内眼手术并发脉络膜上腔出血的处理与危险因素分析

摘要

背景 脉络膜上腔出血(SCH)是一种少见但严重威胁视力的内眼手术并发症,控制SCH的危险因素并给予合适的治疗非常重要. 目的 探讨内眼手术(白内障摘出术、青光眼阀植入术和玻璃体切除术)并发SCH的处理和危险因素. 方法 采用回顾性系列病例研究设计,分析1998年5月至2009年7月在北京协和医院眼科就诊的因内眼手术并发SCH患者15例15眼的临床资料,分析发生SCH的危险因素.所有患者均给予全身及眼局部药物治疗,有手术指征者施行后巩膜切开术和/或玻璃体切除术,分析治疗方法及效果.本组患者中10眼SCH发生于术中,5眼发生于术后1～3d.8眼施行巩膜切开术引流脉络膜上腔积血,其中3眼联合玻璃体切除术;7眼行单纯药物治疗. 结果 治疗后12眼脉络膜上腔积血完全吸收.治疗后视力提高者6眼,视力无变化者6眼,视力下降者3眼.9眼合并视网膜脱离,其中6眼视网膜复位.7眼合并高度近视,6眼有青光眼,1眼为无晶状体眼.4例患者合并高血压病,2例为糖尿病患者. 结论 内眼手术并发SCH时发病急骤,术中发生SCH者处理方法为立即关闭切口,视病情施行巩膜切开术引流,同时给予静脉滴注高渗制剂降低眼压.术后发生SCH者可根据出血范围及合并症选择药物治疗或巩膜切开术.高度近视、眼压突然下降和青光眼等为发生SCH的常见危险因素.%Background Suprachoroidal hemorrhage (SCH)is a rare but devastating complication of ophthalmic surgery,and it is crucial to be aware of the risk factors and select effective treatment. Objective Present study was to assess the treatment and risk factors of SCH induced by intraocular surgery. Methods Retrospective case series were carried out to investigate the clinical data of 15 eyes from 15 patients with SCH at Peking Union Medical College Hospital.The risk factors of SCH were analyzed.Written informed consent was obtained before any medical examination and treatment.SCH was occurred in 10 eyes during intraocular surgery,while the SCH was diagnosed in other 5 eyes 1-3 days after operation.Surgical drainage was carried out in 8 eyes,of which 3 eyes combined with vitrectomy besides surgical drainage and other 5 eyes were treated with medication alone.Results SCH was completely removed and absorbed in 12 eyes.The visual acuity was improved in 6 eyes,unchanged in 6 eyes and decreased in 3 eyes.Nine eyes complicated with retinal detachment and reattached in 6 eyes after treatment.Seven eyes combined with hypermyopia,6 eyes combined with glaucoma,and 1 eye was aphakia.Four patients combined with hypertension,and 2 patients had diabetes mellitus. Conclusions SCH induced by intraocular surgery develops rapidly and violently,and it can result in vision loss without effective treatment.Suturing surgical incision immediately,applying hypertonic agents and sclerotomy drainage are the urgent approaches to treat SCH.Medicines and/or sclerotomy could be optional according to the amount of bleeding and other ocular complication.The risk factors of SCH include myopia,glaucoma and the instantly dropping of intraocular pressure.