浅谈玻璃体切割术治疗外伤性玻璃体积血

目的 观察玻璃体切割术治疗外伤性玻璃体积血的效果。方法 用玻璃体切割术治疗外伤性玻璃体积血58例（58眼），受伤时间5h～1个月，伴有眼内异物30例。结果 眼内异物均一次取出，3例取出异物后发生视网膜脱离，经再次手术后复位。58例患者中4l例取出玻璃体后注入硅油；12例患者注入C3F8气体；5例患者注入无菌空气。术后视力在0．3以上的43例患者均是在伤后2周内接受手术治疗，1例手术后发生眼内炎，经抗炎后保住眼球。结论 玻璃体切割手术是治疗外伤性玻璃体积血的最可靠、最有效的方法，伤后2周为最佳手术时间。     

玻璃体切割术治疗玻璃体积血的疗效观察

目的观察玻璃体切割术治疗玻璃体积血的疗效。方法分析我院自2004年以来收治的玻璃体积血患者25例（25眼），其中视网膜静脉阻塞（RVO）10例（10眼），糖尿病视网膜病变（DR）8例（8眼），眼外伤5例（5眼），孔源性视网膜脱离（RD）2例（2眼），全部患者均经睫状体平坦部行闭合式巩膜三通道玻璃体切割术，其中20眼联合行视网膜光凝术，3眼联合硅油填充术，5眼行C3F8注气术，5眼联合巩膜外环扎术。结果术后随访6个月以上，25例患者仅1例视力无提高，其余24例术后视力均较术前提高，其中1例DR患者术后发生孔源性视网膜脱离二次玻切术网膜复位。2例DR患者发生视网膜再次出血，予药物治疗，出血渐吸收。结论玻璃体切割术治疗玻璃体积血疗效明显。     

玻璃体切除术在外伤性玻璃体积血中的应用

玻璃体积血是眼外伤常见的并发症,预后不佳,致盲率高.由于玻璃体切除术的开展使预后大大改观.我院从1988年起采用玻璃体切除术治疗外伤性玻璃体积血41例,报告如下:一般资料:本组41例41眼,右眼25例,左眼16例.男35例,女6例.年龄:4～73岁,平均28.2岁.41眼中眼球钝挫伤19眼,角膜巩膜穿孔伤9眼,眼内异物9眼,爆炸伤3眼,眼球贯通伤1眼.同时伴有外伤性白内障16眼,晶体脱位3眼.41眼术前均经过急诊处理包括修补和异物摘出等.随访期6～60月,平均11月.     

视网膜静脉阻塞性玻璃体积血的玻璃体切割手术疗效观察

目的观察玻璃体切割手术治疗视网膜静脉阻塞（RVO）性玻璃体积血的疗效。方法回顾性整理分析2006年3月至2009年6月在我院行玻璃体切割手术的玻璃体积血患者241例,其中RVO者28例（28只眼）（占11.6%）。随访6个月至2年观察患者的发病特点、视力预后、RVO相关并发症及手术相关并发症的发生情况。结果 26例患者术后视力较术前不同程度提高,占92.9%,2例术后视力保持不变,占7.1%。中央静脉阻塞11例,分支静脉阻塞17例。分支静脉阻塞术后视力好于中央静脉阻塞（P〈0.0235）。玻璃体积血时间小于2个月的患者（10例）视力预后好于2个月后手术者（18例）（P〈0.05）。玻璃体切除联合白内障超声乳化手术者较单纯玻璃体切除术者视力提高有统计学差异（P〈0.05）。结论玻璃体切割手术是治疗RVO性玻璃体积血的有效方法。手术时机一般选在经药物治疗2～3个月积血仍不吸收时进行。白内障摘除联合玻璃体切割手术治疗合并白内障的RVO性玻璃体积血是安全有效的。     

视网膜静脉阻塞玻璃体积血玻璃体切割手术时机探讨

目的探讨视网膜静脉阻塞玻璃体积血手术治疗的时机,并对治疗效果进行评价。方法对我院连续收治的63例（63只眼）视网膜静脉阻塞玻璃体积血（非糖尿病）患者进行回顾性分析。根据玻璃体积血时间分组：Ⅰ组15—30d,19只眼;Ⅱ组31～90d,24只眼;Ⅱ组〉90d,20只眼。均于术前或术后行荧光素眼底血管造影（FFA）检查以明确诊断。手术采用经睫状体平坦部玻璃体切除术（PPV）,对牵拉性视网膜脱离者联合C3F8或硅油填充,并发白内障者一期或二期行白内障超声乳化联合人工晶状体植入术。术后随访时间6～24个月。数据结果采用SPSS10．0进行统计学分析。结果患者术后最终视力：Ⅰ组平均视力0．39±0．227,Ⅱ组0．19±0．215,Ⅱ组0．14±0．148,Ⅰ组和Ⅱ组比较χ^=13．383,P〈0．01;Ⅰ组和Ⅲ组比较χ^2=13．217,P〈0．01;Ⅱ组和Ⅲ组比较χ^2=0．045,P〉0．05。结果表明：15—30d内行手术治疗最终视力明显高于〉30d手术组患者,最终视力随术前玻璃体积血时间的延长呈下降趋势。结论患者最终视力随术前玻璃体积血时间的延长呈下降趋势。15—30d内手术治疗可取得比较好的视力结果。     

玻璃体切割手术治疗不同类型玻璃体积血的临床研究

目的:观察不同原因导致玻璃体积血玻璃体切割的疗效及年龄等相关因素对玻璃体切割手术疗效影响。 方法:回顾性分析76例通过玻璃体切割手术治疗的玻璃体积血患者76眼的资料,按玻璃体积血原因、发病年龄和玻璃体积血时间分组,并进行统计学分析。 结果:在导致玻璃体积血原因中,糖尿病性视网膜病变（增生性）患者31例(41%),孔源性视网膜脱离24例(32%),视网膜分支静脉阻塞10例(13%),视网膜中央静脉阻塞3例(4%)。视网膜血管炎2例(3%),眼球钝挫伤2例(3%),单纯玻璃体积血2例(3%),增生性玻璃体视网膜病变1例(1%),息肉样脉络膜血管病变1例(1%)。各年龄组病因构成存在统计学差异（χ2=21.89,P<0.01）。年龄<45岁的青年组中,有26例,孔源性视网膜脱离导致玻璃体积血患者最多,共11例,占42%。年龄在45~59的中年组中,有19例,孔源性视网膜脱离导致玻璃体积血患者最多,共9例,占47%。年龄>60的老年组中,有31例,糖尿病性视网膜病变（增生性）导致玻璃体积血患者最多,共24例,占77%。在玻璃体积血时间分组中,各时间组术后视力存在统计学差异（χ2=2037,P<001）。1mo组共26例,术后视力主要为>0.3,共13例,占50%。2mo组共24例,术后视力主要为0.1~0.3,共10例,占42%。3mo组共11例,术后视力主要为0.01~0.09,共5例,占45%。>3mo组共15例,术后视力0.01~0.09和0.1~0.3,各6例,分别占40%。 结论：糖尿病性视网膜病变（增生性）、孔源性视网膜脱离和视网膜分支静脉阻塞是导致玻璃体积血的主要原因。玻璃体切割手术治疗玻璃体积血安全有效,可以在一定程度上提高患者视力。玻璃体积血患者在1~2mo内手术,疗效较好。     

玻璃体切割术治疗玻璃体积血21例临床分析

目的:探讨玻璃体切割术治疗玻璃体积血的临床效果。方法:采用玻璃体切割术治疗玻璃体积血患者21例21眼。观察玻璃体切割术后视力改善情况及分析导致玻璃体积血的原因。结果:本组21例患者中末次随访最佳矫正视力:数指/眼前～者4例,0.05～者12例,≥0.3者5例,脱盲率(视力≥0.05)81%,脱残率(视力≥0.3)24%;导致玻璃体出血的前三位病因分别是分支静脉阻塞、无脱离视网膜裂孔和糖尿病视网膜病变,三者共占76%。结论:玻璃体切割术治疗玻璃体积血安全有效,大部分患者术后视力可得到明显提高。     

玻璃体切割仪在重度前房积血中的应用

重度前房积血的合并症很多，最重要的是继发青光眼，其次是角膜血染。既往对重度前房积血的处理，主要采用前房冲洗术，但因凝血块充满前房，单纯前房冲洗常达不到满意的效果。我院自1998年5月以来采用玻璃体切割仪，对18例(18只眼)重度前房积血患者施行了切割及抽吸手术治疗，取得了满意效果，现报告如下。     

玻璃体内注射曲安奈德联合玻璃体切割术治疗玻璃体积血

目的探讨玻璃体内注射曲安奈德(TA)联合玻璃体切割术治疗玻璃体积血的临床应用。方法对因玻璃体积血住院手术的患者192例进行回顾性分析,比较玻璃体内注射TA联合玻璃体切割术和单纯行玻璃体切割术治疗前和治疗后ld、10d、1个月、3个月时患者的最佳矫正视力、眼压、眼内炎症反应和眼底改变。结果TA注射组在1个月、3个月最佳矫正视力高于单纯手术组,术后眼内炎症反应较单纯手术组降低,差异有统计学意义。结论与单纯玻璃体切割术比较,玻璃体内注射TA联合玻璃体切割术治疗玻璃体积血能在短期内获得更高的最佳矫正视力,并减少眼内炎症反应。     

Intraoperative Optical Coherence Tomography in Vitreoretinal Surgery

ABSTRACT

Intraoperative OCT (iOCT) is an emerging modality capable of displaying real-time OCT images to the surgeon during surgery. The use of iOCT during vitreoretinal surgery improves our understanding of the tissue alterations that occur during surgical manipulations, which may impact surgical decision-making. We review the current iOCT modalities and clinical applications of iOCT.     

iOCT在病理性近视黄斑病变手术中的应用

目的：在病理性近视黄斑病变的手术治疗中评估术中光学相干断层扫描(iOCT)的可行性,并探讨其术中应用价值。方法：回顾性系列病例研究。收集2015年5月至2017年12月期间于温州医科大学附属眼视光医院杭州院区行玻璃体切除术的黄斑前膜、黄斑裂孔、黄斑劈裂及玻璃体黄斑牵拉综合征等病理性近视黄斑病变患者。所有患眼术中均行iOCT检查,定性评估术中视网膜变化,包括术中微损伤、手术技术准确性及裂孔边缘改变等,探讨其术中应用的价值。结果：本研究共纳入29例（29眼）,男9例,女20例;年龄（58.8±10.3）岁;眼轴长度（28.9±2.0）mm。其中,黄斑前膜14眼,黄斑裂孔8眼,黄斑劈裂4眼及玻璃体黄斑牵拉综合征3眼。iOCT显示：7眼（7/29）确认术中存在微损伤或异常情况,其中神经纤维层异常6眼,内层视网膜抬高1眼;黄斑前膜患眼中4眼（4/14）确认剥膜后前膜残留;黄斑裂孔患眼中3眼（3/8）剥膜后观察到孔缘形态改变;黄斑劈裂患眼中均未观察到剥膜后全层黄斑裂孔的发生,其中1眼术前未明确的黄斑裂孔经iOCT确认;术中行保留中心凹内界膜或内界膜翻转覆盖术式的3眼在iOCT图像中均得到确认。结论：iOCT有助于术中实时评估剥膜的完整性、术中微损伤情况及手术技术的精确性,帮助主刀医师提高黄斑裂孔的诊出率,并可在术中观察到黄斑裂孔剥膜后孔缘形态的特殊改变,提示iOCT在病理性近视黄斑病变的手术治疗中有一定的应用价值。     

Anterior Segment Optical Coherence Tomography

Optical coherence tomography (OCT) is a non-contact optical signal acquisition and processing device that provides magnified, high resolution cross-sectional images of ocular tissues. Development of anterior segment OCT (AS-OCT) offers the benefits of fine resolution and noninvasive examination to investigation of anterior segment anatomy to the depth of the iris plane. This imaging device has been utilized for investigation into a myriad of corneal and anterior segment disease. Recent technological advances toward three-dimensional visualization broaden the scope of AS-OCT in ophthalmologic evaluation. The AS-OCT is a valuable imaging tool whose use in research and clinical practice will continue to expand our knowledge and management of various ophthalmic conditions.     

Optical Coherence Tomography for Neuro-ophthalmologic Diagnoses

OCT is probably one of the most revolutionary technologies that has appeared in ophthalmology in recent years. We are still trying to understand and clarify the use of OCT in neuro-ophthalmology. In this article we share our experience using various OCT devices over the last ten years, as well as the experience of others as reported in the literature.     

光学相干断层成像术及其在眼科中的应用

光学相干断层成像术(OCT)是近几年始用于临床的新型影象诊断技术。与超声成像等技术不同,它利用光波在生物组织的传播特性并检测反射光的时程延迟,构成组织横断面图象,以观察其微细结构并进行定量分析,纵向分辨力可高达10μm,并具有非接触性、非侵害性等特点。在眼科,它不仅能够对眼前节的结构进行成像,还可以对视网膜各层次结构进行清晰的显像,为多种眼内疾病、特别是青光眼的早期诊断和研究提供了一种新的有效途径。眼科学报1998;14:116—120。     

Agreement between Two Swept-Source Optical Coherence Tomography Biometers and a Partial Coherence Interferometer

PurposeTo evaluate the level of agreement between ANTERION (Heidelberg Engineering, Heidelberg, Germany), OA-2000 (Tomey, Nagoya, Japan), and IOLMaster 500 (Carl Zeiss AG, Jena, Germany).MethodsFifty-one eyes of 51 patients were included in the study. Flat keratometry (K) and steep K, vector component of astigmatism (Jackson cross-cylinder at 0° and 90° [J₀] and Jackson cross-cylinder at 45° and 135° [J₄₅]), anterior chamber depth, and axial length were compared using the three devices. Repeated measures analysis of variance was conducted to compare the mean values of the biometrics. Pearson correlation test was conducted to analyze the correlations of the measured values, and a Bland-Altman plot was used to assess the agreement between the three devices. The predicted intraocular lens power of each device was compared to the others using the SRK/T, Haigis, Barrett Universal II, and Kane formulas.ResultsAll K values measured using ANTERION were flatter than those of other instruments. However, good agreement was observed for flat K (ANTERION - OA-2000; 95% limits of agreement [LoA], 0.86 diopters [D]) and steep K (ANTERION - OA-2000; 95% LoA, 0.93 D) and OA-2000 - IOLMaster 500 (95% LoA, 0.93 D). J₀ and J₄₅ vector components of astigmatism were not statistically different; however, the agreements were poor between the devices (95% LoA ≥1.97 D). Anterior chamber depth values of ANTERION and OA-2000 were interchangeable (95% LoA, 0.15 mm). The axial length showed a high agreement (95% LoA ≤0.17 mm) among the three devices. The predicted intraocular lens powers of the three devices were not interchangeable regardless of formulas (95% LoA ≥1.04 D).ConclusionsSignificant differences in ocular biometrics were observed between ANTERION and the other two devices. This study demonstrated that only axial length showed good agreement among devices.     

Spectral-domain Optical Coherence Tomography Patterns in Intraocular Lymphoma

Purpose: To examine spectral-domain optical coherence tomography (SD-OCT) patterns in intraocular lymphoma (IOL).

Methods: Records of 13 patients (21 eyes) with IOL were retrospectively reviewed. SD-OCT was evaluated at initial visit and during follow-up.

Results: SD-OCT images at initial visit demonstrated disruption of the ellipsoid zone (8 eyes, 38.1%) and hyperreflective nodules at the retinal pigment epithelium (RPE) level (5 eyes, 23.8%). During follow-up, disruption of the ellipsoid zone (10 eyes, 47.6%) and hyperreflective nodules at the RPE level (7 eyes, 33.3%) were noted. In 5 eyes showing hyperreflective nodules at the RPE level, the hyperreflective nodules were reduced after treatment with intravitreal methotrexate.

Conclusions: Hyperreflective nodules in the outer retina and disruption of the ellipsoid zone were observed in nearly one-half of patients with IOL over time. SD-OCT may allow for early detection of small macular abnormalities and aid in monitoring of treatment efficacy in this disease.     

Methanol-induced Retinal Toxicity Patient Examined by Optical Coherence Tomography

Background

Methanol is a highly toxic substance used as an industrial solvent and automotive antifreeze. Human consumption of methanol may result in severe visual disturbances. Because optical coherence tomography (OCT) is very useful for evaluating retinal edema and nerve fiber swelling, we used OCT to examine a patient with methanol-induced retinal toxicity.

Case

A 37-year-old man who drank industrial alcohol (100?ml/day) for 4 days.

Observations

The retinal profiles were evaluated by OCT and fluorescein angiography during the course of treatment. OCT demonstrated peripapillary nerve fiber swelling and accumulation of intraretinal fluid in the acute phase. In the chronic phase, the retinal thickness was diffusely decreased. Steroid pulse therapy was not effective, and his visual acuity was 6/200 OD and 4/100 OS 2 years after the event.

Conclusion

OCT was very useful for evaluating the severity of the retinal edema and the temporal changes in the retinal profile.?Jpn J Ophthalmol 2006;50:239–241 © Japanese Ophthalmological Society 2006