PDF(Pubmed)
Abstract：
Hemophilia is a serious X-linked inheritance coagulation factor deficiency. Clinically, prolonged bleeding or delayed clotting in any area of vascular disturbance is the main manifestation of all hemophilia. We presented a 23-year-old male with a history of left sensory esotropia since the age of three. The patient had not undergone any previous eye surgery and refused to wear glasses. Hematologic studies confirmed a diagnosis of hemophilia A. Upon ophthalmologic examination, the patient\'s visual acuity was 20/20 in the right eye and 20/120 in the left eye, with deep amblyopia. The patient exhibited left inferior oblique overaction and a V pattern. The ophthalmologic examination otherwise revealed no abnormalities. Preoperative correction of factor VIII was deemed necessary, and the recommended dose was administered to raise the factor VIII level to 52%. The patient underwent bilateral medial rectus recession, left lateral rectus plication, and left inferior oblique myectomy. A new technique utilizing viscodissection with subconjunctival injection of a viscoelastic solution was employed to minimize intraoperative bleeding, resulting in reduced bleeding compared to standard strabismus surgery. No unusual bleeding occurred during the procedure. No postoperative bleeding was observed. The patient was discharged on the fourth postoperative day, having achieved satisfactory cosmetic alignment in the primary position with no complications related to hemophilia. In conclusion, strabismus surgery can be performed safely in strabismic patients with hemophilia. Viscodissection is a helpful novel surgical technique to decrease the risk of bleeding during surgery, and we recommend using this technique in patients using anticoagulants. A multidisciplinary team approach and strict post-operative monitoring are essential in order to achieve optimal results.
摘要：
血友病是一种严重的X连锁遗传凝血因子缺乏症。临床上,任何血管紊乱区域的长期出血或延迟凝血是所有血友病的主要表现。我们介绍了一名23岁的男性，自三岁以来就有左感觉内斜视的病史。患者以前没有接受过任何眼科手术，并且拒绝戴眼镜。血液学研究证实了A型血友病的诊断。患者的视力在右眼为20/20，左眼为20/120，深度弱视.患者表现为左下斜过度和V型。眼科检查未发现异常。术前校正因子VIII被认为是必要的，并给予推荐剂量以将因子VIII水平提高至52%.患者进行了双侧内侧直肌衰退，左直肌折叠,左下斜肌切除术.采用了一种新技术，该技术利用结膜下注射粘弹性溶液来减少术中出血，与标准斜视手术相比，出血减少。术中无异常出血。未观察到术后出血。病人在术后第四天出院,在主要位置实现了令人满意的美容对齐，没有与血友病相关的并发症。总之,斜视手术可以安全地进行斜视患者的血友病。Viscodissection是一种有用的新型手术技术，可降低手术期间出血的风险，我们建议在使用抗凝剂的患者中使用这种技术。为了获得最佳结果，多学科团队方法和严格的术后监测至关重要。
