白内障超声乳化术中灌注液迷流的相关研究

Study on infusion misdirection syndrome during phacoemulsification cataract surgery

摘要:

灌注液迷流综合征(infusion misdirection syndrome， IMS)是白内障超声乳化术中突发的一类罕见且处理棘手的并发症，其通常发生于白内障术中水分离、超声乳化或灌注抽吸(irrigation/aspiration， I/A)时。在悬韧带松弛、晶状体脱位、后囊膜破裂、眼前段拥挤、高灌注压等因素下，灌注液积聚于玻璃体腔中或玻璃体后，造成眼内压升高、前房变浅甚至消失进而导致手术难以进行。这需与暴发性脉络膜上腔出血(suprachoroidal hemorrhage， SCH)、囊袋阻滞综合征(capsular block syndrome，CBS)等进行鉴别。在经过术中紧急处理，如：休息联合甘露醇静滴、玻璃体腔穿刺抽液或玻璃体切除后，患眼术后均能获得良好预后。本文围绕白内障超声乳化术中灌注液迷流的发病机制、诊断及鉴别、术中紧急处理方式、预防及预后进行详细综述，以期为眼科医生提供临床指导。

Abstract:

Infusion misdirection syndrome(IMS)is a rare and troublesome intraoperative complication during phacoemulsification cataract surgery, which usually occurs in hydrodissection, phacoemulsification or irrigation/aspiration(I/A). Under the factors of lax zonular fibers, lens dislocation, posterior capsular rupture, the anterior segment crowding, high perfusion pressure, the infusion fluid accumulates in the vitreous cavity or behind the vitreous, leading to intraocular hypertension, shallowness or even disappearance of the anterior chamber and eventually causing the suspension of surgery. It needs to be differentiated from suprachoroidal hemorrhage(SCH), capsular block syndrome(CBS), etc. After intraoperative emergency treatments, such as rest combined with intravenous drip of mannitol, pars plana needle aspiration or vitrectomy, a favorable prognosis can be obtained. This review discusses the pathogenesis, diagnosis, emergency management, prevention and prognosis of IMS during phacoemulsification cataract surgery, with the aim of providing clinical guidance for ophthalmologists.