增生型糖尿病视网膜病变黄斑裂孔的手术治疗

目的 评价玻璃体切割术治疗增生型糖尿病视网膜病变黄斑裂孔疗效。并分析有关因素。方法 12例增生型糖尿病视网膜病变黄斑裂孔患者接受玻璃体切割术治疗，硅油填充3眼，18?F8填充9眼，平均随访6个月（3-24个月）。结果 黄斑裂孔闭合率83%（10/12），视网膜复位率83%（10/12），术后视力提高10眼（83%，10/12），不变2眼（17%，2/12）。并发症主要包括术后短暂高眼压2眼，晶状体核硬化3眼。视网膜脱离复发2眼。结论 玻璃体切割术是治疗增生型糖尿病视网膜病变黄斑裂孔安全有效的方法。     

糖尿病性视网膜病变玻璃体切除术中保留前囊膜的二期人工晶状体植入术

目的 探讨糖尿病性视网膜病变(DR)行玻璃体切割联合晶状体切除术中保留晶状体前囊膜,二期行人工晶状体植入术的安全性和疗效.方法 回顾性分析26例(28只眼)玻璃体切割联合晶状体超声乳化、保留晶状体前囊膜,二期人工晶状体植入术治疗增生性糖尿病性视网膜病变(PDR)患者的临床资料.根据术前术后视力及并发症对手术效果进行评价.结果 随访期间所有患者术后视力均高于或接近于预期矫正视力.行二期人工晶状体植入术后,1只眼出现一过性高眼压;1只眼发生新生血管性青光眼;1只眼发生黄斑水肿和玻璃体积血.结论 保留前囊膜的玻璃体晶状体联合切割,二期行人工晶状体植入术治疗PDR安全、有效.     

内界膜剥离治疗黄斑部病变的疗效观察

目的 探讨内界膜剥离治疗黄斑部病变的疗效.方法 我院2007年7月至10月收治的黄斑部病变患者6例(6只眼),均采用玻璃体切割联合内界膜剥离(ILMP)手术方式,随访观察术前及术后1、2周,1、3个月视力、视网膜复位、黄斑孔闭合、黄斑水肿消退的情况.结果 术中内界膜剥离后黄斑区点状出血3只眼.3只眼术前有视网膜脱离病例达到视网膜解剖复位,其余病例无医源性裂孔和视网膜脱离发生.4只眼黄斑裂孔中3只眼裂孔闭合,1只眼缩小,2只眼黄斑水肿中1只眼黄斑水肿明显消退,1只眼完全消失,1只眼黄斑前膜无复发,经眼底及荧光素眼底血管造影(FFA)检查证实.术后最低视力0.08,最高视力0.6,与术前视力相比均有不同程度提高,术后视力<0.1者1只眼,0.1～0.3者3只眼,0.3以上者2只眼.除5例(1只眼)外全部病例术后视物变形均有改善.结论 内界膜剥离是治疗黄斑部病变的有效手段之一,可改善术后视力及视物变形.     

玻璃体切割术前口服荧光素钠疗效观察

目的:通过临床研究评价在玻璃体切割术中荧光素钠染色残余皮质的有效性。探讨口服荧光素钠在玻璃体切割手术(vitrectomy)中的标志作用及术后眼压、视力同对照组相比较是否有统计学意义。减少玻璃体切割术中的并发症,及对视网膜和眼内其他组织是否产生毒副反应。方法:对2009-09/2010-09在哈尔滨医科大学第一临床医院附属眼科医院行玻璃体切割术的患者中,选取增殖型糖尿病视网膜病变(PDR)或视网膜脱离等病例,以往没有眼部后节手术史,且排除全身情况影响眼部疾病及不耐受手术的患者60例60眼。所有患者于玻璃体切割术前均行全身和眼局部的常规检查,术眼行视力、眼压、裂隙灯、眼底、B超,详细了解患眼术前角膜、前房、晶状体、玻璃体、视网膜等情况。将玻璃体切割术患者60例60眼分为治疗组和对照组,其中治疗组30眼术前空腹口服荧光素钠,对照组30眼术前未口服荧光素钠。术后进行视力、眼压、裂隙灯、眼底、B超,术后随诊1mo。通过随访,观察两组视力、眼压的变化,分析其统计学意义。结果:在玻璃体切割术中,荧光素钠分散在玻璃体皮质中,可以清楚地显示残留玻璃体皮质的部位和范围,易于剥除残留玻璃体的皮质,两组在视力、眼压的变化差异无统计学意义。结论:荧光素钠可以清晰地标志残留玻璃体,具有手术安全性,未见明显不良反应。减少医源性视网膜裂孔发生率,有利于保护和恢复视功能,且对视网膜及眼内其他组织无毒性。     

23G联合20G玻璃体切割手术治疗脉络膜脱离型视网膜脱离的临床观察

目的 观察23G联合20G玻璃体切割手术治疗脉络膜脱离型视网膜脱离的临床疗效及安全性.方法 将2014年1月至2015年1月于我院明确诊断脉络膜脱离型视网膜的患眼并行23G联合20G玻璃体切割手术治疗的共37例病例37只眼纳入研究.记录术前视力、眼压及眼部病情,手术中切除玻璃体后采用硅油或C3F8气体填充玻璃体腔,术后采取面向下体位.术后平均随访4.34月,观察术后视网膜复位率、术后视力、术后并发症等情况.结果 至随访期结束,视网膜复位31例(83.7％);术后视力较术前提高,差异有统计学意义;发生一过性高眼压11例(29.7％),持续性高眼压2例;发生并发性白内障18例(48.6％)结论 23G联合20G玻璃体切割手术是治疗脉络膜脱离型视网膜脱离的安全有效方法.     

玻璃体切割术的临床疗效分析

目的:观察玻璃体切割术治疗不同类型眼底病的临床疗效。方法:回顾性分析玻璃体切割术治疗91例96眼不同类型眼底病患者的临床资料,其中增殖期糖尿病视网膜病变患者54例59眼,合并高血压病患者21例;单纯高血压性视网膜病变患者8例8眼;单纯视网膜脱离患者17例17眼;其他原因如外伤、增殖性玻璃体视网膜病变等患者12例12眼,总结患者术后视力恢复不良的原因。结果:术后随访1～6mo,术后71眼(71/96)视力均较术前有不同程度的提高,其中视力由术前光感、手动及数指提高到术后0.1以上者18眼(18/96),提高到术后0.02～<0.1者9眼(9/96),术后视力较术前无明显改善20眼(20/96),术后视力较术前下降5眼(5/96)。结论:玻璃体切割术治疗不同类型眼底病疗效明显,可使大多数患者视功能改善,并发症少,手术安全有效。     

增殖性糖尿病性视网膜病变玻璃体切割术后高眼压的研究

目的探讨玻璃体切割手术治疗增殖性糖尿病性视网膜病变(proliferative diabetic retinopathy,PDR)术后高眼压发生的相关危险因素及治疗方法。方法选取行玻璃体切割术的108例121眼PDR患者进行回顾性分析,观察术后高眼压的发生率,并对引起术后高眼压的相关因素进行统计学分析。术后早期高眼压的诊断标准为:术后2周内任何时间非接触性眼压计测眼压>21 mmH g(1 kP a=7.5 mmH g)。结果玻璃体切割术后33眼(27.27%)发生高眼压,眼内充填与平衡液充填者的发病率为32.63%和7.69%,两组比较差异有统计学意义(P<0.05)。术中行全视网膜光凝与补充视网膜光凝者的发病率分别为42.22%和18.42%,两组比较差异有统计学意义(P<0.05)。术前视网膜病变Ⅳ期、Ⅴ期、Ⅵ期组的发病率分别为12.00%、22.00%、41.30%,各组比较差异有统计学意义(P<0.05)。术前未合并视网膜脱离与合并视网膜脱离组的发病率分别为18.67%和41.30%,两组比较差异有统计学意义(P<0.05)。术中联合晶状体切除术与术中未联合晶状体切除术组的发病率为35.21%和16.00%,两组比较差异有统计学意义(P<0.05)。经Logistic回归分析发现,玻璃体切割术后早期高眼压的独立危险因素是术前合并视网膜脱离及术中眼内充填。结论术前合并视网膜脱离、术中联合晶状体切除、术中眼内充填、术中行全视网膜光凝与DR玻璃体切割术后高眼压相关,引起术后高眼压的独立危险因素为术前合并视网膜脱离及术中眼内充填。早期发现、个体化治疗可以最大程度地挽救患者的视力。     

增生性糖尿病视网膜病变手术后视力光感或无光感发生的相关因素分析

目的探讨增生性糖尿病视网膜病变（PDR）玻璃体手术后视力光感或无光感发生的相关因素。设计回顾性、非对照病例系列。研究对象242例（288眼）因PDR行玻璃体手术的患者。方法回顾2002～2006年因PDR在同仁医院接受玻璃体手术治疗的住院病例,对术后视力为光感/无光感患者的术前糖尿病视网膜病变程度、有无黄斑病变、术后玻璃体再出血、视网膜脱离、新生血管性青光眼和多次手术等因素进行分析,随访1～60个月。主要指标PDR分期、黄斑病变程度、术后并发症。结果根据最后一次随访时视力分组为无光感／光感组（14眼）、有光感组（274眼）（术后视力≥眼前手动）。两组在术前严重黄斑病变、术前PDR6期、术后玻璃体积血、视网膜脱离、新生血管性青光眼、多次手术等方面差异有统计学意义（P值分别为0．048、0．042、0．000、0．048、0．000、0．000）。结论术前严重的黄斑病变、PDR6期、术后玻璃体再出血、术后视网膜脱离、术后继发新生血管性青光眼和多次手术是糖尿病视网膜病变术后视力光感／无光感的相关因素。正确的术中处理、减少术后并发症可降低术后光感／无光感的发生率。（眼科,2009,18：251—253）     

玻璃体手术治疗严重增生性糖尿病视网膜病变合并视网膜脱离的效果

目的探讨玻璃体手术治疗严重的增生性糖尿病视网膜病变合并视网膜脱离的疗效及影响视力预后的因素。设计回顾性病例系列。研究对象北京同仁医院2004年3月-2007年3月间行玻璃体手术治疗的87例(95眼)糖尿病视网膜病变Ⅵ期患者。方法回顾上述患者住院病历,均采用传统的三通道玻璃体手术治疗,术后平均随访时间26个月,观察术后视力及眼部并发症发生情况,分析影响视力预后的相关因素。主要指标视力及眼部并发症。结果术后83眼(87%)视网膜复位。视力较术前提高44眼(46.3%),不变16眼(16.8%),下降35眼(36.8%)。手术前后视力差异有统计学意义(P=0.012)。其中60眼视网膜脱离累及黄斑,术后45%的眼视力下降。术后继发新生血管性青光眼7眼(7.4%),角膜失代偿1眼(1.1%),晶状体混浊加重52眼(54.7%)。结论玻璃体切除术治疗严重的增生性糖尿病视网膜病变合并视网膜脱离是有效的,视网膜脱离是否累及黄斑是影响视力预后的最重要的因素。     

玻璃体切除治疗合并脉络膜脱离的黄斑裂孔性视网膜脱离疗效分析

目的探讨玻璃体切除治疗合并脉络膜脱离黄斑裂孔性视网膜脱离的临床疗效。方法对确诊为合并脉络膜脱离黄斑裂孔性视网膜脱离的48例（48只眼）随机分为应用糖皮质激素联合玻璃体切除手术组和直接行玻璃体切除手术组。对比术后视力变化、眼压、脉络膜脱离复位率、视网膜脱离复位率、黄斑裂孔状态及术后并发症等。结果经一次手术38只眼视网膜脉络膜完全复位，平均视力较术前有明显改善（P〈0．05）。术后并发症包括一过性眼压升高、晶状体混浊加剧及复位不成功等。结论对于合并脉络膜脱离的黄斑裂孔性视网膜脱离，无论术前是否应用激素，术后疗效视功能相近。术前应用糖皮质激素的必要性值得探讨。及时采取玻璃体手术是一种有效的治疗手段。     

Two-year follow-up study comparing primary vitrectomy with scleral buckling for macula-off rhegmatogenous retinal detachment

PURPOSE: To compare the anatomic and visual outcomes achieved by scleral buckling and primary vitrectomy for the repair of macula-off rhegmatogenous retinal detachment. METHODS: The records were reviewed for a consecutive series of 167 patients (167 eyes) who were initially treated with scleral buckling or pars plana vitrectomy for primary macula-off retinal detachment. Patients were treated between January 1993 and December 1996. After adjustments for preoperative characteristics, data from 102 cases (55 scleral buckle cases and 47 primary vitrectomy cases) were used for the final comparison. There had been a minimum follow-up period of 24 months. RESULTS: No significant differences in single-procedure reattachment incidence (91%), final success incidence (100%) and incidence of postoperative proliferative vitreoretinopathy development (4%) were observed between the two treatment groups. Preoperative visual acuity, preoperative intraocular pressure, and duration of macular detachment were the three best predictors of postoperative visual recovery in both groups. Favorable overall visual recovery was obtained postoperatively, with no significant differences between the two groups throughout the follow-up period. However, in the eyes with poor preoperative visual acuity (<0.1), ocular hypotony (intraocular pressure <7 mm Hg), or prolonged macular detachment (more than 7 days), visual recovery in the primary vitrectomy group was significantly better (P <.05) than in the scleral buckle group from the first postoperative month. CONCLUSION: Both procedures achieved favorable anatomic and visual outcomes in the majority of patients with primary macula-off retinal detachment. Primary vitrectomy may be more effective than scleral buckling for achieving early visual rehabilitation in cases complicated by poor preoperative vision, ocular hypotony, and prolonged macular detachment.     

Different outcome among eyes with proliferative diabetic retinopathy indicated for vitrectomy

PURPOSE: The postoperative outcome was evaluated in each group of surgical indications of vitreous surgery for proliferative diabetic retinopathy (PDR), to investigate the factors responsible for postoperative visual prognosis. METHODS: Primary vitrectomy was performed in 119 eyes of 92 patients with PDR. Average postoperative follow-up period was 19 months. The indications for vitrectomy included vitrous hemorrhage in 58 eyes, macular tractional retinal detachment in 17 eyes, extramacular tractional retinal detachment in 10 eyes, macular heterotopia in 11 eyes, and progressive fibrovascular proliferation in the posterior fundus in 23 eyes. RESULTS: The visual acuity finally improved by 2 lines or more in 91 eyes (77%), remained unchanged in 10 eyes (8 %), and decreased by 2 lines or more in 18 eyes (15%). Final postoperative visual acuity was significantly better in cases of vitreous hemorrhage or progressive fibrovascular proliferation in the posterior fundus than in others. Preoperative rubeosis iridis and macular tractional retinal detachment were probably responsible for the final visual impairment, and intraocular tamponade affected the difference in visual prognosis between the groups of surgical indication. Multivariate analysis in all cases revealed that factors influencing visual outcome were preoperative rubeosis iridis and anemia. CONCLUSION: Rubeosis iridis and macular tractional retinal detachment were prognostic factors of the surgery. Vitrectomy for PDR may be effective in improving postoperative visual acuity if performed in the early stage of progressive fibrovascular proliferation in the posterior fundus after sufficient retinal photocoagulation.     

Association of preoperative vitreous IL‐8 and VEGF levels with visual acuity after vitrectomy in proliferative diabetic retinopathy

Acta Ophthalmol. 2010: 88: e311–e316

Abstract.

Purpose: To determine whether the vitreous levels of interleukin 8 (IL‐8) and vascular endothelial growth factor (VEGF) of patients with proliferative diabetic retinopathy (PDR) were associated with poor visual acuity after vitrectomy. Methods: Observational cross‐sectional study. Patient clinical characteristics and preoperative eye characteristics (63 eyes): visual acuity, iris neovascularization, vitreous haemorrhage, macular detachment, macular oedema, active retinal neovascularization, neovascularization of the disc, burned out PDR (defined as natural end stage of PDR with inactive membranes without previously performed laser photocoagulation) and panretinal photocoagulation were registered prior to vitrectomy for each patient. Vitreous VEGF and IL‐8 levels were measured using the cytometric bead array method. Poor postoperative visual acuity was defined as visual acuity of <20/200 and was checked 2 years after vitrectomy. Results: Twenty‐one of the 63 eyes (33.3%) had poor visual acuity after vitrectomy. Univariate analysis showed that vitreous levels of IL‐8, the absence of panretinal photocoagulation, preoperative macular detachment and poor preoperative visual acuity were significantly associated with poor final visual acuity after vitrectomy. A stepwise multiple logistic regression analysis showed that elevated vitreous levels of IL‐8 (p < 0.0001), macular detachment (p = 0.011) and the absence of panretinal photocoagulation (p = 0.03) were independent predictors for poor visual outcome. Conclusions: Elevated vitreous IL‐8 level could either be a marker of ischaemic inflammatory reaction, or it could play a role in deteriorating visual acuity by DR progression or both. Further studies are needed to provide better understanding of IL‐8 and inflammation involvement in visual prognosis in PDR.     

玻璃体切除联合曲安奈德治疗增生性糖尿病视网膜病变

目的:评价玻璃体切除联合曲安奈德(triamcinolone acetonide,TA)球内注射治疗增生性糖尿病视网膜病变(proliferative diabetic refinopathy,PDR)的疗效。方法:分析本院因PDR住院治疗患者90例98眼,玻璃体切除术联合TA球内注射50眼和单纯行玻璃体切除术48眼,比较两组患者治疗前后的矫正视力、眼内炎症、反应眼压和眼底等情况。结果:随访至术后6mo。TA注射组术后前房炎症反应及黄斑水肿的发生率较单纯手术组降低,其差异有统计学意义(P<0.05),术后视力改善程度及眼压升高的发生率组间差异无统计学意义。结论:玻璃体切除联合TA球内注射治疗PDR与单纯玻璃体切除术比较,可以减少术后眼内炎症反应及黄斑水肿的发生。     

玻璃体切割术治疗增生性糖尿病视网膜病变

目的观察玻璃体切割术治疗增生性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)的临床疗效。方法回顾性分析行玻璃体切割术治疗的71例(76眼)PDR患者临床资料,观察术后视力及并发症情况,并对PDR不同分期患者的术后视力进行对比,总结影响术后视力恢复的因素。结果术前视力:光感3眼,手动24眼,数指13眼,0.02～0.1者20眼,≥0.1者16眼;术后视力:光感1眼,手动6眼,数指16眼,0.02～0.1者10眼,≥0.1者43眼;手术前后视力差异有显著统计学意义(P=0.000)。其中Ⅳ期、Ⅴ期、Ⅵ期患者中分别有20眼、18眼、16眼术后视力不同程度提高,手术前后视力差异均有统计学意义(P=0.001、0.025、0.036)。术后并发症有角膜水肿伴硅油继发性青光眼,前房纤维素性渗出,玻璃体再次积血,黄斑区及周围视网膜点状出血、渗出等。结论玻璃体切割术疗效明显,可改善大多数患者视功能,是治疗PDR的安全、有效方法。     

Silicone oil in the surgical treatment of traumatic endophthalmitis

PURPOSE: To explore the effects of vitrectomy combined with silicone oil injection in the treatment of traumatic endophthalmitis without retinal detachment, and analyze the relative factors. METHODS: Eighteen eyes of 18 patients with traumatic endophthalmitis and without retinal detachment received the treatment of vitrectomy combined with silicone oil filling. Silicone oil removal combined with intraocular lens implantations were performed in all eyes 6 months postoperatively. The visual acuity was measured by logMAR values. Preoperative visual acuity ranged from light perception to 0.1. The mean preoperative intraocular pressure was 9 mmHg with a range from 5 to 25 mmHg. Follow-up ranged from 6 to 43 months with a mean of 18 months. RESULTS: The postoperative visual acuity ranged from light perception to 0.8 at the last follow-up examination. The visual acuity increased in 15 eyes (83%), and was stable in 3 eyes (17%). The mean postoperative intraocular pressure was 17 mmHg with a range from 10 to 20 mmHg, and was significantly higher than preoperatively (p<0.05). There was no retinal detachment or ocular atrophy. Postoperative complications mainly included fibrosis exudates in the anterior chamber (18 eyes) and temporary intraocular pressure elevation (3eyes). CONCLUSIONS: Under treatment with systemic antibiotics, vitrectomy combined with silicone oil filling may be a reasonable alternative to standard endophthalmitis treatment using intravitreal antibiotics.     

玻璃体切割联合内界膜剥离术治疗黄斑裂孔性视网膜脱离

目的：探讨玻璃体切割联合内界膜剥离术治疗黄斑裂孔性视网膜脱离的疗效和并发症。 方法：收集我院2009-09/2011-12黄斑裂孔性视网膜脱离住院患者22例22眼。均采用玻璃体切割联合内界膜剥离手术方式。随访观察术后1,2,3d;1wk;1mo的患者最佳矫正视力、眼压。并对患者年龄和患病病程与术后1mo最佳矫正视力进行统计学分析。 结果：行气体填充13例,行硅油填充9例。患者术后黄斑裂孔封闭率100%,视网膜均解剖复位。术后最佳矫正视力随术后恢复时间逐渐提高。眼压在术后1,2,3d有升高,7d后下降逐步恢复正常。患病病程＜6mo的患者较病程>6mo的患者术后视力恢复好。黄斑裂孔患者的术后1mo最佳矫正视力与患者年龄无相关性。 结论：玻璃体切割联合内界膜剥离术是治疗黄斑裂孔视网膜脱离的有效手术方式,可提高术后视力。     

玻璃体切除硅油填充治疗无网脱外伤性眼内炎

目的探讨玻璃体切除联合硅油填充手术治疗无视网膜脱离的外伤性眼内炎的疗效,并分析相关因素。方法18例(18眼)因外伤性眼内炎接受玻璃体切除联合硅油填充手术,其中10眼于术后6月将硅油取出,并且6眼同时植入人工晶状体。术前视力光感至0.1。眼压平均为9 mmHg(5~23 mmHg),(1 mmHg=0.133kPa)。平均随访18月(3~43月)。结果术后视力手动至0.8,视力提高15眼(83.33%),不变3眼(16.67%)。眼压平均为17 mmHg(10~20 mmHg),显著高于术前眼压(P<0.05)。无视网膜脱离或眼球萎缩。并发症主要包括前房炎性渗出(16眼),术后短暂高眼压(3眼)。结论玻璃体切除联合硅油填充手术是治疗无视网膜脱离的外伤性眼内炎安全有效的方法。     

A comparative study of visual outcomes following primary vitrectomy and scleral buckling procedures to manage macular off rhegmatogenous retinal detachments

PURPOSE: To determine the difference between two types of retinal detachment surgery in postoperative visual recovery in the management of macular-off rhegmatogenous retinal detachment. METHODS: We evaluated retrospectively the postoperative visual acuity (VA) in 37 patients who underwent primary vitrectomy (group V) and 39 patients treated with conventional scleral buckling (group S). RESULTS: Although the mean preoperative VA in group V (0.03) was significantly worse (p = 0.04) than that in group S (0.06), there was no statistically significant difference between the groups in postoperative VA throughout the follow-up period. However, in the cases with poor preoperative VA (VA < 0.1), ocular hypotony (IOP < 7 mmHg), or prolonged macular detachment (duration > 7 days), the visual recovery was significantly better (p < 0.05) in group V than in group S from 1 month postoperatively. There were more eyes with a final VA of more than 0.5 in group V than in group S. When considering only the eyes with lenses spared intraoperatively, postoperative cataract progression resulting in secondary visual reduction was statistically significantly greater (p < 0.01) in group V (62%) than in group S (8%). CONCLUSIONS: Primary vitrectomy is effective to attain early visual rehabilitation, especially to manage macula-off retinal detachments with poor preoperative VA, ocular hypotony, and prolonged macular detachment. To prevent a secondary visual reduction, cataract surgery combined with vitrectomy is recommended in selected cases.     

Vitrectomy results in proliferative diabetic retinopathy

To evaluate the effectiveness of vitrectomy on eyes with proliferative diabetic retinopathy (PDR). · METHODS: A total of 139 eyes of 93 cases with PDR underwent vitrectomy and were followed up for 3-24 months (16.72±8.53 months; mean±SD). The visual acuity and the factors causing recurrence of operation were analyzed. · RESULTS: The visual acuity was improved in 98 eyes (70.50%) after vitrectomy. The mean postoperative visual acuity was significantly better than the mean preoperative visual acuity. The main reasons for the failure of operation were retinal detachment and maculopathy. · CONCLUSION: These results demonstrate that vitrectomy is generally an effective procedure in treating PDR