白内障扶贫复明术中“灌注液迷流综合征”的处理及原因分析

The causes and treatment of infusion misdirection syndrome in cataract surgery in the poverty alleviation action

目的探讨总结白内障扶贫复明术中“灌注液迷流综合征”的原因及处理方法。方法本院2011-2013年间参与防盲民生工程，共有31例患者发生“灌注液迷流综合征”，临床表现为突发性眼压升高、浅前房、虹膜脱出，通过注入黏弹剂以及升高灌注瓶高度无法维持前房深度，术中检查未发现眼内出血现象，其中7例发生在水分离和水分层后，24例发生在皮质吸出过程中。所有发生灌注液迷流综合征的患者均暂停手术，给予20％甘露醇250ml静脉滴注，若经药物降压无效，可根据手术条件行经平坦部前段玻璃体切割术或玻璃体腔穿刺术，待前房形成后继续进行手术。结果31例患者中，29例经甘露醇静滴治疗后前房形成，继续完成手术，2例经药物降压仍不能形成前房，经平坦部行前段玻璃体切割术后前房形成，继续完成手术。术后1天裸眼视力0．3～1．0者为20例（20眼），视力0．1～0．3者为8例（8眼），视力0．02～0．1者为3例（3眼），眼压高于或等于21mmHg者10例（10眼），发生角膜水肿者14例（14眼）。术后1周裸眼视力0．3～1．0者为24例（24眼），视力0．1～0.3者为7例（7眼），眼压均恢复正常，无角膜水肿发生。结论小切口白内障囊外摘除术中灌注液迷流综合征是一种少见的术中并发症，经正确处理可以缓解突发性眼压升高引起的各种体征，顺利完成手术。

Objetive To summarize the causes and treatment of infusion misdirection syndrome in cataract surgery in the poverty alleviation action. Methods Infusion misdirection syndrome occurred in 31 cases undergoing cataract surgery in the poverty alleviation action of our hospital from 2011 to 2013. The clinical manifestations of these patients include sudden elevation of intraocular pressure, shallow anterior chamber, iris prolapse, and unsustainable anterior chamber depth even with injection of viscoelastic material or increasing perfusion bottle height. The infusion misdirection syndrome occurred in 7 cases after water separation and water stratification, 24 cases during cortex suction. There was no intraocular hemorrhage in all patients. All patients were treated with discontinuing operation and 250ml 20% mannitol injection. If it didn＇t work, vitrectomy or vitreous cavity puncture would be performed, and the cataract operation continued after anterior chamber forming. Results The cataract operations continued to be completed after formation of anterior chamber by mannitol injection in 29/31 cases. The anterior chambers were still not formed even with mannitol therapy in 2/31 cases, so the cataract operations were completed after vitrectomy. Visual acuity in first postoperative day was from 0.3 to 1.0 in 20/31 cases; 0.1 to 0.3 in 8/31 cases; 0.02 to 0.1 in 3/31 eases; intraocular pressure was ≥ 21mmHg in 10/31 cases; corneal edema occurred in 14/31 cases. Visual acuity after 1 week was from 0.3 to 1.0 in 24/31 cases; 0.1 to 0.3 in 7/31 cases; intraocular pressure was normal in all cases and no corneal edema occurred. Conclusions Infusion misdirection syndrome in small incision extracapsular cataract extraction surgery is a rare complication, but the surgery can he completed successfully after a variety of symptoms are properly handled.