玻璃体切除手术后对人工晶状体度数计算的影响

目的:评估玻璃体切除手术对人工晶状体计算的影响。方法:通过测量玻璃体切除手术术前、术后角膜曲率、眼轴长等指标测算预装晶状体残留屈光度,并与术后3mo验光实测等值球镜屈光度的偏差比较验证。结果:患者玻璃体切除手术术前后角膜曲率、眼轴长无明显差异。玻璃体切除手术术前、术后预测残留屈光度和术后3mo验光实测残留屈光度分别为-0.21±0.09D,-0.36±0.08D和-0.42±0.14D,P>0.05,差异不显著。结论:玻璃体切除手术不影响对人工晶状体精确测定。     

玻璃体切除联合眼内异物摘出手术的疗效观察

目的评价玻璃体切除联合眼内异物摘出手术的疗效。方法分析眼后段异物32例34眼经玻璃体切除摘出异物手术的临床资料,对术前术后的视力及并发症情况进行统计。结果玻璃体切除联合眼内异物摘出术,异物摘出成功率100%,术后视力较术前明显提高,并发症发生率低。结论玻璃体切除术是治疗眼内异物有效的方法。     

玻璃体切除术后白内障患者的手术方式选择

玻璃体切除手术会加速白内障的发生与发展,白内障手术在玻璃体切除术后患者比在未行玻璃体切除的眼中具有更高的风险和并发症,其手术方式的选择以及术中的操作对于眼科医生具有一定挑战。相比于无灌注下的玻璃体切除术后白内障手术,25G灌注下行白内障超声乳化术对于维持眼压,稳定前房,减少术中及术后并发症效果良好,是目前玻璃体切除术后白内障患者的首选手术方式。     

曲安奈德辅助玻璃体切除取出眼内异物的疗效观察

目的观察和分析曲安奈德辅助玻璃体切除取出眼内异物的临床疗效。方法选择伴有视网膜损伤且行玻璃体手术的眼内异物伤患者23例(23只眼),玻璃体切除手术中辅助应用曲安奈德染色玻璃体。结合高负压人工玻璃体后脱离法,尽可能切除全玻璃体,同时处理损伤的视网膜,必要时眼内填充C3F8或硅油。结果所有患者异物均一次性取出,15例成功实施玻璃体后脱离,术后视网膜脱离3例。结论玻璃体切除治疗眼内异物伤,术中辅助应用曲安奈德染色,有利于充分切除玻璃体,降低术后视网膜脱离的发生率。     

曲安奈德染色法在玻璃体切除手术中的应用

目的探讨曲安奈德（TA）染色法在玻璃体切除手术中协助辨别和清除残留玻璃体皮质和视网膜前膜的作用及效果。方法选取2008年6月至2010年5月,对我院85例（88只眼）玻璃体视网膜疾病行TA染色法玻璃体切除手术,切除中轴部玻璃体后,注入TA悬浊液染色玻璃体皮质和增生膜,切除残留的玻璃体皮质和视网膜前膜。术后随访时重点观察患者视力、眼压、白内障形成、玻璃体残留及视网膜复位情况。结果 85例（88只眼）术中注入TA后,残留的玻璃体皮质及视网膜前膜均能清晰地显示,容易辨认切除残留的玻璃体皮质和视网膜前膜位置和范围。术后随访观察6～12个月,81只眼（92.05%）视力有不同程度的提高,与手术前相比差异具有统计学意义（P〈0.05）。术前40只眼视网膜脱离术后38只眼（95%）视网膜完全复位,术后未发现与TA相关的严重并发症。结论玻璃体切除手术中,应用TA染色玻璃体,可以清晰地显示残留的玻璃体皮质和视网膜前膜,有助于彻底切除玻璃体皮质和视网膜前膜,提高了手术的安全性和准确性。     

眼科机器人技术

医疗机器人手术系统在眼科主要应用于角膜移植术、玻璃体切除术、视网膜手术等。在角膜移植术中，可完成角膜钻切和缝合两大步骤；在玻璃体视网膜手术中可用于视网膜裂孔激光光凝术、玻璃体切除和玻璃体后脱离手术、视网膜表面异物取出术和视网膜血管插管术等。近年机器人系统在辅助白内障手术方面又有所突破。（国际眼科纵览， 2018,  42:   213-216）     

玻璃体切除联合透明角膜切口超声乳化白内障吸除术

白内障合并玻璃体视网膜疾病的患者在临床并不少见。传统的治疗方法是分期进行手术。随着玻璃体切除术和超声乳化白内障吸除术的普及和提高 ,国外文献报道玻璃体切除联合超声乳化白内障吸除术治疗白内障合并玻璃体视网膜疾病患者的效果良好[1] 。为探讨该手术的可行性和安全性 ,我们对 2 6例白内障合并玻璃体视网膜疾病患者行玻璃体切除联合透明角膜切口超声乳化白内障吸除术 ,观察手术疗效和并发症的发生情况 ,现将结果报告如下。一、资料和方法1.一般资料 :收集 1996年 8月至 2 0 0 0年 2月在我院行玻璃体切除联合透明角膜切口超声乳化白…     

视网膜静脉阻塞玻璃体积血的手术治疗

目的 分析2型糖尿病患者（T2DM）玻璃体积血合并视网膜分支静脉阻塞（BRVO）玻璃体切除手术的效果.方法 回顾分析因玻璃体积血在我院接受玻璃体切除手术治疗的T2DM 228例（289只眼）的临床资料.根据术中观察,其中16例（17只眼）的玻璃体积血由BRVO引起.玻璃体切除手术前视力手动～0.04.随访时间9～60个月,平均（32.80±16.70）月.结果 T2DM玻璃体积血合并BRVO的发生率为5.9％;玻璃体切除手术后视力0.01～1.0,颞上分支静脉阻塞者术后视力较差;手术时机≥6个月者易发生牵引性视网膜脱离,且术后视力较差.结论 颞上分支静脉阻塞、手术迟于6个月者术后视力较差.     

玻璃体切割仪行晶状体切除联合前段玻璃体切割术治疗婴儿先天性白内障

目的 观察应用玻璃体切割仪行晶状体切除联合前段玻璃体切割术治疗婴儿先天性白内障的疗效.方法 对23例(43只眼)1岁以内先天性白内障患儿施行玻璃体切割仪行晶状体切除并前段玻璃体切割术,随访观察术后眼部情况.结果 采用该手术方式治疗婴儿先天性白内障,术后患儿眼部反应轻微,无纤维素性渗出,并发症少,减轻了术后护理的难度.结论 玻璃体切割仪行晶状体切除联合前段玻璃体切割术治疗婴儿先天性白内障,手术操作简单,术后视觉通路保持良好,具有较好的临床应用效果.     

玻璃体切除术中应用曲安奈德治疗增生性糖尿病视网膜病变

增生性糖尿病性视网膜病变是糖尿病患者致盲的主要原因。随着糖尿病发病率的逐年上升也在逐年增加。玻璃体切除是其治疗的主要手段。故在玻璃体切除手术中改善手术方法，快而全的切除掉玻璃体显得十分重要。我们于2007年12月至2009年7月在玻璃体切除术术中应用曲安奈德（TA）行残存玻璃体及增生膜染色治疗增生性糖尿病性视网膜病变54例（58眼），起到了缩短手术时间，减少术后并发症的效果。现报告如下：     

玻璃体切除术后白内障发生或进展的机制及其影响因素

玻璃体切除术(pars plana vitrectomy，PPV)自1972年由O''Malley提出后已成为眼科治疗史的一大革命，打破了既往的手术禁区，为无数玻璃体视网膜疾病的患者带去了希望。随着玻璃体切除术的不断发展，其安全性及有效性增加，手术适应证扩大，目前玻璃体切除术已成为治疗眼后段疾病最常用的手术方式。虽然玻璃体切除术后并发症越来越少，但白内障的发生或进展仍为PPV术后最常见的高发并发症，严重影响患者术后视力及眼底的观察，且目前尚无有效办法预防，白内障摘除手术为其主要治疗方法，严重增加了患者的负担。PPV术后白内障进展的影响因素众多，对其发病机制有多种假说，包括晶状体周围氧分压增高、玻璃体正常结构的破坏、光毒性等，但尚无定论。本文将从PPV术后白内障发生或进展的发生率、发生机制、影响因素几方面对玻璃体切除术后白内障发生或进展进行综述，以期为其后续的研究及临床预防和治疗提供参考。     

微切口玻璃体手术的发展与现状

近年来玻璃体手术技术不断发展与创新,如今已步入微创时代.以25G和23G为代表的微切口玻璃体手术与传统20G手术相比,微切口玻璃体手术具有创伤小、患者术后痛苦小且恢复快等优点,易为手术医师和临床患者所接受.因此有必要就微切口玻璃体手术技术特点、适应证、优点与不足等进行综述,以期与同道交流.

Abstract：

In recent years,accompanying with the development of principles of minimal invasion and engineering technology,vitreoretinal surgery has entered the new era of minimally invasive surgery with the launching of micro-incision vitrectomy represented by 25G and 23G. This paper reviews the history and development of micro-incision vitrectomy,analyzes the technical features of various types of micro-incision vitrectomy,introduces the related surgical indications,and discusses the advantages and disadvantages of micro-incision vitrectomy.     

The expanding role of primary pars plana vitrectomy in the treatment of rhegmatogenous noncomplicated retinal detachment

The surgical management of rhegmatogenous retinal detachment has evolved dramatically during the past 2 decades. Investigators have introduced and refined alternative techniques to scleral buckling surgery including pneumatic retinopexy and primary pars plana vitrectomy (PPV). Rapid parallel developments in instrumentation, including wide-angle viewing systems, perfluorocarbon liquids, novel vitrectomy machines, intraocular tamponades, and endolaser photocoagulators have led to increasing sophistication in primary PPV surgical techniques for the treatment of rhegmatogenous uncomplicated retinal detachment. However, the precise role of primary PPV in new uncomplicated retinal detachment remains debatable owing to the lack of controlled randomized trials. This article examines primary vitrectomy treatment for rhegmatogenous uncomplicated retinal detachment and presents the specific types of retinal detachments for which primary PPV may be optimal, according to personal and reported results, the surgical instrumentation and technique, as well as the complications and limitations of this surgical method.     

The Expanding Role of Primary Pars Plana Vitrectomy in the Treatment of Rhegmatogenous Noncomplicated Retinal Detachment

The surgical management of rhegmatogenous retinal detachment has evolved dramatically during the past 2 decades. Investigators have introduced and refined alternative techniques to scleral buckling surgery including pneumatic retinopexy and primary pars plana vitrectomy (PPV). Rapid parallel developments in instrumentation, including wide-angle viewing systems, perfluorocarbon liquids, novel vitrectomy machines, intraocular tamponades, and endolaser photocoagulators have led to increasing sophistication in primary PPV surgical techniques for the treatment of rhegmatogenous uncomplicated retinal detachment. However, the precise role of primary PPV in new uncomplicated retinal detachment remains debatable owing to the lack of controlled randomized trials. This article examines primary vitrectomy treatment for rhegmatogenous uncomplicated retinal detachment and presents the specific types of retinal detachments for which primary PPV may be optimal, according to personal and reported results, the surgical instrumentation and technique, as well as the complications and limitations of this surgical method     

25-Gauge transconjunctival sutureless vitrectomy

PURPOSE OF REVIEW: The history and development of 25-gauge transconjunctival sutureless vitrectomy are reviewed in this paper. The expanded spectrum of appropriate cases and recent innovations in vitrectomy surgery are discussed, as are longer-term outcomes and possible complications. RECENT FINDINGS: 25-Gauge pars plana vitrectomy has evolved significantly since its introduction in 2002, with newer instruments and novel techniques expanding the scope and improving outcomes in vitreoretinal surgery. Proper case selection is imperative, as the smaller scale of the instruments and decreased fluidics work most efficiently when extensive manipulation of intraocular tissue or significant membrane dissection is not required. Unique complications of 25-gauge surgery such as hypotony and a possible increased rate of endophthalmitis may be related to unsutured sclerotomies, and revisions in surgical approach may help to decrease these potentially devastating complications. SUMMARY: Clinical experience over the last several years has proven that this sutureless system is both safe and efficacious. Decreased surgical times, reduced postoperative inflammation, and more rapid patient recovery have all contributed to an increased acceptance of 25-gauge vitrectomy by retinal physicians.     

Iris neovascularization after vitrectomy combined with phacoemulsification and intraocular lens implantation for proliferative diabetic retinopathy

PURPOSE: To analyze the incidence of iris neovascularization after vitrectomy combined with phacoemulsification and intraocular lens (IOL) implantation using a small incision in the treatment of proliferative diabetic retinopathy (PDR). PATIENTS AND METHODS: We studied a consecutive series of 46 eyes in which vitrectomy combined with phacoemulsification and IOL implantation had been performed, and compared the surgical results with a prior series of 40 eyes in which vitrectomy alone had been performed. RESULTS: Postoperative iris and angle neovascularization was found in 6 eyes (15%) treated by vitrectomy alone, but in only 1 eye (2%) treated by combined vitrectomy (P<0.05). Final visual acuity improved by two or more lines in 23 eyes (57%) in the vitrectomy alone group, and in 35 eyes (76%) in the combined vitrectomy group. CONCLUSIONS: The incidence of postoperative rubeosis iridis was significantly lower, and the visual results were satisfactory with vitrectomy combined with phacoemulsification and IOL implantation for PDR. These findings suggest that combined vitrectomy for PDR is a useful surgical procedure.     

Twenty-gauge Transconjunctival Vitrectomy

Purpose To describe a new 20-gauge transconjunctival vitrectomy procedure that we designed, to evaluate its usefulness, and to compare two different methods of use.Methods The records of 431 patients (433 eyes) who underwent 20-gauge transconjunctival vitrectomy at the Surugadai Hospital of Nihon University between March 2003 and January 2004 were studied retrospectively. In surgical method 1, 20-gauge wounds were made through the conjunctiva and sclera together. In surgical method 2, 20-gauge conjunctival openings were made 2mm posterior to the sclerotomies. Absorbable sutures were used to stitch the scleral and conjunctival openings simultaneously in both methods.Results A 20-gauge transconjunctival vitrectomy has various benefits and is indicated for nearly all ocular diseases. Moreover, it is not limited by the intraocular instruments required. However, since cannulas were not placed in all ports, conjunctival edema occurred more easily with surgical method 2 owing to the leakage of perfusion fluid.Conclusions This new 20-gauge transconjunctival vitrectomy procedure has various benefits and is indicated for nearly all ocular diseases. It is not limited by the intraocular instruments required. Jpn J Ophthalmol 2005;49:257–260 © Japanese Ophthalmological Society 2005     

玻璃体切除术后的白内障摘除术

目的;探讨玻璃体切除术后的白内障手术的操作和疗效。方法;对１６例玻璃体节除术后白内障患者施行了白内障囊外摘除术。术中采用玻璃体腔灌注维持相对恒定的眼压。结果;术后视力基本恢复到玻璃体手术后的最佳视力,未发生晶体或晶体核脱位及复发性视网膜脱离。结论;玻璃体切除术后的白内障摘除术是比较安全的。     

不同手术方式治疗黄斑孔的疗效观察

目的观察分析不同手术方法对黄斑孔治疗的效果。方法使用单纯注气、玻璃体切除联合注气及玻璃体切除联合填充硅油3种不同的方法对54例60眼黄斑孔进行治疗，观察其疗效。结果玻璃体单纯注气治疗黄斑孔28眼，黄斑孔封闭24眼，有效率85．71％；玻璃体切除联合注气治疗黄斑孔18眼，黄斑孔封闭14眼，有效率77．78％；玻璃体切除联合填充硅油16眼，黄斑孔封闭14眼有效率87．50％。结论对于不同的患者选择不同的手术方式封闭黄斑孔均能达到较好的疗效，成功的关键是根据患者玻璃体和眼底的情况选择适合的手术方式。     

A curved vitrectomy probe.

A curved vitrectomy probe for better accessibility of the peripheral retina in phakic eyes is described. The specially designed curved vitrectomy probe has a 20-gauge pneumatic cutter. The radius of curvature at the shaft is 19.4 mm and it is 25 mm long. The ora serrata is accessed through a 3.0- or 4.0-mm sclerotomy in phakic eyes without touching the crystalline lens. Use of this instrument avoids inadvertent trauma to the clear lens in phakic eyes requiring vitreous base excision. This curved vitrectomy instrument complements wide-angle viewing systems and endoscopes for safe surgical treatment of peripheral retinal pathology in phakic eyes.