Turkiye Klinikleri Journal of Ophthalmology

.: ORIGINAL RESEARCH
İnfüzyon Yanlış Yönelim Sendromuna Trokar İmplantasyonu ile Yaklaşım
Management of Infusion Misdirection Syndrome with Trocar Implantation
Hüseyin MAYALIa, Muhammed ALTINIŞIKa, Faruk BIÇAKb, Emin KURTa
aManisa Celal Bayar Üniversitesi Tıp Fakültesi, Göz Hastalıkları ABD, Manisa, TÜRKİYE
bBozyaka Eğitim ve Araştırma Hastanesi, Göz Hastalıkları Kliniği, İzmir, TÜRKİYE
Turkiye Klinikleri J Ophthalmol.2021;30(1):42-7
doi: 10.5336/ophthal.2020-76749
Article Language: TR
Full Text
ÖZET
 Amaç: İnfüzyon yanlış yönelim sendromu (İYYS)nun intraoperatif yönetiminde iğne veya trokar yardımı ile retrolentiküler sıvı aspirasyonunun etkinlik ve güvenliğini değerlendirmek. Gereç ve Yöntemler: Ocak 2016 ve Haziran 2018 yılları arasında fakoemülsifikasyon cerrahisi esnasında İYYS gelişen olgular çalışmaya dâhil edildi. İYYS, koroidal hemoraji veya efüzyon olmaksızın intraoperatif ani göz içi basıncı (GİB) artışı, ön kamara sığlaşması ve iris prolapsusu gelişmesi olarak tanımlandı. İYYS yönetimi için pars planadan 23 Gauge (G) valvsiz trokar ile spontan drenaj veya 26G iğne ile retrolentiküler sıvı aspirasyonu yapıldı. İYYS'nin düzelme durumu ve postoperatif (1. gün, 1. hafta, 1. ay) tam oftalmolojik muayene bulguları değerlendirildi. Bulgular: Dört yüz üç katarakt cerrahisinin 11 (%2,7)'inde İYYS geliştiği gözlendi. Hastaların 6'sı erkek, 5'i kadındı. Yaş ortalaması 70,54±7,62 yıl idi. Katarakt düzeyleri Lens Opacities Classification System II'ye göre evre 2-5 arasında idi. On hastaya 23G valvsiz trokar implantasyonu yapıldı. Yedisinde spontan drenaj sağlanırken, 3'ünde iğne ile aktif aspirasyon gerekti. Bir hastada ise direkt enjektör ile retrolentiküler sıvı aspirasyonu yapıldı. Bütün olgularda, intraoperatif GİB ve ön kamara derinliği normalize olduktan sonra cerrahi başarılı bir şekilde tamamlandı. Olguların takip sürecinde, ön ve arka segment muayenesinde herhangi bir komplikasyon izlenmedi. Sonuç: İYYS, cerrahiyi komplike edebilecek bir durum iken, pars planadan valvsiz trokar veya iğne ile retrolentiküler sıvı aspirasyonu yapılarak, etkili ve güvenilir bir şekilde yönetilebilir.

Anahtar Kelimeler: Fakoemülsifikasyon; infüzyon yanlış yönelim sendromu; pars plana; retrolentiküler aspirasyon; trokar
ABSTRACT
 Objective: To evaluate the efficacy and safety of retrolenticular fluid aspiration in the emergency management of acute intraoperative infusion misdirection syndrome (IMS). Material and Methods: The cases between January 2016 and June 2018 were recruited which IMS was diagnosed as a result of a sudden increase in intraocular pressure (IOP), shallowing of the anterior chamber and iris prolapse without any evidence of choroidal hemorrhage or effusion during phacoemulsification surgery. Retrolenticular fluid aspiration was performed via pars plana 26 gauge (G) needle aspiration or 23G valveless trocar implantation for management of the cases. Resolution of IMS and postoperative (1st day, 1st week, 1st month) full ophthalmologic examination findings were evaluated. Cataracts were graded according to the Lens Opacities Classification System II. Results: IMS developed in 11 (2.7%) of the 403 cataract surgeries (Six males and five females). Mean age was 70.54±7.62 years. Cataracts ranged from grade 2 to 5. Ten cases were managed with valveless trocar, and one case with direct needle aspiration. Spontaneous drainage was provided with trocar in seven out of the 10 patients, while three patients were actively aspirated with injector. The anterior chamber depth and IOP were improved in all cases immediately after fluid aspiration. No complicaiton was observed in the anterior and posterior segment during follow-up period. Conclusion: IMS is an unpredictable, sudden developing condition that complicates surgery when the management is unknown. However, it can be simply resolved with appropriate management techniques including pars plana fluid aspiration via either valveless trocar or needle.

Keywords: Infusion misdirection syndrome; pars plana; phacoemulsification; retrolenticular aspiration; trocar
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