25G辅助巩膜外加压术治疗硅油眼视网膜脱离的疗效观察

目的：观察25G辅助巩膜外加压术治疗硅油眼视网膜脱离的疗效。

方法：回顾性分析硅油填充术后出现视网膜脱离的患者15例15眼行25G辅助直视下巩膜外加压术后3～6mo患者的视网膜复位、最佳矫正视力(best corrected visual acuity,BCVA)及眼压情况。

结果：术前患者15 例15眼均存在3：00～9：00位范围内的视网膜脱离; 术后视网膜解剖复位13例13眼,未复位2 例2眼。术后1mo最佳矫正视力提高1行以上者11例11眼,视力变化1行以内者3例3眼,视力下降1行以上者1例1眼。术后早期部分患者存在眼压升高现象,药物控制后可恢复正常。

结论：25G辅助直视下巩膜外加压术治疗硅油眼视网膜脱离疗效确切。     

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。     

单纯孔源性视网膜脱离行微创巩膜外加压术后影响复位和视力的因素分析

目的：探讨单纯孔源性视网膜脱离(RRD)行微创巩膜外加压术后影响复位和视力恢复的相关因素。

方法：收集2014-12/2017-10于我院就诊的初发RRD患者296例296眼作为研究对象,所有患者行微创巩膜外加压术,观察术后视网膜复位率以及BCVA,并对可能影响视网膜复位和视力恢复的因素进行分析。

结果：首次行微创巩膜外加压术后复位成功272眼(91.9%)。围术期影响视网膜复位的因素有裂孔数、视网膜脱离范围以及C1级PVR。随访6mo时,BCVA≥0.4者 196眼(66.2%),BCVA<0.4者 100眼(33.8%)。病程长短、术前BCVA、视网膜脱离范围、黄斑累及与否是影响术后BCVA的危险因素(均P<0.05),术前BCVA是影响术后BCVA恢复的独立危险因素(P<0.05)。

结论：微创巩膜外加压术治疗RRD疗效确切,术后复位率较高,对于RRD患者需早发现早治疗。     

玻璃体切割联合下方巩膜外垫压治疗特殊视网膜脱离

目的：评估玻璃体切割联合下方巩膜外垫压治疗一类特殊视网膜脱离的效果。

方法：对具有以下特点：(1)病程大于6mo;(2)裂孔位于5：00～7：00的视网膜周边部或者在多发视网膜裂孔中有开放裂孔位于5：00～7：00的视网膜周边部;(3)视网膜脱离范围超过270度、并且伴有脱离区视网膜条索样增殖的19眼特殊类型视网膜脱离,采取玻璃体切割联合下方巩膜外垫压治疗,观察视网膜解剖复位和视功能恢复情况。

结果：视网膜解剖复位19眼; 最佳矫正视力均有不同程度提高,其中0.01～0.1有5眼; 0.12～0.3有9眼; ≥0.4有5眼。

结论：玻璃体切割联合下方巩膜外垫压是治疗病程大于6mo、视网膜裂孔位于5：00～7：00的视网膜周边部或者在多发视网膜裂孔中有开放裂孔位于5：00～7：00的视网膜周边部、视网膜脱离范围超过270度、并且伴有脱离区视网膜条索样增殖这类特殊视网膜脱离的有效方法。     

裂孔源性视网膜脱离的最小量巩膜外加压手术

目的探讨裂孔源性（原发性）视网膜脱离巩膜外加压手术的最小量手术方式及其效果。方法裂孔源性视网膜脱离26例（26眼），在手术显微镜下行球结膜环形剪开、四直肌预置牵引线，在间接检眼镜下行视网膜裂孔精确定位及中度冷凝，手术显微镜下行巩膜外放液及巩膜缝线固定外加压块，所有外加压均采用修剪后的小硅胶海绵块，只固定巩膜褥式缝线1对。多发性裂孔于每个裂孔处分别于巩膜表面以1对褥式缝线固定硅胶海绵。所有手术眼均未行环扎术。手术后随访3～9月。结果所有患者手术过程顺利，无术中并发症，手术损伤小；手术后眼底检查外加压精确地顶压裂孔，视网膜完全复位25眼，1眼高度近视于手术后2周视网膜脱离复发经玻璃体手术后视网膜复位；手术后视力提高者21眼，不变4眼，下降1眼。结论最小量的外加压手术的优点是精确、可靠、创伤小，能避免传统巩膜扣带手术的一些并发症，手术成功率高。     

裂孔源性视网膜脱离的最小量巩膜外加压手术

目的探讨原发性裂孔源性视网膜脱离巩膜外加压手术的最小量手术方式及其效果。方法裂孔源性视网膜脱离22例(22眼),在直视下行球结膜环形剪开、四直肌预置牵引线,在间接检眼镜下行视网膜裂孔精确定位及中度冷凝,巩膜缝线固定外加压块,所有外加压均采用修剪后的小硅胶海绵块,只固定巩膜褥式缝线1对。多发性裂孔于每个裂孔处分别于巩膜表面以1对褥式缝线固定硅胶海绵。所有手术眼均未行环扎术。手术后随访3～6月。结果所有患者手术过程顺利,无一例术中并发症,手术损伤小;手术后眼底检查外加压精确地顶压裂孔,视网膜完全复位20眼,2眼高度近视于手术后2周视网膜脱离复发经玻璃体手术后视网膜复位;手术后视力提高者18眼,不变2眼,下降2眼。结论最小量的外加压手术的优点是精确、可靠、创伤小,能避免传统巩膜扣带手术的一些并发症,手术成功率高。     

改良结膜切口行巩膜外垫压手术的临床观察

目的:探讨改良结膜切口行巩膜外垫压手术治疗视网膜脱离的可行性及效果。方法:2007-08/2008-04对30例30眼经术前仔细检查确定适合行单纯巩膜外垫压手术的孔源性视网膜脱离患者,术中先根据术前检查的裂孔位置,经结膜缝线预置裂孔所在象限的相邻两直肌牵引线,再行结膜外裂孔定位,根据裂孔位置行结膜切口,根据裂孔的形态、大小及方向,平行或垂直于角膜缘剪开该处球结膜及筋膜,充分暴露裂孔相对应的巩膜,再次巩膜外裂孔定位、标记,巩膜缝线硅海绵外加压块,检查眼底确保正确的孔嵴关系,连续缝合球结膜。术中对裂孔未作凝固处理,术后裂孔周围行激光光凝。手术后随访2～8mo。结果:所有患者手术过程顺利,结膜切口缝合后均呈直线状,长约1.0～1.8cm,切口最前端距离角膜缘0.8～1.4cm。手术后随访2～8mo,所有患者均未见发生垫压带暴露的情况。视网膜完全复位27眼,1眼手术后视网膜脱离未复位经二次外加压块调位术后视网膜复位,2眼术后复发,1眼经玻璃体手术后视网膜复位,1眼行巩膜外环扎外垫压而均获视网膜复位;手术后视力提高23眼,不变5眼,下降2眼。结论:改良结膜切口行巩膜外垫压手术治疗视网膜脱离不仅符合最小量手术原则,而且初步体现了尽量避免损伤角膜缘干细胞的切口设计思想,手术创伤小,术后视网膜复位率与以往常规结膜切口手术相同,是一种在临床上值得应用的手术方法。     

改良硅油取出联合巩膜扣带术治疗硅油填充术后视网膜脱离

目的：探讨改良硅油取出联合巩膜扣带术治疗硅油填充状态下视网膜脱离的效果。

方法：回顾性研究。选取2021-01/2023-02于我院治疗的硅油填充状态下视网膜脱离的患者14例14眼,采用改良硅油取出联合巩膜扣带术进行治疗。硅油取出方法采用自制的23 G抽吸器,即将一次性输血器的针管取出,靠近乳头端剪至2.5-3.0 mm,另一端连接已去除推注手柄的10 mL注射器,注射器另一端连接玻璃体切割器的负压系统,进行硅油取出; 巩膜扣带术中外加压块采用外加压复合体; 术后未重新注入硅油。随访6 mo,观察术后视网膜复位、最佳矫正视力(BCVA)、眼压和并发症等情况。

结果：术后6 mo,视网膜完全复位13眼,视网膜复位率达93%,BCVA(LogMAR)较术前改善(0.95±0.18 vs 1.15±0.21,P=0.002)。术后1 d出现一过性高眼压6眼,药物控制后恢复正常。术中未见视网膜出血、嵌顿、医源性裂孔等并发症,术后未出现眼内炎、脉络膜脱离等并发症。

结论：改良硅油取出联合巩膜扣带术可以有效治疗硅油填充状态下视网膜脱离,促使视网膜再复位。     

改良穿刺放液在23G玻璃体切除治疗脉络膜脱离型视网膜脱离中的疗效

目的：观察巩膜全层切开、原位穿刺放液术在微创玻璃体切除术治疗脉络膜脱离型视网膜脱离中的安全性和临床疗效。

方法：临床病例回顾性分析。纳入2015-04/2017-04江苏省人民医院眼科住院治疗的脉络膜脱离型视网膜脱离患者20例20眼,所有患者均接受改良巩膜穿刺放液联合23G微创玻璃体切割术治疗。观察术中穿刺放液的成功率,手术前后视力、眼压变化情况,以及手术后视网膜复位率等情况。

结果：所有手术均一次顺利放出脉络膜上腔液体。患者术后视力较术前视力提高,差异有统计学意义(P<0.01)。术前眼压7.00±2.05mmHg,术后3mo时平均眼压为15.38±2.66mmHg,两者比较差异有统计学意义(P<0.01)。初次手术视网膜复位率为90%(18/20),最终视网膜复位率为95%(19/20)。

结论：改良巩膜穿刺放液在微创玻璃体切割术治疗脉络膜脱离型孔源性视网膜脱离中可简化手术操作,降低手术难度,减少术中并发症的发生。     

间接眼底镜联合显微镜下行巩膜扣带手术

目的探讨间接眼底镜联合显微镜行巩膜扣带手术的可行性及效果。方法自2005年1月～2005年6月间对40例40眼裂孔源性视网膜脱离患者，在显微镜下行球结膜环形剪开、四直肌预置牵引线、巩膜外放液、巩膜缝线固定硅胶（或硅海绵）外加压块及环扎条带及缝合球结膜，在间接眼底镜下行视网膜裂孔定位及冷凝。手术后随访6m～12m。结果所有患者手术过程顺利，无手术中并发症；手术后视网膜完全复位38眼，1眼经补充光凝后视网膜复位，1眼手术后视网膜脱离复发经玻璃体手术后视网膜复位；手术后视力提高33眼，不变6眼，下降1眼。结论间接眼底镜联合显微镜操作巩膜扣带术，精确、可靠、创伤小、手术效果好，病人满意度高。     

Pars plana vitrectomy without scleral buckle for pseudophakic retinal detachments

ObjectiveTo report the anatomic and visual results of primary pars plana vitrectomy (PPV) without scleral buckling to repair primary rhegmatogenous retinal detachments in pseudophakic eyes.DesignNonrandomized, prospective, comparative clinical trial.ParticipantsTwo hundred eighty-three consecutive patients (294 eyes) with pseudophakia, peripheral retinal tears, and new rhegmatogenous retinal detachments were treated according to the surgery protocol.InterventionPatients underwent PPV with fluid-gas exchange and endolaser to repair the retinal detachment. Two hundred sixty-four patients (275 eyes) were followed from 6 months to 6 years and 8 months with an average follow-up of 19 months.Main outcome measuresReattachment of the retina and visual outcome were compared to previously published studies.ResultsOf 97 eyes with a macula-attached rhegmatogenous retinal detachment, 88 eyes (91%) were reattached with a single operation, and of the 178 eyes with a macula-detached retinal detachment, 153 (86%) eyes were reattached with a single operation. In 241 (88%) of 275 eyes, the retina was reattached with a single operation, and in 265 (96%) of 275 eyes, the retina was ultimately reattached with subsequent operations. The median initial visual acuity was 20/300, and the median final visual acuity was 20/40. The rate of reattachment with one operation was similar for eyes with an anterior chamber intraocular lens (91%) and for eyes with a posterior chamber intraocular lens (88%). Refractive error measurements obtained in 81 eyes were essentially unchanged. The mean change in refractive error was −0.15 diopter. Seventeen eyes (6%) developed macular puckers requiring surgery, 46 eyes (17%) developed cystoid macular edema, and 6 eyes (2%) developed full-thickness macular holes.ConclusionPrimary PPV with fluid-gas exchange and laser is a safe, effective method to repair primary pseudophakic retinal detachments. The anatomic reattachment rate and the visual acuity obtained with this technique appear to be at least as good as those reported in the literature for scleral buckling, PPV with scleral buckling, and pneumatic retinopexy.     

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.     

裂孔源性视网膜脱离显微外路手术临床观察

目的 观察手术显微镜直视下经外路手术治疗裂孔源性视网膜脱离的疗效.方法 在手术显微镜直视下,8眼PVR分级A级和9眼B级实行了裂孔定位、冷凝和外加压术,9眼C1级行裂孔冷凝、外加压和环扎术,共36例36眼.术后随访6个月,观察手术疗效.结果 一次手术视网膜复位34眼(94.4％),二次手术视网膜复位35眼(97.2％),1眼失败改行玻璃体视网膜手术.无明显手术并发症发生.结论 手术显微镜直视下治疗简单性裂孔源性视网膜脱离立体感好、疗效可靠.     

人工晶状体眼视网膜脱离临床分析

目的 分析人工晶状体眼视网膜脱离的临床特点及手术疗效。方法 对21例(22只眼)人工晶状体植入术后视网膜脱离病例进行回顾性分析。结果 术前发现视网膜裂孔l3例，术中发现7例。2例未发现裂孔。马蹄孔13例，圆孔7例。单个裂孔7例，两个或两个以上裂孔13例。其中行巩膜扣带术12例，玻璃体切除联合扣带术10例。视网膜复位16例，未复位6例。结论 人工晶状体眼视网膜脱离术前检查裂孔困难，且裂孔常为多发，但选择适当的手术方式仍可取得较好的疗效。     

巩膜外局部加压术与巩膜环扎手术治疗孔源性视网膜脱离的疗效比较

目的比较巩膜外局部加压术与巩膜环扎手术治疗孔源性视网膜脱离的疗效。方法将30眼孔源性视网膜脱离病人随机分A,B两组,A组16眼,采用巩膜外局部加压术;B组14眼采用巩膜环扎手术,术后随访半年至一年,观其视网膜复位和视功能的恢复程度。结果 A组13眼视网膜复位顺利,一次手术成功率为81.25%;术后视力提高13眼,不变2眼,下降1眼,出现并发症8眼。B组11眼视网膜一次手术复位,一次手术成功率为78.57%;术后视力提高9眼,不变2眼,下降3眼,出现并发症9眼。两组一次手术成功率、术后视力提高情况、并发症发生率比较.差异无显著性（P〉0.05）。结论巩膜外局部加压术手术治疗RRD是经济,操作简单,并发症较少的理想的手术方法。     

Anatomic and visual results in asymptomatic clinical rhegmatogenous retinal detachment repaired by scleral buckling

PURPOSE: To report presenting characteristics as well as anatomic and visual results in asymptomatic clinical rhegmatogenous retinal detachment repaired by scleral buckling. METHODS: Review of 28 eyes of 27 patients with an asymptomatic clinical retinal detachment-defined as a rhegmatogenous retinal detachment with subretinal fluid extending more than 2 disk diameters posterior to the equator-which were repaired by scleral buckling from January 1989 through December 1996 with follow-up of 6 months or longer. RESULTS: With a single scleral buckling procedure, anatomic reattachment of the retina occurred in all eyes; one eye redetached 14 months after the initial surgery secondary to a new retinal break and was successfully reattached. All eyes had best-corrected presenting and final visual acuity of 20/50 or better. Final best-corrected Snellen visual acuity was within 1 line of best-corrected presenting visual acuity in 82% of eyes; three eyes improved more than 1 line of Snellen visual acuity and two eyes lost more than 1 line. CONCLUSION: Anatomic and visual results in asymptomatic clinical rhegmatogenous retinal detachment after scleral buckling surgery are excellent. Strong consideration should be given to repair of these detachments.     

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。     

不放液的巩膜外垫压治疗孔源性视网膜脱离的疗效

目的:探讨不放液的巩膜外垫压治疗孔源性视网膜脱离的临床疗效.方法:回顾性分析2012-01/2017-01我院收治的孔源性视网膜脱离患者111例113眼,所有纳入研究的病例均采用双目间接检眼镜下视网膜裂孔定位、巩膜外冷凝、巩膜外垫压的手术方法.术中98眼单纯巩膜外垫压,15眼术后玻璃体腔注射消毒空气,所有病例均行变性区及裂孔处巩膜外冷凝,结扎缝线前行前房穿刺放液.术后观察最终视网膜复位率、术后最佳矫正视力、眼压、并发症情况.结果:术后随访6 mo.视网膜最终复位率97.4%;术后视力提高91眼(80.5%).术后高眼压均能控制.术中发生并发症共7眼,术后并发症3眼.结论:不放液的巩膜外垫压术治疗孔源性视网膜脱离的并发症少,疗效肯定.