玻璃体切割手术致眼静脉空气栓塞的研究现状及进展

眼静脉空气栓塞(OVAE)是玻璃体切割手术中一种罕见的致命并发症。因手术部位靠近心脏且位于心脏上方，OVAE可能是所有手术中引起静脉空气栓塞(VAE)最严重的。随着玻璃体切割手术的发展，免缝合状态的灌注套管可出现向外滑动，使得灌注气体进入脉络膜上腔，导致涡静脉撕裂。玻璃体腔气体灌注时，外伤及脉络膜黑色素瘤手术导致的脉络膜血管伤口暴露于气体中，这使得加压气体可能通过撕裂的涡静脉或异常的脉络膜静脉开口进入循环系统导致OVAE。目前OVAE的定义、发病机制、临床表现及防治措施在不断完善，但多数玻璃体视网膜外科医生和麻醉医师仍不了解该医源性并发症。提高对OVAE的认识将有助于早期发现该并发症，进而做出及时处理，同时制定有效的预防策略。通过临床和实验室研究相结合，可不断优化OVAE防治原则。充分认识OVAE的发病机理和临床特点，关注 OVAE继发性病变的特征以及重视多学科间的合作有助于OVAE应急处理和预防措施的建立和完善。

Progress and research status of ocular venous air embolism caused by vitrectomy

Ocular venous air embolism(OVAE)is a rare and fatal complication in vitrectomy. Due to the proximity of the surgical site to the heart and its level above the heart, OVAE may be the most severe complication in the venous air embolism(VAE)caused by surgery. With the development of vitrectomy, perfusion cannulas in the suture-free state may slide outward, and the perfused gas can enter the suprachoroidal space, which results in tearing of the vortex veins. Choroidal vascular wounds resulting from trauma and endoresection of choroidal melanoma can expose directly in the perfused gas during vitreous cavity gas-liquid exchange. This makes it possible that the pressurized gas enters the circulatory system through the torn vortex veins or the anomalous choroidal venous openings, which leads to OVAE. Nowadays, the definition, pathogenesis, clinical presentation and prevention of OVAE are being refined. However, most vitreoretinal surgeons and anesthesiologists are still unaware of this iatrogenic complication. It will be helpful to detect this complication early and make emergency management in time by increasing the awareness of OVAE and develop effective prevention strategies. The prevention and control principles of OVAE can be continuously optimized by the combination of clinical and laboratory studies. It will be conducive to the establishment and improvement of emergency treatment and preventive measures of OVAE to fully understand the pathogenesis and clinical characteristics of OVAE, to pay attention to the characteristics of secondary lesions of OVAE, and to attach importance to multi-disciplinary cooperation.