全身麻醉非眼科手术患者术后发生眼损伤2例报告及文献复习

Eye injury after non-ocular surgery in patients underwent general anesthesia:A report of 2 cases and literature review

目的:探讨全身麻醉非眼科手术患者发生眼损伤的病因和危险因素,为其临床预防和诊治提供参考。方法:分析2例全身麻醉非眼科手术后发生眼损伤患者的临床资料,并复习相关文献。结果:1例青年女性患者于全身麻醉头低位下行"腹腔镜下全子宫切除术",术中眼睑自然闭合,无眼保护措施,术后发生角膜擦伤,对症治疗后完全康复。1例老年男性患者于全身麻醉俯卧位下行"颈椎后路椎管扩大成形术",术后发生缺血性视神经病变(ION),对症治疗后视力部分恢复。结论:角膜擦伤是全身麻醉相关的最常见的眼科并发症,患者大多预后良好。术后视力丧失(POVL)是最严重的并发症,其具体发病原因及机制尚未完全阐明,缺乏有效治疗手段,重在预防。

Objective:To study the pathogenesis and the risk factors of eye injury after non-ocular surgery in the patients underwent general anesthesia,and to provide the reference for its prevention,diagnosis and treatment.Methods:The clinical materials of two patients with eye injury after non-ocular surgery underwent general anesthesia were analyzed and the related literatures were reviewed.Results:A young woman patient underwent laparoscopic hysterectomy with general anesthesia while positioned Trendelenburg,the eyes were being closed naturally without protection,and corneal abrasion of both eyes occurred after operation.The lesion had completely resolved with no sequelae after treatment.An old man underwent cervical posterior laminoplasty with general anesthesia in prone position developed ischemic optic neuropathy(ION)after operation.The vision of the patients partly recovered after symptomatic treatment.Conclusion:Corneal abrasion is the most frequent ophthalmologic complication during general anesthesia,most of the patients have good prognosis.Postoperative visual loss(POVL)is the most severe ophthalmologic complication without effective treatment available,the delicate reasons and mechanisms are not totally clear,prevention outweighs treatment.