白內障術中發生逐出性上脈絡膜出血併有良好預後－壹病例報告

A Favourable Outcome for the Expulsive Suprachoroidal Hemorrhage during Cataract Surgery-Report of a Case

邱瑞祥(Jui-Hsiang Chiu) ； 曾順輝(Sung-Huei Tseng) ； 黃正賢(Cheng-Hsien Huang)

《中華民國眼科醫學會雜誌》 35卷4期 (1996/12) Pp. 461-465

https://doi.org/10.30048/ACTASOS.199612.0014

摘要

逐出性上脈絡膜出血是眼內手術時，可導致眼睛內容物被推擠至眼球外，而嚴重損害患者視力之極具破壞性之併發症。壹66歲有青光眼，糖尿病及高血壓病史之男性病患，其右眼在接受白內障手術植入後房人工水晶體後發生逐出性上脈絡膜出血。當時傷口立即予以縫合，清除傷口附近脫出之玻璃體，以及切開鞏膜引流上脈絡膜的出血。術發眼底可見出血性脈絡膜剝離併眼壓升高。因殘餘積血及玻璃體混濁，患者於術後壹個月再次進行玻璃體切除術及鞏膜切開引流。術後七個月追蹤，最佳矯正視力可達20/50。吾等歸諸此不錯之預後在於發現併發症時，立即關閉傷口，以及引流上脈絡膜出血有關。而術中較完整之前囊膜以及植入之水晶體，形成之阻檔效果(barrier effect)，亦可能有相當助益。

並列摘要

Expulsive suprachoroidal hemorrhage, a devastating complication of intraocular surgery, can result in the extrusion of intraocular contents and poor visual outcome. A 66-year-old male with a previous history of glaucoma, diabetes and hypertension underwent cataract surgery in his right eye. Intraoperative expulsive hemorrhage was recognized after posterior chamber lens implantation. Anterior vitrectomy for the herniated vitreous and wound closure were done immediately. Additionally, two sclerotomies were performed to drain the suprachoroidal blood. Severe hemorrhagic choroidal detachment with elevated intraocular pressure were noted postoperatively. One month after the initial surgery, patient underwent another vitrectomy and repeated sclerotorny drainage uneventfully. He was followed up regularly and achieved the best-corrected visual acuity to 20/50 at seventh month follow-up. We conclude that such a favourable outcome was mainly attributable to the immediate wound closure, the drainage of the suprachoroidal hemorrhage, and most noteworthy the barrier effect of the nearly intact anterior capsule and the already implanted posterior chamber lens.

並列關鍵字

Expulsive suprachoroidal hemorrhage ； Sclerotomy drainage ； Endocapsular cataract surgery