复杂性孔源性视网膜脱离的玻璃体视网膜手术失败原因初步探讨

目的探讨复杂性孔源性视网膜脱离的玻璃体视网膜手术失败原因。方法对４７７例（４７９只眼）复杂性孔源性视网膜脱离采用玻璃体视网膜手术（ｖｉｔｒｅｏｒｅｔｉｎａｌｓｕｒｇｅｒｙ,ＶＲ术）,即玻璃体切除、膜剥离、气液交换、惰性气体（ＳＦ６,Ｃ３Ｆ８）及硅油眼内填充。结果近期有效者３４７例（３４９只眼,７２．９％）,失败者１３０例（１３０只眼,２７．１％）。结论多因素逐步回归分析显示影响ＶＲ术近期效果的显著因素为眼内填充硅油、巨大裂孔、眼内填充ＳＦ６、医源性裂孔、前部增殖性玻璃体视网膜病变（ｐｒｏｌｉｆｅｒａｔｉｖｅｖｉｔｒｅｏｒｅｔｉｎｏｐａｔｈｙ,ＰＶＲ）、严重视网膜下增殖、ＰＶＲ、眼内填充Ｃ３Ｆ８、手术频次及脉络膜脱离     

联合手术治疗复杂性视网膜脱离回顾分析

目的探讨玻璃体视网膜手术（vitreoretinal surgery，VR）联合晶体切除或超声粉碎的效果。方法对81例（81眼）应用晶体玻璃体视网膜联合手术（lenticular-vitreoretinal surgery，LVR）治疗的复杂性视网膜脱离进行回顾性分析。结果解剖性成功者64眼（79．01％），功能性成功者45眼（55．56％）；手术成功率显著降低的原因是前部增殖性玻璃体视网膜病变（proliferatve vit-reoretinopathy，PVR）（成功率42．86％，P〈0．01）和术中或术后眼内出血（成功率58．82％，P〈0．025）。结论LVR是治疗复杂性视网膜脱离的主要方法；显著影响手术预后的因素是前部PVR和术中或术后眼内出血。     

前部增殖性玻璃体视网膜病变的视网脱离及其手术治疗

目的 探讨前部增殖性玻璃体视网膜病变（ｐｒｏｌｉｆｅｒａｔｉｖｅ ｖｉｔｒｅｏｒｅｔｉｎｏｐａｔｈｙ,ＰＶＲ）视网膜脱离的临床特点及其手术治疗效果,方法 分析Ｃ～Ｄ级ＰＶＲ视网膜脱离患者８３例（８３只眼）;并针对其前部和后部病变,采用不同的手术方法进行治疗。结果 ８３例视网膜脱离患者中,前部ＰＶＲ３４只眼,占４１．０％;后部ＰＶＲ４９只眼,占５９．０％,发病年龄前者较轻,平均２８．５岁;后者３８．     

前部增殖性玻璃体视网膜病变的手术治疗

为探讨前部增殖性玻璃体视网膜病变（ａｎｔｅｒｉｏｒｐｒｏｌｉｆｅｒａｔｉｖｅｖｉｔｒｅｏｒｅｔｉｎｏｐａｔｈｙ，ａＰＶＲ）的手术效果，对３９例伴有ａＰＶＲ的复杂性视网膜脱离３９只眼进行玻璃体视网膜手术治疗；依手术日期先后顺序将３９只眼分为前期手术组（Ⅰ组，１９只眼）和后期手术组（Ⅱ组，２０只眼），分析不同时期的手术效果。结果：Ⅰ组和Ⅱ组视网膜完全复位分别为４只眼（２１．０５％）和１７只眼（８５％，Ｐ＜０．００５）；合计复位２１只眼（５３．８５％）。手术失败１８只眼中９只眼（５０％）为前部增殖松解不足所致。结论：对ａＰＶＲ的认识和处理能力的提高是后期手术组（Ⅱ组）视网膜复位成功率高的主要原因。     

增殖性玻璃体视网膜病变的玻璃体手术治疗

目的 评估玻璃体手术治疗增殖性玻璃体视网膜病变（ＰＶＲ）的疗效。方法 Ｃ２级以上ＰＶＲ合并视网膜脱离２１眼,其中特发性ＰＶＲ１４眼,外伤性ＰＶＲ７眼;Ｃ级９眼,Ｄ级１２眼,均作常规玻璃体切除术联合巩膜环扎、膜剥离、松解性视网膜切开、气体或硅油填充等附加术式。结果 出院时２１眼视网膜全部复位（１００％）,１９眼随访２～９个月,视网膜复位成功率为７８．９％（１５／１９）、术后视力提高９５．２％（２０／     

硅油在复杂性视网膜脱离复位术中的应用

报告玻璃体切除联合硅油填充治疗复杂性视网膜脱离６０例（６０只眼），包括增殖性玻璃体现网膜病变（ｐｒｏｌｉｆｅｒａｔｉｖｅｖｉｔｒｅｏｒｅｔｉｎｏｐａｔｈｙ，ＰＶＲ）Ｄ级２７只眼，后瓣翻转的巨大裂孔视网膜脱离１５只眼，后极或黄斑裂孔１３只眼，外伤性ＰＶＲ５只眼。经３～２４个月随访，４８只眼获得解剖学复位，成功率为８０％。４３只眼术后视力进步，其中３２只眼视力≥０．０５。玻璃体切除、膜剥离为硅油填充创造了条件并充分发挥了硅油填充的作用，而硅油填充完善了玻璃体手术并提高了成功率。作者对硅油手术的原理、适应证、优缺点及并发症也进行了扼要讨论。     

玻璃体手术治疗复杂性黄斑裂孔性视网膜脱离

应用玻璃体手术治疗有明显玻璃体牵引、伴严重ＰＶＲ或多次手术未能成功的黄斑裂孔视网膜脱离（简称网脱）３７例３７只眼。根据病情不同，合理选择玻璃体腔注气、完全气体／液体交换或硅油／液体交换作眼内充填，部分病例结合环扎术，术后取面向下体位。经过６－３０个月（平均１６．５个月）的随访，３７例中３０例视网膜完全复位，成功率８１％，成功病例视力均有不同程度提高，随访视力在０．０５以上者共有１９例。认为玻璃体手术是治疗复杂性黄斑裂孔视网膜脱离的有效方法，对不同的眼内充填物的优缺点进行比较，并提出各自的适应症。     

玻璃体手术治疗复杂性黄斑裂孔性视网膜脱离

应用玻璃体的手术治疗有明显玻璃体牵引、伴严重ＰＶＲ或多次手术未能成功的黄玻璃裂孔视网膜脱离（简称网脱）３７例只眼，根据病情不同，合理选择玻璃体腔注气、完全气体／液体交换或硅油／液体交换作眼内充填，部分病例结合环孔术，术后取面向下体位，经过６－３０个月（平均１６．５个月）的随访，３７例３０例视网膜完全复位，成功率８１％，成功病例视力均有不同程度提高，随访视力０．０５以上者共有１９例，认为玻璃体手术是     

显微玻璃体视网膜手术联合硅油填充治疗穿通伤性视网膜脱离

目的评价显微玻璃体视网膜手术（ｍｉｃｒｏｖｉｔｒｅｏ－ｒｅｔｉｎａｌｓｕｒｇｅｒｙ，Ｖ－Ｒ术）、视网膜切开、硅油填充对穿通伤性视网膜脱离（ｒｅｔｉｎａｌｄｅｔａｃｈｍｅｎｔ，ＲＤ）的治疗价值和效果。方法用Ｖ－Ｒ术结合视网膜切开及硅油填充治疗６４例穿通性ＲＤ患者。结果出院时视网膜复位者５８例（９０．６％），其中３４例随访３～１５个月，视网膜保持平复者占７３．５％；视力在数指以上者２２只眼（６４．７％），≥０．０５者６只眼（１７．６％）。结论该方法能治愈用常规显微Ｖ－Ｒ术难以治愈的患者，其中占１／６的患者达到脱盲。     

过氟化碳液体在晶体及玻璃体视网膜手术中的应用

探讨过氟化碳液体（ｐｅｒｆｌｕｏｒｏｃａｒｂｏｎｌｉｑｕｉｄ,ＰＥＦＣＬ）在晶体及玻璃体视网膜手术（ｖｉｔｒｅｏｒｅｔｉｎａｌｓｕｒｇｅｒｙ,ＶＲ术）中的应用价值。方法应用ＰＦＣＬ（法国产过氟萘烷,ｐｅｆｌｕｏｒｏｄｅｃｌｉｎ,纯度１００％,Ｃ１０Ｆ１８）治疗２例（２只眼）晶体脱位于玻璃体内,采用玻璃体切除,ＰＦＣＬ漂浮晶体于前房,再行常规的白内障摘除术,在ＶＲ术中应用ＰＦＣＬ治疗３７例（３７只眼     

晶体玻璃体视网膜手术联合硅油填充治疗复杂性视网膜脱离

目的：探讨晶体玻璃体视网膜手术（Lenticular-retinovetinal surgery,LVR)联合硅油填充治疗复杂性外伤性视网膜脱离的效果。方法：对38例（38眼）应用晶体玻璃体视网膜手术联合硅油填充治疗的外伤性视网膜脱离进行回顾性分析。结果：解剖必忝功者35眼（92 11%),功能成功者32眼(84.21%).结论:LVR联合硅油填充是治疗复杂性外伤性视网膜脱离的主要方法.显著影响手术预后的因素是前部PVR和术中术后眼内出血及角膜外伤性病变.     

Long-term outcomes of heavy silicone oil tamponade for complicated retinal detachment

PURPOSE: To assess the long-term success rates and complications of heavy silicone oil tamponade (Oxane HD) in the management of complicated retinal detachment with proliferative vitreoretinopathy (PVR). METHODS: Twenty-one eyes of 21 patients with complicated retinal detachment and PVR were included in this study. Vitreoretinal surgery with heavy silicone oil (Oxane HD) tamponade was performed in all patients. Heavy silicone oil was injected by perfluorocarbon liquid-air-silicone oil exchange, and was removed after 3 months. The main outcomes of the surgery including the success and complication rates were evaluated during the mean follow-up period of 11.4+/-0.88 months. Wilcoxon signed ranks test was used for statistical analysis of visual acuity changes. The outcomes of our study were compared with those of the previous studies. RESULTS: All eyes had complicated retinal detachment with PVR Grade C3 or worse. Retinal detachment was rhegmatogenous in 6 eyes, secondary to previous detachment surgery in 11 eyes, secondary to proliferative diabetic retinopathy in 3 eyes, and secondary to perforating eye injury in 1 eye. The overall anatomic success rate was 80.9% at the end of the follow-up period. The overall visual success rate was 42.8%, with no statistically significant difference from baseline (p>0.05). Postoperative complications included severe reproliferation (4 eyes), intraocular pressure rise (3 eyes), anterior dislocation of silicone oil (2 eyes), posterior subcapsular cataract formation (4 eyes), vitreous hemorrhage (1 eye), rubeosis iridis (3 eyes), optic atrophy (1 eye), and ocular pain and photophobia (21 eyes). CONCLUSIONS: According to the results of this study, vitreoretinal surgery with temporary heavy silicone oil tamponade appears to increase the anatomic success rates with minimal complication rate in cases with complicated retinal detachment and PVR.     

Combined 5-fluorouracil, low-molecular-weight heparin, and silicone oil in the management of complicated retinal detachment with proliferative vitreoretinopathy grade C.

BACKGROUND AND OBJECTIVE: To determine whether combined 5-fluorouracil (5-FU) and low-molecular-weight heparin (LMWH) could improve the outcome of vitreoretinal surgery with silicone oil for the management of complicated retinal detachment with proliferative vitreoretinopathy (PVR) grade C. PATIENTS AND METHODS: In an interventional, controlled, nonrandomized clinical trial, 33 eyes with complicated retinal detachment and PVR underwent vitrectomy with silicone oil and perioperative infusion of 5-FU and LMWH (study group) and 31 eyes underwent vitrectomy with silicone oil without adjunctive medication (control group). RESULTS: In the study group, 24 eyes (72.7%) had the retina attached and 9 had a retinal redetachment (27.3%) at 6 months. In the control group, 25 eyes (80.6%) had the retina attached and 6 eyes (19.4%) had a retinal redetachment at 6 months (chi-square: 0.53, P > .05). One-year postoperative data were available for 17 eyes in the study group and 19 eyes in the control group. Four eyes in each group (23.5% and 21%, respectively) developed retinal redetachment (chi-square: 0.03, P > .05). CONCLUSIONS: Combined 5-FU and LMWH does not seem to improve the outcome of vitreoretinal surgery with silicone oil for the management of complicated retinal detachment with PVR grade C.     

二次玻璃体手术治疗复杂眼外伤

目的探讨二次玻璃体视网膜手术治疗复杂性外伤性视网膜脱离的疗效并分析首次手术失败的原因。方法分析复杂眼外伤26眼在玻璃体视网膜手术后因出现视网膜前膜或视网膜脱离,在术后7d～6月分别再次行玻璃体视网膜手术等2次以上手术,并对第2次手术原因进行分析。结果术后增生性玻璃体视网膜病变复发、视网膜裂孔封闭不良、首次手术玻璃体切除不彻底是第1次玻璃体手术失败的主要原因。第2次手术后26眼中视网膜完全解剖复位23眼,2眼因局限性视网脱离分别再行玻璃体切除联合巩膜环扎或视网膜切开术,另1眼失败,复位率88.46%。术后视力提高者20眼（76.92%）,术后视力与手术前比较,差异有统计学意义（U=-3.397,P〈0.001）。结论彻底清除PVR增生组织、恢复视网膜活动度、选择合适封孔方式及眼内填充物,方能够复位视网膜,并恢复部分视力。     

Retinal detachment and massive vitreoretinal proliferation: clinical study of 60 cases

Perfluoropropane gas as an adjunct to vitreoretinal microsurgery in the management of proliferative vitreoretinopathy. Pure perfluoropropane gas was used as an adjunct to vitreoretinal microsurgery in 60 eyes of 60 patients with rhegmatogenous retinal detachment complicated by proliferative vitreoretinopathy. 0.3 ml to 1.8 ml (average 0.9 ml) of pure perfluoropropane gas were used. The surgical procedure included a vitrectomy and a scleral buckling procedure in all patients. The follow-up after complete gas absorption ranges from 6 months to 3 years in the successful eyes. Total retinal reattachment was achieved in 41 eyes (68.3%). The anatomical success rate was 88% (22/25 eyes) in grade C1-C2 PVR cases, 68.7% (11/16 eyes) in grade C3-D1 PVR cases, and 42% (8/19 eyes) in grade D2-D3 PVR cases. Visual acuity of 0.1 or better was achieved in 80% of eyes with grade C PVR and 61% of eyes with grade D PVR. Visual acuity of 0.4 or better was achieved in 26.9% of eyes with grade C PVR. Macular changes were revealed by fluorescein angiography in 53% of successful eyes. We recommend the use of C3F8 rather than SF6 in the management of rhegmatogenous retinal detachment complicated by PVR. In our experience the anatomical success rate achieved with C3F8 is approximately the same as that achieved with SF6. However permanent retinal reattachment was achieved with a single operation in 87.8% of successful eyes of the present series of patients manages with C3F8 as compared to only 12% of successful eyes of a previous series of patients managed with SF6.(ABSTRACT TRUNCATED AT 250 WORDS)     

Vitreous surgery with trypan blue staining of membranes in PVR retinal detachment surgery

BACKGROUND: In our clinic we used trypan blue staining routinely for removal of internal limiting membranes (ILM) and epiretinal membranes (ERM) during vitreoretinal surgery for PVR retinal detachment. PATIENTS AND METHODS: We treated 27 eyes of 27 patients with severe PVR retinal detachment with vitreoretinal surgery. After complete vitrectomy and removal of epiretinal membranes we injected 0.15 % trypan blue solution and proceeded with further removal of the visualized remaining epiretinal membranes and ILM. We performed relaxing retinotomies in 14 eyes. Follow-up lasted six months. RESULTS: After the first surgery the retina was reattached in 24 of 27 eyes and after the second surgery in all eyes. The final visual acuity was: hand movements in 3 eyes, 1/50 or better in 24 eyes (eight of them had a visual acuity of 0.1 - 0.5). No case of macular pucker was observed during the follow-up. CONCLUSIONS: Trypan blue staining during vitreoretinal surgery in PVR retinal detachment therapy allows complete removal of ILM, ERM, and peripheral vitreous. It upgrades the quality of the surgery.     

Prevalence and risk factors for proliferative vitreoretinopathy in eyes with rhegmatogenous retinal detachment but no previous vitreoretinal surgery

PURPOSE: To determine the prevalence of and risk factors for proliferatative vitreoretinopathy (PVR) in eyes with rhegmatogenous retinal detachment but no previous vitreoretinal surgery. DESIGN: Observational case series. METHODS: Prospective study. SETTING: A private vitreoretinal clinic in Caracas, Venezuela. STUDY POPULATION: 119 eyes of 119 patients who presented with rhegmatogenous retinal detachment but no previous vitreoretinal surgery between 1995 and 1998. OBSERVATION PROCEDURES: Data from detailed preoperative and postoperative examinations of each eye were recorded prospectively and entered into an electronic database. MAIN OUTCOME MEASURES: Prevalence of PVR of any type and severe PVR, preoperative risk factors for PVR of any type and severe PVR, effect of PVR and retinal detachment duration on initial and final visual acuity, and surgical complexity. RESULTS: The prevalence of PVR of any type was 52.9% and of severe PVR was 26.9%. The mean retinal detachment duration (+/-SD) was 58.4 (+/-129.1) days, and the mean time from initial examination to surgical treatment (+/-SD) was 24.3 (81.2) days. By univariable analysis, long retinal detachment duration, poor initial visual acuity, and large retinal detachment extent were significantly associated with PVR prevalence and severity. The presence of vitreous hemorrhage was significantly associated with PVR prevalence, and cataract was significantly associated with PVR severity. By multivariable analysis, long retinal detachment duration and large retinal detachment extent were simultaneous risk factors for PVR prevalence, while long retinal detachment, large retinal detachment extent, and poor initial visual acuity were simultaneous risk factors for PVR severity. Eyes with longer retinal detachment duration, PVR of any type, and severe PVR had worse initial and final visual acuities than eyes with shorter retinal detachment duration or those without PVR, respectively. Eyes with PVR had more complex surgery than those without PVR. CONCLUSIONS: PVR occurred very frequently in this population and was associated with more complex surgery and worse visual outcomes than among eyes without PVR. We have identified preventable risk factors associated with PVR that suggest a specific and significant need for better access to ophthalmologic care and patient education in this group of patients.     

C3F8 in the treatment of retinal detachment associated with vitreoretinal proliferation

The perfluoropropane gas was used as an adjunct to vitreoretinal microsurgery in 60 eyes of 60 patients with rhegmatogenous retinal detachment complicated by proliferative vitreoretinopathy. 0.3 ml to 1.8 ml (average 0.9 ml) of pure perfluoropropane gas was used. The surgical procedure included vitrectomy and scleral buckling in all patients. The follow-up after complete gas absorption ranged from 6 months to 3 years in the successful eyes. Total retinal reattachment was achieved in 41 eyes (68.3%). The anatomical success rate was 88% (22/25 eyes) in grade C1-C2 PVR cases, 68.7% (11/15 eyes) in grade C3-D1 PVR cases, and 42% (8/19 eyes) in grade D2-D3 PVR cases. Visual acuity of 0.1 or better was achieved in 80% of eyes with grade C PVR and 61% of eyes with grade D PVR. Visual acuity of 0.4 or better was achieved in 26.9% of eyes with grade C PVR. Macular changes were revealed by fluorescein angiography in 53% of successful eyes. We recommend the use of C3F8 rather than SF6 in the management of rhegmatogenous retinal detachment complicated by PVR. In our experience the anatomical success rate achieved with C3F8 is approximately the same as that achieved with SF6. However permanent retinal reattachment was achieved with a single operation in 87.8% of successful eyes of the present series of patients managed with C3F8 as compared to only 12% of successful eyes of a previous series of patients managed with SF6. The anatomical results achieved with a single operation in the C3F8 series are probably related to the greater longevity of C3F8 as compared to that of SF6.(ABSTRACT TRUNCATED AT 250 WORDS)     

Perfluoro-octane in the treatment of giant retinal tears with proliferative vitreoretinopathy.

Giant retinal tears complicated by proliferative vitreoretinopathy (PVR) pose one of the more complex problems in vitreoretinal surgery. The authors developed a technique using perfluoro-octane, a temporary vitreous substitute that is heavier than water, combined with vitrectomy, scleral buckling, fluid-gas exchange, and direct manipulation of the retina to treat these cases. Ten eyes with giant retinal tears and grade D-1 PVR or worse were treated. In all eyes, the retina was successfully reattached at the end of surgery. Nine of the ten retinas remained attached after 6 months of follow-up. Five eyes required a total of six reoperations for epiretinal membrane formation without retinal detachment. The one eye in which the retina did not remain reattached developed severe recurrent PVR and iris neovascularization. Visual acuity improved in 8 of 10 eyes. Final visual acuity was 20/400 or better in 8 of 10 eyes, and 20/80 or better in 4 eyes.