zhao Jun;Tian Chaowei;Zhao Runze;Sang Di;Zhang Zifeng;Wang Yusheng(Department of Ophthalmology,Eye Institute of PLA,Xijing Hospital,Xi'an 710032,China;Tianshui Aier Eye Hospital,Tianshui 741000,China)

机构地区：[1]空军军医大学西京医院眼科,西安710032 [2]天水爱尔眼科医院,天水741000

出　　处：《临床眼科杂志》2024年第6期511-516,共6页Journal of Clinical Ophthalmology

基　　金：空军军医大学临床研究项目(2022LC2247);西京医院临床应用研究课题(JSYXM02)。

摘　　要：目的分析微创玻璃体切割术后短暂性视力无光感的原因及疗效。方法回顾性病例研究。2019年11月至2022年11月在我院进行微创玻璃体切割术后短暂性视力无光感患者29例(31只眼)纳入研究。其中男性20例(22只眼),女性9例(9只眼),年龄(47.62±13.64)岁(21~73岁)。所有患者术前均行最佳矫正视力(BCVA)、眼压、裂隙灯显微镜、A/B超声、间接检眼镜和(或)三面镜、视觉电生理等检查。其中增生性糖尿病视网膜病变2例(2只眼)、术前或术后证实为视网膜静脉阻塞引起的玻璃体积血者2例(2只眼)、孔源性视网膜脱离10例(11只眼)、硅油填充眼10例(11只眼)、眼外伤引起的玻璃体积血或眼内炎2例(2只眼)、人工晶状体脱位者3例(3只眼)。所有患者中7例(9只眼)为独眼患者。16例(17只眼)为高度近视患者。患者全身合并症:4例伴高血压病史;3例伴糖尿病史;1例同时伴糖尿病和高血压;1例人类免疫缺陷病毒(HIV)阳性;1例肾炎病史;1例十二指肠溃疡病史;1例类风湿性关节炎病史;1例马凡综合征;其余16例未伴全身特殊病史。所有患者符合玻璃体切割手术指征,均行微创玻璃体切割手术。手术为局麻下进行,球后麻醉后光感明确,手术结束时反复检查视力为无光感,给予硝酸甘油舌下含化、吸氧、静脉滴注地塞米松磷酸钠注射液及能量合剂、眼球按摩等相关措施,15~185 min后均光感恢复。分析术中可能引起光感消失的原因,观察光感恢复时间。随访6个月至1年,观察术后短暂性视力无光感对最终视功能的影响、原发病变稳定程度以及相关并发症的发生。结果玻璃体切割手术结束时,7只眼灌注液填充、8只眼空气填充、3只眼长效气体(C3F8)填充、13只眼硅油填充,光感恢复时间为术后15~185 min,15 min内光感恢复者3只眼,15~30 min光感恢复者4只眼,30~45 min光感恢复者7只眼,45~60 min光感恢复者5只眼,60~90 min光感恢复�Objective To analyze the causes and treatment effects of transitory amaurosis following minimally invasive vitrectomy.Methods Retrospective case study.with transient acuity after minimally invasive vitrectomy in our hospital from November 2019 to November 2022 were included in the study.Among the patients,20 males(22 eyes)and 9 females(9 eyes),ranged in age from 21 to 73 years,with a mean age of(47.62±13.64)years.All patients underwent preoperative best-corrected visual acuity(BCVA),intraocular pressure,slit lamp microscope,A/B ultrasound,indirect ophthalmoscopy and/or three-mirror lens,and visual electrophysiology examinations.Among the patients,2 patients(2 eyes)had proliferative diabetic retinopathy,2 patients(2 eyes)had vitreous hemorrhage due to retinal vein occlusion confirmed before or after the surgery,10 patients(11 eyes)had rhegmatogenous retinal detachment,10 patients(11 eyes)had silicone oil tamponade,2 patients(2 eyes)had vitreous hemorrhage or endophthalmitis due to ocular trauma,and 3 patients(3 eyes)had dislocated intraocular lens.7 patients(9 eyes)had only one functional eye.6 patients(17 eyes)had high myopia.Systemic comorbidity included 4 cases of hypertension,3 cases of diabetes,1 case of diabetes and hypertension,1 case of HIV positive,1 case of nephritis,1 case of duodenal ulcer,1 case of rheumatoid arthritis and 1 case of marfan's syndrome,while the remaining 1 cases had no specific systemic history.All patients met the indications for vitrectomy and underwent the procedure.Surgery was performed under local anesthesia.Light perception was clear after retrobulbar anesthesia,but no light perception was observed at the end of the surgery.Various measures,including sublingual nitroglycerin,oxygen inhalation,intravenous dexamethasone sodium phosphate injection and energy mixture,and eyeball massage,were applied.Light perception was restored in all patients within 15 to 185 minutes.The possible causes of loss of light perception during surgery were analyzed,and the time to restoration of light p

关 键 词：玻璃体视网膜手术 无光感 危险因素 

分 类 号：R47[医药卫生—护理学]