巩膜扣带术治疗术前未发现裂孔的视网膜脱离

目的 观察巩膜扣带术治疗术前未发现裂孔的视网膜脱离的效果.方法 回顾性分析从2010年3月至2011年3月在南京医科大学第一附属医院眼科治疗的术前未发现裂孔的视网膜脱离患者36例(36眼),在显微镜下行巩膜扣带术.其中30例术中找到裂孔,其中10例行巩膜表面节段性外加压联合环扎术;20例单纯行环扎术.其余6例术中仍未找到明显裂孔,单纯行环扎术.32例进行了视网膜下液引流;4例在手术结束时行玻璃体腔气体充填.结果 36例术前未发现裂孔的视网膜脱离中有2例视网膜未能复位,余均复位良好.术后随访最短3个月,最长12个月,最终复位率94.4％.结论 巩膜扣带术治疗术前未发现裂孔的视网膜脱离安全有效.     

巩膜扣带术后视网膜脱离

目的：分析巩膜扣带术后视网膜脱离形成的原因和玻璃体手术治疗方法。方法：回顾46例（46只眼）孔源性视网膜脱离患者的临床资料及其手术治疗方法。结果：巩膜扣带术后24只眼出现新孔，其中7只眼为黄斑部裂孔；18只眼PVR发展C级 以上；5只眼原裂孔未封闭；5只眼合并有脉络膜脱离；这些因素导致35只眼视网膜下液持续不吸收。38只眼玻璃体手术后视网膜复位，占82.6%；多次手术后最终手术成功45只眼，成功率为97.8%。结论：巩膜扣带术后失败原因主要为新孔的发生、PVR发展和视网膜下液不吸收；再次玻璃体手术时，掌握手术时机，对症处理，是提高手术成功的关键。     

视网膜脱离巩膜扣带术后激光光凝封闭裂孔

目的 评价巩膜扣带术后激光光凝封闭裂孔治疗视网膜脱离的效果.方法 回顾性分析2003年1月至2005年5月我科在巩膜扣带术后采用532nm激光经瞳孔光凝封闭裂孔治疗的原发性（孔源性）视网膜脱离35例（35眼）的临床资料,术后随访3～6月.结果 经一次治疗视网膜复位者33眼（94.29%）.结论 巩膜扣带术后激光光凝裂孔治疗原发性（孔源性）视网膜脱离,安全可靠,术后并发症少,是治疗视网膜脱离的一种有效方法.     

巩膜扣带术治疗孔源性视网膜脱离的临床观察

目的:观察巩膜扣带术治疗孔源性视网膜脱离的效果。方法:孔源性视网膜脱离患者94例96眼,术中直视下定位、冷凝视网膜裂孔。91眼行巩膜表面节段性外加压,其中37眼联合环扎术,另5眼单纯行环扎术。67眼进行了视网膜下液引流术,19眼在手术结束时行玻璃体腔气体充填。结果:90眼单次手术视网膜解剖复位,首次手术复位率94%,4眼再次手术后复位,手术最终解剖复位率98%。术中及术后无严重并发症发生。结论:巩膜扣带术治疗孔源性视网膜脱离安全有效。     

巩膜扣带术治疗陈旧性孔源性视网膜脱离

目的:观察巩膜扣带术治疗陈旧性孔源性视网膜脱离的疗效。方法:陈旧性孔源性视网膜脱离患者12例12眼,术前均在裂隙灯下用三面镜进行裂孔定位,术中均在显微镜下行巩膜扣带术,按术前裂孔的定位预置巩膜缝线,放出黏稠视网膜下液,冷凝封闭裂孔,预置缝线下植入硅胶,根据病情,部分患者植入环扎带,结扎缝线固定。术后随访,观察视网膜复位情况。结果:本组病例初次手术视网膜解剖复位率100%。结论:巩膜扣带术对于部分陈旧性孔源性视网膜脱离可以取得较好的效果。     

巩膜扣带术在玻璃体切除术后视网膜未复位患者中的应用

目的 探讨应用巩膜扣带术治疗玻璃体切除术后视网膜未复位患者的手术疗效.设计回顾性病例系列.研究对象2004～2010年北京同二医院43例43眼玻璃体切除术后视网膜未复位患者.方法 所有患者采用间接检眼镜直视下冷冻裂孔、巩膜环扎或外垫压、外放液方法治疗.对硅油填充眼,先行巩膜扣带术,术后1～4周后再行硅油取出.主要指标术后视网膜复位情况、视力、眼压和并发症等.结果 43眼中,12眼为单纯行玻璃体切除或联合玻璃体腔注气术后视网膜脱离,经一次巩膜扣带术,11眼复位,1眼失败后再次行玻璃体切除硅油填充术 24眼为硅油填充眼,其中22眼行巩膜扣带术后视网膜完全复位,1～4周后行硅油取出,2眼视网膜未复位,取油时联合视网膜切开,硅油再填充,最终1眼完全复位,1眼广泛视网膜增殖,增生性玻璃体视网膜病变（PVR）形成,光感消失,眼球萎缩 7眼为硅油取出术后视网膜再脱离眼,行巩膜扣带手术后6眼视网膜完全复位,1眼再次硅油填充.随访3～72个月,经一次巩膜扣带术后视网膜复位39眼（90.7%）,最终42眼（97.7%）视网膜复位.结论 对于玻璃体切除手术失败且裂孔位于周边部的视网膜脱离患者,采用巩膜扣带术式能有效地使视网膜再复位.     

光导直视下巩膜扣带术治疗硅油眼视网膜脱离的临床分析

目的 总结硅油填充眼视网膜脱离复发时应用光导直视下巩膜扣带术治疗的效果.方法 对就诊于吉林大学第二医院并接受光导直视下巩膜扣带术治疗硅油眼视网膜脱离复发的12例(12只眼)患者进行回顾性分析.结果 应用光导直视下巩膜扣带术治疗后网膜复位11只眼(91.7%),其中8只眼行硅油取出术后网膜保持复位.术眼均保持了一定视力,其中4只眼(33.3%)视力在0.1以上.结论 对于硅油填充术后视网膜再脱离范围局限、前部PVR轻微、裂孔较明确、多位于赤道前、下方裂孔、伴有孔缘局部网膜僵硬的上方裂孔的患者,采用光导直视下行裂孔冷冻、巩膜外垫压或联合环扎术进行治疗,取得了较好的治疗效果.     

未发现裂孔的人工晶状体眼视网膜脱离的治疗

目的回顾玻璃体切割联合巩膜扣带术治疗未发现裂孔的人工晶状体眼视网膜脱离的结果。方法5例（5眼）未发现视网膜裂孔的人工晶状体眼视网膜脱离患者应用标准的三通道经睫状体扁平部的玻璃体切割、液-气交换、内引流、眼内激光和巩膜扣带术治疗,术后随访6～12个月,观察术前、术后视力,术后视网膜复位状态及手术并发症。结果所有患眼在施行一次手术后视网膜均获复位,应用对数视力表检查3眼视力增进至少3行,视力不变和减退者各有1眼,后者都有黄斑病变。结论对未发现裂孔的人工晶状体眼视网膜脱离患者联合应用玻璃体切割、液-气交换、内引流、眼内激光和巩膜扣带术治疗,显示有良好的解剖和功能效果。     

巩膜扣带术治疗陈旧性视网膜脱离

目的:观察巩膜扣带术治疗陈旧性视网膜脱离的效果。方法:选取38例38眼陈旧性视网膜脱离患者,术中直视下定位、冷凝视网膜裂孔。针对不同病例36眼于裂孔处缝合硅海绵(其中19眼加缝硅胶环扎带),另2眼单纯行环扎术。26眼进行了视网膜下液引流术,7眼在手术前、后联合了激光光凝术。结果:其中33眼单次手术视网膜解剖复位,首次手术复位率87%,2眼再次手术后复位,手术最终解剖复位率92%。术中及术后无严重并发症发生。结论:通过个体化设计手术方案,巩膜扣带术治疗伴有视网膜下增生的陈旧性视网膜脱离可获得较高的手术治愈率。     

23G后节灌注辅助下的巩膜扣带术治疗球形视网膜脱离

目的：观察23G后节灌注辅助下的巩膜扣带术治疗球形视网膜脱离的疗效,探讨其可行性。

方法：选取我院2017-02/2018-02被确诊为孔源性视网膜脱离且视网膜下液较多、呈球形脱离外观的患者21例21眼,在行巩膜扣带术中引流视网膜下积液前于睫状体扁平部预置23G后节灌注,术中对裂孔未作凝固处理,术后裂孔周围行激光光凝治疗。术后随访观察3～10mo,观察视网膜复位和并发症情况。

结果：所有患者手术过程顺利,术中均引流出视网膜下液并未见脉络膜出血和视网膜嵌顿; 术后第1d视网膜完全复位者18眼; 术后2～3d残留视网膜下液吸收完毕者2眼,视网膜脱离未复位者1眼,经再次外加压块调位术后视网膜复位,术后视网膜脱离复发者1眼,经玻璃体手术后视网膜复位。术中有视网膜下出血者1眼,出血范围<1PD,3mo后吸收,未见眼压异常、眼前段缺血和其他严重并发症。

结论：在球形视网膜脱离的巩膜扣带术中引流视网膜下积液前预置灌注,可有效维持术中眼内压平稳,减少因引流视网膜下积液时眼压过快下降导致的爆发性脉络膜上腔出血和术后发生脉络膜脱离的可能性,同时术中视网膜基本趋于平伏,裂孔定位相对准确,可提高手术成功率。     

视网膜脱离外路显微手术关键技术应用总结

目的：总结孔源性视网膜脱离外路显微手术关键技术的临床应用情况。

方法：孔源性视网膜脱离152例,手术显微镜下完成穿刺排液、冷凝、裂孔定位、硅胶垫压等关键技术。

结果：一次手术复位率89.5%,总复位率96.7%; 术后1mo,矫正视力>0.05者89.8%,>0.3者35.2%; 一次穿刺排液成功83.6%,硅胶垫压环扎后需再穿刺排液占13.1%; 显微镜下裂孔冷凝定位准确率82.9%,术中调整后准确率90.0%; 术中硅胶位置调整占6.6%,需再次手术调整占10.6%; 95.4%硅胶垫压后缘位于角膜缘后20mm以前,4.6%位于20mm以后。

结论：孔源性视网膜脱离外路显微手术可获得期望的临床效果,其关键技术应用简便、可靠,出现偏差时可适时调整; 视网膜可观察范围达角膜缘后20mm,大眼轴高度近视者可达角膜缘后20～24mm。     

Place of "exploratory vitrectomy" in the treatment of retinal detachment without proliferative vitreoretinopathy

INTRODUCTION: One of the principal causes that may contribute to failure in the treatment of retinal detachment without PVR is the inability to detect the retinal break before and during surgery. We propose in these cases the use of exploratory primary vitrectomy allowing the location and the treatment of the retinal break. MATERIAL AND METHODS: We have studied retrospectively 19 cases of retinal detachment without any preoperatively identified break. In 14 cases, it was a pseudophakic detachment (the IOL was in the posterior chamber with an optic between 5 and 6 mm), in 5 cases it was a phakic detachment. Peripheral fundus was examined with the vitrectomy probes with and without perfluorocarbon liquid injection. Cryotherapy or endophotocoagulations have been used to create a chorio-retinal adhesion and a gaz tamponade was used without scleral buckling procedure. RESULT: In 2 cases, no retinal break was found. In the other cases, the retinal tear has been identified during basal vitrectomy in 8 cases, during injection of perfluorocarbon in 2 cases and during the vitrectomy done forward the PFLC in 7 cases. The retinal break was identified as a small retinal tear along the posterior margin of the vitreous base in 15 cases (several in 2 cases) and as atrophic hole in 2 cases. DISCUSSION: Exploratory vitrectomy is an interesting technique to identify a retinal break when a scleral indentation cannot offer a good visualization of the anterior retina or retinal tears. In young phakic patients, a primary vitrectomy may be dangerous but seems to be justified in pseudophakic eyes. The research of the tear is sometimes facilitated by a peroperative tamponade of the retro equatorial retina.     

Lincoff temporary balloon buckle in retinal detachment surgery

PURPOSE: To assess the long-term anatomical and functional results of balloon buckle surgery for rhegmatogenous retinal detachment. PATIENTS AND METHODS: Twenty-five selected detachments with a single break or a group of breaks close together were treated with a temporary parabulbar balloon. Adhesion was obtained with transconjunctival cryopexy and argon laser photocoagulation. Retinal detachment was associated with the following risk factors: myopia (15 eyes), aphakia (2 eyes), blunt trauma (1 eye). Twenty-three eyes had a detached macula. The balloon was withdrawn after one week. The patients were kept under observation for at least six months (mean 44.7 months). RESULTS: Initial retinal attachment was achieved in 29 eyes. After the balloon was removed redetachment occurred in two eyes; thus, complete attachment was attained in 27 eyes. Causes of failure were: undetected break (2 eyes), inadequate buckle (4 eyes), proliferative vitreoretinopathy (2 eyes). Conventional scleral buckling and subretinal fluid drainage was done in all failed cases. Vitrectomy and silicone oil were employed in one patient, and finally retinal attachment was achieved in all patients. CONCLUSIONS: Temporary balloon buckling is a simple and curative technique for a selected group of patients with retinal detachments.     

Spontaneous reattachment of the retina despite proliferative vitreoretinopathy

In six cases of spontaneous retinal reattachment despite severe proliferative vitreoretinopathy, the retina was initially attached after a buckling procedure or vitreous surgery for proliferative vitreoretinopathy. However, each retina suddenly detached several weeks later. Surprisingly, the retinas settled slowly during the following weeks without further treatment. One case was marked by repeated episodes of detachment and reattachment. In none of the cases could an open retinal break be detected. In certain cases of proliferative vitreoretinopathy in which no open break is apparent and the detachment appears to be tractional, an observation period of several weeks may allow the retina to reattach spontaneously without further surgery.     

预防性玻璃体手术治疗急性视网膜坏死综合征

目的 报告一组Ⅰ～Ⅱ期急性视网膜坏死综合征患者经预防性玻璃体手术治疗的临床效果.方法 回顾性分析2006年2月至2008年7月20例(20只眼)Ⅰ～Ⅱ期急性视网膜坏死综合征患者接受预防性玻璃体手术治疗的临床资料.所有患者接受完全玻璃体切除联合激光光凝及硅油填充,术中用曲安奈德玻璃体腔注射以增加玻璃体可视性,术后常规面朝下体位,术前、术后均给予阿昔洛韦等药物治疗.随防10～12月.结果 20例20只眼中,硅油取出后,18只眼视网膜在位;2只眼出现视网膜脱离,其中1只眼再次行视网膜前膜剥除+硅油注入+激光光凝术,硅油取出后,视网膜在位;另1只眼因术前视网膜坏死广泛,视网膜动脉广泛闭塞,再次手术后,视网膜未能复位.术后视力提高13只眼、不变5只眼、下降2只眼.结论 预防性玻璃体切除联合激光光凝及硅油填充是治疗急性视网膜坏死综合征的有效方法,术后患者能改善或保持视力,减少视网膜脱离的发生率.     

双腔球囊顶压术与巩膜外垫压术治疗裂孔源性视网膜脱离的对比研究

目的对比观察自行研制的眼用双腔球囊顶压器在治疗裂孔源性视网膜脱离（RRD）中的疗效。方法选取RRD患者74例（74眼）,其中球囊手术组40眼,采用双腔球囊巩膜外顶压术;巩膜外垫压组34眼,采用常规节段性巩膜外垫压术。结果术后3个月,2组的视网膜解剖复位率、术后最佳矫正视力差异均无统计学意义（P〉0.05）。球囊手术组手术时间为（27±8.60）min,术后3个月的柱镜度数为（0.81±0.41）D,术前为（0.52±0.33）D,术前、术后比较差异无统计学意义（P〉0.05）;巩膜外垫压组手术时间为（47±14.30）min,术后3个月的柱镜度数为（1.83±0.69）D,术前为（0.65±0.32）D,术前、术后比较差异有统计学意义（P〈0.05）。结论双腔球囊巩膜外顶压治疗临床上单个或数个裂孔引起的视网膜脱离（C1级及以下）,精确、可靠、创伤小、并发症少。     

Postoperative laser coagulation as retinopexy in patients with rhegmatogenous retinal detachment treated with scleral buckling surgery: a prospective clinical study

PURPOSE: To evaluate postoperative laser photocoagulation as retinopexy mode in patients with rhegmatogenous retinal detachment treated with scleral buckling surgery. METHODS: The authors conducted a prospective feasibility study of consecutive patients with rhegmatogenous retinal detachment treated with scleral buckling surgery and postoperative laser during an 18-month period with a minimal follow-up of 6 months. Outcome measures were total retinal reattachment and the occurrence of proliferative vitreoretinopathy (PVR). RESULTS: A total of 123 patients (124 eyes) were included in this study. Seventy-six percent were phakic and 24% were pseudophakic. Fifty percent presented with one horseshoe tear, 15% with multiple tears, 30% with round breaks, and 5% with no identifiable break. Ten percent presented with a vitreous hemorrhage and 25% with three or four quadrants of detached retina. Six patients had PVR C1. Twelve patients required a postoperative gas injection, five patients received an additional buckle, and five patients underwent a vitrectomy, in four because of PVR. In all patients the retina was fully reattached at the end of follow-up. Planned postoperative laser coagulation took place 1 day to 10 weeks (median 3(1/2) weeks) after buckling surgery. Buckling material was removed in three patients without redetachment. CONCLUSION: Postoperative laser coagulation is a feasible alternative retinopexy mode in scleral buckling surgery, with encouraging anatomical results and a low incidence of PVR.     

最小量节段性外垫压手术治疗复杂原发性视网膜脱离76例临床分析

目的:分析最小量节段性外垫压手术治疗复杂原发性视网膜脱离的效果和手术并发症。方法:回顾性分析2006-10/2008-10在西安市第四医院眼科住院的、接受最小量节段性外垫压术治疗的连续的复杂原发性孔源性视网膜脱离76例。复杂原发性孔源性视网膜脱离限定为裂孔位于两个及两个以上象限,玻璃体视网膜病变分级在C1～C2。最小量节段性外垫压术是指仅限于裂孔区的节段性外垫压,联合前房穿刺放房水,术后裂孔周围激光凝固。分析其发病年龄、病程、手术前后视力、视网膜脱离范围、裂孔数目、裂孔形态、一次手术复位率、再次手术复位率、再次手术率及术后并发症,并行统计学处理。结果:患者发病年龄平均31.92(19～62)岁,平均病程为7.40(2.0～36.5)mo,视网膜脱离象限平均为3.33个,平均裂孔数量为3.43(2～7)个。手术后视力提高的患者为48例,一次手术复位率是84%(64/76);再次手术复位率是93%;再次手术率为38%。术后并发症包括:术后短期复视3例,短期高眼压12例,黄斑水肿2例,共17例。结论:和文献资料比较,以最小量手术治疗复杂原发性视网膜脱离可以取得与环扎手术同样的解剖及功能复位,但是再次手术率较高。强调手术适应证选择的重要性。     

双目间接检眼镜在巩膜扣带术中的应用

目的探讨双目间接检眼镜在巩膜扣带术中的应用价值及效果。方法116例(116眼)原发性(孔源性)视网膜脱离中共检出视网膜裂孔208个。其中合并黄斑部脱离81眼。PVR程度分级A级及B级106眼,C1级8眼,C2级2眼。所有病例均行巩膜扣带术,术中在双目间接检眼镜直视下定位裂孔,冷凝封闭裂孔。结果初次手术视网膜解剖复位110例,复位率94.83%。4例再次手术视网膜解剖复位。2例放弃治疗。最终,114眼视网膜解剖复位,复位率为98.28%。视网膜复位病例视功能不同程度改善。术中术后无严重并发症出现。结论双目间接检眼镜检查在原发性视网膜脱离术前、术后评价玻璃体视网膜及在巩膜扣带术中直视下定位裂孔,冷凝封闭裂孔具有独特优越性。     

巩膜扣带术治疗视网膜脱离合并视网膜囊肿

目的观察合并视网膜囊肿的视网膜脱离采用巩膜扣带术（sc leral buckling）治疗的效果。方法回顾分析采用巩膜扣带术治疗的合并视网膜囊肿的视网膜脱离21例（21眼）,总结其临床特点、手术方式、术后情况。结果21例术后视网膜均复位。13例视网膜囊肿在术后1周-9月（平均2.3月）吸收,8例未见视网膜囊肿明显吸收。术后视力提高者15例,其余视力无明显改变。结论合并视网膜囊肿的视网膜脱离,巩膜扣带术是有效的治疗手段,封闭裂孔,视网膜均可复位。术中视网膜囊肿不需要处理,术后大部分可吸收。