球后麻醉致眼球穿通12例临床特征分析

doi:10.13281/j.cnki.issn.1004-4469.2021.04.006

眼科 ›› 2021, Vol. 30 ›› Issue (4): 278-282.doi: 10.13281/j.cnki.issn.1004-4469.2021.04.006

球后麻醉致眼球穿通12例临床特征分析

曾蕊1 杨嘉嵩2, 3 李云鹏4 李红惠5 李文生2, 3

1上海唯宜儿科200050； 2中南大学爱尔眼科学院，湖南长沙410000； 3上海爱尔眼科医院200335； 4驻马店眼科医院，河南驻马店463000； 5成都爱尔眼科医院610041

收稿日期:2021-03-16 出版日期:2021-07-25 发布日期:2021-07-22
通讯作者: 李文生，Email：drlws@qq.com
基金资助:
爱尔眼科医院集团科研基金（AM1901D3/AR2001D1）；湖南省科技厅创新引导项目（2018SK50102）

Analysis of clinical characteristics of 12 cases of scleral penetration caused by retrobulbar anesthesia

Zeng Rui1, Yang Jiasong2, 3, Li Yunpeng4, Li Honghui5, Li Wensheng2, 3

1Shanghai Wellem Medical Group, Shanghai 200050, China; 2Central South University Aier School of Ophthalmology, Changsha 410000, China; 3Shanghai Aier Eye Hospital, Shanghai 200335, China; 4Zhumadian Eye Hospital, Zhumadian 463000, China; 5Chengdu Aier Eye Hospital, Chengdu 610041, China

Received:2021-03-16 Online:2021-07-25 Published:2021-07-22
Contact: Li Wensheng, Email: drlws@qq.com
Supported by:
Science Research Fundation of Aier Eye Hospital Group (AM1901D3/AR2001D1); Innovation Guidance Project of Science and Technology Department of Hunan Province (2018SK50102)

摘要/Abstract

摘要： 目的总结球后麻醉所致眼球穿通并发症的临床特点及处理方法。设计回顾性病例系列。研究对象 2012-2019年四家医院因球后麻醉致眼球穿通患者12例。方法回顾患者的病历资料。平均随访（9.5±5.4）个月。主要指标年龄、性别、病史、临床表现、术中情况及术后随访结果。结果 12例患者平均年龄（54.9±7.8）岁，女性8例。既往存在高度近视眼11例。球后麻醉的原手术分别为孔源性视网膜脱离行玻璃体切除术8例，单纯硅油取出术2例，硅油取出联合白内障超声乳化手术1例，高度近视黄斑劈裂行玻璃体切除术联合超声乳化手术1例。眼球穿通均在手术中及时发现。孔源性视网膜脱离患者在发现眼球穿通后，全部病例予以硅油玻璃体腔填充。拟行硅油取出的患者和黄斑劈裂的患者术毕时均予以空气填充。巩膜穿通的处理是清除视网膜前后的出血后予以穿通口处的视网膜激光光凝，如有视网膜脱离的情况予以玻璃体腔硅油填充，无视网膜脱离的情况予以消毒空气玻璃体腔填充。末次随访时，最佳矫正视力为HM~0.6，其中10例较术前有提高。12例患者中，8例孔源性视网膜脱离患者玻璃体切除联合硅油填充术后7例完成硅油取出术，硅油取出患者术后未见视网膜再次脱离。1例高度近视独眼患者后极部视网膜未复位，硅油未能取出。结论球后麻醉致眼球穿通并发症后可造成严重眼部损害，及时恰当地处理可将眼部损伤减至最小。（眼科， 2021， 30： 278-282）

关键词: 球后麻醉, 巩膜穿通, 玻璃体切除术

Abstract: Objective To summarize the clinical characteristics and management of scleral perforation during retrobulbar anesthesia. Design Retrospective case series. Paticipants 12 cases of scleral perforation during retrobulbar anesthesia were enrolled from 2012 to 2019. Methods Patient’s medical records were reviewed. The follow-up period of 12 patients was 9.5±5.4 months. Main Outcome Measures Age, gender, medical history, clinical manifestations, intraoperative conditions, and postoperative follow-up results. Results The average age of 12 patients was (54.9 ±7.8) years, including 8 females. There were 11 patients with high myopia. The operations to be performed under retrobulbar anesthesia were vitrectomy for rhegmatogenous retinal detachment in 8 cases, silicone oil removal in 2 cases, silicone oil removal combined with phacoemulsification in 1 case, and vitrectomy combined with phacoemulsification in 1 case of myopic foveoschisis. Eyeball perforation was found in time during the operation. All patients with rhegmatogenous retinal detachment were tamponaded with silicone oil after scleral perforation was found. In addition, patients with silicone oil removal and myopic foveoschisis were tamponaded with air at the end of the operation. The treatment of scleral penetration was laser photocoagulation of the retina after the removal of hemorrhage beneath or above the retina, silicone oil tamponaded in the case with retinal detachment, and disinfection air tamponaded in the case with no retinal detachment. At the last follow-up, the best corrected visual acuity was from HM to 0.6, and was improved compared with before surgery in 10 cases. Among the 12 patients, 7 of 8 patients with rhegmatogenous retinal detachment underwent vitrectomy combined with silicone oil filling, and no retinal detachment was found after silicone oil removal. In one case of high myopia, the posterior retina was not reattached and the silicone oil could not be removed. Conclusions The complications of eyeball penetration caused by retrobulbar anesthesia can cause serious eye damage, which can be minimized by timely and appropriate treatment. (Ophthalmol CHN, 2021, 30: 278-282)

Key words: retrobulbar anesthesia, scleral perforation, vitrectomy

曾蕊杨嘉嵩, 李云鹏李红惠李文生, . 球后麻醉致眼球穿通12例临床特征分析[J]. 眼科, 2021, 30(4): 278-282.

Zeng Rui, Yang Jiasong, , Li Yunpeng, Li Honghui, Li Wensheng, . Analysis of clinical characteristics of 12 cases of scleral penetration caused by retrobulbar anesthesia[J]. Ophthalmology in China, 2021, 30(4): 278-282.

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球后麻醉致眼球穿通12例临床特征分析

Analysis of clinical characteristics of 12 cases of scleral penetration caused by retrobulbar anesthesia

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