内眼手术并发脉络膜上腔出血的临床分析

目的：探讨内眼手术术中和术后并发脉络膜上腔出血(suprachoroidal hemorrhage, SCH)的临床特点以及发生的危险因素,观察其视力预后。

方法：回顾性分析2005-06/2015-06共10a间本科收治的手术相关的SCH患者13例13眼,年龄22～76岁。13例13眼患者中,合并高度近视者6眼(46%),有高眼压病史者6眼(46%),合并高血压病者4眼(31%)。术中发生的驱逐性出血8眼,术后发生者迟发性出血5眼; 7眼为硅油取出术并发,4眼为白内障囊外取出术并发,1眼为小梁切除联合白内障囊外摘除术并发,1眼为晶状体脱位行晶状体切除联合玻璃体切除手术并发。5眼药物治疗,4眼行巩膜外放液引流联合玻璃体注气术,4眼行玻璃体切割联合重水和硅油注入。

结果：随访10mo,所有SCH全部吸收,最终视力除1眼放弃治疗无光感之外,其余12眼视力光感～0.4。

结论：内眼手术并发的SCH后果严重,高龄、高血压、高度近视和高眼压可能为其危险因素,手术切口导致术中眼压波动大可能与其发生有关,积极治疗后可以维持一定视力。     

内眼手术术中及术后暴发性脉络膜上腔出血的原因、处理和预后

目的　分析与评价内眼手术及术中术后暴发性脉络膜上腔出血的原因、处理和预后。方法　选取暴发性脉络膜上腔出血患者１１例,术前５例合并高度近视,４例合并高眼压,２例有既往内眼手术史,２例患者发生二次出血。出血后采取保守或于出血后１０～１６ｄ（平均１２．１ｄ）手术治疗。手术方法包括单纯后巩膜脉络膜上腔积血穿刺放液术,或联合玻璃体切割及硅油填充术。结果　１１例患者中有７例发生于术中,４例发生在术后１～３ｄ,约占同期我科内眼手术的０．１５％（１１／７２０４）。１１例患者中,２例保守治疗,４例行单纯后巩膜脉络膜上腔积血穿刺放液术,１例行玻璃体切割及后巩膜脉络膜上腔积血穿刺放液术,另外４例行玻璃体切割硅油填充及后巩膜脉络膜上腔积血穿刺放液术。平均随访８．２个月,术后７例患者视力改善,１例无变化,３例恶化。结论　术前高眼压、高度近视及既往内眼手术史是暴发性脉络膜上腔出血的高危因素。通过术中迅速关闭切口,术后采取保守治疗,择机行后巩膜脉络膜上腔积血穿刺放液术,视网膜脱离时联合玻璃体切割术,可保留患者部分视力。     

驱逐性脉络膜上腔出血的危险因素和预后分析

目的分析驱逐性脉络膜上腔出血的危险因素及其预后.方法 16例(16只眼)术中或术后发生的驱逐性脉络膜上腔出血,2例药物治疗,14例于出血后平均13.6天采用手术处理,先从角膜缘持续灌注,赤道部1或2个巩膜切口引流脉络膜上腔积血,睫状体脱离回复后改从平坦部灌注,行闭合式玻璃体切除视网膜复位术.结果 12例术中发生的均有眼内压突然下降,4例术后发生者均有明显低眼压,高度近视眼6例,7例记录术中心率加快.14例均成功引流脉络膜上腔积血,积血为巧克力色,无血凝块.经平均9.2个月随访,4例眼球萎缩,12例视力有提高,其中7例视力≥0.1.结论术中眼内压突然下降和持续低眼压、青光眼、高度近视等可能为发生驱逐性脉络膜上腔出血的危险因素.及时关闭切口,控制眼压,适时选择手术,引流脉络膜上腔积血联合玻璃体视网膜手术是处理驱逐性脉络膜上腔出血的有效方法,可明显改善预后.     

青光眼术后迟发性脉络膜上腔出血9例的临床观察

目的:分析青光眼术后迟发性脉络膜上腔出血的危险因素及其预后。方法:对我院自2003-04/2009-12行抗青光眼手术后发生迟发型脉络膜上腔出血的9例患者的临床资料进行整理分析。结果:患者9例9眼术后发生的迟发性脉络膜上腔出血,其中高度近视眼2例,婴幼儿青光眼3例,2例复杂青光眼联合前房人工晶状体取出术,1例无玻璃体眼,另外1例老年患者伴有全身血管性疾病。均于小梁切除术后1~7d发生。早期均药物治疗,1例于出血后11d采用手术处理,成功引流脉络膜上腔积血,余8例出血自行吸收。经平均14mo随访,无眼球萎缩,其中1例视力1.0,3例婴幼儿患者不能配合检查,其余患者术前术后视力无明显变化。4例于1~12mo出现眼压再次升高。结论:术前长时间高眼压、术中眼内压突然下降和持续低眼压、无玻璃体眼、高度近视、复杂青光眼及婴幼儿青光眼等可能为发生迟发性脉络膜上腔出血的危险因素。发生迟发性脉络膜上腔出血后可先给予药物治疗观察,若出血不能吸收,可考虑手术引流脉络膜上腔积血改善预后。     

巩膜切开术治疗严重眼外伤脉络膜上腔出血

目的评价巩膜切开术治疗严重外伤眼脉络膜上腔出血的疗效。方法对18例（18眼）因严重眼外伤致脉络膜上腔出血行巩膜切开联合玻璃体切除术治疗。在睫状体平坦部做巩膜切口,必要时于赤道前做放射状巩膜切口引流脉络膜上腔积血,然后行玻璃体切除术,术终眼内填充气体或硅油。结果经睫状体平坦部切口脉络膜上腔积血引流充分者11眼;7眼需要另外做放射状巩膜切口引流,其中3眼完全复位,4眼部分复位。2眼因合并脉络膜破口,术后硅油进入脉络膜上腔。2眼因眼球萎缩而摘除眼球。结论巩膜切开术可以有效引流眼外伤所致脉络膜上腔出血。有脉络膜破口的出血性脉络膜脱离是治疗的难点,预后差。     

改良超声乳化联合小梁切除术的临床应用

目的探讨改良超声乳化联合小梁切除术治疗青光眼合并白内障的可行性及临床效果。方法对21例(21眼)青光眼合并白内障患者施行改良白内障超声乳化联合巩膜隧道切口内的小梁切除术,术后随访观察视力、眼压、滤过泡、人工晶状体位置等情况。结果术后平均随访1年,18眼术后视力均有不同程度提高。指数者2眼,<0.1者1眼,0.1～0.3者5眼,0.3以上者13眼,术后眼压均在正常范围,平均眼压为(12.32±4.06)mmHg(1mmHg=0.133kPa)。结论改良白内障超声乳化及人工晶状体植入联合巩膜隧道内小梁切除术,可达到降眼压和提高视力的双重效果,是青光眼合并白内障较好的手术方法之一。     

Ahmed青光眼阀植入联合玻璃体切割术治疗伴玻璃体积血的新生血管性青光眼的临床观察

目的探讨Ahm ed青光眼阀植入联合玻璃体切割术治疗伴有玻璃体积血新生血管性青光眼的效果。方法回顾性分析48例(52只眼)因新生血管性青光眼伴有玻璃体积血接受玻璃体切割及联合白内障摘除、全视网膜光凝及Ahm ed青光眼阀植入患者的病例资料。手术前视力光感~0.3,眼压平均42mmHg(38~65mmHg)(1mmHg=0.133kPa),平均随访10个月(6~15个月)。结果手术后视力光感~0.3;眼压平均18mmHg(10~34mmHg),显著低于手术前眼压(P<0.05);并发症主要包括前房及玻璃体内炎性渗出(3只眼)、玻璃体内再出血(3只眼)、术后一过性低眼压(5只眼)、1~2周内高眼压(4只眼)、手术后脉络膜上腔出血(2只眼)、视网膜脱离(1只眼)。结论玻璃体切割联合白内障摘除、全视网膜光凝及Ahm ed青光眼阀植入术可能是治疗某些新生血管性青光眼伴有玻璃体积血的有效方法.     

Fuchs综合征并发白内障青光眼手术治疗的临床体会

目的: 探讨Fuchs综合征并发白内障青光眼的手术治疗效果。方法: 对Fuchs综合征患者16例16眼合并白内障行超声乳化联合人工晶状体植入术,2例2眼合并白内障及青光眼行超声乳化人工晶状体植入术联合小梁切除术,观察术前和术后视力、眼压以及治疗效果。结果: 患者18例18眼术后视力均有明显提高,术后3mo视力(含矫正)≥0.5者16眼(88.89%),10眼后囊混浊行YAG激光后囊切开术后视力均≥0.5。2眼合并青光眼者术后眼压降至正常范围。结论: 超声乳化联合人工晶状体植入术以及联合小梁切除术治疗Fuchs综合征并发白内障青光眼效果良好,安全可靠,术后反应轻,并发症少,是可行的手术方法。     

急性闭角型青光眼持续高眼压下的手术治疗

目的探讨急性闭角型青光眼发作期持续高眼压状态下手术的特点及效果。方法对应用大剂量降眼压药物2~3天后眼压仍持续在40mmHg以上的60例65眼施行小梁切除术。术中先间断地缓慢放出房水,减低眼压后进行小梁切除术。术后随访6个月。结果65眼术前视力均在0.05以下。术后1周视力≥0.05者64眼,视力≥0.3者31眼;眼压≤21mmHg者52眼。术中术后无玻璃体脱出、脉络膜脱离、脉络膜下大出血或睫状环阻塞性青光眼等并发症发生。结论急性闭角型青光眼持续高眼压时,小梁切除术术中多次间断缓慢放出房水对持续高眼压状态下的治疗是安全有效的。     

玻璃体切割联合术治疗伴有玻璃体积血的 新生血管性青光眼

目的探讨玻璃体切割联合术治疗伴有玻璃体积血新生血管性青光眼的效果。方法7例患者7只眼因玻璃体积血新生血管性青光眼接受玻璃体切割联合白内障摘除、全视网膜光凝及小梁切除术。手术前视力光感～0.2，眼压平均 54 mm Hg(38～64 mm Hg )(1 mm Hg=0.133 kPa)。平均随访8个月(6～15个月)。结果手术后视力光感～0.4；眼压平均17 mm Hg(10～30 mm Hg)，显著低于手术前眼压(P＜0.05)；并发症主要包括前房炎性渗出(7只眼)，手术后1～2周内高眼压(2只眼)，手术后脉络膜上腔出血(2只眼)。结论玻璃体切割联合白内障摘除、全视网膜光凝及小梁切除手术可能是治疗某些伴有玻璃体积血新生血管性青光眼的有效方法。(中华眼底病杂志,2005,21:148-149)     

Massive suprachoroidal hemorrhage: secondary treatment and outcome

PURPOSE: Massive suprachoroidal expulsive hemorrhage (SCH) is a dramatic and devastating intraocular complication of intraocular surgery and trauma that can result in total loss of vision. The aim of our study was to present the results of secondary surgical treatment of eyes following massive SCH. PATIENTS AND METHODS: We treated 10 patients suffering from massive SCH by combined radial sclerotomies for suprachoroidal drainage and vitrectomy with use of perfluorocarbon and instillation of silicone oil. We analyzed the clinical characteristics, visual acuity and anatomical status before and after secondary treatment. RESULTS: Visual acuity of all eyes suffering from SCH was light perception. Postoperatively five patients with SCH showed either no improvement of function or visual acuity of counting fingers. An increase in visual acuity to maximal 0.1 was seen in four eyes; one patient achieved 0.6. With a minimum of 6 months' follow-up, four eyes developed hypotony, two eyes became phthisical, and in two eyes recurrent traction retinal detachment occurred. CONCLUSIONS: Secondary treatment by combined suprachoroidal drainage by sclerotomies and vitrectomy should be performed to minimize the damaging effect of choroidal hemorrhage.     

Acute angle-closure glaucoma resulting from spontaneous hemorrhagic retinal detachment in age-related macular degeneration: case reports and literature review

PURPOSE: Acute angle-closure glaucoma resulting from massive subretinal hemorrhage is a rare and catastrophic complication in age-related macular degeneration. Anticoagulant usage had been strongly correlated with this complication in previously reported cases. METHODS: Four patients (4 eyes), 3 men and 1 woman, developed angle-closure glaucoma with diffuse subretinal hemorrhage and total hemorrhagic retinal detachment. RESULTS: Serial funduscopic examinations and echographic studies in 2 eyes showed that the blood gradually accumulated in the subretinal space. It took more than 10 days for the bleeding to build up to bullous hemorrhagic retinal detachment and secondary glaucoma. Anti-glaucomatous agents were given and sclerotomy was performed in 3 of the 4 patients. Phthisical changes were observed subsequently in these 3 eyes. The eye that received early drainage of blood was an exception, and a small degree of residual acuity was retained. Three of the 4 patients had diabetes mellitus, and hypertension and vascular diseases were also present in the same 3 patients. CONCLUSIONS: Diabetes mellitus might be a predisposing factor for the impaired hemostasis. Anti-glaucomatous agents were of no effect in the management of intraocular pressure. Sclerotomy and drainage of blood help control intraocular pressure and relieve ocular pain. Poor final visual acuity is inevitable. However, phthisical changes might be prevented with early sclerotomy and drainage of blood.     

双巩膜咬切联合前房角分离治疗难治性青光眼

目的 研究双巩膜咬切联合前房角分离手术对难治性青光眼的治疗效果。方法 选择处于持续高眼压状态下的难治性青光眼36例36眼，实行双巩膜咬切联合前房角分离术，观察对比手术前后视力、眼压、滤过泡及并发症的情况。结果 36眼术后视力进步和不变者31眼(86．11％)。近期眼压控制32眼(88．89％)，远期眼压控制22眼(22／27)(81．48％)。近期获得功能性滤过泡28眼(77．78％)。36眼术中术后均无严重并发症。结论 双巩膜咬切联合前房角分离手术对难治性青光眼是一种有效而安全的术式。     

Suprachoroidal bleeding: review and description of eight cases

INTRODUCTION: Suprachoroidal hemorrhage (SCH) is a dramatic complication of intraocular surgery that can result in total loss of vision. METHODS: The records of eight cases of SCH during cataract surgery were reviewed. Six of eight patients were treated by combined radial sclerotomies for suprachoroidal drainage and vitrectomy. Risk factors, therapeutic strategies, and functional and anatomical results were analyzed. RESULTS: The incidence of SCH was 0.45%. Preoperative visual acuity of all eyes suffering from SCH was limited to the perception of light. Postoperatively, six patients showed an increase in visual acuity greater than 0.1; one patient achieved 0.5. Ocular and general risk factors (ocular hypotony, myopia, Valsalva-type maneuvers, intraoperative systemic hypertension) and surgery complications were analyzed. CONCLUSIONS: In spite of using state-of-the-art surgical techniques, the prognosis of SCH remains serious, with a poorer outcome associated with increasing complications due to hemorrhage. Secondary treatment combining radial sclerotomies and vitrectomy should be performed to minimize the damaging effect of choroidal hemorrhage.     

术前应用康柏西普以不同手术方法治疗新生血管性青光眼

目的 比较术前应用康柏西普两种手术方法治疗糖尿病继发新生血管性青光眼(NVG)的效果.方法 前瞻性随机临床对照研究.以菏泽市中医医院眼科2018年2月至2019年8月诊治的糖尿病所致NVG61例(62眼)为研究对象.患者按随机数字表法分为两组,两组患者手术前均进行康柏西普玻璃体内注射.试验组,31例(32眼),采取玻璃...     

青光眼引流器植入联合小梁切除术治疗难治性青光眼的临床观察

目的：观察青光眼引流器植入联合小梁切除术治疗难治性青光眼的疗效。方法对34例（46只眼）难治性青光眼行青光眼引流器植入联合小梁切除术治疗,观察术后视力、眼压、滤过泡及并发症等情况。结果34例难治性青光眼中,新生血管性青光眼12例（17只眼）,无晶状体眼4例（4只眼）,人工晶状体眼1例（1只眼）,外伤性青光眼2例（2只眼）,发育性青光眼9例（12只眼）,色素播散性青光眼2例（2只眼）。术前平均眼压（42．15±2．32）mmHg,术后眼压控制30只眼,眼压部分控制7只眼,眼压失控9只眼,术后平均眼压（18．34±3.55）mmHg,眼压有效控制率为80．43％。功能性滤过泡形成率67．39％,手术并发症较少。结论新型国产青光眼引流器植入联合小梁切除术治疗难治性青光眼疗效好,安全性高,术后并发症少,可以推广使用。     

Laser and unsutured sclerotomy in nanophthalmos

Among 30 eyes with nanophthalmos, 21 had angle-closure glaucoma and two had open-angle glaucoma associated with pseudoexfoliation of the lens capsule. Laser iridotomies, sometimes combined with laser iridoplasty, were sufficient to control, or to allow medical control of, the glaucoma in 15 of 18 eyes. Four eyes with uveal effusion underwent an unsutured sclerotomy or sclerectomy, and all had resolution of the choroidal detachment within two weeks. Cataract extraction improved the vision in seven of nine eyes. Previous or simultaneous sclerotomy or sclerectomy was performed on all nine eyes that underwent cataract extraction and in two eyes at the time of glaucoma surgery; no eye had postoperative uveal effusion or other major complications. Laser iridotomy and iridoplasty, sometimes with supplemental medical therapy, are often sufficient in the treatment of angle-closure glaucoma in nanophthalmos and are safer than surgery. Nanophthalmic uveal effusion can be prevented or treated with an unsutured sclerotomy or sclerectomy.     

Management of cornea-lens touch after filtering surgery for glaucoma

The success of filtering surgery for glaucoma may be compromised by a postoperative flat anterior chamber associated with cornea-lens touch, hypotony, and absence of wound leakage. The clinical course of eight patients with this complication was reviewed. Six patients had chronic angle-closure glaucoma. Only one patient responded to medical therapy which included frequent topical application of atropine sulfate 3.0% for 1 hour. Reformation of the anterior chamber with air and drainage of any suprachoroidal fluid was immediately performed in the remaining seven. At the time of follow-up (mean, 16 months), the glaucoma was controlled in all eyes except one. The mean intraocular pressure (IOP) was 14 mmHg in those eyes not requiring reoperation. Six (75%) of eight eyes had diffuse, succulent filter blebs. Five eyes (63%) required no antiglaucoma medications, one eye (12%) required one, one eye (12%) required two, and one eye (12%) underwent repeat filtering surgery. The results suggest that, once medical therapy is not immediately successful, prompt surgical reformation of the anterior chamber along with drainage of any suprachoroidal fluid may preserve the filter blebs in these eyes.     

Surgical outcomes of combined phacoemulsification and glaucoma drainage implant surgery for Asian patients with refractory glaucoma with cataract

PURPOSE: To examine the safety and efficacy of combined phacoemulsification and glaucoma drainage implant surgery in providing reduction of intraocular pressure (IOP) and visual rehabilitation in eyes with refractory glaucoma and cataract. DESIGN: Interventional case series. METHODS: A retrospective chart review was performed on all subjects who underwent combined phacoemulsification with intraocular lens implantation and glaucoma drainage implant surgery by a single surgeon at the National University Hospital, Singapore. The implants used were the 185 mm2 Ahmed glaucoma valve and the 350 mm2 Baerveldt glaucoma implant. In terms of IOP, a complete success was defined as IOP of between 6 to 21 mm Hg without medication, qualified success as IOP between 6 to 21 mm Hg with one or more medication, and failure as a sustained IOP of >21 mm Hg or <6 mm Hg with or without one or more medication on two or more visits. RESULTS: A total of 32 combined phacoemulsification and glaucoma implant surgeries in 32 patients was performed. All patients were of Asian origin, and the mean age was 58 +/- 16 years (range, 20-78 years). The Baerveldt glaucoma implant and Ahmed glaucoma valve implant were inserted in 16 eyes each. With a mean follow-up of 13 +/- 5 months (range 6 to 22 months), IOP was reduced from a mean of 28.0 +/- 11.5 mm Hg to 15.2 +/- 6.0 mm Hg postoperatively (P <.0001), whereas the number of antiglaucoma medications decreased from a mean of 2.4 +/- 1.4 to.3 +/-.7 (P <.0001) at last follow-up. Overall, there were 24 eyes (75%) that were classified as complete successes, 4 eyes (12.5%) that were qualified successes, and 4 eyes that failed (12.5%). Twenty-three eyes (72%) had improvement of visual acuity, while only one eye had a loss of more than 1 line of Snellen acuity. There was no case that encountered an intraoperative complication, and postoperative complications occurred in 12 eyes (38%), the most common of which was hypotony (in six eyes, 19%). CONCLUSION: For subjects with refractory glaucoma and cataract, combined phacoemulsification and glaucoma drainage implant surgery provide good visual rehabilitation and control of IOP, with low incidence of complications.