Beyer C F, Peyman G A, Hill J M
LSU Eye Center, Department of Ophthalmology, New Orleans 70112.
Arch Ophthalmol. 1989 Nov;107(11):1648-53. doi: 10.1001/archopht.1989.01070020726036.
Expulsive hemorrhage is a catastrophic complication of intraocular surgery that can result in total loss of vision. Suprachoroidal effusion and hemorrhage may precede the development of expulsive hemorrhage; however, the relationship remains unclear. After sedation with intravenous pentobarbital sodium, 11 rabbits were given lactated Ringer's solution and heparin sodium intravenously. The right eyes were proptosed, and the central cornea, lens, and anterior vitreous were removed. After surgery, all 11 eyes (100%) developed choroidal effusion, choroidal hemorrhage, or expulsive hemorrhage. The rabbits were killed at various intervals after surgery so that the eyes could be enucleated and processed for light microscopy. Histologic examination revealed four sequential stages of expulsive hemorrhage as follows: (1) There was engorgement of the choriocapillaris. (2) Suprachoroidal effusion occurred mainly near the posterior pole. (3) As the effusion enlarged, stretching and tearing of choroidal vessels as well as tearing of the vessels and attachments at the base of the ciliary body occurred. (4) Massive extravasation of blood, primarily from the torn vessels at the ciliary body base, resulted in suprachoroidal hemorrhage and expulsion of blood through the surgical wound. This experimental model may provide new information relating to the cause and prevention of expulsive choroidal hemorrhage.
暴发性出血是眼内手术的一种灾难性并发症，可导致视力完全丧失。脉络膜上腔积液和出血可能先于暴发性出血的发生；然而，两者之间的关系仍不清楚。用静脉注射戊巴比妥钠镇静后，给11只兔子静脉注射乳酸林格氏液和肝素钠。将右眼眼球突出，切除中央角膜、晶状体和前部玻璃体。术后，所有11只眼（100%）均出现脉络膜积液、脉络膜出血或暴发性出血。术后在不同时间点处死兔子，以便摘除眼球并进行光学显微镜检查。组织学检查显示暴发性出血有四个连续阶段如下：（1）脉络膜毛细血管充血。（2）脉络膜上腔积液主要发生在眼球后极附近。（3）随着积液增大，脉络膜血管被拉伸撕裂，睫状体基部的血管和附着处也发生撕裂。（4）大量血液外渗，主要来自睫状体基部撕裂的血管，导致脉络膜上腔出血并通过手术伤口排出血液。该实验模型可能为暴发性脉络膜出血的病因和预防提供新的信息。
