Lakhanpal V, Schocket S S, Elman M J, Dogra M R
Department of Ophthalmology, University of Maryland School of Medicine, Baltimore 21201.
Ophthalmology. 1990 Sep;97(9):1114-9. doi: 10.1016/s0161-6420(90)32448-x.
Seven eyes (7 patients) developed massive suprachoroidal hemorrhage (MSCH) during pars plana vitrectomy (PPV) for complicated retinal detachments. The MSCH developed late in the procedure following PPV, air fluid exchange, endolaser, cryopexy, and scleral buckling in five of seven eyes. In two eyes, mild hemorrhagic choroidal detachments noted intraoperatively progressed to MSCH within 72 hours postoperatively. Diagnosis of MSCH was confirmed by echography and CT scan. Multiple scleral buckling surgeries, high myopia, aphakia, and intraocular inflammation were the main risk factors. Placement of a broad posterior scleral buckle with intraoperative hypotony and cryopexy were important precipitating factors. Visual results were poor, with six of seven eyes showing no light perception. The mean follow-up time was 12.8 months. Once acute MSCH is recognized intraoperatively, surgical decompression at that time should be avoided as MSCH itself may tamponade the choroidal bleed. Details of prevention and management are discussed.
7例患者的7只眼在复杂性视网膜脱离的玻璃体切割术（PPV）过程中发生了大量脉络膜上腔出血（MSCH）。7只眼中有5只眼的MSCH发生在PPV、气液交换、眼内激光、冷冻治疗和巩膜扣带术后的手术后期。在2只眼中，术中发现的轻度出血性脉络膜脱离在术后72小时内进展为MSCH。MSCH的诊断通过超声检查和CT扫描得以证实。多次巩膜扣带手术、高度近视、无晶状体眼和眼内炎症是主要的危险因素。术中低眼压下放置宽的后部巩膜扣带和冷冻治疗是重要的促发因素。视力结果较差，7只眼中有6只无光感。平均随访时间为12.8个月。一旦术中识别出急性MSCH，此时应避免手术减压，因为MSCH本身可能压迫脉络膜出血。文中讨论了预防和处理的细节。
