INTRACTABLE HYPHEMA FOLLOWING ND:YAG IRIDOTOMY IN A UREMIC HEMODIALYSIS PATIENT -- A CASE REPORT

尿毒症洗腎患者在接受Nd:YAG雷射虹膜穿孔術後發生之嚴重前房出血－病例報告

張珮瑤(Pei-Yao Chang) ； 董奎廷(Kuei-Ting Tung) ； 王嘉康(Jia-Kang Wang) ； 張淑雯(Shu-Wen, Chang)

《中華民國眼科醫學會雜誌》 55卷 (2016/12) Pp. 45-49

https://doi.org/10.30048/ACTASOS.201612_55.0007

摘要

Purpose: To report a case with intractable hyphema following Nd:YAG iridotomy in a uremic patient under hemodialysis. Method: An observational case report. Result: A uremic patient without discontinuing aspirin had total hyphema after undergoing Nd:YAG iridotomy. Recurrent bleeding was noted after intracameral injection of tissue plasminogen activator and surgical irrigation. Severe corneal blood staining developed and had a great impact on her vision. Conclusion: Nd:YAG laser peripheral iridotomy may carry the risk of intractable hyphema in uremic patients. Ophthalmologists should be aware of this complication following the procedure.

關鍵字

Nd:YAG iridotomy ； hyphema ； corneal blood staining

並列摘要

目的：報告一尿毒症洗腎患者在接受Nd:YAG雷射虹膜穿孔術後發生之嚴重前房出血。方法：病例報告。結果：患者因隅角閉鎖接受Nd:YAG雷射虹膜穿孔術，因為中風高危險族群，故雷射前沒有停止抗凝血劑，患者雷射後立即發生嚴重全前房出血。雖然經過兩次前房沖洗及tissue plasminogen activator（tPA）前房注射以及內科靜脈輸送凝血因子治療，仍然反覆出血，最後產生嚴重之血漬角膜內皮,嚴重影響視力。結論：Nd:YAG雷射虹膜穿孔術為門診常見之雷射，雖然安全性極高，但在尿毒症洗腎患者服用抗凝血劑期間，仍有可能發生嚴重前房出血合併血漬角膜的情形。本文提醒眼科醫師在施行前應審慎評估，並充分告知病人此一併發症之可能。