激光光凝辅助角膜原位磨镶术前眼底病变分析及治疗

目的探讨近视LASIK术前眼底病变及治疗方法.方法对385例(721只眼)LASIK术前患者行散瞳眼底三面镜检查并作详细眼底记录.结果发现各种视网膜变性136只眼(18.86%),视网膜干性裂孔16只眼(2.22%),亚临床视网膜脱离(RD)5只眼(0.69%).其中37只眼严重视网膜变性、16只眼干孔和4只眼亚临床RD行氩激光光凝治疗,仅1例亚临床RD需行视网膜脱离手术.结论近视LASIK术前及术后眼底常规检查和病变治疗是必要的.同时本文提出眼底病变光凝的指征.     

Photocoagulation to prevent retinal detachment in acute retinal necrosis

Retinal detachment (RD) occurs in more than 50% of eyes with acute retinal necrosis (ARN) and is the leading cause of visual loss in this syndrome. In order to decrease the incidence of RD in ARN, the authors treated 12 eyes of 10 patients with prophylactic laser photocoagulation. Retinal detachment occurred in two eyes (17%). Over the same time period, seven eyes with ARN did not receive prophylactic laser treatment, most often because of dense vitreous debris, with a 67% rate of RD. Prophylactic photocoagulation treatment should be considered in the management of patients with ARN.     

Arterial crimping in branch retinal vein occlusion with macular edema

PURPOSE: To evaluate the effects of arterial crimping plus grid pattern laser photocoagulation on the macular edema due to branch retinal vein occlusion. PATIENTS AND METHODS: Seventy two eyes (70 patients) with macular edema due to BRVO were divided into two similar groups according to age, gender, location and extent of the occluded area. Grid pattern laser photocoagulation alone was applied in 34 eyes (group A), whereas arterial crimping plus grid pattern laser was used in 38 eyes (group B). Visual acuity, central 30 degree perimetry, and fundus fluorescein angiography were carried out in all patients at each examination. Patients were followed up for an average of 23 mo (ranging from 11 to 34 mo). FINDINGS: A rate of 62% and 79% improvement in macular edema was recorded in groups A and B, respectively (p=0.057). The perimetric performance value improved more in group B than in group A (p=0.028). In addition, visual acuity improved more in group B than group A (p=0.041). CONCLUSION: In patients with BRVO, grid pattern retinal photocoagulation treatment plus arterial crimping resulted in better visual performance two years after treatment than did grid pattern photocoagulation alone.     

儿童牵牛花综合征并发视网膜脱离的临床特征及治疗效果观察

目的 观察儿童牵牛花综合征（MGS）并发视网膜脱离（RD）的临床特征和治疗效果。方法 回顾分析经双目间接检眼镜、眼部B型超声、广角数码视网膜成像系统眼底照相、头颅磁共振和（或）磁共振脑血管造影检查确诊的49例MGS并发RD患儿51只眼的资料。其中,男性27例27只眼,女性22例24只眼。确诊时年龄为出生后1周~13岁,平均年龄（4.2±3.2）岁。RD类型能明确为渗出性RD者33只眼,孔源性RD者3只眼,其余15只眼不能明确RD类型。有20例20只眼合并其他先天性眼部异常。包括永存原始玻璃体增生症、先天性小眼球、脉络膜缺损、虹膜缺损。除并发RD外,还可并发白内障、瞳孔后黏连、继发性青光眼、角膜混浊、斜视、眼球震颤。22例22只眼进行了治疗。5例5只轻度渗出性RD眼患儿予口服醋甲唑胺治疗;3例3只眼行视盘周围激光光凝治疗;14例14只眼行手术治疗。手术治疗的14只眼中,6只眼仅MGS并发RD,行玻璃体切割手术,其中3只眼联合晶状体切除手术;8只眼伴继发性青光眼和并发性白内障,行单纯晶状体切除手术或超声乳化白内障吸除手术。治疗后随访时间均在3个月以上,平均随访时间（20.3±11.8）个月。对比治疗前后患儿视力、视网膜复位情况以及有无眼压升高等并发症。结果 5例口服醋甲唑胺治疗者随访期间病情稳定,RD未加重。3例视盘周围激光光凝治疗者中,2例病情稳定,1例在2次激光光凝治疗后RD范围扩大。行晶状体切除或超声乳化白内障吸除手术的8只眼中,手术后白内障解除,前房形成、眼压下降。行玻璃体切割手术的6只眼中,手术后视网膜平伏。进行治疗的患儿中,10例10只眼配合行视力检查。其中,1只激光光凝治疗眼的视力由治疗前手动提高至治疗后眼前数指,9只眼视力维持不变。未见其他与药物和手术治疗相关的并发症。结论 儿童MGS并发RD最早可发生在出生后1周,患儿往往还合并其他先天性眼部异常或眼疾病。定期随访,尽早发现RD,结合患儿病情进行药物、激光光凝或手术治疗,对保存患儿视功能有重要意义。     

玻璃体腔注射雷珠单抗联合光凝治疗BRVO继发黄斑水肿

目的：观察玻璃体腔注射雷珠单抗联合视网膜激光光凝治疗视网膜分支静脉阻塞(BRVO)继发黄斑水肿的临床疗效。

方法：收集我院2013-08/2016-03收治的经散瞳眼底检查、眼底荧光血管造影(FFA)及光学相干断层扫描(OCT)检查确诊的BRVO继发黄斑水肿患者,随机分为2组,最终回访3mo时共47例47眼。观察组采用玻璃体注射雷珠单抗2wk后联合静脉回流区视网膜激光光凝治疗25例25眼,对照组采用单纯玻璃体注射雷珠单抗治疗22例22眼。比较两组患者治疗后1mo的最佳矫正视力(BCVA)、眼压(IOP)、黄斑中心视网膜厚度(CMT)以及并发症情况。

结果：两组治疗后1mo BCVA、CMT与治疗前比较,差异均有统计学意义(P<0.01),而IOP与治疗前比较无统计学意义(P>0.05); 治疗后1mo两组间BCVA、IOP比较差异均无统计学意义(P>0.05),而组间CMT比较差异有统计学意义(P<0.01)。

结论：玻璃体注射雷珠单抗联合阻塞静脉回流区视网膜光凝治疗BRVO的临床疗效明显优于单纯玻璃体注射雷珠单抗治疗,且激光治疗过程中不刺激黄斑,安全性较高。     

球后注射曲安奈德联合激光光凝治疗糖尿病弥漫性黄斑水肿的临床观察

目的观察球后注射曲安奈德(TA)联合激光光凝治疗糖尿病性弥漫性黄斑水肿的疗效。方法34例48眼经眼底检查、荧光素眼底血管造影(FFA)检查确诊的糖尿病性弥漫性黄斑水肿患者24眼球后注射TA联合激光光凝,24眼单纯激光光凝,随访6m,观察治疗前后患眼视力、眼底情况、眼压以及眼底荧光素血管造影的变化。结果联合组视力提高15眼(62.5%),视力不变5眼(20.8%),视力下降4眼(16.7%)。水肿减轻20眼(83.3%),水肿未退4眼(16.7%)。单纯光凝组视力提高5眼(20.8%),视力不变12眼(50%),视力下降7眼(29.2%)。水肿减轻9眼(37.5%),水肿未退15眼(62.5%)。结论光凝治疗糖尿病弥漫性黄斑水肿时联合球后注射曲安奈德球可促进水肿吸收和视力改善,且安全、方便。     

倍频固体激光治疗视网膜静脉阻塞疗效分析

目的探讨倍频固体激光治疗视网膜静脉阻塞的方法和疗效。方法应用倍频固体激光治疗视网膜静脉阻塞46例47眼,对其中10眼行全网膜光凝术,37眼行局域性视网膜光凝术,治疗次数1-4次,光凝后3m-6m随访,4眼复查后行补充光凝。对比分析治疗前后视力及眼底荧光血管造影(FFA)情况。结果激光治疗后视力提高(2行以上)者5眼(10.6%);视力无明显变化者29眼(61.7%);视力下降者13眼(27.7%)。荧光血管造影显示治疗有效42眼(89.4%),治疗无效5眼(10.6%)。结论激光治疗虽不能明确提高视力,但能促进水肿、出血、渗出的吸收,阻止病变的进一步发展,防止增殖性玻璃体视网膜病变和新生血管性青光眼的发生。     

Combined use of cryotherapy and diode laser photocoagulation for the treatment of threshold retinopathy of prematurity.

PURPOSE: Cryotherapy and indirect laser retinal photoablation are both effective in the treatment of retinopathy of prematurity (ROP). We describe the safety, efficiency, and effectiveness of combined cryotherapy and diode laser photocoagulation to treat threshold ROP. METHODS: Records of patients developing threshold ROP from January 1, 1996 through December 31, 1998, were retrospectively reviewed to identify those treated with combined cryotherapy and photocoagulation and followed up for at least 45 days postoperatively. Diode laser was used to ablate posterior avascular retina, and cryotherapy was used for anterior retina. Data reviewed included ocular and systemic complication rates, treatment duration, number of laser burns, most recent fundus examination, visual acuity, and refraction. RESULTS: In 13 patients, 23 eyes received combined treatment. No intraoperative complications occurred. Mean duration of anesthesia and treatment was 35 +/- 8 minutes/eye. A mean of 117 +/- 84 laser burns/eye were applied. In 20 of 23 eyes (87.0%), anatomic outcome was favorable at last examination. In 13 of 16 eyes (81.3%), functional (visual acuity) outcome was favorable (visual acuity better than 20/200) at 1 year. At 6 months or later, 14 of 16 eyes (87.5%) measured were myopic, of which 5 (31.3%) were highly myopic (> 6 diopters). CONCLUSIONS: The effectiveness of treating ROP with combined cryotherapy and diode laser photocoagulation compares with that of either modality alone. By decreasing the number of laser applications, combined therapy may be faster and technically easier for eyes with very posterior ROP. This may decrease the number of complications seen when either excessive cryotherapy or laser retinal photoablation is used.     

Retinal detachment after Excimer laser (myopic LASIK or PRK). A retrospective multicentric study: 15 cases

INTRODUCTION: Refractive surgery by LASIK or photorefractive keratectomy (PRK) generaly aims at a myopic population that has a high probability of developing rhegmatogenous retinal detachment (RD). The authors report a multicenter study with 15 cases of RD appearing after refractive surgery by Excimer laser and discuss the role played by the techniques used. MATERIAL AND METHODS: Five centers fitted with nine Excimer laser devices took part in this study. Of 22,700 eyes undergoing refractive myopic surgery during the period 1994-2002, 15 eyes developed rhegmatogenous RD. The average age of the patients with RD was 37 years. The average myopia was 13.5 D. RD occurred a mean of 20 months after refractive laser. RESULTS: Fifteen eyes of 13 patients developed a rhegmatogenous RD, two of which were bilateral. Eight of these cases had LASIK surgery and six had photorefractive keratectomy; one of the latter patients was retreated with LASIK because of substantial regression after PRK. RD was total or subtotal in five eyes, partial superior with a temporal tear in six eyes, and nasal in three eyes. One case with inferior RD, two cases with giant retinal tear and one case with posterior tear were also repaired. Fourteen eyes were suitable for operation. The retina was reattached in 12 cases. Mean postoperative visual acuity was 7/10. DISCUSSION: The occurrence of rhegmatogenous RD in the myopic population is estimated at 2.2%. It is estimated at 0.1% in the emmetropic population. The Excimer laser, through its thermic effects, shock wave, traumatism undergone by the suction ring at the time of LASIK surgery, could increase this risk in myopic patients. A review of the literature cast doubt on the cause and effect hypothesis. Personal and multicenter studies (including ours) show that the frequency rate of rhegmatogenous RD after Excimer laser is equivalent and even lower than that estimated with an emmetropic population. The low percentage of RD after Excimer surgery found in the literature as well as in our study (<0.1%) may be explained by patient selection, the systematic monitoring of the peripheral fundus, and the prophylactic treatment of degenerative lesions by photocoagulation. In RD surgery, the cornea must be manipulated carefully, a case of flap dehiscence has been reported in the literature. CONCLUSION: Refractive surgery by LASIK or PRK for severe myopia increases the risk of RD. Systematically monitoring the peripheral fundus and preventive photocoagulation have mitigated its occurrence, and the risk incurred in the myopic population has fallen to the emmetropic population's rate. Nevertheless, candidates for LASIK or PRK surgery must be informed because severe myopia constitutes a non-negligible risk factor.     

Combined treatment with laser photocoagulation and cryotherapy for threshold retinopathy of prematurity

PURPOSE: To report the structural, functional, and refractive outcome, safety, and effectiveness of combined cryotherapy and diode laser indirect photocoagulation in the treatment of threshold retinopathy of prematurity (ROP). METHODS: Medical records of patients developing threshold ROP between 1995 and 2003 were reviewed to identify those with combined treatment and followed up for at least 4 years postoperatively. A total of 94 patients (172 eyes) received combined treatment. Data consisted of grade of ROP pre- and postoperatively, most recent fundus examination, birthweight, visual acuity, complications, and refraction. Diode laser was used to ablate posterior avascular retina, and cryotherapy was used for anterior retina. RESULTS: A total of 149 (87%) eyes responded to combined treatment and they had favorable anatomic outcome at last examination. In 131 eyes (76%), functional outcome was favorable (visual acuity better than 20/200) at last examination. Perioperative complications included hemorrhages in 26% of eyes, which resorbed spontaneously. Mean duration of treatment was 31 minutes/eye. At final visit (4 to 12 years), 115 eyes (66.8%) refracted were myopic, of which 26 (22.5%) had high myopia over -6 diopters. CONCLUSIONS: Combined cryotherapy and diode laser photocoagulation for ROP in our patients resulted in regression of threshold ROP with relatively successful structural and functional outcomes. Combined therapy may be faster and useful for eyes with very posterior ROP. This may decrease the number of complications occurring when excessive cryotherapy or laser photoablation must be used in zone 1 ROP.     

曲安奈德联合577nm激光治疗黄斑囊样水肿临床研究

目的:评价球后注射曲安奈德(triamcinolone acetonide,TA)联合577nm激光黄斑区格栅样光凝治疗黄斑囊样水肿的治疗效果。方法:对58例66眼不同原因导致的黄斑囊样水肿患者,给予球后注射曲安奈德联合577nm激光黄斑部格栅样光凝治疗,观察所有病例激光后第1wk;1,3mo最佳矫正视力、黄斑厚度、眼底及眼压情况。结果:所有66眼中,光相干断层成像技术及眼底荧光造影检查示黄斑囊样水肿均部分或完全消退,54眼(82%)视力好转,12眼视力不变。结论:对于黄斑囊样水肿,球后注射曲安奈德联合577nm激光黄斑部格栅样光凝,治疗效果好,操作简单,并发症少。     

Capillary-free Vascularized Retina in Patients with Aggressive Posterior Retinopathy of Prematurity and Late Retinal Capillary Formation

Purpose

To report the clinical features, clinical course, and treatment outcomes after laser photocoagulation in infants with aggressive posterior retinopathy of prematurity (APROP) and capillary-free zones in vascularized retina.

Methods

Six patients (12 eyes) with APROP and capillary-free zones in vascularized retina were retrospectively reviewed. Twelve eyes of six infants were included and were treated with laser photocoagulation for avascular retina and for capillary-free zones in vascularized retina, except for the posterior pole, and fundus findings were photographically-documented in sequence. In addition, anatomic and visual outcomes were evaluated with complications of APROP.

Results

Among all of the consecutive infants with APROP, capillary-free zones in vascularized retina were demonstrated in 24% of the infants. All of the infants were >27 weeks of gestation age and had birth weights >1,000 g. After laser treatment, 7 eyes (58.3%) had favorable outcomes, and late capillary filling in capillary-free zones of vascularized retina were noted, however 4 eyes (33.3%) progressed to retinal detachment and 1 eye (8.3%) was complicated by a retinal fold-distorting posterior pole. The visual outcomes were associated with anatomic outcomes.

Conclusions

The anatomic outcomes in infants with APROP who had capillary-free zones were comparable to previously reported infants with APROP. The late capillary filling of capillary-free zones in vascularized retina was noted, and angiogenesis was considered to be involved. This process toward normal capillary formation or neovascularization in APROP, might determine its outcome.     

532nm倍频激光治疗高原血管性眼底病变的临床研究

目的：观察532nm倍频激光视网膜光凝(panretinal photocoagulation, PRP)治疗高原地区糖尿病视网膜病变(diabetic retinpathy, DR)及视网膜静脉阻塞(retinal vein occlusion,RVO)的临床疗效,评价氩激光治疗眼底血管病的安全性、有效性。

方法：选择DR患者122例227眼,其中增殖前期糖尿病性视网膜病变(preproliferative diabetic retinopathy, PPDR)51例90眼、增殖期糖尿病性视网膜病变(proliferative diabetic retinopathy,PDR)71例137眼; RVO患者120例124眼,其中中央静脉阻塞(central retinal vein occlusion,CRVO)27例27眼,分支静脉阻塞(branch retinal vein occlusion,BRVO)93例97眼,进行532nm底激光视网膜光凝治疗。每位患者在结束最后一次治疗后1,3,6mo复查眼底、视力、FFA检查。

结果：DR患者行视网膜光凝术后,PPDR有效81眼(90.0%)、无效9眼(10.0%); PDR有效98眼(71.5%),无效39眼(28.5%),总有效率78.9%; RVO患者行视网膜光凝术后, BRVO有效者90眼(92.8%),CRVO有效者22眼(81.5%)。532nm倍频激光治疗眼底血管性疾病的总有效率为82.9%。

结论：532nm倍频激光光凝治疗高原地区眼底血管性疾病是一种安全有效的治疗方法,糖尿病视网膜病变增殖前期激光治疗的有效率高于增殖期,治疗时机的合理选择可有效阻止DR的进展,防止失明的严重后果; 对RVO及时进行视网膜激光光凝的干预治疗,可以加速出血水肿吸收,防止新生血管的产生,降低并发症。     

A comparison of laser photocoagulation with cryotherapy for threshold retinopathy of prematurity at 10 years: part 1. Visual function and structural outcome

OBJECTIVE: To assess visual and structural outcomes after laser photocoagulation and transscleral cryotherapy for threshold retinopathy of prematurity (ROP) after 10 years. DESIGN: Extended follow-up of a randomized controlled clinical trial. PARTICIPANTS: One hundred eighteen eyes from 66 patients were randomly assigned to receive either cryotherapy or laser photocoagulation for threshold ROP. Forty-four eyes from 25 patients were examined for 10-year follow-up evaluations. INTERVENTION: Early Treatment of Diabetic Retinopathy Study (ETDRS) visual acuity, slit-lamp, and fundus examination; fundus photography; and B-scans (eyes with retinal detachments) were performed. Patients' histories were taken to elicit past amblyopia therapy. Based on fundus photographs, independent observers graded the degree of retinal dragging as none, mild, moderate, or severe. MAIN AND SECONDARY OUTCOME MEASURES: Best-corrected ETDRS visual acuity (BCVA). The degree of dragging was determined clinically and photographically. In addition, the presence of strabismus or amblyopia and/or any history of treatment for amblyopia were noted accordingly. RESULTS: Eyes treated with laser had a mean BCVA of 20/66 (Snellen equivalent), whereas cryotherapy-treated eyes had a mean BCVA of 20/182 (Snellen equivalent) (P = 0.015, n = 42). Compared with eyes treated with cryotherapy, eyes treated with laser photocoagulation were 5.2 times more likely to have a 20/50 or better BCVA (95% confidence interval, 1.37-19.8, n = 42). Eyes treated with cryotherapy were 7.2 times (95% confidence interval, 1.54-33.6, n = 33) more likely to develop retinal dragging compared with laser treatment. By linear regression analysis, ETDRS visual acuity was inversely proportionate to the degree of retinal dragging in both laser (r = -0.637, P = 0.006) and cryotherapy (r = -0.517, P = 0.040) treated eyes. Among the 21 patients with favorable outcomes in both eyes, 13 had strabismus (62%) and 6 had received amblyopia therapy (29%). Ptosis, loss of cilia, and cortical cataract were among probable treatment-related complications that were noted in this study. CONCLUSIONS: Overall, laser-treated eyes had better structural and functional outcome compared with eyes treated with cryotherapy.     

激光光凝治疗糖尿病视网膜病变疗效观察

目的探讨激光光凝治疗糖尿病视网膜病变（DR）的治疗效果。方法 89例（178只眼）DR患者行激光光凝治疗后,定期观察视力,进行眼底及荧光素眼底血管造影（FFA）检查,记录眼底新生血管、视网膜出血渗出、玻璃体积血等情况,观察4个月至2年。结果激光治疗1个月后视力提高≥2行69只眼（38.7%）,无变化63只眼（35.3%）,视力下降≥2行35只眼（26%）。视网膜及视盘新生血管消退170只眼（95.5%）。8只眼（4.5%）发生玻璃体积血,行玻璃体切割术,术中璃体腔曲安奈德注射,补充激光治疗。结论激光光凝是治疗DR的有效方法 。     

激光治疗视网膜静脉阻塞疗效分析

目的 评价激光在治疗视网膜静脉阻塞中的作用和疗效。方法 使用美国HGM M－5氩氪激光机、日本Nidek GYC-2000倍频532激光机及法国光太（BIV）VIRIDIS－LIET 532激光机对112例视网膜中央或分支静脉阻塞的患者进行光凝治疗。随访6－18个月，对比分析光凝前后视力、眼底及眼底荧光血管造影（FFA）结果的变化情况。结果 36眼缺血型视网膜中央静脉阻塞中22眼有效，占61．11％；6眼好转，占16．67％；8眼因玻璃体出血、继发青光眼或并发白内障失明而无效，占22．22％；76眼视网膜分支静脉阻塞中59眼有效，占77．63％；13眼好转，占17．11％；4眼无效，占5．26％，总有效率达72．32％。视力提高的84眼，占75％。结论 激光光凝术对治疗视网膜静脉阻塞有显著疗效。     

Juxtapapillary capillary hemangiomas. Clinical features and visual acuity outcomes

OBJECTIVE: To describe the clinical features, association with von Hippel-Lindau (VHL) disease and visual acuity outcomes of patients with a juxtapapillary capillary hemangioma. DESIGN: Retrospective observational case series. PARTICIPANTS: Seventy-two eyes of 68 patients identified with a juxtapapillary capillary hemangioma. Follow-up data of at least 6 months duration were available for 60 eyes. METHODS: A retrospective chart review of patients diagnosed with a juxtapapillary capillary hemangioma examined at four medical centers. MAIN OUTCOME MEASURES: Age at diagnosis, visual acuity (VA) at first examination and at last follow-up, tumor growth pattern and location, associated clinical features, type of treatment, association with VHL, and presence of peripheral hemangiomas were recorded for each patient. RESULTS: On initial examination, VA was >/=20/40 in 43 of 70 eyes (61%) and was >/=20/200 in 60 eyes (86%). At an average follow-up of 5.4 years (range, 0.5-19 years), VA of >/=20/40 was achieved in 21 eyes (35%) and >/=20/200 in 33 eyes (55%). Patients with VHL had poorer initial VA (48% vs. 70% with VA >/=20/40, and 74% vs. 93% with VA >/=20/200) and final VA (26% vs. 41% with VA >/=20/40, and 39% vs. 65% with VA >/=20/200) compared with patients without VHL. Patients with VHL more commonly were seen at an earlier age (average, 20 vs. 44 years, P: < 0.001), with bilateral (17% vs. 0%), and/or peripheral (39% vs. 0%) (P: < 0.001) tumors that more often had an endophytic growth pattern (63% vs. 22%, P: = 0.001) compared with patients without VHL. Patients selected for laser treatment generally had poorer initial (52% vs. 74% with VA >/=20/40, 79% vs. 96% with VA >/=20/200) and final VAs (18% vs. 56% with VA >/=20/40, 45% vs. 67% with VA >/=20/200) compared with patients not treated with laser. CONCLUSIONS: On long-term follow-up of patients with a juxtapapillary capillary hemangioma, the VA generally worsens. Patients with VHL and a juxtapapillary hemangioma more often present at a younger age, have tumors with an endophytic growth pattern, and have bilateral, multiple tumors. Treatment with laser photocoagulation results in variable VA outcomes.     

玻璃体切除联合视网膜光凝治疗增生性糖尿病视网膜病变

目的：评价玻璃体切除联合视网膜光凝治疗增生性糖尿病视网膜病变（ proliferative diabetic retinopathy, PDR）的临床效果。 方法：回顾性分析了2009-07/2012-11在我院行玻璃体切除,术后行眼底血管荧光造影后,4 wk内给予视网膜光凝的PDR患者72例104眼,出院后随访12 mo以上,统计分析术前、术后及最终矫正视力、手术并发症等临床资料。 结果：视网膜光凝（最后一次视网膜光凝）后1 wk内视力提高有效率88.5%（92/104）,1mo 视力提高有效率92.3%（96/104）,3mo视力提高有效率90.4%（94/104）,其中1眼发生新生血管青光眼,6 mo 视力提高有效率88.5%（92/104）,其中1眼发生视网膜脱离,12mo视力提高有效率80.8%（84/104）,并出现2眼硅油乳化,随着糖尿病眼底病变发展,视力提高率下降,硅油眼手术并发症增多,尤其吁期及遇期患眼。 结论：玻璃体切除造影后联合视网膜光凝治疗PDR是安全有效的,玻璃体切除术后进行造影可以有的放矢的进行视网膜光凝,既能减少过度光凝,又能防止光凝不足。可以有效提高患者视力,降低并发症。     

倍频Nd∶YAG激光治疗视网膜静脉阻塞的临床疗效分析

目的:探讨倍频532nmNd∶YAG激光治疗视网膜静脉阻塞的方法及疗效。方法:回顾性分析我院近年应用倍频Nd∶YAG激光仪治疗视网膜静脉阻塞病例42例,根据其分型及眼底血管荧光造影改变,采用不同的光凝方法进行治疗,并分析其疗效。结果:42例视网膜静脉阻塞病例视力提高者(2行以上)4眼(10%);视力无明显变化者30眼(71%);视力下降者(2行以上)8眼(19%);眼底荧光血管造影(fundusfluoresceinangiography,FFA)检查显示视网膜出血吸收、黄斑水肿消退,治疗有效者38眼(90%)。结论:尽管对非缺血型和缺血型视网膜静脉阻塞的治疗目的和方法有所不同,倍频Nd∶YAG激光能有效地缩短病程,促进视网膜出血吸收和视力恢复,预防和减少并发症的发生。     

Phacoemulsification without intraocular lens implantation in patients with high myopia: long-term results

PURPOSE: To estimate the cumulative incidence of postoperative retinal detachment (RD), rhegmatogenous retinal lesions requiring argon laser treatments, anterior (ACO) and posterior (PCO) capsule opacification, and neodymium:YAG (Nd:YAG) laser capsulotomy in patients with high myopia who had phacoemulsification without intraocular lens (IOL) implantation. SETTING: Department of Ophthalmology and Neurosurgery, University of Siena, Siena, Italy. METHODS: Seventy-three eyes of 57 patients with high myopia who had phacoemulsification without IOL implantation from 1993 to 1996 were retrospectively reviewed. The mean postoperative follow-up was 62.3 months and the mean axial length, 30.22 mm (range 29.10 to 33.70 mm). The incidence of RD and preoperative and postoperative prophylactic argon laser photocoagulation for rhegmatogenous retinal lesions were assessed. Between 1997 and 2000, ACO was evaluated subjectively and PCO was evaluated using the EPCO photographic image-analysis system. The incidence of Nd:YAG laser capsulotomy was noted. RESULTS: Argon laser photocoagulation was performed in 8 eyes (10.9%) preoperatively and 3 eyes (4.1%) postoperatively. One RD (1.3%) was observed 26 months after surgery; no preoperative or postoperative prophylactic argon laser photocoagulation or Nd:YAG laser capsulotomy was performed in this eye. At 1 year, 49 eyes (67.1%) had mild ACO and 24 (32.8%) had anterior capsule fibrosis. The data did not change during subsequent follow-up visits. At 6 years, the mean PCO grade was 1.109 (range 0.972 to 2.931); an Nd:YAG laser capsulotomy was performed in 12 eyes (16.4%). CONCLUSIONS: Compared with other studies that evaluated the outcomes of highly myopic patients who had cataract surgery with posterior chamber IOL implantation, our patients, who did not have IOL implantation, had a lower incidence of postoperative rhegmatogenous retinal lesions requiring argon laser treatments and a similar incidence of postoperative RD and visually significant PCO.