玻璃体切除联合巩膜切开引流术治疗驱逐性脉络膜上腔出血的疗效

目的探讨应用玻璃体显微手术联合巩膜切开引流术作为Ⅱ期手术方式治疗脉络膜上腔出血的疗效。方法回顾分析2004年3月-2008年9月我院收治的驱逐性脉络膜上腔出血患者11例,常规行检眼镜,眼B超检查确诊,记录视力和病因。所有病例均于出血后2周左右采用玻璃体切除联合巩膜切开引流术。结果11例均成功引流脉络膜上腔积血,视网膜复位,随访6-18个月,视力均有改善。结论及时关闭切口,控制眼压,适时选择手术,行玻璃体切除联合巩膜切开引流术是二期处理驱逐性脉络膜上腔出血的最有效方法。     

驱逐性脉络膜上腔出血2例

脉络膜上腔出血是内眼手术中最严重的并发症 ,可致视力完全丧失 ,甚至眼球剜除。我院在进行高眼压状态下抗青光眼小梁切除时 ,曾遇 2例 ,现报告如下。例 1　女　 6 8岁　双眼反复胀痛伴头痛 6年余 ,右眼失明5年 ,左眼再发加重 1个月。诊断 :双眼闭角型青光眼 (右眼急性期 ,右眼绝对期 )。既往有高血压病史。心肺未见异常 (- )。右眼视力失明 ,左眼视力眼前手动。眼压右眼 30 .39mm Hg,左眼46 .46 mm Hg。左眼睫状充血 ,房角窄 4,kp( ) ,虹膜后粘连 ,部分节段性扇形萎缩。瞳孔 6 mm,光反应消失。药物降压不理想。在局麻下行左巩膜瓣下小梁切…     

迟发性非驱逐性脉络膜上腔出血2例

迟发性非驱逐性脉络膜上腔出血２例张怡红王长玲史惠玲李仲秀郭秀瑾河北医科大学第二医院眼科（０５００００）内眼手术时突然发生脉络膜出血为驱逐性脉络膜上腔出血，在术后几小时～１周内发生脉络膜出血为迟发性非驱逐性脉络膜上腔出血。我院遇到两例，报告如下。例１何...     

白内障术后非驱逐性脉络膜上腔出血

1病例.例1：患者女,75岁.因左眼视力下降1年余在2002年12月17日入院.既往有高血压史.眼部检查：左眼视力0.01,角膜透明,前房深度正常,虹膜纹理清晰,瞳孔光反射正常,晶状体棕黄色浑浊,眼底模糊可见,未见明显异常.眼压14mmHg（1mmHg=0.133kPa）.眼轴23.4mm.入院后各项常规化验均正常,血压控制正常后2002年12月19日在局部麻醉下行白内障现代囊外联合后房型人工晶状体植入术.术中操作顺利,术毕患者无不良反应.     

驱逐性脉络膜上腔出血2例

0引言驱逐性脉络膜上腔出血是一种少见而严重的内眼手术并发症,来势凶猛,预后不良,最终导致失明甚至眼球摘除。近年我科遇2例行术中发生驱逐性脉络膜上腔出血,现汇报如下。1病例报告例1,患者,男,39岁。患者于2011-08-22因"右眼外伤性玻璃体积血、外伤性白内障"在我科行"右眼白内障摘除、玻璃体切割术"手术,顺利出院。于2012-02-29因"右眼玻璃体切除术后0.5a"来我院,拟行二期人工     

白内障超声乳化术后非驱逐性脉络膜上腔出血

患者　女　 70岁　因左眼视力下降 1年入院。既往有高血压及高度近视。眼部检查 :左眼矫正视力 0 0 2 ,角膜透明 ,前房深浅正常 ,虹膜纹理清晰 ,瞳孔光反应正常 ,晶状体核棕黄色混浊、后囊下混浊。眼底黄斑区色素紊乱 ,中心凹光反射未见。眼压 19 8mmHg ,眼轴长 2 8 3 6mm ,视网膜电图3 0Hz重度下降。 1年前因左眼玻璃体积血行玻璃体切除术(玻切术 )。此次因左眼老年性白内障局麻下行白内障超声乳化联合后房型人工晶状体植入术 ,术中前房涌动较明显 ,术毕眼压T -1。术后第 1天发现眼底鼻下方脉络膜呈棕色球形隆起 ,前房不浅 ,人工晶状体…     

玻璃体切除术中驱逐性脉络膜上腔出血1例

1病例报告患者,男,45岁,因右眼视网膜脱离1mo入院。全身检查(-),视力:右眼眼前指数,左眼1.0,右眼前节(-),眼底:8∶30~3∶30视网膜高度隆起,累及黄斑,未查见裂洞。入院后第2d行右眼玻璃体切除术,术中发现周边部2∶00位置有一约1/5PD裂洞,眼内注入全氟化碳液(重水)使视网膜复位,在气液交换过程中突见视网膜脉络膜逐渐隆起,玻璃体腔呈漏斗状,继而前房混血,眼内视不清,指测眼压升高,诊断为脉络膜上腔出血,给予玻璃体内注射硅油,缝合各切口,终止手术,予止血、止痛和降眼压治疗。术后第1d右眼视力无光感,前房内大量积血,眼内结构不清,B超显示脉络膜脱离,脉络膜上腔出血,予前房穿刺放出     

迟发性脉络膜上腔出血的手术治疗

目的:探讨迟发性脉络膜上腔出血的发病机制、诱因、临床表现及手术治疗方法。方法:对2008-02/2010-09来我院就诊的4例迟发性脉络膜上腔出血患者,进行玻璃体切割联合巩膜赤道部放射性切开放血疗法手术治疗并观察疗效。结果:患者4例术后脉络膜上腔积血均完全被清除,脉络膜视网膜解剖复位,视功能取得不同程度提高。结论:迟发性脉络膜上腔出血是一种严重的致盲性眼病,但如果能正确诊断,手术时机掌握恰当,采用合适的手术方法,则能使病情得以缓解或治愈,挽救眼球甚至视功能。玻璃体切割联合巩膜赤道部放射性切开放血疗法是治疗本病的有效方法。     

眼球破裂伤合并脉络膜上腔出血患者的手术疗效分析

目的 初步评价眼球破裂伤合并脉络膜上腔出血患者的手术治疗效果。方法 对17例（17只眼）因眼球破裂伤致脉络膜上腔出血的患者行Ⅱ期手术治疗,玻璃体腔内灌注BSS,由睫状体平坦部行巩膜切口引流脉络膜上腔积血,然后经睫状体平坦部行玻璃体切除联合视网膜复位术,术中眼内填充气体或硅油。结果 17例患者均成功引流脉络膜上腔积血,术后随访3－27个月,15例患者视网膜和脉络膜在位,眼球保存率88．2％,视力较术前有所提高;2例患者视网膜再脱离,眼球萎缩。结论 经Ⅱ期手术引流脉络膜上腔积血及玻璃体切除,视网膜复位术,大部分严重的眼外伤合并脉络膜上腔出血的患者可保留眼球,甚至恢复一定的视力。     

Secondary management and outcome of massive suprachoroidal hemorrhage

PURPOSE: To present the results of secondary surgical treatment of five patients with massive suprachoroidal hemorrhage (MSCH), which occurred intraoperatively, postoperatively, or following ocular trauma. METHODS: Five patients presenting with MSCH were included in this study during or after phacoemulsification surgery (1 patient), glaucoma surgery (1 patient), combined glaucoma and phacoemulsification surgery (2 patients), and after traumatic sclera rupture (1 patient). Diagnosis was confirmed by ophthalmoscopy and B-scan ultrasonography. Pre-existing risk factors and distance visual acuity were documented. All cases received medical therapy and underwent secondary surgical intervention with radial sclerotomies combined with vitrectomy, use of perfluorocarbon, and silicone oil. Postoperative assessment included visual acuity measurement, ocular examination, and ultrasonography. RESULTS: In all cases, anatomic restoration of ocular structures was achieved. Distance visual acuity improved in all cases (preoperative Snellen visual acuity ranged from light perception to hand motions; postoperative Snellen visual acuity ranged from 0.05 to 0.3).The mean follow-up period was 17 months. CONCLUSIONS: In general, despite the advanced surgical techniques, the prognosis of MSCH remains guarded and the visual outcome poor. However, secondary surgical treatment with combined radial sclerotomies and vitrectomy should be considered in order to minimize the damaging effect and maximize the anatomic and functional restoration.     

脉络膜上腔出血的超声波和彩色多普勒检查

目的总结脉络膜上腔出血的超声波和彩色多普勒显像特点及其临床价值。方法使用美国ＳｏｎｏｍｅｄＡ／Ｂ２５００眼科专用超声诊断仪和德国ＳＩＥＭＥＮＳｓｏｎｌｎｅｖｅｒｓａ多功能彩色多普勒超声诊断仪检查１４例内眼手术后发生的驱逐性脉络膜上腔出血患者,对其显像特点及血流信号进行分析。结果１４例患者均经超声波检查（其中５例行彩色多普勒检查）明确了脉络膜上腔出血的诊断,其中完全性出血１０例,部分性出血４例,经１～３次超声波检查,出血１周后血凝块开始液化,其中１３例于出血后平均１５．４天再次手术证实血凝块液化。结论超声波和彩色多普勒检查对脉络膜上腔出血的诊断有较大的价值,在了解血凝块是否液化、出血范围及玻璃体视网膜状态等方面为治疗提供重要依据;讨论了在鉴别诊断上的意义     

A new modified vitreoretinal surgical approach in the management of massive suprachoroidal hemorrhage

The authors describe a new surgical approach used in six consecutive patients referred to us between August 1986 and August 1988 with massive suprachoroidal hemorrhage (MSCH) during or after cataract extraction (4 patients), glaucoma filtering surgery (1 patient), or scleral buckling (1 patient). All patients had large hemorrhagic choroidal detachments with five eyes showing "kissing" detachments. Secondary surgery was delayed 7 to 25 days (mean, 14 days) to allow liquefaction of the blood clot and reduce intraocular inflammation. All eyes underwent posterior drainage sclerotomies under constantly maintained limbal fluid infusion line pressure, followed by pars plana anterior and posterior vitrectomy in five of six eyes. Additionally, two eyes underwent secondary lens implantation during surgery and 6 months later, respectively. Mean follow-up was 10 months. Visual acuity improved in all eyes from a preoperative range of light perception-hand motions to hand motions-20/40. Advantages and disadvantages of this aggressive surgical approach in the management of MSCH are discussed.     

玻璃体切割手术治疗息肉状脉络膜血管病变引起的玻璃体积血的疗效观察

目的 观察玻璃体切割手术治疗息肉状脉络膜血管病变(PCV)引起的玻璃体积血的疗效.方法 伴玻璃体积血的PCV患者14例14只眼纳入研究.男性8例8只眼,女性6例6只眼.平均年龄(58.7±6.0)岁.均行常规眼科检查,以及A/B型超声、荧光索眼底血管造影、吲哚青绿血管造影等检查确诊.行常规玻璃体切割手术,手术中切除玻璃体积血,手术结束时行硅油或C3F8气体填充.手术后行光动力疗法(PDT)治疗8只眼.观察患眼视网膜复位情况、视力改善状况、病变稳定程度以及手术后并发症发生情况.结果 14只眼中,治愈6只眼,占42.9％;好转7只眼,占50.0％;无效或加重1只眼,占7.1％.1次手术后视网膜复位良好10只眼.视网膜复位不良4只眼.其中,再次注入硅油后视网膜复位1只眼;再次C3F8填充后视网膜复位1只眼;下方裂孔1只眼行巩膜外垫压手术后视网膜复位;未行特殊处理1只眼,硅油维持.最终视网膜复位13只眼,占92.9％,手术后1～7 d出现前房积血5只眼,经前房冲洗或药物治疗积血吸收,眼压稳定.视力提高2行以上者1只眼,1～2行者1只眼,不变10只眼,下降2只眼.行PDT治疗的8只眼中,异常血管消退5只眼,未消退3只眼.结论 对于伴玻璃体积血的PCV行玻璃体切割手术清除玻璃体积血,恢复屈光间质透明性,手术后联合PDT治疗,对稳定或提高视功能有一定的疗效.     

内眼手术中脉络膜上腔出血

为探讨内眼手术中脉络膜上腔出血的临床特点及手术治疗与预后的关系，对１３例脉络膜上腔出血进行了回顾性分析。临床检查和Ｂ超显示：全部病例都有玻璃体出血，大部分病例有环周脉络膜上腔出血和前房出血而无视网膜脱离。４例做了后巩膜切开引流术，４例做了玻璃体视网膜手术，结果３例视力为０．０５～０．１２，１例为手动，其余均完全失明。表明内眼手术中脉络膜上腔出血预后差。玻璃体视网膜手术在部分病例可挽救眼球并获得有用的视力。关键在于认识危险因素并加强预防。     

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。     

Rhegmatogenous retinal detachment associated with massive spontaneous suprachoroidal hemorrhage and prognosis of pars plana vitrectomy

AIM:To describe the clinical characters of rhegmatogenous retinal detachment (RRD) associated with massive spontaneous suprachoroidal hemorrhage (SSCH). To evaluate optimal timing and prognosis of pars plana vitrectomy.METHODS: A retrospective review of 6 cases (6 eyes) of RRD and massive SSCH among 3772 cases of RRD was conducted. All of 6 patients were treated with twenty-gauge vitrectomy, suprachoroidal blood drainage, phacoemulsification (PHACO) or lensectomy and silicon oil tamponade. The clinical characters, intraoperative findings and treatment outcomes were reported.RESULTS: In the 6 affected eyes of 6 patients (3 men and 3 women; mean age, 53.83y; range 34-61y), preoperative visual acuity ranged from faint light perception (LP) to counting finger (CF). The average interventional duration from visual decreased to surgery was 12.8 d (range 9-15d). All eyes were associated with high myopia and the mean ocular length was 30.32 mm (range 28.14-32.32 mm). Choroidal hemorrhage were successfully drained in the operation of all 6 eyes. Intraoperative findings showed there were multiple retinal breaks in all 6 eyes and in 4 eyes breaks were along supratemporal and/or infratemporal retinal vascular arcade, especially in the edge of chorioretinal atrophy areas. These patients were followed up from 6 to 34mo (Mean, 23.5mo). The best-corrected visual acuity after surgery varied from CF to 20/100, with improvement in 5 eyes (83.33%) and no change in 1 eye (16.67%). Ocular hypertension ocurred in 1 eye (16.67%), which was successfully treated by silicon oil removal combined with trabeculectomy. In 4 eyes, tractional retinal detachment caused by proliferative vitreoretinopathy (PVR) appeared and a secondary surgery of pre-retinal membrane peeling and silicon oil retained were performed. In 4 eyes, silicon oil cannot be removed. The initial and final reattachment rates were 33.33% and 66.67%, respectively.CONCLUSION: RRD associated with massive SSCH is an extremely rare event. The most common risk factor is long axial length. Vitrectomy and choroidal blood drainage can effectively remove suprachoroidal hemorrhage and promote retinal reattachment in these eyes. However, silicon oil could not be removed in most eyes and final visual acuities are generally poor.     

Secondary management of suprachoroidal hemorrhages

Ten cases of postoperative suprachoroidal hemorrhages involving the macular area, following eight cataract extractions and two trabeculectomies, were drained through an anterior temporal sclerostomy. Vitrectomy was performed only in case of vitreous incarceration in the corneal wound and through the same sclerostomy. This simple procedure gave good anatomical results in eight cases and good visual results in seven cases. Since this postoperative complication can spontaneously heal well, we limit the indications for drainage to cases of kissing choroidal detachments, of associated serous retinal detachment, and when a vitrectomy is needed.