小梁切除联合白内障超声乳化手术中发生脉络膜上腔出血3例的临床分析

Clinical analysis of 3 cases with subchoroidal hemorrhage during trabeculectomy combined with phacoemulsification

目的分析小梁切除联合白内障超声乳化手术中发生脉络膜上腔出血(SCH)的临床特征。方法收集行小梁切除联合白内障超声乳化手术中发生SCH患者3例的临床资料,分析SCH的临床特征、诊断和治疗。结果3例SCH患者年龄≥75岁,有长期高血压病史和高眼压病史,术中及时发现并积极治疗后保住眼球。1例右眼外伤继发性闭角型青光眼合并晶状体半脱位患者出血较多,于术后10 d行后巩膜切开放液后缓解,术后1个月视力指数1米;1例右眼原发性急性闭角型青光眼患者,术前和术后视力均无光感;1例左眼原发性慢性闭角型青光眼,术后18个月视力达0.6。结论3例SCH患者术中一些经验值得临床借鉴,以防误诊误治。术前必须正确认识SCH危险因素,术中操作尽可能避免SCH发生,一旦发生必须及时发现并行有效的急救处理。

Objective To analyze the clinical characteristics of subchoroidal hemorrhage(SCH)during trabeculectomy combined with phacoemulsification.Methods The clinical data of the patients with SCH undergoing trabeculectomy combined with phacoemulsification were retrospectively analyzed.The clinical characteristics,diagnosis and treatment of SCH were analyzed.Results Three SCH patients were aged≥75 years old and had a long history of hypertension and ocular hypertension.SCH was found timely and the patients kept their eyeballs after treatment.One case of angle-closure glaucoma combined with lens subluxation secondary to eye trauma had more bleeding,which was relieved after posterior scleral resection with open fluid 10 days after surgery,and the eyesight index was 1 meter 1 month after surgery.One patient with primary acute angle-closure glaucoma had no eyesight before and after surgery.One case with primary chronic angle-closure glaucoma had eyesight of 0.618 months after surgery.Conclusion The experience of the 3 cases with SCH during the operation is worth learning to prevent misdiagnosis and mistreatment.The risk factors of SCH must be correctly recognized before surgery,and the occurrence of SCH should be avoided as much as possible during the operation.Once SCH occurs,it must be recognized timely and treated effectively.