内眼手术及外伤术后迟发型脉络膜上腔出血的处理

Management of delayed suprachoroidal hemorrhage after intraocular surgery and trauma

目的探讨迟发型脉络膜上腔出血(delayed suprachoriodal haemorrhage,DSCH)的手术相关危险因素,并分析分步手术治疗DSCH的效果。方法分析2007年7月至2012年12月在我院诊断为DSCH的10例(10眼)患者,收集并分析临床数据,包括眼底检查、眼部B超、手术方式的选择、术后视力和眼压等。结果 10例(10眼)患者中男6例,女4例,年龄(56.60±17.67)岁。8例患者行巩膜切开引流术或/和玻璃体切割术,另2例行保守治疗。随访时间为(15.2±4.3)个月。所有患者接受手术后眼压明显降低,视力明显提高,差异均有统计学意义(均为P<0.01)。结论术中使用丝裂霉素C,全身使用抗凝剂或溶栓剂及慢性肾病是DSCH的危险因素。一旦确诊为DSCH,早期进行手术干预将会为患者的预后带来更好的视力。

Objective To indentify surgical risk factors for delayed suprachoroidal hemorrhage （ DSCH）, and report the outcomes of effective intervention in a consecutive of patients. Methods The clinical data of 10 patients diagnosed with DSCH in our hospital from July 2007 to December 2012 were extracted from hospital records and analyzed, including ophthalmologic examination, ophthalmologic B ultrasound, surgical procedures and outcome measures including visual acuity and intraocuiar pressure. Resuits The 10 eyes of l0 patients included 6 men and 4 women,with age of （56.60 ± 17.67 ）years. After diagnosis, drainage or/and pars plan vitrectomy were performed in 8 cases,another 2 cases received conservative treatment. All the patients were followed up for （ 15.2 ± 4.3 ） months. The postoperative intraocular pressure in all patients decreased significantly, and the visual acuity increased, there were significant differences （ all P 〈 0.001 ）. Conclusion The intraoperative mitomycin-C using, systemic anticoaguiation or thrombolysis, chronic kidney disease are the risk factors for DSCH. It seems that earlier surgical intervention after the diagnosis of DSCH will be beneficial to the patients by improving their fmal visual acuity.