角膜移植手術中併發膨出性上脈絡膜出血－病例報告

Intraoperative Expulsive Supra Choroidal Hemorrhage in Penetrating Keratoplasty-A Case Report

劉美麟(Mei-Lin Liu) ； 陳俊寰(Jiun-Hwan Chen) ； 魏福宗(Fu-Chung Wei) ； 陳伯卿(Po-Ching Chen) ； 林主國(Ju-Kao Lin) ； 蔡武甫(Wu-Fu Tsai)

《中華民國眼科醫學會雜誌》 46卷1期 (2007/03) Pp. 93-98

https://doi.org/10.30048/ACTASOS.200703.0017

摘要

目的：報告一位77歲男性因無水晶體水泡性角膜病變，接受角膜移植手術，術中發生膨出性上脈絡膜出血的情況並加以討論分析。
方法：病例報告
結果：一位77歲男性病患因無水晶體水泡性角膜病變，視力不斷惡化而接受角膜移植併二次人工水晶體植入手術。病人無糖尿病、高血壓病史，術前眼睛無任何發炎，眼壓亦控制良好。手術自取下角膜(cornea button)至前玻璃體切除(anterior vitrectomy)，一切順利，正預備植入二次人工水晶體時，病患血壓由88毫米汞柱一路竄升至138毫米汞柱，並立刻發生大量膨出性上脈絡膜出血，將全部眼球內容物擠出傷口外。經手指壓迫止血及鞏膜切開術等各項處理，眼球內容物仍完全膨出眼球外，因不可能將眼球內容物再置入眼球內，於是與患者家屬討論後，決定進行眼球內容物摘除術，並順利結束此一手術。
結論：術中發生大量膨出性上脈絡膜出血，是一項非技術性且無法預測的併發症，也是每一位眼科醫師的夢靨，僅能就危險因子加以預防。本文彙整相關文獻所提及之危險因子，並加以分析：發現本病患出血前血壓波動併急速升高，應是導致本次悲劇發生的主要原因。

並列摘要

Purpose: To report a case of intraoperative expulsive suprachoroidal hemorrhage during penetrating keratoplasty (PK) for aphakic bullous keratoplasty (ABK)
Method: A case report
Result: A 77-year-old ABK patient received penetrating keratoplasty and secondary intraocular lens (IOL) implantation due to progressive loss of vision in his left eye. The patient denied diabetic mellitus and hypertension. Except for well-controlled glaucoma and aphakic bullous keratoplasty, the condition of his left eye was unremarkable preoperatively. We performed the surgery smoothly, including the procedures of donor and recipient cornea trephination and anterior vitrectomy. Unfortunately, the blood pressure was elevated from 88 mmHg to 138 mmHg in 15 minutes, then ensuing massive expulsive suprachoroidal hemorrhage occurred when we prepared to perform secondary intraocular lens implantation. Because all the ocular contents were expulsed out of eyeball completely, we tried to stop bleeding by immediate digital compression over the closed eyelid with sterile gauze. Meanwhile, the anesthesia team continued to control the patient's hypertension and we drained the blood clot through two sclerotomies. Because there was no possibility for repositioning the ocular contents back in the original position, patient's family agreed to evisceration for the left eye.
Conclusion: Intraoperative expulsive suprachoroidal hemorrhage is one of the most catastrophic complications for intraocular surgery. Because of its unpredictability, surgeons should effort to control every risk factor as possible to avoid this complication. We believe that fluctuation and acute elevation of blood pressure may be the major predisposing risk factor for this patient.

並列關鍵字

expulsive suprachoroidal hemorrhage ； suprachoroidal hemorrhage ； penetrating keratoplasty ； intraoperative hypertension