表面麻醉联合球结膜浸润麻醉下的黄斑部疾病的玻璃体视网膜手术

目的]探讨应用表面麻醉联合球结膜下浸润麻醉进行黄斑部疾病玻璃体视网膜手术的可行性.方法]对需行玻璃体视网膜手术的黄斑部疾病30例30眼,术中采用表面麻醉联合球结膜下浸润麻醉.行标准的三通道玻璃体视网膜手术,根据病情行视网膜前膜、黄斑前膜和或内界膜剥离,眼内光凝、气液交换和体积分数16%全氟丙烷(C3F8)充填.观察术中的镇痛效果,术眼的合作程度以及并发症.结果]在所有手术眼中,麻醉效果优良者13眼,麻醉效果中等者15眼,麻醉效果差者2眼.麻醉效果差的2眼均为视网膜脱离术后继发性黄斑前膜,在术中肌注哌替啶后均顺利完成手术.患者诉术眼疼痛多发生在巩膜穿刺刀刺入巩膜时、术中顶压视网膜周边部切除基底部玻璃体以及眼内光凝时,但是疼痛均较轻微,能继续耐受手术.所有病例术中未发生与麻醉相关并发症.结论]在黄斑部疾病玻璃体视网膜手术中,采用表面麻醉联合球结膜下浸润麻醉,能顺利的完成手术,同时避免了球后麻醉所引起的并发症,但是要求手术医生必须具有熟练的手术技巧,并且在手术前与患者充分沟通以配合手术.

Vitreo-retinal Surgery of Macular Diseases Under Topical Anesthesia Combined with Sub-conjunctiva Anesthesia

To evaluate the possibility of performing vitreo retinal operation of macular diseases under topical anesthesia combined with sub conjunctiva anesthesia.30 eyes of 30 patients with macular diseases were performed vitreo retinal surgery under topical anesthesia combined with sub conjunctiva anesthesia. The standard three portion vitreo retinal surgery , peeling of epiretinal membrane and internal limiting membrane, intraocular laser coagulation, air fluid exchange and stuffing of C3F8 were performed according to the necessity of the diseases. The effect of erasing pain, degree of co operation and complications of the operation were observed.In all those of eyes, the effect of anesthesia was good in 13 eyes, moderate in 15 eyes, and bad in 2 eyes. Both the 2 bad eyes were macular pucker secondary to retinal detachment surgery, and the operation were finished successfully after muscle injection of Dolantin. Pain during the operation mostly occurred when the sclera knife penetrated into the wall of the eye,or at the time when the operator pressed the peripheral retina and cut the vitreous in the base or during intraocular laser coagulation. There were no complications related with anesthesia.Conclusion]Under topical anesthesia combined with sub conjunctiva anesthesia, the vitreo retinal surgery of macular diseases can be finished successfully, and the complica tions related to retroocular anesthesia can be avoided. The perfect skills of the surgeon and good communication with patients before operation are required.