中华眼视光学与视觉科学杂志
中華眼視光學與視覺科學雜誌
중화안시광학여시각과학잡지
CHINESE JOURNAL OF OPTOMETRY OPHTHALMOLOGY AND VISUAL SCIENCE
2014年
8期
504-507
,共4页
金玲艳%张龄洁%段宏辉%王超军%徐德建
金玲豔%張齡潔%段宏輝%王超軍%徐德建
금령염%장령길%단굉휘%왕초군%서덕건
灌注液错流综合征%超声乳化白内障吸除术%鉴别诊断%处理方法
灌註液錯流綜閤徵%超聲乳化白內障吸除術%鑒彆診斷%處理方法
관주액착류종합정%초성유화백내장흡제술%감별진단%처리방법
Infusion misdirection syndrome%Phacoemulsification%Differential diagnosis%Management methods
目的 探讨白内障超声乳化术中灌注液错流综合征的术中鉴别与处理.方法 回顾性病例研究.2005年1月至2013年6月在施行白内障超声乳化术中突发高眼压、浅前房者中,经鉴别诊断确认的13例(13眼)灌注液错流综合征.这些病例在术中予以20％甘露醇250 ml快速静脉滴注降眼压,如果前房仍未形成再予以睫状体平坦部穿刺玻璃体腔抽液或23G玻璃体手术系统干性单通道玻璃体切除.结果 4眼经术中静脉快速滴注20％甘露醇,3眼联合睫状体平坦部玻璃体腔穿刺抽液及6眼联合睫状体平坦部23G干性玻璃体切除后前房形成,眼压下降,均能完成余下的手术操作步骤,无后囊膜破裂,无玻璃体脱出.术后第1天,术眼裸眼视力0.2者3眼,0.3～0.4者6眼,0.5～0.6者4眼;术后1周0.3～0.4者2眼,0.5～0.6者6眼,0.7～0.8者5眼.所有术眼角膜透明,前房深度正常,瞳孔圆形居中,IOL位置良好.结论 超声乳化术中发生的灌注液错流综合征可经鉴别确诊.20％甘露醇快速静脉滴注降眼压,睫状体平坦部穿刺玻璃体腔抽液尤其是23/25G玻璃体手术系统干性单通道玻璃体切除可解决其引起的各种体征,顺利完成手术操作.
目的 探討白內障超聲乳化術中灌註液錯流綜閤徵的術中鑒彆與處理.方法 迴顧性病例研究.2005年1月至2013年6月在施行白內障超聲乳化術中突髮高眼壓、淺前房者中,經鑒彆診斷確認的13例(13眼)灌註液錯流綜閤徵.這些病例在術中予以20％甘露醇250 ml快速靜脈滴註降眼壓,如果前房仍未形成再予以睫狀體平坦部穿刺玻璃體腔抽液或23G玻璃體手術繫統榦性單通道玻璃體切除.結果 4眼經術中靜脈快速滴註20％甘露醇,3眼聯閤睫狀體平坦部玻璃體腔穿刺抽液及6眼聯閤睫狀體平坦部23G榦性玻璃體切除後前房形成,眼壓下降,均能完成餘下的手術操作步驟,無後囊膜破裂,無玻璃體脫齣.術後第1天,術眼裸眼視力0.2者3眼,0.3～0.4者6眼,0.5～0.6者4眼;術後1週0.3～0.4者2眼,0.5～0.6者6眼,0.7～0.8者5眼.所有術眼角膜透明,前房深度正常,瞳孔圓形居中,IOL位置良好.結論 超聲乳化術中髮生的灌註液錯流綜閤徵可經鑒彆確診.20％甘露醇快速靜脈滴註降眼壓,睫狀體平坦部穿刺玻璃體腔抽液尤其是23/25G玻璃體手術繫統榦性單通道玻璃體切除可解決其引起的各種體徵,順利完成手術操作.
목적 탐토백내장초성유화술중관주액착류종합정적술중감별여처리.방법 회고성병례연구.2005년1월지2013년6월재시행백내장초성유화술중돌발고안압、천전방자중,경감별진단학인적13례(13안)관주액착류종합정.저사병례재술중여이20％감로순250 ml쾌속정맥적주강안압,여과전방잉미형성재여이첩상체평탄부천자파리체강추액혹23G파리체수술계통간성단통도파리체절제.결과 4안경술중정맥쾌속적주20％감로순,3안연합첩상체평탄부파리체강천자추액급6안연합첩상체평탄부23G간성파리체절제후전방형성,안압하강,균능완성여하적수술조작보취,무후낭막파렬,무파리체탈출.술후제1천,술안라안시력0.2자3안,0.3～0.4자6안,0.5～0.6자4안;술후1주0.3～0.4자2안,0.5～0.6자6안,0.7～0.8자5안.소유술안각막투명,전방심도정상,동공원형거중,IOL위치량호.결론 초성유화술중발생적관주액착류종합정가경감별학진.20％감로순쾌속정맥적주강안압,첩상체평탄부천자파리체강추액우기시23/25G파리체수술계통간성단통도파리체절제가해결기인기적각충체정,순리완성수술조작.
Objective To study the differential diagnosis and management of the infusion misdirection syndrome during phacoemulsification.Methods This was a retrospective case study.Thirteen patients (13 eyes) diagnosed with infusion misdirection syndrome who suddenly developed a shallow anterior chamber and high intraocular pressure during phacoemulsification were selected by differential diagnosis between January 2005 and June 2013.Patients were treated with a 20％ mannital rapid intravenous drip to decrease intraocular pressure,pars plana vitreous cavity puncture aspiration and dryness vitrectomy through a single channel by a 23G vitreoretinal surgical system.Results Four eyes were treated with a 20％ mannital rapid intravenous drip,3 eyes underwent pars plana vitreous cavity puncture aspiration and 6 eyes underwent dryness vitrectomy through a single channel by a 23G vitreoretinal surgical system during the operation.The anterior chamber re-formed and intraocular pressure decreased after the above management procedures.The remaining operative procedures could be finished successfully.No posterior capsular rupture or vitreous prolapse occurred in any cases.Visual acuity was 0.2 in 3 eyes,0.3-0.4 in 6 eyes and 0.5-0.6 in 4 eyes on 1 day postoperatively and 0.3-0.4 in 2 eyes,0.5-0.6 in 6 eyes,and 0.7-0.8 in 5 eyes at 1 week postoperatively.The cornea was clear,anterior chamber depth was normal,the pupil was round and centered,and the IOL was in position in every operated eye.Conclusion Infusion misdirection syndrome during phacoemulsification can be diagnosed definitely by differential diagnosis.A 20％ mannital rapid intravenous drip,pars plana vitreous cavity puncture aspiration and especially single channel dryness vitrectomy by a 23/25G vitreoretinal surgery system can resolve shallow anterior chamber and high intraocular pressure that occurred during the operation.The rest of the operation could be finished successfully.
