驱逐性脉络膜上腔出血的手术处理

Secondary surgical management of massive suprachoroidal hemorrhage

目的评估驱逐性脉络膜上腔出血的手术处理方法及效果。方法对１１例术中或术后发生的驱逐性脉络膜上腔出血，于出血后１１～２８天（平均１５．４天）采用手术处理，先从角膜缘持续灌注，赤道部１或２个巩膜切口引流脉络膜上腔积血，睫状体脱离回复后改从平坦部灌注，行闭合式玻璃体切除视网膜复位术，６例术中应用过氟化碳液体。结果１１例均成功引流脉络膜上腔积血，积血为巧克力色，无血凝块。其中２例发生牵拉性视网膜脱离，余９例视网膜复位，经平均７．８个月随访，视力均有提高，其中６例视力≥０．１。结论及时关闭切口，控制眼压，适时选择手术。

Objective To evaluate the surgical techniques and the efficacy for massive suprachoroidal hemorrhage (MSH). Methods Secondary surgery performed on 11 cases of MSH occurring during or after intraocular surgery was delayed for 11 to 28 days (mean, 15.4 days). All eyes underwent posterior drainage sclerotomies under constantly maintained limbal fluid line pressure, followed by pars plana infusion and vitreoretinal surgery. The perfluorocarbon liquid was used intraoperatively in 6 cases. Results The drainage of the choroidal hemorrhage was successful in all cases. The blood drained from suprachoroidal space was completely liquified and chocolate in color. Tractional retinal detachment occurred in 2 eyes; 9 eyes had retinas normal in position. The mean follow up was 7.8 months. Visual acuities were improved, ≥0.1 in 6 eyes. Conclusion Immediate management of MSH includes watertight wound closure and medical treatment for elevated intraocular pressure, and secondary surgery was performed timely, including external drainage by creating sclerotomies and vitreoretinal surgery. The above methods of treatment have certain advantages and are promising for the management of MSH.