Wang Chih-Ping, Huang Evelyn Jou-Chen, Kuo Chien-Neng, Lai Chien-Hsiung
Department of Ophthalmology, Chang Gung Memorial Hospital-Chiayi, Puzih City, Taiwan.
Department of Medicine, Chang Gung University College of Medicine, Tao-Yuan, Taiwan.
Taiwan J Ophthalmol. 2016 Apr-Jun;6(2):96-97. doi: 10.1016/j.tjo.2015.05.002. Epub 2015 Aug 6.
In March 2014, a 56-year-old woman without previous underlying disease underwent encircling scleral buckling, 20-gauge pars plana vitrectomy, cryotherapy around a retinal tear, and gas-fluid exchange with 15% perfluoropropane flush for upper rhegmatogenous retinal detachment of the left eye. However, she developed progressive left leg swelling, pain, warmth, and redness, associated with difficulty in elevating her left leg after continuously maintaining a prone head position when either lying down or sitting for 2 days. When she arrived at the emergency room, she had an elevated D-dimer level. After undergoing Doppler ultrasound imaging, she was diagnosed as having deep vein thrombosis of the left leg. She received anticoagulation therapy with enoxaparin and warfarin overlapping for 7 days. The edema, pain, and paresthesia of her left leg were relieved. However, because of the risk of bleeding with anti-coagulation drug usage, the patient needed to be monitored for 6 months. Prone positioning for gas tamponade is important for anatomic and functional success in retinal detachment surgery; however, timely walking and rest between periods of continuous prone positioning should be encouraged to prevent deep vein thrombosis and other impaired circulation-related complications.
2014年3月，一名无既往基础疾病的56岁女性因左眼上半孔源性视网膜脱离接受了环扎巩膜扣带术、20G玻璃体切除术、视网膜裂孔周围冷冻治疗以及15%全氟丙烷冲洗的气液交换术。然而，在连续俯卧位头部姿势躺卧或坐立2天后，她出现了左腿渐进性肿胀、疼痛、发热和发红，且左腿抬高困难。她到急诊室就诊时，D-二聚体水平升高。经多普勒超声成像检查后，她被诊断为左腿深静脉血栓形成。她接受了依诺肝素和华法林重叠抗凝治疗7天。其左腿的水肿、疼痛和感觉异常得到缓解。然而，由于使用抗凝药物有出血风险，该患者需要接受6个月的监测。气体填塞的俯卧位对于视网膜脱离手术的解剖和功能成功很重要；然而，应鼓励在连续俯卧位期间适时行走和休息，以预防深静脉血栓形成和其他与循环障碍相关的并发症。
