穿透性角膜移植联合玻璃体手术暴发脉络膜上腔出血2例

暴发性脉络膜上腔出血又称为脉络膜驱逐性出血。多种内眼手术中均可发生。但在眼前后段联合手术中极为少见。同仁医院眼外伤专业组自1995年开展眼穿透性角膜移植术联合玻璃体视网膜手术以来，仅在2004年5月至2004年7月间。发生2例暴发性脉络膜上腔出血，现报告如下。     

玻璃体切除术中暴发性脉络膜出血三例

玻璃体切除术中暴发性脉络膜出血三例惠玲张卫忠邢淑惠黄芹关键词玻璃体切除术脉络膜出血病例报告暴发性脉络膜上腔出血是内眼手术和眼外伤的一种预后极差的并发症［１］，在闭合式玻璃体切除术中极少发生［２］，现报告３例。例１女，５７岁，右眼白内障摘除术后４周，视...     

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。     

内眼手术与脉络膜上腔出血

脉络膜上腔出血,是内眼手术罕见而最严重的并发症,常致视力完全丧失、眼球萎缩,甚至摘除眼球。其发生可表现为暴发性脉络膜上腔出血(ECH)或非暴发性(局限性)脉络膜E腔出血(LCH);可发生于术中(速发性)、也可发生于术后(迟发性)。以白内障手术多见,其次见于抗青光眼手术、视网膜脱离手术、角膜移植术。非手术情况,如眼球外伤破裂、角膜溃疡穿孔、脉络膜黑色素瘤坏死等也偶有发生。我院近7年来遇此症5     

白内障术中暴发性脉络膜出血一例

暴发性脉络膜出血（subchoroidal expulsive hemorrhage．SEH）是一种严重的内眼手术并发症。我科在白内障术中发生1例，报告如下。     

高度近视超声乳化术后暴发性脉络膜上腔出血

暴发性脉络膜上腔出血是内眼手术最严重的并发症,发生于术中及术后,可致视力完全丧失.其眼部的危险因素包括青光眼、高度近视、眼内出血及炎症等.     

脉络膜上腔暴发性出血

脉络膜上腔暴发性出血,又称脉络膜暴发性出血,或脉络膜躯逐性出血,是内眼手术罕见的并发症。因其情况紧急,预后严重,国内文献未见报导,近十多年来我们遇到数例,故将国外主要文献综述如下。一、历史1870年法国学者Wenzel第一次报导白内障手术发生脉络脉上腔暴发性出血。当初法国文献曾用“bete of the ophthalmic surgeon”来形容本症之严重性,意即眼外科医生的不幸。     

脉络膜暴发性出血

脉络膜暴发性出血又称脉络膜驱逐性出血,是一种罕见而又极严重的内眼手术合并症。它可发生在白内障、青光眼、角膜移植、虹膜光学切除、视网膜脱离等内眼手术和眼外伤。但以白内障手术为多见。一般认为白内障手术,脉络膜驱逐性出血发生率为0.2%,其中最高为0.4%,最低为0.05%。     

脉络膜驱逐性出血2例报告

脉络膜驱逐性出血,又称脉络膜暴发性出血或脉络膜上腔暴发性出血,是眼外伤和内眼手术罕见的,而又是破坏性极其严重的合并症。据胡伟芳综合国外文献报道,本病在白内障摘除时的发生率为0.05～0.4%。我院自1956年至1981年共作白内障摘除588例,发生脉络膜驱逐性出血者2例,发生率为0.3%。现介绍于后。     

脉络膜上腔暴发性出血2例报告

脉络膜上腔暴发性出血是眼内手术最可怕的、最严重的并发症之一。据国内外文献报告在内眼手术中本症发生率为0.05％～0.4％。我科自1973～1985年共作内眼手术623例,发生脉络膜上腔暴发性出血2例,发生率为0.3％,现介绍于后。 病例报告 例1:徐××,男,58岁,农民。住院号     

青光眼滤过性手术后脉络膜脱离的临床观察

目的:探讨抗青光眼滤过性手术后出现脉络膜脱离的相关因素及治疗措施,总结临床特点。方法:对457眼青光眼滤过性手术后发生脉络膜脱离的42眼患者进行回顾性分析和总结。结果:脉络膜脱离发生时间为术后3~7(平均4.51±1.14)d,患者的平均年龄为65.30±3.50岁。通过皮质类固醇类药物、散瞳、高渗剂等治疗,42眼脉络膜脱离全部恢复。治疗所需时间平均为16.50±2.75d。结论:脉络膜脱离是青光眼滤过性手术后的一个常见并发症,与术前眼压控制不好、术后眼压过低、患者年龄偏大及高血压、糖尿病有关。     

Outer Retinal Ischemic Infarction—A Newly Recognized Complication of Cataract Extraction and Closed Vitrectomy: Part 1. A Case Report

This report describes a peculiar syndrome occurring as a complication of cataract extraction. The syndrome is characterized initially by (1) acute loss of central and paracentral vision discovered usually on the first postoperative day; (2) diffuse and patchy whitening of the outer retinal layers in the posterior fundus; (3) normal angiographic retinal and choroidal appearance and circulation time; (4) a peculiar polygonal pattern of fluorescein staining of the pigment epithelium and outer retina in the area of retinal whitening, and followed later by (5) clearing of the retinal whitening and mottled changes in the pigment epithelium; (6) partial recovery of the central visual field; and (7) preservation of normal optic disc and retinal vessel caliber. Prolonged elevation of the intraocular pressure sufficient to obstruct choroidal blood flow occurring during the use of intraocular volume-reducing devices before surgery, during phakoemulsification or closed vitrectomy is postulated as the major cause of this complication.     

Management of Delayed Suprachoroidal Hemorrhage after Glaucoma Surgery

ABSTRACT

Purpose: To review the most current treatment recommendations and outcomes for delayed suprachoroidal hemorrhages. Methods: Article review of management and outcomes of suprachoroidal hemorrhages, with emphasis on delayed suprachoroidal hemorrhages in the setting of glaucoma surgery. Conclusion: Time of drainage of suprachoroidal hemorrhages remains controversial. Earlier drainage should be considered with high intraocular pressure, expulsion of intraocular content, or retinal detachment. In clinically stable eyes with suprachoroidal hemorrhage, recommendations range from observation to immediate drainage. Clot lysis occurs at roughly 14 days.     

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。     

青光眼滤过术后恶性青光眼合并睫状体脉络膜脱离

目的：探讨青光眼滤过术后恶性青光眼合并睫体脉和膜脱离的特点及治疗方法。方法：对10例12只青光眼小梁切除术后恶性青光眼合并睫状体脉络膜脱离的临床资料作回顾性分析。结果：4只眼经1－3次脉络膜上腔放液联合抽玻璃体水囊联合前房注气术后，3只眼压恢复正常，1只眼前房不恢复，改行前部玻璃体切除联合超声乳化白内障吸除及人工晶状体植入术。其余8只眼均一次行前 部玻璃体切除联合超声乳化白内障吸除及人工晶状体植入术，眼压控制正常，前房形成.结论：青光眼滤过术后恶性青光眼合并睫状体脉络膜脱离为难治并发症。脉络膜上腔放液联合抽玻璃体水囊治疗有效，前玻璃体切除联合超声乳化白内障吸除及人工晶状体植入术可提高一次手术成功率。     

暴发性脉络膜上腔出血的研究进展

暴发性脉络膜上腔出血（expulsive suprachoroidal hemorrhage,ESCH）是内眼手术少见的最严重并发症之一,可累及睫状体、玻璃体、视网膜,可致视力完全丧失。其发病机制尚不清楚,但与脉络膜组织成分及血供相关。既往研究表明,ESCH最重要的诱发因素之一是眼压突然下降,多出现于白内障、青光眼、玻璃体切除手术的术中及术后。眼部B超可诊断ESCH,并且可观察脉络膜上腔凝血液化的程度,这有助于明确手术时机。手术是ESCH最重要的治疗方式,早期行脉络膜上腔引流手术可挽救残存视力,但不同引流方式的效果存在争议。术前重视危险因素管理,术中谨慎操作,及时发现并有效处理可避免ESCH的严重后果。（国际眼科纵览,2022, 46：522-527）     

Dislocation of a plate-haptic silicone intraocular lens into the anterior chamber

Posterior dislocation is a well-described complication of plate-haptic intraocular lenses (IOLs). It usually occurs after an opening in the posterior capsule, either intraoperatively or after a neodymium: YAG capsulotomy occurs. We report a case of anterior luxation of a plate-haptic silicone IOL occurring 4 months after uneventful cataract surgery. This case emphasizes the need for a small and continuous capsulorhexis as well as in-the-bag implantation of plate-haptic IOLs.     

Combination therapy of low-fluence photodynamic therapy and intravitreal ranibizumab for choroidal neovascular membrane in choroidal osteoma

Choroidal osteoma is an unusual form of intraocular calcification seen in otherwise healthy eyes. It is a benign idiopathic osseous tumor of the choroid, typically seen in young females. Choroidal neovascular membrane (CNVM) is a complication seen in one-third of these patients and carries a poor visual outcome. We report a case of a 25-year-old hyperthyroid female with choroidal osteoma and subfoveal CNVM in her left eye which was successfully treated using low-fluence photodynamic therapy (PDT) with verteporfin followed by a single injection of intravitreal ranibizumab.     

小切口白内障囊外摘出术中前房维持器的应用

目的探讨小切口白内障手术中前房维持器的临床价值。方法对471例(497眼)白内障行小切口白内障囊外摘出术中使用前房维持器维持灌注,并植入后房型人工晶状体。结果无一眼因眼压波动而造成术中严重的并发症,术后第1天裸眼视力0.5~0.9者264眼,占53.12%,第3天≥0.5者325眼,占65.39%,≥1.0者155眼,占31.18%。结论小切口白内障术中使用前房维持器,能较好地维持前房和眼内压,简化手术操作,使手术更安全,便捷。