玻璃体切割术治疗高度近视眼黄斑裂孔视网膜脱离疗效观察

目的探讨玻璃体切割术治疗黄斑裂孔视网膜脱离的疗效。方法对41例(42只眼)高度近视眼黄斑裂孔视网膜脱离,行玻璃体切割术联合眼内光凝黄斑裂孔、12?F8填充术,术后面向下体位两周。结果42只眼黄斑裂孔闭合,视网膜复位,随诊1~4年,2只眼术后因合并周边裂孔再次发生局限性视网膜脱离,给予巩膜外垫压、冷凝术封闭周边裂孔后视网膜平复。其中34只眼术后视力不同程度的提高,8只眼视力保持不变。结论玻璃体切割联合眼内光凝黄斑裂孔、12?F8填充术是治疗高度近视眼黄斑裂孔视网膜脱离安全有效的方法。     

玻璃体切割联合黄斑加固术治疗高度近视合并黄斑裂孔性视网膜脱离

目的　观察玻璃体切割联合黄斑加固术治疗高度近视合并黄斑裂孔性视网膜脱离患者术后视网膜的解剖复位率和黄斑裂孔的闭合率。方法　收集自２０１２年１月至２０１４年１２月在我院手术的高度近视合并黄斑裂孔性视网膜脱离的患者６４例（６４眼）,根据手术方式不同分成２组:一组行单纯玻璃体切割术为单纯玻切组,另一组行玻璃体切割联合黄斑加固术为联合手术组,观察两组视力及视网膜解剖复位率和黄斑裂孔闭合率。结果　６４例６４眼中,单纯玻切组３６例,术前视力平均为０．９０ｌｏｇＭＡＲ,术后平均为０．４１ｌｏｇＭＡＲ;联合手术组２８例,术前视力平均为０．８９ｌｏｇＭＡＲ,术后平均为０．６２ｌｏｇＭＡＲ;两组术前视力差异无统计学意义,术后差异有统计学意义（Ｐ＝０．０４）。两组患者术后视网膜复位均率为１００％;联合手术组的黄斑裂孔闭合率较高,为９２．９％,单纯玻切组为４１．７％,两组比较差异有统计学意义（Ｐ＝０．０２）。结论　在高度近视合并黄斑裂孔性视网膜脱离的患者中,联合行黄斑加固术较单纯玻璃体切割术患者的黄斑裂孔闭合率要高。     

玻璃体切割联合后巩膜加固术治疗高度近视眼黄斑裂孔性视网膜脱离

目的：探讨玻璃体切割联合后巩膜加固治疗高度近视眼黄斑裂孔伴视网膜脱离的方法与疗效。
　　方法：于2012-01/2013-12间收集高度近视性黄斑裂孔伴视网膜脱离患者45例45眼,分为玻璃体切割内界膜撕除联合后巩膜加固组( A组)28眼和玻璃体切割内界膜撕除组( B组)17眼。术前分别行视力、眼压、间接检眼镜、OCT检查,术后随访6~12mo,行视力、OCT检查,分别对视力、视网膜复位情况、黄斑裂孔闭合情况进行统计比较。
　　结果：(1)视力检查：术后视力：A 组1.19±0.39, B 组1.51±0.34,二者比较有显著性差异(P<0.05);(2)术后视网膜复位率：A组100%,B组88.24%,两者比较无统计学差异;(3)术后黄斑裂孔闭合率：A 组82%,B 组53%,两者比较有统计学差异(P<0.05)。
　　结论：玻璃体切割术联合后巩膜加固术治疗高度近视眼黄斑裂孔伴视网膜脱离的手术方法安全可行,可更好的改善视力,提高黄斑裂孔的闭合率。     

安藤式黄斑外顶压治疗高度近视黄斑裂孔1例

对高度近视眼发生黄斑裂孔引起视网膜脱离患者 ,治疗方法主要有黄斑外顶压、巩膜缩短术、单纯眼内气体注入术 ,以及玻璃体切割手术等。本文报告采用安藤式黄斑外顶压器 [1 ] (以下称外顶压器 )治疗高度近视黄斑裂孔 1例。患者 ,女 ,67岁。单眼高度近视 ( - 11D) ,以往右眼视力不佳。 1个月前开始视野中央出现暗点 ,视力下降。左眼视力1.0 ,眼前节及眼底未见异常。右眼视力 :手动 /眼前 ,眼前节未见异常 ,眼底玻璃体稍混浊 ,后极部脉络膜葡萄肿内可见局限性视网膜脱离及黄斑裂孔 ,未见黄斑前膜的存在。手术方法 :本病例实施安藤式黄斑外顶压…     

高度近视黄斑劈裂的研究进展

黄斑劈裂是高度近视常见的黄斑病变之一.玻璃体后皮质和内界膜的切线和前后方向牵引、视网膜血管牵拉、巩膜扩张被认为是重要发病因素.目前的治疗手段主要是玻璃体手术或联合内界膜剥除术、黄斑扣带术.治疗时机及治疗手段虽有共识但存在争议.     

玻璃体切割术治疗黄斑裂孔视网膜脱离

用玻璃体切割术治疗黄斑裂孔视网膜脱离６４只眼，其中伴重度增殖性玻璃体视网膜病变者２０只眼，另有１８只眼查见玻璃体黄斑部牵引。视网膜复位５７只眼（８９．１％），复位眼中视力增进者４３只眼、未变者１３只眼、下降者１只眼。影响手术成功的主要因素是重度ＰＶＲ、高度近视、后巩膜葡萄肿、视网膜脱离的范围以及病程时间。     

近视性黄斑劈裂治疗的现状及挑战

近视性黄斑劈裂（myopic foveoschisis,MF）是高度近视患者最常引起视力损害的视网膜病变,可继发黄斑裂孔、黄斑裂孔性视网膜脱离等多种严重眼底病变。目前MF的手术方法多样,以玻璃体切除术为主,近年来后巩膜加固术的报道不断增加。MF的发病大多呈慢性进行性。患者分散、就诊少、长期未关注等问题是开展临床试验研究的难点。MF的临床表现及其评价方法多种多样,包括累及范围、劈裂高度、是否合并玻璃体后脱离、玻璃体后皮质粘连及视网膜前膜的牵拉等。对于各种情况相应处理的研究证据尚不足。除开展随机对照试验外,在大数据时代开展基于真实世界的临床研究是开展治疗MF研究的新希望。     

后巩膜加固术治疗高度近视黄斑裂孔性视网膜脱离

目的：探讨改进的后巩膜加固术对高度近视黄斑裂孔性视网膜脱离的治疗效果。 方法：1993年3月至1995年11月对住院的20例高度近视黄斑裂孔性视网膜脱离患者的20只眼，采用后巩膜加固术治疗，有关临床资料进行回顾分析。 结果：眼轴可对比的14只眼，术前与出院时的均值为28.22mm与26.87mm，17只眼视网膜复位，获得0.02一0.2的矫正视力，3只眼失败，增殖性玻璃体视网膜病变(proliferative vitreous retinopathy，PVR)加重。 结论：后巩膜加固术可有效治疗无严重PVR的高度近视黄斑裂孔所致的视网膜脱离，不必采用视网膜粘连法以尽量保存残留的中心视力。 （中华眼底病杂志，1996，12：214-216）     

充分认识后巩膜加固术的临床价值

在科技高速发展的今天,临床对高度近视眼的屈光矫正虽然有许多较好的解决方法,但矫正后往往仍有屈光进展;对于高度近视眼底病变虽有一些先进的治疗技术在应用,但往往难以逆转和控制已发生的眼底病变,成为患者致盲的主要威胁。而从临床观察角度来看,高度近视的屈光进展及眼底病变的发生和加重与患者的病程进展有关,屈光进展是后巩膜扩张眼轴延长引起的,眼底病变是脉络膜、视网膜对抗后巩膜扩张的表现。后巩膜加固术作为控制后巩膜扩张的方法,其机制的合理性毋容置疑,但既往受科技发展水平的限制,术式和材料难以符合手术机制的要求,不能发挥其真正的作用,故未能得到临床的广泛认同。近年来随着术式和材料的改进,后巩膜加固术稳定眼轴和治疗黄斑劈裂、裂孔、脱离等方面的疗效,在进一步地得到证实和肯定。临床应重视对高度近视病程进展进行控制,充分认识后巩膜加固术的临床价值,把控制和治疗高度近视眼底病变作为手术适应证选择的要旨在临床稳步开展。随着术式和材料的逐步改进和规范,后巩膜加固术的临床疗效将不断提高,有望成为高度近视盲防控的一项关键技术。     

玻璃体切割联合内界膜剥除术治疗高度近视继发黄斑劈裂的观察

目的：探讨和评价玻璃体切割联合内界膜剥除治疗高度近视继发黄斑劈裂的疗效和安全性。
　　方法：将2011-03/2013-03高度近视继发黄斑劈裂患者30例30眼随机分为治疗组(16眼)和对照组(14眼),治疗组给予玻璃体切割联合内界膜剥除,对照组给予玻璃体切割但未联合内界膜剥除,观察术后2 mo视网膜复位率、视力提高率。
　　结果：治疗组视网膜复位率、视力提高率均高于对照组(P<0.05)。
　　结论：玻璃体切割联合内界膜剥除是治疗高度近视继发黄斑劈裂的有效手段。     

Posterior scleral reinforcement in the treatment of macular retinoschisis in highly myopic patients

The objective of this study was to evaluate the clinical curative effect of posterior scleral reinforcement for macular retinoschisis in highly myopic patients. Twenty-four highly myopic eyes with macular retinoschisis were treated with posterior scleral reinforcement surgery from September 2005 to March 2007 in our hospital. Visual field, best corrected vision acuity (BCVA), refractive error, optical coherence tomography and A/B Scan ultrasound graphy results were retrospectively analysed. The central visual field in 18 eyes was improved after surgery; optical coherence tomography showed complete resolution of the myopic foveoschisis in 20 (83.33%) of the 24 eyes after surgery. The postoperative BCVA was improved by 0.1 or more in 18 eyes (75%), and remained within 0.1 of the preoperative BCVA in five eyes (20.83%) at the end of follow-up. Compared with the preoperative data of 23 eyes, the final magnitude of myopia after surgery was significantly decreased ( t  = 3.527, P  = 0.002). In conclusion, this procedure can effectively treat highly myopic patients with macular retinoschisis without macular hole or retinal detachment, and might be better for maintaining central vision and preventing the occurrence of complications.     

Myopic traction maculopathy - vitreoretinal traction syndrome in high myopic eyes and posterior staphyloma

The pathology of the posterior pole in high myopic eyes is characterised by scleral thinning and staphyloma associated with structural changes of the retina. Epiretinal membranes and epiretinal traction together with partial separation of the ILM result in myopic foveoschisis and posterior tractional detachment with myopic macular holes. Foveal detachment and retinoschisis in highly myopic eyes may resolve after vitrectomy with ILM peeling: however, there is a considerable risk for the development of macular hole formation. Skleral buckling surgery is currently regaining interest and allows one to reduce the tractional forces in selected cases. While reading visual acuity is usually not regained after macular hole development, prophylactic measures should be considered for the fellow eye. Vitreous surgery might have a rationale as prophylactic treatment for highly myopic eyes at high risk of macular hole development; however, this needs to be weighed against possible surgical complications.     

Scleral infolding combined with vitrectomy and gas tamponade for retinal detachment with macular holes in highly myopic eyes

PURPOSE: To describe the effectiveness of a surgical procedure, scleral infolding combined with vitrectomy and gas tamponade, for retinal detachment caused by macular holes in highly myopic eyes. METHODS: In a pilot study, scleral infolding was performed in 5 patients with macular holes, who were selected from 10 consecutive highly myopic patients with retinal detachment caused by macular holes (8 patients) or extramacular posterior-pole holes (2 patients), treated during 1 year at Okayama University Hospital. The patients were all women, 48-77 years of age (mean = 63.4 years), who had been followed-up for 1-2 years. Selection criteria for scleral infolding were either second surgeries for reopening of macular holes (2 patients) or residual retinal detachment around macular holes after complete fluid-air exchange with drainage of subretinal fluid at the initial surgery (3 patients). Following vitrectomy and complete epiretinal membrane removal in the posterior pole, the sclera was shortened by infolding on the temporal side. Three mattress sutures with 5-0 Dacron in each quadrant, 6 sutures in total, were placed at a 7-mm anteroposterior interval with posterior sutures located as deep as possible, near vortex veins. Fluid-gas exchange was then done, with or without endophotocoagulation applied around macular holes. RESULTS: After scleral infolding, macular holes were closed, and the retina was totally attached in all 5 patients. The final visual acuity ranged from 20/2000 to 20/70. CONCLUSION: Scleral infolding is a simple and effective procedure for treating retinal detachment with macular holes in highly myopic eyes and could be used as an optional procedure of reoperation for a failed initial vitrectomy.     

扩大的内界膜剥离手术治疗高度近视伴后葡萄肿的黄斑白孔性视网膜脱离

目的 探讨扩大的内界膜剥离手术治疗高度近视伴后葡萄肿的黄斑白孔性视网膜脱离的效果.方法 在玻璃体切除手术中采用扩大的内界膜剥离手术(即剥离范围达到后葡萄肿边缘)治疗30只眼高度近视伴后葡萄肿的黄斑白孔性视网膜脱离的患者,其中12只眼(40%)注C3F8,18只眼(60%)注硅油.结果 27只眼(90%)视网膜复位,3只眼(10%)经再次手术后复位(P<0.05);视力改善16只眼(53.4%),不变10只眼(33.3%),下降4只眼(13.3%)(P>0.05).结论 扩大的内界膜剥离手术可有效复位高度近视伴后葡萄肿的黄斑白孔性视网膜脱离,但视力提高无显著性差异.     

高度近视黄斑孔性视网膜脱离手术探讨

目的 评价黄斑加固联合内界膜剥离、注气治疗早期高度近视黄斑孔性视网膜脱离的效果.方法 10例10只眼早期高度近视黄斑孔性视网膜脱离进行了黄斑加固、玻璃体切除、内界膜剥离、玻璃体腔注气治疗.均有黄斑部视网膜脱离,眼轴长度均超过27.0 mm,均有黄斑全层破孔.视网膜已僵硬者排除在外.术后随访6～18个月.结果 10只眼初次手术后,视网膜全部复位.但1只眼1月后视网膜再次脱离,再次行玻璃体腔注气术后视网膜复位,黄斑孔未闭合.10只眼中有5只眼黄斑孔闭合;5只眼黄斑孔部分区域闭合,部分组织缺损（1个月后黄斑孔周围行激光封闭）.术中未见医源性裂孔形成,术后1只眼玻璃体积血,2周后自行吸收.余术后无眼内出血或眼内炎等严重并发症发生.结论 黄斑加固联合内界膜剥离注气术是治疗早期高度近视黄斑孔性视网膜脱离安全有效的手术方法.能提高视网膜解剖复位率、黄斑孔闭合率.     

Scleral resection technique combined with vitrectomy for a macular hole retinal detachment in highly myopic eyes

PURPOSE: To evaluate scleral resection technique combined with vitrectomy for macular hole retinal detachment of highly myopic eyes. MATERIALS AND METHODS: Seventeencases (17 eyes) of macular hole retinal detachment in highly myopic eyes, in which the patient underwent vitrectomy combined with scleral resection technique formacular hole retinal detachment between January 1996 and December 2003 at Fukuoka University Chikushi Hospital, were studied.Following pars plana vitrectomy, as much as possible of the residual vitreous and/or epiretinal membrane was removed. A scleral resection was performed in 2 quadrants of the equatorial region of the temporal sclera. Finally, a fluid-air exchange with SF(6) gas injection was performed to achieve retinal attachment. Pre- and postoperative axial length of the eyeballs were measured by B-scan ultrasonography. RESULTS: All cases had the retina reattached at the initial surgery, and visual acuities were stabilized or improved after the surgery. The posterior staphyloma became obscure in 13 out of 17 eyes (76.8%). The macular hole closed in 14 of 17 eyes (82.4%) ophthalmoscopically. There were no cases in which retinal redetachment occurred during follow-up periods of more than 6 months. CONCLUSION: In cases of macular hole retinal detachment of a highly myopic eye, scleral resection technique combined with vitrectomy changed the shape of the eyeballs and allowed successful retinal reattachment at the initial surgery.     

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。     

后巩膜加固术治疗近视牵引性黄斑病变

目的探讨改良后巩膜加固术治疗近视牵引性黄斑病变（MTM）的安全性和疗效。方法回顾性系列病例研究。观察分析30例（52眼）行改良后巩膜加固术的MTM患者的临床资料,其中高度近视黄斑劈裂（MF）14例（26眼）,黄斑脱离不合并黄斑裂孔（MD）11例（19眼）,黄斑脱离合并黄斑裂孔（MHMD）5例（7眼）。所有患者均行改良后巩膜加固联合前房穿刺放液术。手术前后各组视力和眼轴长度比较采用配对t检验。结果术前和术后3个月平均最佳矫正视力：MF组为0.82±0.15和0.58±0.24（t=7.552,P＜0.001）,MD组为1.06±0.17和 0.71±0.27（t=7.120,P＜0.001）,MHMD组为1.78±0.22和0.91±0.21（t=17.571,P＜0.001）,术后视力较术前改善,差异均有统计学意义。术前和术后3个月平均眼轴长度为（29.59±1.57）mm和（27.60±1.35）mm,眼轴缩短（1.99±0.63）mm,差异有统计学意义（t=22.880,P＜0.001）。MHMD患眼视网膜均复位,4眼（4/7）裂孔闭合。所有MD患眼及21只MF患眼视网膜复位,余5只MF患眼病情明显改善。术后并发症包括疼痛、结膜损伤、视物变形或变形加重等。结论改良后巩膜加固术治疗MTM安全有效,在临床上可考虑首选。