中华眼外伤职业眼病杂志
中華眼外傷職業眼病雜誌
중화안외상직업안병잡지
CHINESE JOURNAL OF OCULAR TRAUMA AND OCCUPATIONAL EYE DISEASE
2013年
4期
286-289
,共4页
傅波%苗春旭%冯万国%宫冰冰%肖梦媛
傅波%苗春旭%馮萬國%宮冰冰%肖夢媛
부파%묘춘욱%풍만국%궁빙빙%초몽원
白内障%超声乳化%前房消失%高眼压
白內障%超聲乳化%前房消失%高眼壓
백내장%초성유화%전방소실%고안압
Cataract%Phacoemulsification%Disappearance,anterior chamber%Intraocular pressure,high
目的 研究白内障超声乳化术中前房突然消失伴眼压升高的原因、处理及预防.方法 单纯性老年性白内障行超声乳化过程中,67例(67眼)突发前房消失、高眼压,其中4例暂停手术,快速静脉滴注20％甘露醇250 ml,1h后眼压降低,黏弹剂重建前房,顺利完成手术.3例于睫状体平坦部进针吸出玻璃体内0.1ml液体,顺利重建前房.其余60例(60眼)前房频注黏弹剂,勉强完成手术,出现并发症.结果 切口处虹膜反复脱出43例,相应部位虹膜萎缩脱色素,瞳孔不圆.后囊较小破裂3例,人工晶状体照常植入囊袋内.后囊明显破裂2例,玻璃体脱出,施行前段玻璃体切除,人工晶体睫状沟植入,缝线悬吊.术中后弹力层部分脱离6例,用空气泡复位.58例不同程度角膜内皮水肿,于术后3～5d恢复.结论 白内障超声乳化术中前房突然消失、眼压升高,导致失去器械活动空间,手术风险增大,并发症相对增加.此情况的出现部分为解剖因素,但不乏与操作有关,应予以高度重视并采取有效措施,可转危为安.
目的 研究白內障超聲乳化術中前房突然消失伴眼壓升高的原因、處理及預防.方法 單純性老年性白內障行超聲乳化過程中,67例(67眼)突髮前房消失、高眼壓,其中4例暫停手術,快速靜脈滴註20％甘露醇250 ml,1h後眼壓降低,黏彈劑重建前房,順利完成手術.3例于睫狀體平坦部進針吸齣玻璃體內0.1ml液體,順利重建前房.其餘60例(60眼)前房頻註黏彈劑,勉彊完成手術,齣現併髮癥.結果 切口處虹膜反複脫齣43例,相應部位虹膜萎縮脫色素,瞳孔不圓.後囊較小破裂3例,人工晶狀體照常植入囊袋內.後囊明顯破裂2例,玻璃體脫齣,施行前段玻璃體切除,人工晶體睫狀溝植入,縫線懸弔.術中後彈力層部分脫離6例,用空氣泡複位.58例不同程度角膜內皮水腫,于術後3～5d恢複.結論 白內障超聲乳化術中前房突然消失、眼壓升高,導緻失去器械活動空間,手術風險增大,併髮癥相對增加.此情況的齣現部分為解剖因素,但不乏與操作有關,應予以高度重視併採取有效措施,可轉危為安.
목적 연구백내장초성유화술중전방돌연소실반안압승고적원인、처리급예방.방법 단순성노년성백내장행초성유화과정중,67례(67안)돌발전방소실、고안압,기중4례잠정수술,쾌속정맥적주20％감로순250 ml,1h후안압강저,점탄제중건전방,순리완성수술.3례우첩상체평탄부진침흡출파리체내0.1ml액체,순리중건전방.기여60례(60안)전방빈주점탄제,면강완성수술,출현병발증.결과 절구처홍막반복탈출43례,상응부위홍막위축탈색소,동공불원.후낭교소파렬3례,인공정상체조상식입낭대내.후낭명현파렬2례,파리체탈출,시행전단파리체절제,인공정체첩상구식입,봉선현조.술중후탄력층부분탈리6례,용공기포복위.58례불동정도각막내피수종,우술후3～5d회복.결론 백내장초성유화술중전방돌연소실、안압승고,도치실거기계활동공간,수술풍험증대,병발증상대증가.차정황적출현부분위해부인소,단불핍여조작유관,응여이고도중시병채취유효조시,가전위위안.
Objective To study the reasons,treatment and prevention of anterior chamber disappearance with high intraocular pressure during cataract phacoemulsification.Methods Of simply age-related cataract in our hospital' s Ophthamology Dept.,67 cases (67 eyes) of anterior chamber disappearance with high intraocular pressure happened in phacoemulsification.Operation process suspended for 4 cases,immediately intravenous injection of 20％ mannital 250 ml.Intraocular pressure lowered 1 hour later.Reconstruct anterior chamber with viscoelastic agent to complete operation safely.For 3 cases,insert needle through pars plana of ciliary body sucking 0.1 ml liquid from vitreous.Reconstruct anterior chamber smoothly.For the remaining 60 cases (60 eyes),repeatedly inject viscoelastic agent into anterior chamber.Operation finished difficultly,complication appeared.Results Iris prolapsed from incision in 43 cases.Iris atrophy and depigmentation observed at corresponding part.The pupil is no longer circular.For 3 eyes with minor rupture of posterior capsule,IOL was implanted in capsular bag as usual.For 2 cases which had apparent rupture of posterior capsule and vitreous prolapse,anterior vetrectomy performed,IOL was implanted through ciliary groove and suspended by suturing above.Detachement of Descemte' s membrane in 6 cases,repositioned by bubbles.Corneal edema to varied extent appeared in 58 cases but recovered within 3 ～ 5 days.Conclusion Anterior chamber disappearance with high intraocular pressure might happened in cataract phacoemulsification.It makes tools lose operating room,increases operation risk and complication accordingly.It' s partly related to anatomy factors,but some related to operation skills.Special attention and effective measures should be given to overcome the risks.
