Sukpen Intira, Stewart Jay M
Department of Ophthalmology, University of California, San Francisco, San Francisco, California.
Retin Cases Brief Rep. 2018;12 Suppl 1:S9-S11. doi: 10.1097/ICB.0000000000000659.
To report the intraoperative occurrence of acute intraoperative suprachoroidal hemorrhage during small-gauge pars plana vitrectomy.
A review of a surgical patient who developed acute intraoperative suprachoroidal hemorrhage during small-gauge pars plana vitrectomy because of bucking under general anesthesia.
A 32-year-old obese woman with proliferative diabetic retinopathy and traction retinal detachment in the left eye who developed intraoperative suprachoroidal hemorrhage during small-gauge pars plana vitrectomy because of bucking under general anesthesia while doing endolaser under air infusion. The pressure was immediately elevated to stabilize the hemorrhage without sclerotomy creation, and then gas (14% C3F8) was injected, with subsequent face-down positioning. The patient subsequently developed proliferative vitreoretinopathy, requiring additional surgery. The final visual acuity at 14-month follow-up was hand motions with a reattached retina in the left eye.
Valsalva-induced suprachoroidal hemorrhage during pars plana vitrectomy under general anesthesia may result in sight-threatening visual consequences. Current small-gauge vitrectomy techniques using valved cannulas may allow for better intraoperative management of this complication through control of the intraocular pressure in a closed system.
报告在小切口玻璃体切割术中急性术中脉络膜上腔出血的术中发生情况。
回顾一名手术患者，该患者在小切口玻璃体切割术中因全身麻醉下躁动而发生急性术中脉络膜上腔出血。
一名32岁肥胖女性，左眼患有增殖性糖尿病视网膜病变和牵拉性视网膜脱离，在小切口玻璃体切割术中，于空气注入下行视网膜内激光光凝时因全身麻醉下躁动而发生术中脉络膜上腔出血。立即升高眼压以稳定出血，未行巩膜切开，然后注入气体（14%全氟丙烷），随后采取面朝下体位。患者随后发生增殖性玻璃体视网膜病变，需要再次手术。14个月随访时的最终视力为左眼手动，视网膜复位。
全身麻醉下玻璃体切割术中瓦尔萨尔瓦动作引起的脉络膜上腔出血可能导致威胁视力的视觉后果。目前使用带瓣膜套管的小切口玻璃体切割技术可通过在封闭系统中控制眼压，更好地在术中处理这种并发症。
