【摘要】 61岁男性，因“左眼前黑影遮挡伴视力下降近2周”就诊。患者4年前、2年前和1年前分别行左眼小梁切除术，右眼穿透性角膜移植术和右眼白内障超声乳化+人工晶状体(IOL)植入术。半年前因左眼颗粒状角膜营养不良，于我院行左眼深板层角膜移植术，手术顺利，术后规律复诊。左眼角膜移植术后3个月和4个月，分别行左眼部分角膜缝线拆除，左眼白内障超声乳化+人工晶体植入术。左眼角膜移植术后半年，再次行左眼角膜缝线拆除。此次拆线术后2周至门诊复诊，主诉“左眼前黑影遮挡伴视力下降近2周”，查体如下。裸眼视力：左眼CF/10 cm；眼压：左眼5 mmHg。左眼角膜植片透明，位置良好，前房清，瞳孔圆，光反射存在，IOL明。眼底：左眼脉络膜广泛脱离，未查见裂孔及出血。B超查及脉络膜脱离回声。经扩瞳、局部及全身抗炎治疗5天后，脉络膜脱离仍未见明显好转，遂决定行左眼玻璃体切除+脉络膜脱离复位术。术中可放出大量微黄色脉络膜上腔液体，复位脉络膜，未见视网膜裂孔，术毕气体填充，术后患者脉络膜复位良好，视力逐渐提高。追问病史，患者第2次角膜拆线过程中，痛感非常明显，术中高度紧张，存在用力屏气过程。讨论体会：患者角膜拆线时的Valsava动作很有可能是该例脉络膜脱离发生的原因，要详细了解病情，做好术前沟通、加强人文关怀，术中充分麻醉，密切关注患者术中情况，做好患教工作，术后尽早随访，以便及时发现特殊并发症。更多还原

【Abstract】 A 61-year-old male visited the hospital with the main complaint of black shadow in the left eye accompanied by vision loss for 2 weeks. The patient underwent trabeculectomy in the left eye 4 years ago, penetrating keratoplasty in the right eye 2 years ago and cataract surgery in the right eye 1 year ago.Due to granular corneal dystrophy in the left eye, the patient underwent deep lamellar keratoplasty in our hospital 6 months ago. The operation was successful, and the follow-up visits were regularly arranged. Some corneal sutures were removed 3 months after the operation. Four months after deep lamellar keratoplasty,phacoemulsification and IOL implantation were performed on the left eye. Two months thereafter, the corneal sutures of the left eye were removed again. Two weeks later, the patient complained of black shadow in the left eye accompanied by loss of vision. Physical examination of the left eye showed the uncorrected visual acuity was CF/10 cm, the intraocular pressure was 5 mmHg, the corneal graft was transparent and well-positioned,the anterior chamber was clear, the pupil was round with normal light reflex, the IOL was transparent, and the choroid was extensively detached without retinal hole or hemorrhage. The choroidal detachment was obvious in B-scan. After 5 days of local mydriatics and local and systemic anti-inflammatory treatments, the choroidal detachment did not show significant improvement. Then we decided to perform vitrectomy and choroidal reattachment surgery on her left eye. During the operation, a large amount of yellowish fluid in the suprachoroidal space was released. The choroid was reattached without retinal hole, and the vitreous cavity was filled with gas. Vision of the left eye improved gradually postoperatively. After further inquiry of the patient, we noticed that the patient felt obvious pain and nervous with forced breath-holding during the second procedure of suture removal. Summary of discussions: the Valsalva maneuver during the corneal suture removal could be the cause of choroidal detachment in this case; it is necessary to know the detailed condition of the patient, communicate well before the operation; enhance humanistic care, administer thorough anesthesia, and closely monitor the patient’s condition intraoperatively; provide effective patient education, and ensure early postoperative follow-up to promptly identify any potential complications.更多还原