灌注液错流综合征的术中鉴别与处理

摘要

目的 探讨白内障超声乳化术中灌注液错流综合征的术中鉴别与处理.方法 回顾性病例研究.2005年1月至2013年6月在施行白内障超声乳化术中突发高眼压、浅前房者中,经鉴别诊断确认的13例(13眼)灌注液错流综合征.这些病例在术中予以20％甘露醇250 ml快速静脉滴注降眼压,如果前房仍未形成再予以睫状体平坦部穿刺玻璃体腔抽液或23G玻璃体手术系统干性单通道玻璃体切除.结果 4眼经术中静脉快速滴注20％甘露醇,3眼联合睫状体平坦部玻璃体腔穿刺抽液及6眼联合睫状体平坦部23G干性玻璃体切除后前房形成,眼压下降,均能完成余下的手术操作步骤,无后囊膜破裂,无玻璃体脱出.术后第1天,术眼裸眼视力0.2者3眼,0.3～0.4者6眼,0.5～0.6者4眼;术后1周0.3～0.4者2眼,0.5～0.6者6眼,0.7～0.8者5眼.所有术眼角膜透明,前房深度正常,瞳孔圆形居中,IOL位置良好.结论 超声乳化术中发生的灌注液错流综合征可经鉴别确诊.20％甘露醇快速静脉滴注降眼压,睫状体平坦部穿刺玻璃体腔抽液尤其是23/25G玻璃体手术系统干性单通道玻璃体切除可解决其引起的各种体征,顺利完成手术操作.%Objective To study the differential diagnosis and management of the infusion misdirection syndrome during phacoemulsification.Methods This was a retrospective case study.Thirteen patients (13 eyes) diagnosed with infusion misdirection syndrome who suddenly developed a shallow anterior chamber and high intraocular pressure during phacoemulsification were selected by differential diagnosis between January 2005 and June 2013.Patients were treated with a 20％ mannital rapid intravenous drip to decrease intraocular pressure,pars plana vitreous cavity puncture aspiration and dryness vitrectomy through a single channel by a 23G vitreoretinal surgical system.Results Four eyes were treated with a 20％ mannital rapid intravenous drip,3 eyes underwent pars plana vitreous cavity puncture aspiration and 6 eyes underwent dryness vitrectomy through a single channel by a 23G vitreoretinal surgical system during the operation.The anterior chamber re-formed and intraocular pressure decreased after the above management procedures.The remaining operative procedures could be finished successfully.No posterior capsular rupture or vitreous prolapse occurred in any cases.Visual acuity was 0.2 in 3 eyes,0.3-0.4 in 6 eyes and 0.5-0.6 in 4 eyes on 1 day postoperatively and 0.3-0.4 in 2 eyes,0.5-0.6 in 6 eyes,and 0.7-0.8 in 5 eyes at 1 week postoperatively.The cornea was clear,anterior chamber depth was normal,the pupil was round and centered,and the IOL was in position in every operated eye.Conclusion Infusion misdirection syndrome during phacoemulsification can be diagnosed definitely by differential diagnosis.A 20％ mannital rapid intravenous drip,pars plana vitreous cavity puncture aspiration and especially single channel dryness vitrectomy by a 23/25G vitreoretinal surgery system can resolve shallow anterior chamber and high intraocular pressure that occurred during the operation.The rest of the operation could be finished successfully.