Lartey S, Armah P, Ampong A
Eye Ear Nose and Throat Department, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Ghana Med J. 2013 Jun;47(2):96-9.
We share our experience of a 50-year-old controlled hypertensive woman who had routine cataract surgery in her left eye. She was given retrobulbar Xylocaine with adrenalin and postoperative gentamycin. She subsequently became blind in the operated eye after developing macular infarction by the first day post operative and optic atrophy by 2 months postoperative. This could have been caused by vascular occlusion in an already compromised artherosclerosed vessels. It could also have been due to gentamyin toxicity. Gentamycin injection given subconjunctivally is known to rarely result in severe retinal toxicity. This case illustrates that even though cataract surgery is considerd a simple routine procedure, and is performed in high volumes, it is not without its blinding complications. We recommend that the use of adrenaline in xylocaine should be used with caution in hypertensive patients and also the routine use of subconjunctival gentamycin injection after cataract surgery should be reviewed and other modes of endophthalmitis prophylaxis be considered.
我们分享一位50岁血压控制良好的女性患者的经历，她接受了左眼常规白内障手术。术中给予球后注射含肾上腺素的利多卡因，术后使用庆大霉素。术后第一天她出现黄斑梗死，术后2个月出现视神经萎缩，随后手术眼失明。这可能是由于已有动脉粥样硬化病变的血管发生血管闭塞所致，也可能是庆大霉素毒性引起的。结膜下注射庆大霉素已知很少导致严重的视网膜毒性。该病例表明，尽管白内障手术被认为是一种简单的常规手术，且实施量大，但并非没有致盲并发症。我们建议，高血压患者使用含肾上腺素的利多卡因时应谨慎，白内障手术后结膜下常规注射庆大霉素的做法也应重新审视，并考虑其他预防眼内炎的方式。
