硅油填充术后眼组织病理改变

目的 探讨硅油对人眼内组织毒副作用的发生时间及机制。 方法 对19例因硅油填充术后严重并发症而摘除的眼球进行组织病理学观察。 结果 在感觉层视网膜、视网膜色素上皮(retinal pigment epithelium,RPE)细胞、视神经、视网膜前膜和下膜、虹膜、前房角、以及角膜内皮中均可见硅油小泡或小滴。在硅油填充短于9个月的眼中,硅油小泡仅见于视网膜表面(视网膜前膜及巨噬细胞内);硅油填充9个月以上的眼中,硅油小泡进入感觉层视网膜内。1例硅油填充39个月的眼中,视神经间质和蛛网膜下间隙受到硅油小泡弥漫性浸润。 结论 眼内硅油填充术后的并发症与硅油在眼内存留的时间长短有关。 (中华眼底病杂志, 1999, 15: 232-234)     

硅油长期填充眼的临床观察

目的 观察硅油长期填充眼的病情转归、并发症及预后.方法 回顾性系列病例研究.收集1992至2005年间行硅油填充且未取出硅油达2年以上的36例(37只眼)患者临床资料,进行回顾性分析.其中男性30例(31只眼),女性6例(6只眼).年龄最小1岁零2个月,最大73岁.硅油填充时间2至13年.37只眼均为开放性眼球损伤,其中眼球破裂伤24只眼,球内异物伤5只眼,贯通伤3只眼,穿通伤5只眼.采用三通道玻璃体切除、视网膜切开及切除、眼内激光光凝、硅油填充等手术.结果 手术后硅油下视网膜良好复位13只眼(35.1%),部分复位11只眼,硅油下视网膜仍然脱离7只眼.视力达0.01以上者9只眼(24.3%),最佳视力为0..1.长期随访发现的并发症:角膜带状变性13只眼(35.1%),角膜全混浊6只眼,硅油乳化17只眼(45.9%),继发性青光眼2只眼,晶状体混浊4只眼;无明确硅油并发症8只眼(21.6%).结论 对重症眼外伤患者确无有效疗法时,长期行眼内硅油填充仍可获得视网膜复位或维持眼球外观的机会.     

Intraocular tissue migration of silicone oil after silicone oil tamponade: a histopathological study of enucleated silicone oil-filled eyes

Retrospective clinical and histopathological review of eight silicone oil-filled enucleated eyeballs using light microscopy was carried out in our department of ocular pathology during a period of six years. In all cases, silicone oil vacuoles, both free and incorporated within macrophages were seen in all the retinal layers. Silicone oil vacuoles were seen in the optic nerve, choroid, retinal pigment epithelium, corneal stroma, iris and ciliary body stroma, preretinal and subretinal membranes and retro-corneal membranes. Silicone oil migration could be seen in intraocular tissues as early as two months post surgery. There was no definite histopathological correlation between duration of tamponade and distribution of silicone oil vacuoles. Silicone oil vacuoles were seen in the optic nerve in eyes with neovascular glaucoma. Chronic inflammatory reaction was observed in the retinal tissue in the vicinity of silicone oil vacuoles.     

Heavy metal concentrations in human eyes

PURPOSE: To measure the concentration of toxic heavy metals in the fluids and tissues of human eyes. DESIGN: Laboratory investigation. METHODS: Thirty autopsy eyes of 16 subjects were dissected to obtain the aqueous, vitreous, lens, ciliary body, retina, and retinal pigment epithelium/choroid. Concentrations of lead, cadmium, mercury, and thallium in ocular tissues, ocular fluids, and blood were determined using an inductively coupled plasma-mass spectrometer and expressed as ng/g. Heavy metal concentrations in ocular tissues were compared using a paired t test. RESULTS: Lead and cadmium were found in all of the pigmented ocular tissues studied, concentrating to the greatest extent in the retinal pigment epithelium/choroid (mean, 432 +/- 485 ng/g and 2,358 +/- 1,522 ng/g). Cadmium was found in the retina in all eyes (mean, 1,072 +/- 489 ng/g) whereas lead was found in the retina in 9 (30%) of 30 eyes (mean, 53 +/- 54 ng/g). Trace concentrations of lead and cadmium were detected in the vitreous (mean, 0.5 +/- 1.0 ng/dl and 19 +/- 29 ng/dl), lens (mean, 13 +/- 18 ng/g and 20 +/- 18 ng/g), and blood (mean, 0.5 +/- 1.2 mug/dl and 3.1 +/- 4.1 mug/l) but were not detected in the aqueous. Mercury and thallium were not detected in any ocular tissues or fluids or in the blood. CONCLUSIONS: Lead and cadmium accumulate in human ocular tissues, particularly in the retinal pigment epithelium and choroid. The potential ocular toxicity of these heavy metals and their possible role in eye disease requires further study.     

Concentrations of betaxolol in ocular tissues of patients with glaucoma and normal monkeys after 1 month of topical ocular administration

PURPOSE: To measure the concentration of betaxolol in tissues of humans with glaucoma and normal monkeys after topical administration. METHODS: Enucleated eyes (n = 7) of patients with glaucoma (age range, 27-79 years), without apparent anatomic disruption that would be likely to influence betaxolol absorption and intraocular distribution (exceptions: one pseudophakic, one aphakic) or other disease, were analyzed for betaxolol concentrations after self-administration of 0.25% betaxolol twice daily for 28 days or longer. The last instillation was made within 6 hours of surgery. Cynomolgus monkeys (n = 3) received 0.25% betaxolol twice daily unilaterally for 30 days. Betaxolol was measured by HPLC and tandem mass spectrometry (MS/MS) in plasma and ocular tissues. RESULTS: In humans, mean betaxolol concentrations (excluding the aphakic patient) were 71.4 +/- 41.8 ng/g in the retina, 31.2 +/- 14.8 ng/g in the optic nerve head, and 1290 +/- 1170 ng/g in the choroid. Mean concentrations in the iris and ciliary body were 73,200 +/- 89,600 and 4,250 +/- 3,020 ng/g, respectively. Betaxolol concentration was higher in all ocular tissues than in the plasma (0.59 +/- 0.32 ng/mL). In the monkeys the concentrations in the posterior tissues of the treated eyes were higher than in the untreated eyes, with mean differences in the retina and optic nerve head of 121 and 130 ng/g, respectively. CONCLUSIONS: Topically applied betaxolol was bioavailable to posterior ocular tissues, including the retina and optic nerve head, of patients with glaucoma and of normal cynomolgus monkeys. The higher betaxolol levels in the treated versus untreated monkey eyes are consistent with betaxolol's reaching posterior tissues by local absorption and distribution.     

重度开放性眼外伤尝试性硅油取出后的结果

目的分析重度开放性眼外伤手术后,尝试性硅油取出失败的原因。方法对因重度开放性眼外伤而行玻璃体切除、≥270°视网膜切开切除联合硅油填充手术治疗后,符合尝试性硅油取出条件的16例（16眼）施行了硅油取出手术。通过回顾性复习首次修复和二期玻璃体视网膜手术的记录,结合硅油取出手术中对眼底和睫状体状况的观察以及手术后眼部的检查结果,分析硅油取出手术后的结果和低眼压发生的原因。结果7眼（43．75％）硅油取出手术后眼压为0—3．0mmHg并出现低眼压性眼部损害及明显睫状体原发性和继发性损伤;1眼失随访,6眼再次硅油填充或义眼台植入手术。9眼（56．25％）硅油成功取出,手术后眼压4．8—14．0mmHg,且无低眼压性眼部损害,无睫状体原发性损伤或较轻,术中见继发局限性损害,矫正视力为数指-0．6。结论对可尝试性硅油取出的重度开放性眼外伤患者,硅油取出后低眼压及低眼压性眼部损害的发生率高达43．75％。大面积视网膜的缺损、睫状体的原发性损伤和继发性损害是此类伤眼硅油取出手术后低眼压及其眼部损害发生的两个主要原因,而睫状体的严重受损是此类伤眼须再次硅油充填和丧失眼球的重要原因之一。     

复杂性眼外伤视网膜大范围切开硅油填充后远期疗效

目的:观察复杂性眼外伤视网膜大范围切开/切除联合硅油填充术后的远期临床效果,以及硅油取舍对眼球、眼压及视功能的影响。方法:回顾分析2006-01/2010-01收治的复杂性开放性眼外伤伴视网膜嵌顿而行视网膜大范围切开/切除联合硅油填充治疗的28例28眼患者的临床资料。 男27例,女1例,年龄19~57岁。术中行180°或360°视网膜切开及部分切除,激光光凝及硅油填充。10例视网膜360°视网膜切开,视网膜切至赤道部;18例180°视网膜切开部分视网膜切除。硅油取出条件:硅油填充6mo以上,眼压＞10mmHg,视网膜复位良好,视网膜切开边缘封闭良好。术后观察2~5a。结果:视网膜切开/切除硅油填充后,早期视网膜均复位。10例视网膜360°切开眼中有8眼(80%)取出硅油, 2眼（20%）因眼压低(＜5 mmHg)成为硅油支持眼。取出硅油的8眼中有2眼的眼压在正常范围内,视力均为指数;6眼的眼压在3~7mmHg范围内,角膜水肿浑浊,脉络膜水肿,有3眼伴玻璃体出血,其中5眼出现眼球萎缩,二期行义眼台植入。18眼180°视网膜切开眼行硅油取出后,17眼的矫正视力为指数~0.3,眼压均在正常范围;1眼（5.5%）出现眼球萎缩。结论:复杂性重度眼外伤视网膜嵌顿后,视网膜大范围切开/切除后联合硅油填充,虽然早期视网膜复位率高,但远期低眼压和眼球萎缩率较高。我们应该严格掌握手术指征。     

Silicone oil-RMN3 mixture ("heavy silicone oil") as internal tamponade for complicated retinal detachment

PURPOSE: To evaluate the efficacy and safety of a silicone oil-RMN3 mixture ("heavy silicone oil") as heavier as water internal retinal tamponade after vitrectomy for complicated retinal detachment. The relative density of the heavier-than-water silicone oil was 1.03 g/cm3, and the viscosity was 3,800 cSt. Heavy silicone oil is designed to tamponade the inferior retina in complicated retinal detachment. METHODS: Patients with a complicated retinal detachment involving the inferior part of the retina requiring internal tamponade with silicone oil were recruited for this prospective study. Inclusion criteria were retinal detachment secondary to proliferative vitreoretinopathy (stage > or = C2), inferior or posterior tears, or penetrating trauma. The heavy silicone oil was injected at the end of surgery after peeling of retinal membranes or retinotomy. Follow-up examinations were scheduled at 1, 3, 6 months, and 1 year after the initial surgery. RESULTS: A total of 33 eyes of 33 patients aged from 20 to 84 years (mean, 56 +/- 18 years) were treated with heavy silicone oil. Follow-up ranged from 12 to 16 months. Rhegmatogenous retinal detachment with significant proliferative vitreoretinopathy accounted for 17 cases, inferior holes for three, and trauma with retinal detachment for three. Initial visual acuity ranged from 20/50 to hand motions. Initial retinal reattachment was achieved in all cases. Complications included increased intraocular pressure in six eyes (18%), intraocular inflammation and synechia formation in one eye (3%), a central retinal artery occlusion after heavy oil removal in one eye, and scattered retinal hemorrhages during follow-up in two eyes (6%). Significant emulsification was not observed during intraocular tamponade with heavy silicone oil. At the last follow-up, all eyes had macular attachment, and 24 eyes had a visual acuity better than or equal to 20/400. CONCLUSIONS: The results of this prospective study show the good intraocular tolerance of heavy silicone oil as tamponade in complicated retinal detachment. Its specific gravity allows for sufficient tamponade of inferior retinal tears for at least 3 months without significant side effects.     

眼内硅油填充术后硅油相关并发症的组织病理及超微结构观察

目的观察眼内硅油填充术后硅油相关并发症的组织病理及超微结构改变,并探讨其发生机制。方法收集中山大学中山眼科中心病理室有眼内硅油填充术史的25例病理标本,其中包括眼球8例,眼内容物1例,视网膜前膜4例,角膜4例及晶状体8例,对其进行组织病理学观察及免疫组化分析,对其中获得的2例新鲜前膜组织行电镜下观察。结果眼内硅油填充术后硅油相关角膜病变以内皮细胞消失(90%)、带状角膜变性(83%)为主;而硅油相关白内障则以上皮细胞纤维化生为主。8例眼球及1例眼内容物组织见到典型硅油相关视网膜病变,即视网膜结构紊乱,增殖膜形成,其内较多大小不一的圆形硅油泡,神经元细胞数量减少。3例硅油存留时间>60个月的眼球,视网膜组织已完全被增殖膜替代,且硅油广泛浸润至角巩缘陈旧创口、小梁、虹膜睫状体、脉络膜、视神经及其鞘膜组织内,提示随着硅油在眼内存留时间的延长,硅油并发症更广泛、严重。2例视网膜前膜光镜下仅见少量硅油,但电镜下可见典型硅油浸润。免疫组化检查结果在硅油浸润部位,可见散在或灶性CD68阳性巨噬细胞;油泡周围的包裹膜部分胶质纤维酸性蛋白阳性、部分波形蛋白阳性,提示硅油可通过巨噬细胞向邻近组织浸润。结论眼内硅油填充术后硅油长期眼内存留可导致眼组织结构和(或)功能异常,应在视网     

Slow release of acetylsalicylic acid by intravitreal silicone oil

PURPOSE: To assess in vitro the potential of silicone oil as a delivery system for acetylsalicylic acid (ASA) and to evaluate in vivo the pharmacokinetic distribution of salicylic acid (SA) in the eye. METHODS: In an experimental model ASA/silicone oil suspension mixed to a concentration of 1.67 mg/mL was investigated for release rate of ASA and SA. In vivo vitrectomy and intravitreal injection of two different ASA/silicone oil suspensions, both mixed to a concentration of 1.67 mg/mL, was performed on two groups, A and B, of New Zealand white rabbits. Salicylic acid concentrations in ocular tissues, aqueous, vitreous, and blood plasma were evaluated at 6 hours, 24 hours, and 5 days using high performance liquid chromatography. RESULTS: Salicylic acid was detected in all tissues. The highest levels were obtained in the vitreous: 745.4 microg/mL (A) and 640.0 microg/mL (B) at 6 hours. The retina followed with 332.9 ng/mg (A) and 281.3 ng/mg (B) at 6 hours and 31.6 ng/mg (A) and 48.1 ng/mg (B) at day 5. The maximum blood plasma levels were 5.2 microg/mL. CONCLUSION: Silicone oil is an efficacious delivery system of ASA in vitro and in vivo. Higher concentrations of SA were found in all ocular tissues and fluids when compared to intravenous administration of maximum doses.     

Pharmacokinetics and distributions of bevacizumab by intravitreal injection of bevacizumab-PLGA microspheres in rabbits

AIM:To investigate the pharmacokinetics and distributions of bevacizumab by intravitreal injection of prepared bevacizumab-poly (L-lactic-co-glycolic acid) (PLGA) microspheres in rabbits, to provide evidence for clinical application of this kind of bevacizumab sustained release dosage form.METHODS:Bevacizumab was encapsulated into PLGA microsphere via the solid-in-oil-in-hydrophilic oil (S/O/hO) method. Fifteen healthy New Zealand albino-rabbits were used in experiments. The eyes of each rabbit received an intravitreal injection. The left eyes were injected with prepared bevacizumab-PLGA microspheres and the right eyes were injected with bevacizumab solution. After intravitreal injection, rabbits were randomly selected at days 3, 7, 14, 28 and 42 respectively, three animals each day. Then we used immunofluorescence staining to observe the distribution and duration of bevacizumab in rabbit eye tissues, and used the sandwich ELISA to quantify the concentration of free bevacizumab from the rabbit aqueous humor and vitreous after intravitreal injection.RESULTS:The results show that the concentration of bevacizumab in vitreous and aqueous humor after administration of PLGA formulation was higher than that of bevacizumab solution. The T1/2 of intravitreal injection of bevacizumab-PLGA microspheres is 9.6d in vitreous and 10.2d in aqueous humor, and the T1/2 of intravitreal injection of soluble bevacizumab is 3.91d in vitreous and 4.1d in aqueous humor. There were statistical significant difference for comparison the results of the bevacizumab in vitreous and aqueous humor between the left and right eyes (P<0.05). The AUC0-t of the sustained release dosage form was 1-fold higher than that of the soluble form. The relative bioavailability was raised significantly. The immunofluorescence staining of PLGA-encapsulated bevacizumab (b-PLGA) in rabbit eye tissues was still observed up to 42d. It was longer than that of the soluble form.CONCLUSION: The result of this study shows the beneficial effects of PLGA in prolonging the residency of bevacizumab in the vitreous. And the drug delivery system may have potential as a treatment modality for related disease.     

维甲酸硅油的视网膜毒性实验研究

目的：了解维甲酸硅油对视网膜是否产生毒性。 方法：12只新西兰白兔的24只眼，随机分为3组，行气体压迫玻璃体手术3天后，分别向玻璃体腔内注入硅油(4只眼)、5μg/ml维甲酸硅油(10只眼)、10μg/ml维甲酸硅油(10只眼)各
0.5m1，用检眼镜、光漳和电镜检查来观察视网膜变化情况。 结果：注入硅油28天后，未发现各浓度的维甲酸硅油对视网膜产生毒性作用。结论：浓度为5、10μg/ml的维甲酸硅油注入玻璃体腔4周，对视网膜不产生毒性作用。 （中华眼底病杂志，1997，13：81-82）     

后巩膜加固术治疗硅油填充术后复发性超高度近视黄斑裂孔性视网膜脱离

目的　探讨后巩膜加固术治疗硅油填充术后复发性超高度近视黄斑裂孔性视网膜脱离（ｍａｃｕｌａｒｈｏｌｅｒｅｔｉｎａｌｄｅｔａｃｈｍｅｎｔ,ＭＨＲＤ）的可行性及疗效。方法　选取２０１１年６月至２０１４年６月硅油填充术后的复发性超高度近视性ＭＨＲＤ患者３６例（３６眼）,所有患者均由同一术者行黄斑区改良后巩膜加固术,术后３个月取出硅油。术后随访１２个月,观察记录术后并发症、视网膜脱离复位情况、黄斑裂孔闭合情况、术后视力、眼轴长度等指标。结果　３６眼视网膜完全复位,视网膜复位率为１００％;末次随访ＳＤ-ＯＣＴ示２２眼黄斑裂孔完全闭合,占６１．１％,１１眼黄斑部分闭合,占３０．６％,３眼仍未闭合,占８．３％;３１眼术后最佳矫正视力（ｂｅｓｔｃｏｒｒｅｃｔｖｉｓｕａｌａｃｕｉｔｙ,ＢＣＶＡ）较术前提高,占８６．１％,５眼ＢＣＶＡ较术前无明显改变,占１３．９％;术前患者ＢＣＶＡ为（１．４８±０．９２）ｌｏｇＭＡＲ,术后ＢＣＶＡ为（０．９３±０．３８）ｌｏｇＭＡＲ,差异有统计学意义（Ｐ＜０．０５）;术前患者眼轴长度为（３０．９５±１．１６）ｍｍ,术后为（２８．４６±１．３４）ｍｍ,差异有统计学意义（Ｐ＜０．００１）。所有患眼均未发生眼底出血、眼内炎、涡静脉回流障碍、眼前部缺血综合征等并发症。结论　改良后巩膜加固术是治疗硅油填充术后复发性超高度近视ＭＨＲＤ安全有效的手术方法,能提高视网膜解剖复位率、黄斑裂孔闭合率、视力及减少并发症。     

硅油下视网膜复位术疗效探讨

目的 总结硅油填充术后视网膜再脱离行硅油正视网膜复位术的疗效,探讨该手术的适应证及手术技巧。方法 对１７例（１７只眼）硅油填充术后视网膜再脱离者,在保留硅油的条件下,做睫状体扁平部３切口,在导光纤维的导引下行剥膜、断膜、视网膜切开、内放液、内激光光凝、视网膜下全氟化碳液体取出、补充硅油等使视网膜得位。结果 １７只眼中,术后视网膜重位１４只眼,成功率为８２．４％。术中硅油误入前房１只眼,误入脉络膜上     

急性视网膜坏死综合征硅油填充术后硅油取出时机选择

目的观察急性视网膜坏死综合征(ARN)行玻璃体切除联合硅油填充术后硅油充填期间及硅油取出术后并发症,进而探讨硅油取出的适宜时机。方法对连续就诊的伴有视网膜脱离的48例(48只眼)ARN患者实施玻璃体切除视网膜复位联合硅油填充术,对于确认视网膜已经复位,没有活动性的增生病变及视网膜裂孔,并在视网膜变性区域补充激光光凝的所有患者经不同时长的硅油填充期后实施硅油取出术,回顾分析其硅油填充期间及硅油取出术后并发症如视网膜脱离、并发性白内障、继发性青光眼、角膜变性等的发生情况。结果硅油填充术后视力总体上较术前有明显提高;硅油填充时间为3~15个月,平均5.8个月。取出硅油之后,总体视力无明显改变;8例于取硅油术后随访期内发生视网膜再脱离;1例角膜变性的病例,在硅油取出之后无明显改变;5例并发性白内障取油时实施超声乳化联合人工晶状体植入术;6例发生脉络膜脱离经药物治疗后痊愈;24例在硅油取出之后晶状体混浊程度较硅油取出术前无明显改变;3例无晶状体眼患者取油术后裸眼视力下降,但最佳矫正视力同硅油取出术前。结论硅油填充及硅油取出术的并发症主要为视网膜再脱离、脉络膜脱离、并发性白内障、继发性青光眼、硅油乳化、角膜变性、低眼压等。对于ARN而言,硅油填充时限4~6月时取油术后视网膜再脱离的发生率较低,取油较为适宜。     

Effects and distribution of intravitreally or subretinally injected silicone oil identified in rabbit retina using osmium tetroxide method.

Silicone oil was injected into the eyes of 28 rabbits. Utilizing the specific affinity of osmium tetroxide for lipids, the pathological features and histochemical localization of silicone oil within the retina were studied. This osmium tetroxide technique makes it possible to identify the presence of silicone oil particles in the ocular tissues. It was demonstrated that in eyes with silicone oil injected into the vitreous cavity or subretinal space, silicone oil was detected in the inner retinal layer and in phagocytes in the vitreous cavity but not in the outer retinal layer, retinal pigment epithelium and choroid. In addition, prominent subretinal and epiretinal proliferation with abundant phagocytes containing silicone oil particles were noted in the eyes with subretinal injection of silicone oil through an artificial retinal break. This study suggests that when injected subretinally silicone oil induces excessive subretinal and epiretinal proliferation.     

玻璃体切除联合重硅油填充治疗下方PVR视网膜脱离

目的探讨玻璃体切除联合重硅油眼内填充治疗下方严重PVR视网膜脱离的效果。方法对26例（26眼）诊断为合并下方PVR视网膜脱离者行玻璃体切除联合眼内重硅油填充,并同时随机抽取26眼患相似类型的视网膜脱离者,在玻璃体切除术后给予眼内硅油填充作为对照治疗。术后随访7～12月,观察其视网膜复位、视力、眼压及硅油乳化等情况。结果重硅油组视网膜一次性完全复位者24眼,占92．30％,硅油组一次性视网膜完全复位者18眼,占69．23％,（P〈0．05）。视网膜完全复位者绝大部分视力有不同程度提高。所有患者均未见明显炎症反应。结论玻璃体切除联合重硅油眼内填充是治疗下方PVR视网膜脱离的有效方法,可以降低术后视网膜脱离的复发率。     

重硅油在术后无法保持俯卧位患者的应用

目的 分析重硅油在术后无法长期保持俯卧位患者中应用的效果、并发症以及重硅油的取出时间。方法 玻璃体视网膜等术后不能长期保持俯卧位患者12例（12只眼）,玻璃体切除或联合视网膜手术中填充重硅油,对视网膜未复位患者1～3．5月后二期将重硅油取出。在患者身体条件允许的情况下,采用普通硅油或者惰性气体再次填充。主要观察指标为视网膜复位率、视力、眼压、眼前段情况、重硅油乳化率及重硅油的取出时间。结果 一次填充重硅油后视网膜复位率为66．67％（8／12）;未复位患者二期填充普通硅油或者惰性气体后视网膜复位率75．00％（3／4）,总复位率91．67％（11／12）。平均随访3～12个月,随访结束时所有患者眼内重硅油均已取出。术后视力较术前明显提高者6例。术后未发现难以控制的高眼压,保留晶状体者均出现不同程度的白内障,重硅油乳化率91．67％（11／12）。本组所有患者均无眼外不可耐受的不适。结论 应用重硅油眼内填充对不能长期保持俯卧位的术后患者效果较好,并发症少,患者容易耐受,但是重硅油乳化时间较短,应根据视网膜情况适时取出。     

复杂性视网膜脱离硅油注入手术后视神经萎缩多因素回归分析

摘要 目的探讨复杂性视网膜脱离玻璃体视网膜手术中硅油注入手术后视神经萎缩发生的危险因素。 方法 回顾性分析97例硅油注入手术后发生视神经萎缩患者的临床资料，采用SPSS统计软件对患者年龄、既往史、原发疾病、手术前眼部情况、手术中并发症、手术后并发症、取硅油时间及取硅油时眼部情况、硅油乳化等因素进行Logistic多因素回归分析，P≤0.05为差异有统计学意义。 结果 所有患眼视盘边界清晰，色泽变淡者65只眼，苍白者21只眼，色泽变淡且杯盘比明显增大（≥0.6 ）者11只眼。Logistic多因素回归分析，逐步排除混杂因素后，取硅油时眼压（P=0.02.2）及视力（P=0.001）进入回归方程。 结论 硅油注入手术后的慢性眼压升高是发生视神经萎缩的相关因素。 (中华眼底病杂志, 2006, 22: 305-307)     

Primary silicone oil tamponade in the management of severe intraocular foreign body injuries: an 8-year follow-up

PURPOSE: To evaluate the long-term outcome of pars plana vitrectomy and primary silicone oil tamponade in patients with severe intraocular foreign body (IOFB) injuries and high risk of proliferative vitreoretinopathy (PVR). METHODS: This retrospective consecutive study included 23 patients with severe IOFB injuries who had extensive lacerations including sclera, choroid, and retina, and were complicated by predictive factors for elevated proliferative activity and an unfavorable outcome. All patients underwent pars plana vitrectomy, removal of the IOFB, and primary silicone oil tamponade and were followed up for a mean 8.9 years. Main functional outcome was assessed as final best-corrected visual acuity. Anatomic success was defined as permanent retinal attachment. RESULTS: PVR occurred in 70% of all eyes and required 16 revisions. Silicone oil was removed in 78% of the eyes after a mean tamponade duration of 9.1 months. Complete retinal attachment was achieved in 83% of the eyes. Three eyes developed a persisting hypotony that was stabilized under permanent silicone oil. Functional stabilization was observed in the third year resulting in a final visual acuity of 20/630. Useful vision of better than 20/400 could be preserved in 55% of the patients. Only one eye underwent a late enucleation after 6.8 years. CONCLUSIONS: Primary silicone oil stabilizes the retina during the critical period of active PVR and may limit the visual loss in selected high-risk eyes in the long term.