一种无晶状体眼内硅油取出的改良手术

目的:报道并演示一种简便的改良手术方式取出无晶状体眼内的硅油。方法:对既往进行了玻璃体切割、晶状体切除及硅油填充术的18例患者(18眼),采用自闭式透明角膜切口取出其眼内硅油。结果:所有18眼的眼内硅油均能成功取尽,并发症少且角膜切口无须缝合。结论:采用自闭式的透明角膜切口能有效地取出无晶状体眼内的硅油。     

经透明角膜切口晶状体超声乳化联合硅油取出方法的探讨

目的探讨经透明角膜切口进行晶状体超声乳化联合硅油取出人工晶状体（IOL）植入手术方法。方法回顾分析36例（36眼）实行透明角膜切口晶状体超声乳化、鼻下睫状体平坦部放置灌注、撕开后囊、自超声乳化的角膜切口取出硅油、IOL植入手术的临床资料。结果全部病例顺利实施晶状体超声乳化、硅油取出,其中30例IOL植入于囊袋内,6例植入于睫状沟,未发生视网膜脱离或硅油残留等并发症。结论上述手术方法手术时间短,术后反应轻,并发症少。     

经角膜切口行白内障超声乳化联合硅油取出术临床观察

在玻璃体切割术后硅油充填眼中,并发性白内障是最常见的手术并发症。我院对2006年1月至2010年4月间玻璃体切割术后硅油充填眼白内障患者36例（36只眼）经透明角膜切口行白内障超声乳化、硅油取出、人工晶状体植入联合手术。一、资料与方法1.一般资料：采用经透明角膜切口行此联合手术36例     

硅油填充并发白内障行超声乳化联合硅油取出及人工晶状体植入术观察

目的 评价硅油填充合并白内障眼经透明角膜切口行白内障超声乳化,联合经瞳孔硅油取出及折叠人工晶状体植入的临床效果.方法 选择硅油填充术后合并白内障患者27只眼,手术方法为经透明角膜切口行白内障超声乳化,然后做3 mm大小的晶状体后囊切开,通过前房灌注,由后囊切开处进行硅油取出,将折叠晶状体植入囊袋内或者睫状沟.评价手术时间、术后反应以及视力恢复效果.结果 手术时间基本控制在20分钟以内,大部分病例折叠人工晶状体植入囊袋内.术后未见视网膜脱离复发、IOL脱位和其他严重并发症,部分病例有不同程度的角膜水肿,患者无明显刺激症状.结论 经透明角膜切口行白内障超声乳化联合经瞳孔区硅油取出并植入折叠人工晶状体,这种方法与经巩膜切口的方法相比,不但减少了手术的时间,而且从理论上也较少了术后并发症和患者的刺激症状,是一种安全高效的硅油取出联合白内障手术方式.     

同一切口完成硅油取出和白内障摘出术临床观察

目的观察硅油存留眼同一角巩膜切口完成硅油取出和白内障摘出术的有效性与安全性。方法对23例（23眼）原硅油充填眼行超声乳化或小切口白内障摘出联合硅油取出术。后囊撕开，使硅油经瞳孔和巩膜隧道排出。结果全部病例硅油完全取出，17眼顺利植入后房型人丁晶状体，术后视力均保持视网膜脱离术后水平或有所提高。所有病例未发现玻璃体出血、持续性角膜变性、后发白内障和与手术相关的黄斑囊样水肿。术后3个月复查3例视网膜再脱离，发生率为13％。结论同一切口取出硅油和白内障手术安全有效，手术时间短，并发症少。     

硅油充填眼行白内障超声乳化人工晶状体植入联合硅油取出术

目的 探讨玻璃体切割术后硅油充填眼经透明角膜切口行白内障超声乳化摘除、硅油取出、人工晶状体植入联合手术(1组)以及经睫状体平坦部置灌注管行白内障超声乳化摘除、硅油取出、人工晶状体植人(2组)两种手术方式的临床疗效观察。方法 对2000年1月～2003年4月间玻璃体切割术后硅油充填眼白内障患者78例(78只眼)经透明角膜行联合手术。对49例(49只眼)经睫状体平坦部行联合手术。观察眼底视网膜复位良好，行人工晶状体植入术。结果 1组病例有中52只眼最佳矫正视力达0.1～0.6(66．67％)；19只眼视力为0.02～0.1(24．36％)；7只眼视力为光感～指数(8．97％，包括5只眼视网膜脱离复发者)。2组病例中31只眼最佳矫正视力达0.1～0.6(65．3％)；11只眼视力为0.02～0.1(22．45％)；7只眼视力为光感～指数(14．3％，包括2只眼视网膜脱离复发者)。2组病例中有1只眼出现睫状体平坦部切口渗血，所有病例均无持续性角膜内皮失代偿、硅油泡残留、人工晶状体移位等并发症发生。结论 硅油眼行白内障超声乳化、硅油取出、人工晶状体植入术对于玻璃体切除手术后硅油充填眼并发白内障是一种安全、有效的方法。经透明角膜切口行此手术简化了手术步骤，减少了手术并发症的发生。     

自闭式巩膜隧道切口在有晶状体眼硅油取出术中的应用观察

目的 硅油作为眼内充填物治疗复杂性视网膜脱离，硅油在手术后一段时间内要取出以减少长期眼内硅油存在可能引起的并发症，本文介绍一种有晶状体眼的自闭式巩膜隧道灌注口硅油取出方法。方法37只有晶状体硅油眼接受自闭式巩膜隧道灌注口的硅油取出，记录术毕时切口的渗漏情况，术后观察视力、眼压、视网膜再脱离及其它并发症。随访3～6个月。结果 术中同时进行晶状体摘除5例，晶状体摘除联合人工晶状体植入8例，术毕时有4只眼切口有轻度渗漏，需要补充缝线，随访视网膜在位34眼(91．9％)，视力提高或不变29眼(78．4％)。结论 拔除灌注管后迅速有效地封闭切口是硅油取出术的一个重要手术技巧，应用自闭式巩膜切口作为灌注口，可以防止拔管后切口的渗漏，有效地维持眼压，对减少硅油取出术后的视网膜再次脱离有一定作用。     

白内障乳化手术不同切口效果比较

目的　探讨白内障超声乳化人工晶状体植入手术的两种切口(透明角膜切口和改良巩膜角膜切口)的效果。方法143例(179眼)分别采用两种切口,分析比较其术中操作、术后视力、术后散光、切口愈合、角膜状态。结果　改良巩膜角膜切口术后视力、角膜散光、并发症等均比透明角膜切口有明显优势,x2=24.04,P<0.05。结论　改良巩膜角膜切口具有自闭性好、术后恢复快、角膜散光小及并发症少等优点。     

经角膜隧道切口的无晶状体眼硅油取出术

目的 应用经角膜隧道切口的改良手术方法取出品状体玻璃体切割(PPV PPL)术后填充的眼内硅油，考察并评价其临床效果。方法 对18例曾行PPV PPL的无晶状体硅油填充眼行经角膜隧道切口的硅油取出术。局麻下，将灌注管固定于术眼颞下方平坦部处灌注，用剪短至5mm左右长的20G静脉穿刺套管经透明角膜隧道穿刺口负压抽取硅油，并在显微镜下仔细置换出残留的小油滴。结果 18例眼内硅油均一次成功取出(成功率100％)。主要并发症有：14眼术后低眼压(77．8％)；7眼玻璃体混浊(38、9％)；1眼视网膜脱离复发(5．6％)。结论 经角膜隧道切口取出无晶状体眼内硅油的改良手术，方法简单有效而且并发症少，具有较广泛的临床应用价值。     

硅油取出、白内障超声乳化摘除联合人工晶状体植入术临床观察

目的探讨玻璃体切除硅油填充术后,硅油取出联合白内障超声乳化摘除联合人工晶状体植入的手术方法和临床效果。方法采用标准三通道睫状体平坦部巩膜切口取出硅油联合白内障超声乳化摘除及人工晶状体植入术,对13例(13只眼)硅油填充眼行三联手术治疗,术后随访超过3月。结果三联手术顺利,最佳矫正视力0.04~0.1者3例,0.1~0.5者9例;术后因再次发生视网膜脱离需再次手术治疗者1例;并发症主要有角膜水肿、黄斑囊样水肿、复发性视网膜脱离及后发性白内障。结论硅油取出联合白内障超声乳化摘除及人工晶状体植入是安全有效的方法,既可以减少手术次数、减轻手术损伤,同时还可以减轻患者的经济负担,能有效提高患者的视力。     

Removal of silicone oil from aphakia: use of a self-sealing corneal incision

PURPOSE: To report and illustrate a modified and simple technique for silicone oil removal from aphakic eyes. DESIGN: Interventional case series. METHODS: Eighteen eyes of 18 patients who once had pars plana vitrectomy and lensectomy combined with silicone oil tamponade underwent silicone oil removal using a self-sealing corneal incision. RESULTS: All of the 18 silicone oil removal procedures performed had clear corneal incisions, which did not require suturing. CONCLUSIONS: Silicone oil can be removed successfully from aphakia using the self-sealing corneal incision under local anesthesia.     

两种硅油取出术并发症分析

目的:比较常规扁平部三通道硅油取出术和既往两切口单纯硅油取出术的手术并发症,考察并评价其临床效果。方法:回顾性分析2001-04/2003-06以及2003-06/2006-11两个时期(分为两组)在本院行硅油取出术的临床连续病例。前组共78例(78眼),47例无晶状体眼采用角膜缘或角膜小切口取出硅油;7例有晶状体眼采用睫状体平坦部双切口取硅油;16例联合白内障手术者,常规行超声乳化或ECCE术,再撕开后囊膜,从前房白内障手术切口放出硅油;8例视网膜复位欠佳,或局部有增生膜者,硅油取出联合常规三通道玻璃体切除术。后组病例共113例(113眼),不论有无晶状体,全部病例均采用常规扁平部三通道取硅油,取油时联合切除残余玻璃体基底部、视网膜光凝及剥离视网膜前膜。硅油取出术后随访5mo～5a,平均随访时间为(2.7±2.1)a。结果:前组中共有3例发生脉络膜上腔出血(3.8%);15例发生视网膜再脱离(19.2%);8例眼压控制不良需加用降眼压药物(10.3%);12例出现低眼压(眼压<5mmHg)(15.4%);1例术后发生角膜内皮失代偿(1.3%);38眼视力提高2行以上(48.7%)。后组病例中未出现脉络膜上腔出血和新发角膜病变,11例发生视网膜再脱离(9.7%),与前组比较差异具有统计学意义(P<0.05)。7例眼压控制不良需加用降眼压药物(6.2%),15例出现低眼压(13.3%);58眼视力提高2行以上(51.3%)。结论:虽然两切口单纯硅油取出术方法简单,在几年前应用较为普遍,但术中不能做一些眼底的详细检查及适当处理;而常规扁平部三切口硅油取出可以联合玻璃体切割及膜剥离、激光光凝等操作,有助于保持视网膜复位和视功能提高,减少并发症的出现,具有广泛的临床应用价值。     

硅油对角膜内皮的影响

目的：探讨硅油在不同情况下对角膜内皮的影响。方法;对１７０只眼行不同手术术前,术后２周,４周,８周及３个月时的角膜内皮细胞密度进行观察记录,同时对硅油人前房的２０只眼进行观察。结果;在眼压控制良好的情况下,有晶体眼行单纯玻璃体和切割术及玻璃体切割硅的填充术,无晶体眼行玻璃体切割硅油填充术。有晶体眼及无晶体眼行硅油取出术手术后各期内皮细胞密度与术前相比均无显著差异,有晶体眼行玻璃体切割晶体切割硅油填     

Acute corneal decompensation after silicone oil removal

Purpose: To assess acute corneal decompensation after silicone oil removal in some aphakic eyes with clear corneas whose anterior chambers were completely filled with silicone oil for a considerable period of time. Methods: Eight eyes of 8 patients who underwent vitrectomy and intraocular silicone oil injection were studied. All the eyes were aphakic and anterior chambers were completely filled with silicone oil. In all eyes, corneas were clear and no corneal finding indicating keratopathy was detected by slit-lamp microscopy before silicone oil removal. The mean silicone oil removal time was 4 months (range 2–7 months). A specular microscope was used for the evaluation of corneal endothelial changes and corneal pachometry was performed to observe corneal changes before and after the silicone oil removal in 5 eyes besides slit-lamp microscopy. The follow up period after silicone oil removal was 2–12 months (mean 6 months).Results: In all eyes severe corneal stromal edema and clouding was detected in the first day following silicone oil removal. Increased corneal thickness was seen in all eyes. Decreased (at or below critical levels) corneal cell density was detected by specular microscopy before and after silicone oil removal. No significant improvement was observed during the follow up period. Conclusion: Eyes whose anterior chambers completely filled with silicone oil could be evaluated as clear corneas by slit lamp microscopy despite severe endothelial damage. We recommend that eyes with silicone oil in the anterior chambers should be monitored by a combination of slit-lamp microscopic examination and specular microscopy to determine the relative corneal endothelial tolerance to the silicone oil and endothelial damage. Early removal of the silicone oil can be considered when the retinal adhesion allows.     

The influence of silicone oil removal on intraocular pressure

PURPOSE: The aim of this study was to evaluate the influence of silicone oil removal on intraocular pressure. MATERIAL AND METHOD: Our material consists of 98 patients (104 eyes), who underwent vitrectomy with silicone oil tamponade. Sixteen eyes in this group were aphakic before vitrectomy. The mean duration of silicone-oil tamponade was 8.8 months. We examined and compared intraocular pressure in all cases before vitrectomy, during tamponade and after silicone oil removal. RESULTS: The increased intraocular pressure (> 22 mmHg) was found in 27 eyes (seven of them were aphakic) during tamponade. We had to remove silicone oil due to glaucoma in 6 eyes (three of them were aphakic). In 9 eyes (four aphakic) the intraocular pressure was higher than 22 mmHg after silicone oil removal. Seven patients required additional topical medication and 2 patients were qualified for operation--trabeculectomy. Hypotony (< 10 mmHg) was observed in 11 eyes, and it coexisted with retinal redetachment in 4 cases. CONCLUSIONS: The increased intraocular pressure is a frequent complication of silicone oil tamponade, and it normalizes after silicone oil removal in most of these cases.     

硅油填充眼并发性白内障的手术疗效观察

目的：观察玻璃体切割术后硅油填充眼并发白内障行超声乳化联合硅油取出及人工晶状体植入术的临床效果及安全性。方法：对32例32眼硅油填充术后并发白内障患者行超声乳化联合经睫状体平坦部切口取硅油及折叠式人工晶状体植入术。术后随访3～18（平均9）mo。结果：术后最佳矫正视力：光感～数指/眼前者3眼,0.02～0.1者10眼,〉0.1～0.2者12眼,≥0.3者7眼。所有患者均无视网膜脱离、角膜内皮失代偿、人工晶状体移位或硅油残留等。结论：白内障行超声乳化联合硅油取出及折叠式人工晶状体植入术治疗硅油填充眼并发性白内障安全、有效。     

硅油填充术后的角膜内皮改变

目的评价硅油对有晶状体及无晶状体眼角膜内皮的影响。方法对45例(45眼)视网膜脱离患者行玻璃体切割联合硅油填充术,其中有晶状体组(22眼)及无晶状体组(23眼),比较其术前,术后1、3、6、9个月的改变。了解前房硅油对角膜内皮的影响。结果两组患者手术前后角膜内皮细胞的密度及角膜厚度的改变均无统计学差异,但两组同期角膜内皮细胞密度比较在术后1个月、6个月呈现显著差异(P=0.002,P=0.034)。硅油接触角膜内皮时,呈现“亮度颠倒”现象。末次随访时(术后9个月)的内皮细胞密度与无前房硅油组相比有极显著差异(P=0.000)。结论无论晶状体是否存在,玻璃体腔内的硅油对角膜内皮无明显的损害。而当硅油进入前房则将对角膜内皮造成严重的损害。     

DR硅油填充后并发白内障行超声乳化联合硅油取出

目的：探讨糖尿病视网膜病变硅油填充后并发白内障的超声乳化及人工晶状体（IOL）植入联合硅油取出术的临床疗效。 方法：糖尿病视网膜病变患者22例22眼硅油填充后并发白内障行超声乳化及IOL植入联合硅油取出术,均通过角膜透明切口植入软性IOL。 结果：患者19眼视力均在白内障超声乳化手术后视力较术前提高,其中0.1以上者13例,3例同术前视力;手术中后囊膜保持完整,均顺利植入软性可折叠IOL;5例术后不同程度发生角膜水肿,均在术后3~7d内消退。22例硅油均顺利取出。3例术后1mo内发现玻璃体腔积血,其中2例约4wk内玻璃体腔积血自行吸收,1例再行玻璃体手术去除积血联合眼内光凝。22例术后均未发现视网膜再脱离。 结论：糖尿病视网膜病变硅油填充眼并发性白内障的超声乳化IOL植入术联合硅油取出手术效果满意,可减少患者多次手术的痛苦。