Marfan综合征伴孔源性视网膜脱离

目的：分析Marfan综合征伴孔源性视网膜脱离眼发病特征与治疗原则。方法：回顾并随访了1998年至2001年间上海市第一人民医院进行视网膜脱离手术治疗的10例12眼。结果：平均随访5．2个月，总的视网膜解剖复位率83．3％(10／12)，其中只作巩膜外手术7眼，复位率100％，玻璃体手术5眼，复位率60％。视力提高7眼(58．3％)。结论：仔细采用多种方法检查可以提高术前裂孔检出率。经巩膜环扎加压手术可以有效处理简单视网膜脱离眼，而毋实施玻璃体手术联合晶体摘除术。治疗中需加倍警惕对侧眼病变。     

Late onset vitreoretinal complications of regressed retinopathy of prematurity

AIM: To report the clinical findings, management, and outcomes in eyes undergoing surgery for regressed retinopathy of prematurity (ROP) with vitreoretinal complications. METHOD: Retrospective review of 40 eyes of 32 patients with regressed ROP who presented between 1989 and 2001 at two UK referral centres. RESULTS: Of 29 eyes presenting with rhegmatogenous retinal detachment (RRD), 15 initially underwent a scleral buckling procedure and 14 initially underwent vitrectomy with or without additional buckling. Primary surgery was anatomically successful in 11/15 eyes that underwent a non-vitrectomy retinal detachment repair and 8/14 that required vitrectomy. The final reattachment rate after reoperation was 28/29 eyes. Median visual acuity improved from 6/60 to 6/36 following retinal detachment repair. A further 11 eyes of eight patients from this series underwent prophylactic surgery, laser, or cryotherapy for predisposing vitreoretinal pathology and/or retinal breaks, all of which were stabilised. CONCLUSIONS: In eyes with RRD and signs of regressed ROP successful reattachment of the retina can be achieved using either vitrectomy or external surgery with an associated overall improvement in visual acuity. A range of external and closed microsurgical approaches is required to effectively deal with the diverse manifestations of regressed ROP.     

急性视网膜坏死综合征视网膜脱离的手术治疗

目的 探讨急性视网膜坏死综合征视网膜脱离的手术治疗的方法和效果。方法 回顾性分析1985-2002年6月收治的52例71眼急性视网膜坏死综合征中33例41眼视网膜脱离的患者。结果 接受普通外路视网膜脱离手术治疗13眼中8眼视网膜复位，手术成功率61％；接受玻璃体视网膜手术治疗10眼全部视网膜复位，手术成功率100％。结论 视网膜脱离手术，特别是玻璃体视网膜手术，可有效地使急性视网膜坏死综合征视网膜脱离复位。     

手术治疗急性视网膜坏死5例报告

目的 通过5例病例总结，探讨手术治疗急性视网膜坏死综合征(acute retinal necrosis，ARN)的临床效果。方法应用巩膜环扎联合玻璃体切除加气／硅油交换手术治疗ARN。结果5例患者(5只眼)均视网膜复位，裂孔封闭，视力提高至0．1～0．15。结论对急性视网膜坏死综合征(ARN)后期致视网膜裂孔、脱离者，应用巩膜环扎联合玻璃体切除加气／硅油交换手术治疗，可以解除玻璃体对视网膜的牵引，封闭视网膜裂孔，使脱离的视网膜复位，最大限度地挽救患眼视功能。     

马凡综合征合并视网膜脱离的手术治疗

目的探讨马凡综合征合并视网膜脱离患者在不同手术方式的治疗下其视网膜解剖复位率和视功能恢复的结果。方法回顾性的分析14例(16只眼)马凡综合征患者的手术资料。其中有12只眼行巩膜扣带环扎术,4只眼行巩膜扣带环扎联合晶状体玻璃体切除术。手术结果的评估指标包括视网膜的解剖复位率以及视功能是否提高。结果行单纯巩膜扣带环扎术的12只眼中1次手术网膜复位率为91.7%(11/12),行巩膜扣带环扎联合晶状体玻璃体切除术的4只眼中1次手术网膜复位率为75%(3/4),但行2次手术后,术后8个月时随访,14例患者的16只眼达到100%解剖复位。术后最佳矫正视力达0.05以上有12只眼。结论马凡综合征合并视网膜脱离的手术治疗应根据裂孔的位置和视网膜脱离的情况来选择手术的方式。     

双目间接检眼镜在巩膜扣带术中的应用

目的探讨双目间接检眼镜在巩膜扣带术中的应用价值及效果。方法116例(116眼)原发性(孔源性)视网膜脱离中共检出视网膜裂孔208个。其中合并黄斑部脱离81眼。PVR程度分级A级及B级106眼,C1级8眼,C2级2眼。所有病例均行巩膜扣带术,术中在双目间接检眼镜直视下定位裂孔,冷凝封闭裂孔。结果初次手术视网膜解剖复位110例,复位率94.83%。4例再次手术视网膜解剖复位。2例放弃治疗。最终,114眼视网膜解剖复位,复位率为98.28%。视网膜复位病例视功能不同程度改善。术中术后无严重并发症出现。结论双目间接检眼镜检查在原发性视网膜脱离术前、术后评价玻璃体视网膜及在巩膜扣带术中直视下定位裂孔,冷凝封闭裂孔具有独特优越性。     

Surgical management of late-onset retinal detachments associated with regressed retinopathy of prematurity

The authors report their experience in managing 16 cases of late-onset retinal detachments (RDs) associated with regressed retinopathy of prematurity (ROP). Fourteen (88%) of the 16 eyes were successfully reattached. An initial scleral buckling procedure was successful in 6 of 12 eyes. A pars plana vitrectomy was necessary in a total of eight eyes that either initially presented with proliferative vitreoretinopathy (1 case), posterior retinal breaks (1 case), subretinal fibrosis (1 case), vitreoretinal traction bands (1 case), or had persistent vitreoretinal traction after failed scleral buckling procedures (4 cases). Visual acuity stabilized or improved in 13 of the 14 eyes with successful retinal reattachment. Because these cases often have significant vitreoretinal traction and/or posterior retinal breaks, pars plana vitrectomy in conjunction with scleral buckling may be necessary in order to achieve long-term retinal reattachment.     

单纯气液交换联合环扎治疗玻璃体切割术后视网膜脱离的疗效

目的 分析单纯气液交换联合环扎手术治疗玻璃体切割术后视网膜脱离的效果以及影响因素.方法 收集2005年1月至2007年6月应用单纯气液交换联合环扎手术治疗玻切术后视网膜脱离的临床资料,应用Pierce考马斯亮蓝比色法测定术中取出的玻璃体腔液体蛋白质总浓度.分析影响手术效果的可能因素.结果 单纯气液交换联合环扎手术治疗玻切术后视网膜脱离共19例(19只眼),手术成功率为78.9%.失败4只眼均为下方裂孔,视网膜脱离时间平均11.3d,3只眼为视网膜全脱离.蛋白质浓度手术失败眼与成功眼差异有显著性(P<0.01.结论 单纯气液交换联合环扎治疗玻切术后视网膜脱离可以获得较好的疗效.对于下方裂孔并且视网膜脱离时间长,范围大的患者应采用再次玻璃体手术.     

孔源性视网膜脱离手术60例疗效分析

目的分析视网膜脱离的手术方法和效果。方法印例孔源性视网膜脱离患者，分别采用裂孔定位后经巩膜CO2冷凝、视网膜下放液、硅胶外加压或环扎、玻璃体注气等方法治疗。结果术后随访3个月至1a，视网膜复位55例．53例患者视力提高，未愈者原因包括玻璃体增殖膜形成、无晶状体眼、巨大裂孔等。结论巩膜冷凝和硅胶外加压或环扎是治疗孔源性视网膜脱离常用有效的方法，应掌握手术适应征并根据具体情况选择手术方式。     

Scleral buckling for stage 4 retinopathy of prematurity

BACKGROUND AND OBJECTIVE: Both vitrectomy and scleral buckling have been used to treat patients with stage 4 retinopathy of prematurity (ROP). The standard procedure of scleral buckling for treatment of stage 4 ROP is encircling scleral buckling. The effectiveness of segmental scleral buckling is still unclear. The purpose of this study was to analyze the surgical results of patients with stage 4 retinopathy of prematurity treated with either encircling or segmental scleral buckling. PATIENTS AND METHODS: We retrospectively analyzed the anatomic outcomes of 23 eyes (18 infants) with stage 4 A or B ROP treated with scleral buckling. Segmental buckling was used to treat 15 eyes with detachment limited to the temporal side of the retina, while 9 eyes with detachment involving both the nasal and temporal sides were treated with encircling scleral buckling. RESULTS: Macular reattachment during a mean follow-up period of 34 months (range: 2 weeks to 9 years) was accomplished in 11 (79%) of the 14 eyes treated with segmental scleral buckling and 4 (44%) of the 9 eyes that received encircling scleral buckling. There were no intraoperative complications recorded. None of the eyes that achieved macular reattachment developed recurrent macular detachment during the follow-up period. CONCLUSIONS: Scleral buckling appears to be effective for treatment of stage 4 ROP. In patients with temporal side retinal detachment only, segmental scleral buckling provides adequate treatment for stage 4 ROP.     

合并脉络膜脱离的孔源性视网膜脱离临床特点及手术疗效分析

目的:分析合并脉络膜脱离的裂孔性视网膜脱离的临床特点及手术治疗效果。方法:合并脉络膜脱离的裂孔性视网膜脱离患者64例64眼,26例行巩膜扣带术,38例行玻璃体视网膜手术,术中均不行巩膜外冷凝,观察眼部表现及手术复位率等情况,分析合并脉络膜脱离的裂孔性视网膜脱离临床特点。结果:本组病例>-6.00D高度近视占总病例数的41%。64例合并脉络膜脱离的孔源性视网膜脱离均有葡萄膜炎反应,眼压2.00～8.00mmHg;26例行巩膜扣带术,19例视网膜复位,复位率73%,行玻璃体视网膜手术38例,32例视网膜复位,一次手术复位率84%。结论:合并脉络膜脱离的孔源性视网膜脱离高度近视眼、人工晶状体眼及无晶状体眼多发,视网膜光凝替代术中巩膜外冷凝可能提高视网膜复位率及减少术后复发率。     

球形孔源性视网膜脱离的手术探讨

目的：探讨球形孔源性视网膜脱离的手术方法选择与手术预后,方法：回顾性分析1999年在我院手术的球形视网膜脱离患者161例161眼资料。最终手术采用环扎加压不放液53眼,环扎加压放液75眼,玻璃体手术33眼,平均随访3个月。结果：出院时手术复位159眼,复位率98．8％,随访期间复发2眼,最终手术成功157眼,成功率97．5％,术后视力有明显提高,结论：球形孔源性视网膜脱离由于其发病急,就诊快,只要手术方法选择适当,大部分还是可以取得成功,对于膜形成严重,裂孔多,大,靠后,或再手术病例,采用玻璃体手术,其术后解剖复位率和视功能恢复还是相当满意的。     

巩膜扣带术治疗视网膜脱离118例临床分析

目的 对原发怍（孔源性）视网膜脱离行巩膜扣带术治疗并对其效果进行评价。方法 对118例118眼原发性视网膜脱离病人行巩膜扣带术治疗。术中直接检眼镜定位，放视网膜下液，巩膜外液氮冷凝，巩膜扣带或环扎术。结果 术后随访1周至半年，视网膜裂孔封闭、完全复位107眼（90．68％），视力提高90眼（76.27％）。结论 巩膜扣带术是治疗原发性视网膜脱离常用有效的方法。     

不同手术方式治疗复杂视网膜脱离的对比观察

目的：对比玻璃体切除与玻璃体切除联合下方巩膜外垫压治疗复杂视网膜脱离的效果。方法：选取复杂视网膜脱离病例100例100眼,均病程≥1mo,合并下方周边视网膜裂孔,脱离区视网膜增殖、至少有一处皱襞。随机分成两组：治疗组50眼采取玻璃体切除联合下方巩膜外垫压治疗;对照组50眼采取单纯玻璃体切除治疗,比较两组视网膜解剖复位、矫正视力、术后1 wk黄斑中央凹厚度及术后并发症情况。结果：治疗组视网膜解剖复位有49眼（98％）,对照组视网膜复位42眼（84％）,差异有统计学意义（χ2＝4．2605,P＜0．05）;治疗组术后矫正视力：0．254±0．238,对照组术后最佳矫正视力：0．219±0．229,差异无统计学意义（ t＝1.8879,P＞0．05）;术后1wk,黄斑中央凹厚度：治疗组272±32.21μm,对照组316±33．46μm,差异有统计学意义（ t＝12．597,P＜0．01）;术后1wk内治疗组共有12眼（24％）眼压超过30mmHg,对照组有4眼（8％）眼压超过30mmHg,差异有统计学意义（χ2＝4．7619,P＜0．05）,术后1mo两组患者眼压均能控制在21 mmHg以下。结论：对于复杂视网膜脱离,采取玻璃体切除联合下方巩膜外垫压治疗安全、操作准确,相对于单纯玻璃体切除手术更有助于术后视网膜的解剖复位和黄斑水肿的早期消退。     

Late-onset retinal detachment associated with regressed retinopathy of prematurity

PURPOSE: To study the characteristics of late-onset retinal detachments in patients with regressed retinopathy of prematurity (ROP) and the condition of their fellow eyes. METHODS: We carried out a retrospective review of 29 patients (38 eyes) who had been treated at two institutions, one in the US and the other in Japan, between 1986 and 1997. The age at the time of treatment ranged from 6 to 51 years (mean=23.1). Five of the 38 eyes with tractional detachment were treated with either open-sky vitrectomy, closed vitrectomy, or scleral buckling; 27 of the 38 eyes with rhegmatogenous retinal detachment underwent scleral buckling or closed vitrectomy or both. The remaining 6 of the 38 eyes had subclinical rhegmatogenous detachment and were treated with photocoagulation or cryopexy, or followed without treatment. The most characteristic retinal breaks were multiple holes with a prevalence of equator and posterior types. RESULTS: Overall, anatomical reattachment was accomplished in 27/32 eyes (84%) that underwent surgery. Two thirds of the patients who underwent vitrectomy either initially or at a later time had poor postoperative visual acuity. More than half of the fellow eyes had retinal detachment and others had various characteristic fundus changes of regressed ROP. CONCLUSIONS: Long-term, probably life-long follow-up of high-risk patients is necessary so that diagnosis and treatment can be instituted at an early stage of retinal detachment.     

The role of the vitreous in retinal detachment surgery with external buckling

PURPOSE: To prove the role of the vitreous in retinal detachment surgery with scleral buckling procedures, we retrospectively investigated the charts of patients who were operated on for retinal detachment by scleral buckling between January 1995 and June 1997. METHODS: Out of a total of 718 cases, 41 retinal detachments occurred in previously vitrectomized eyes. The buckling procedure consisted of silicone sponge explants in 513 cases (254 radial, 259 circumferential) and of encircling elements in 202 cases. Three eyes received a temporary balloon. The minimal follow-up was 3 months. RESULTS: After primary surgery in the 677 nonvitrectomized eyes, the retina was attached in 482 eyes (71.2%), after reoperation in 627 eyes (92.6%). With up to 3 reoperations (including vitrectomy with gas or silicone oil tamponade in 79 eyes), the final success rate was 98.7%. The corresponding reattachment rates in the 41 vitrectomized eyes were 82.9% after primary surgery and 97.6% after reoperation. Repeated surgery in 6 eyes consisted of successful internal tamponade by silicone oil. The reattachment rates after primary buckle procedure are of most interest to the role of the vitreous: the highest success rate (82.9%) was achieved in the vitrectomized eyes versus 71.2% in the nonvitrectomized eyes. The difference is statistically not significant. CONCLUSIONS: We therefore conclude that the absence of the vitreous has no adverse effect on the results of buckling procedures for retinal detachment. The choice of the surgical technique in treating retinal detachments in vitrectomized eyes should only determined by retinal findings such as the number and extent of breaks or the presence and stage of proliferative vitreoretinopathy.     

Comparison of scleral buckling and vitrectomy for retinal detachment resulting from flap tears in superior quadrants

PURPOSE: To compare the surgical results of vitrectomy and scleral buckling for uncomplicated superior retinal detachment caused by flap tears. METHODS: Included in the study were 225 patients (225 phakic eyes) undergoing primary surgery by three surgeons between January 1990 and December 1996 for superior retinal detachment caused by flap tears (138 eyes by scleral buckling, 87 eyes by vitrectomy); all patients had been followed up for longer than 6 months after surgery. The choice of one of the two procedures was based on each surgeon's preference. The surgical outcome and the rate of complications were retrospectively compared between the two groups of eyes. RESULTS: Initial and final anatomical success rate were 92% and 100% after each procedure. Retinal redetachment after the initial procedure was due to new retinal breaks in 5 eyes, reopening of original breaks in 2 eyes of vitrectomy cases, and due to malpositioned buckle in 11 eyes of scleral buckling cases. Proliferative vitreoretinopathy occurred in 3 eyes of vitrectomy cases. CONCLUSION: Primary vitrectomy was as successful as scleral buckling for treating superior rhegmatogenous retinal detachment. Even though the high incidence of postoperative cataract formation was the major drawback, vitrectomy had some advantages over scleral buckling.     

巩膜环扎术是否必须?——玻璃体视网膜手术方法的探讨

目的探讨巩膜环扎带对玻璃体手术治疗孔源性视网膜脱离(RRD)治愈率及视力预后的影响。方法回顾分析有随访纪录的以玻璃体手术治疗的孔源性视网膜脱离140例(140眼)(除去黄斑孔),按是否做巩膜环扎术分为环扎组和非环扎组。比较环扎组与非环扎组在不同增生型玻璃体视网膜病变(PVR)分级及裂孔不同位置的复位率以及两组术后视力的改善情况。结果环扎组79眼,视网膜完全复位67眼,复位率84.81%。非环扎组61眼视网膜完全复位52眼,复位率85.25%。非环扎组视网膜解剖复位率略高于环扎组,但差异无统计学意义(P>0.05)。两组在不同PVR级别以及裂孔不同位置的视网膜复位率相比差异无统计学意义(P>0.05)。术后视力改善者,环扎组63眼占79.75%;非环扎组49眼占80.33%,两组间差别无统计学意义(P>0.05)。结论有玻璃体手术指征的RRD提高玻璃体视网膜手术成功率的关键是彻底松解视网膜固定皱襞及裂孔周围的牵引,彻底地封闭所有视网膜裂孔及有效的眼内填充,巩膜环扎术并非必须。     

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.     

Pars plana vitrectomy for the treatment of rhegmatogenous retinal detachment uncomplicated by advanced proliferative vitreoretinopathy.

A consecutive series of 114 eyes (112 patients) undergoing pars plana vitrectomy for rhegmatogenous retinal detachment not complicated by severe proliferative vitreoretinopathy is presented (follow up 1 to 4 years; mean 19 months). The indications for vitrectomy fell into two main groups: (1) where the retinal view was poor and vitrectomy was required to clear media opacities to allow identification of retinal breaks (n = 62); and (2) where technically difficult breaks existed and vitrectomy with internal tamponade was used to relieve vitreoretinal traction and facilitate retinal break closure (n = 44). In some of these cases the need for scleral buckling was eliminated. A smaller third group (n = 8) existed where the position of the break(s) was uncertain in the presence of an adequate view. The success rate with one procedure was 74% and with further surgery retinal reattachment was achieved in 92%. At 6 months after further surgery, beyond which interval no new failures were encountered, best corrected visual acuity was improved in 92 eyes (81%), unchanged in 14(12%), and worse in eight (7%). We conclude that pars plana vitrectomy is an effective method for treatment of selected cases of rhegmatogenous retinal detachment not complicated by proliferative vitreoretinopathy.