增殖性玻璃体视网膜病变的玻璃体手术治疗

目的 评估玻璃体手术治疗增殖性玻璃体视网膜病变的疗效。方法 Ｃ２级以上ＰＶＲ合并视网膜脱离２１眼，特发性ＰＶＲ１４眼，外伤性ＰＶＲ７组，Ｃ级９眼，Ｄ级１２眼，均作常规玻璃体切除术联合环扎、膜剥离、视网膜切开、气体或硅油填充等附加术式。结果随访２～９个月，视网膜复位１５眼（７８．９％），视力提高２０眼（９５．２％）。４眼手术失败，均系ＰＶＲ再次复发所致。结论 现代玻璃体手术是治疗严重ＰＶＲ的理想术     

马凡综合征并发视网膜脱离的手术治疗

目的 探讨不同手术方法对马凡综合征并发视网膜脱离（ＲＤ）的疗效。方法 对３０例３５眼马凡综合症并发ＲＤ病人行手术治疗，手术方法分４种。术后观察３月，进行效果统计分析。结果 术后３月视网膜复位率为２５／３５（７１．４％），其中ＰＶＲＢ～Ｃ１－２级、ＰＶＲＣ３级、ＰＶＲＤ级视网膜复位率分别为６／８（７５％）、２／４（５０％）、１７／２７（７３．９％）。结论 环扎、加压术治疗马凡综合征并发ＰＶＲＢ～Ｃ１     

前部增殖性玻璃体视网膜病变的手术治疗

为探讨前部增殖性玻璃体视网膜病变（ａｎｔｅｒｉｏｒｐｒｏｌｉｆｅｒａｔｉｖｅｖｉｔｒｅｏｒｅｔｉｎｏｐａｔｈｙ，ａＰＶＲ）的手术效果，对３９例伴有ａＰＶＲ的复杂性视网膜脱离３９只眼进行玻璃体视网膜手术治疗；依手术日期先后顺序将３９只眼分为前期手术组（Ⅰ组，１９只眼）和后期手术组（Ⅱ组，２０只眼），分析不同时期的手术效果。结果：Ⅰ组和Ⅱ组视网膜完全复位分别为４只眼（２１．０５％）和１７只眼（８５％，Ｐ＜０．００５）；合计复位２１只眼（５３．８５％）。手术失败１８只眼中９只眼（５０％）为前部增殖松解不足所致。结论：对ａＰＶＲ的认识和处理能力的提高是后期手术组（Ⅱ组）视网膜复位成功率高的主要原因。     

晶体玻璃体视网膜联合手术治疗复杂性视网膜脱离

目的探讨玻璃体视网膜手术（ｖｉｔｒｅｒｅｔｉｎａｌｓｕｒｇｅｒｙ，ＶＲ术）联合晶体切除／超声粉碎的效果。方法对８１例（８１只眼）应用晶体玻璃体视网膜联合手术（ｌｅｎｔｉｃｕｌａｒ－ｖｉｔｒｅｏｒｅｔｉｎａｌｓｕｒｇｅｒｙ，ＬＶＲ术）治疗的复杂性视网膜脱离进行回顾性分析。结果解剖性成功者６４只眼（７９．０１％），功能性成功者４５只眼（５５．５６％）；手术成功率显著降低的原因是前部增殖性玻璃体视网膜病变（ｐｒｏｌｉｆｅｒａｔｉｖｅｖｉｔｒｅｏ－ｒｅｔｉｎｏｐａｔｈｙ，ＰＶＲ）（成功率４２．８６％，Ｐ＜０．０１）和术中／术后眼内出血（成功率５８．８２％，Ｐ＜０．０２５）。结论ＬＶＲ术是治疗复杂性视网膜脱离的主要方法；显著影响手术预后的因素是前部ＰＶＲ和术中／术后眼内出血。     

复杂性孔源性视网膜脱离的玻璃体视网膜手术失败原因初步探讨

目的探讨复杂性孔源性视网膜脱离的玻璃体视网膜手术失败原因。方法对４７７例（４７９只眼）复杂性孔源性视网膜脱离采用玻璃体视网膜手术（ｖｉｔｒｅｏｒｅｔｉｎａｌｓｕｒｇｅｒｙ,ＶＲ术）,即玻璃体切除、膜剥离、气液交换、惰性气体（ＳＦ６,Ｃ３Ｆ８）及硅油眼内填充。结果近期有效者３４７例（３４９只眼,７２．９％）,失败者１３０例（１３０只眼,２７．１％）。结论多因素逐步回归分析显示影响ＶＲ术近期效果的显著因素为眼内填充硅油、巨大裂孔、眼内填充ＳＦ６、医源性裂孔、前部增殖性玻璃体视网膜病变（ｐｒｏｌｉｆｅｒａｔｉｖｅｖｉｔｒｅｏｒｅｔｉｎｏｐａｔｈｙ,ＰＶＲ）、严重视网膜下增殖、ＰＶＲ、眼内填充Ｃ３Ｆ８、手术频次及脉络膜脱离     

维甲酸硅油防治增生性玻璃体视网膜病变临床研究

目的为明确维甲酸硅油（ＲＡ）对人类增生性玻璃体视网膜病变（ＰＶＲ）的作用寻求一种能有效防治ＰＶＲ的手段。方法将眼底情况相近的４０名患者４０眼分成２组；其中连续入选的２０眼，术中注入含５μｇ／ｍｌ、１０μｇ／ｍｌ维甲酸的硅油，另２０眼作为对照。结果经过２～６个月的随访，实验组与对照组在视网膜复位率和视功能方面无显著差异；实验组的增生复发率低于对照组，Ｐ＝０．０５。结论实验证实了维甲酸硅油能抑制玻璃体切割术后ＰＶＲ的复发。     

前部增殖性玻璃体视网膜病变的视网脱离及其手术治疗

目的 探讨前部增殖性玻璃体视网膜病变（ｐｒｏｌｉｆｅｒａｔｉｖｅ ｖｉｔｒｅｏｒｅｔｉｎｏｐａｔｈｙ,ＰＶＲ）视网膜脱离的临床特点及其手术治疗效果,方法 分析Ｃ～Ｄ级ＰＶＲ视网膜脱离患者８３例（８３只眼）;并针对其前部和后部病变,采用不同的手术方法进行治疗。结果 ８３例视网膜脱离患者中,前部ＰＶＲ３４只眼,占４１．０％;后部ＰＶＲ４９只眼,占５９．０％,发病年龄前者较轻,平均２８．５岁;后者３８．     

玻璃体手术治疗复杂性视网膜脱离

目的 评价玻璃体切除术治疗复杂性视网膜脱离的效果。方法 对３５例（３６眼）复杂性视网膜脱离行玻璃体视网膜手术治疗做回顾性分析。结果 ３６眼经１次或２次玻璃体视网膜联合术,总有效者３２眼（８８．９％）。术后随访３１眼,平均随访时间１０．４月,视网膜复位２７眼（８７．１％）,视网膜再脱离４眼（１２．９％）,其中视力提高２２眼（７１％）,不变５眼（１６．１％）,下降４眼（１２．９％）。结论 玻璃体视网膜     

玻璃体切除术治疗增殖型糖尿病性视网膜病变

目的 回顾性分析玻璃体切除治疗增殖型糖尿病性视网膜病谱（ｐｒｏｌｉｆｅｒａｔｉｖｅ ｄｉａｂｅｔｉｃ ｒｅｔｉｎｏｐａｔｈｙ,ＰＤＲ）的疗效。方法 对３４例（４０眼０ＰＤＲ患者（ＩＶ期１０眼,Ｖ期１４眼,ＶＩ期１６眼）行常规扁平部三切口闭合式玻璃体切除术,同时根据病情分别行晶状体超声粉碎晶状体切除、视网膜复位、眼内激光、硅油注入等。结果 随访３～３６ｍｏ（平均１８．５ｍｏ）,术后脱盲率４７．５０％     

过氟化碳液体在晶体及玻璃体视网膜手术中的应用

探讨过氟化碳液体（ｐｅｒｆｌｕｏｒｏｃａｒｂｏｎｌｉｑｕｉｄ,ＰＥＦＣＬ）在晶体及玻璃体视网膜手术（ｖｉｔｒｅｏｒｅｔｉｎａｌｓｕｒｇｅｒｙ,ＶＲ术）中的应用价值。方法应用ＰＦＣＬ（法国产过氟萘烷,ｐｅｆｌｕｏｒｏｄｅｃｌｉｎ,纯度１００％,Ｃ１０Ｆ１８）治疗２例（２只眼）晶体脱位于玻璃体内,采用玻璃体切除,ＰＦＣＬ漂浮晶体于前房,再行常规的白内障摘除术,在ＶＲ术中应用ＰＦＣＬ治疗３７例（３７只眼     

增生性玻璃体视网膜病变的发病机制及治疗研究进展

增生性玻璃体视网膜病变（proliferative vitreoretinopathy,PVR）是孔源性视网膜脱离手术常见的并发症,它是一种由多种细胞成分、玻璃体、细胞外基质以及大量自分泌或旁分泌的细胞因子的混合作用构成的复杂病理反应.胶质细胞、视网膜色素上皮细胞、视网膜色素上皮衍生细胞、成纤维细胞、成纤维细胞样细胞和巨噬细胞被认为在PVR产生的过程中起重要作用.较之PVR中固定成分和细胞组分,细胞因子如色素上皮细胞衍生因子、单核细胞趋化蛋白1、血管内皮生长因子、肿瘤坏死因子α及其受体和血小板衍生生长因子及其受体也不容忽视.PVR相关的细胞生物学和细胞因子机制仍需进一步阐明.在PVR形成之前进行临床干预将是防治本病的研究方向.5-氟尿嘧啶、低分子量肝素、柔红霉素、13顺式维甲酸等对PVR预防和治疗的临床有效性试验研究结果不尽相同.     

增生性玻璃体视网膜病变与细胞因子研究进展

增生性玻璃体视网膜病变是一种严重的眼疾,常导致视力下降甚至失明。它是孔源性视网膜脱离手术失败、复发以及眼外伤致盲的主要原因之一。其发病机制目前尚未完全明了。大多学者认为细胞因子与PVR的发生发展有密切关系。从免疫学发病机制的角度,对与PVR有关的细胞因子及其可能作用机制加以综述,从而为PVR的诊断和治疗提供新的思路和切入点。     

Use of silicone oil in the treatment of complicated retinal detachment: Results from 1981 to 1994

Purpose: To evaluate the advantages and disadvantages of the retention and removal of silicone oil in the treatment of complicated retinal detachments. Methods: The records of 344 patients (348 eyes) that underwent vitrectomy and silicone oil injection for complicated retinal detachments were abstracted and analysed. The anatomical and functional results, complications and influencing factors are discussed. The outcome in eyes after removal of the silicone oil was compared with the outcome in a comparable group of eyes in which the silicone oil was retained. Results: The overall retinal reattachment rate was 63% (220/348). The final vision of 5/300 or better was 52% (115/220) in those eyes with totally attached retinas. The silicone oil-related complications included keratopathy (23%) and secondary glaucoma (11%). Comparing removal of silicone oil with retention of silicone oil, we found: (i) there was no statistical difference in the redetachment rate (19 vs 17%); (ii) Oil-removed eyes had a better final vision (P < 0.05); and (iii) keratopathy (13 vs 23%), secondary glaucoma (11 vs 25%) and optic nerve atrophy (4 vs 18%) were significantly lower in oil-removed eyes. Conclusion: Silicone oil injection is useful in the treatment of complicated retinal detachments. For reducing the incidence of complications, early removal of silicone oil is recommended in those cases in which the retina is attached, all breaks adequately closed and traction relieved.     

Interleukin (IL)-6, Interleukin (IL)-8 Levels and Cellular Composition of the Vitreous Humor in Proliferative Diabetic Retinopathy,Proliferative Vitreoretinopathy,and Traumatic Proliferative Vitreoretinopathy

Purpose: To investigate the interleukin (IL)-6 levels, IL-8 levels, and cellular composition of the vitreous humor in patients with proliferative diabetic retinopathy (PDR), proliferative vitreoretinopathy (PVR), and traumatic PVR. Methods: Vitreous samples from 14 patients with PDR, 10 patients with PVR, and 10 patients with traumatic PVR were analyzed. Fifteen cadaver eyes were used as controls. Cytokine levels were measured by ELISA. Results: Elevated IL-6 levels were detected in the vitreous of 12 (85.7%) of the PDR patients, eight (80%) of the PVR patients, and all (100%) of the traumatic PVR patients. None of the control IL-6 results were elevated. Vitreous IL-8 levels were elevated in 12 (85.7%) of the PDR patients, six (60%) of the PVR patients, all (100%) of the traumatic PVR patients, and one (6.7%) of the control eyes. Cytological examination of the vitreous specimens revealed a predominance of macrophages (50%) in the PDR samples and a predominance of retinal pigment epithelial (RPE) cells (60%) in the PVR samples. In contrast, neutrophils predominated (88%) in the traumatic PVR samples. Conclusion: The findings suggest that IL-6 and IL-8 may be involved in the pathogenesis of PDR, PVR, and traumatic PVR. High proportions of RPE cells and macrophages are associated with elevated IL-6 and IL-8 levels in the vitreous of PDR and PVR patients; however, the fact that these cells are not predominant in traumatic PVR suggests that different immune response mechanisms may be active in the pathogenesis of these disorders.     

肝素防治增生性玻璃性视网膜病变的实验研究

本研究旨在探讨肝素对实验性增生性玻璃体视网膜病变PVR的疗效及毒性。用新鲜兔自血0．1ml注入玻璃体腔内造成PVR模型。用兔眼玻璃体内注射药物的方法观察肝素对限内纤维增生的抑制作用及肝素的毒性。结果表明：肝素对防治增生性玻璃体现网膜病变有效，玻璃体内注射肝素100IU和50IU对眼部无毒性。本研究为肝素应用于临床提供了依据。     

Tug of war: A bimanual technique for anterior circumferential proliferative vitreoretinopathy in recurrent retinal detachment

Purpose:To describe a bimanual technique, “tug of war” for managing anterior circumferential proliferative vitreoretinopathy (PVR) in eyes with recurrent retinal detachment (RRD).Methods:We retrospectively analyzed outcomes from eyes with RRD that underwent reattachment surgery using this maneuver and had a minimum of 6 months follow-up. A chandelier light was inserted for endo-illumination and the circumferential anterior PVR was tackled with two 25-gauge forceps stretching circumferential tractional membranes in opposite direction (tug of war) till they snapped.Results:Eleven eyes of 11 patients with a mean age of 38.2 ± 19.7 years underwent surgery. All eyes had advanced PVR of Grade C A Type 4 (Circumferential). The median duration of RD from the time of first surgery was 6 months (interquartile range = 3–8 months). The tug of war maneuver was successful in relieving the anterior retinal traction leading to retinal reattachment in all eyes without the need for relaxing retinotomies or retinectomies. Small iatrogenic retina tears occurred at the time of tug of war maneuver in 3 (27%) eyes at the site of maximum traction. The mean best-corrected visual acuity (BCVA) improved from 1.87 ± 0.2 logarithm of minimum angle of resolution (logMAR) to 1.3 ± 0.4 logMAR at 6-months follow-up (P = 0.04).Conclusion:The ''tug of war'' maneuver is useful for relieving circumferential anterior traction and reattaching the retina in eyes with RRD without having to resort to large relaxing retinotomies or retinectomies.     

增生性玻璃体视网膜病变膜免疫组织化学初步研究

通过对增生性玻璃体视网膜病变膜的病理,免疫组化观察,探讨巨噬细胞与ＰＶＲ形成间关系的研究途径。广泛利用免疫组化技术对玻璃体手术中获得的人眼膜进行病理学研究。结果ＰＶＲ的基本病理形态是损伤修复过程。７０％膜标本中检测出巨噬细胞。结论应进一步用免疫组化,分子生物学,免疫电镜,研究巨噬细胞与ＰＶＲ发病间的关系。     

马蹄形裂孔与增殖性玻璃体视网膜病变

裂孔性视网膜脱离术后发生严重PVR的危险眼只限于马蹄形裂孔的这些眼,为了阐明马蹄形裂孔发生PVR的机制及其两者关系.本文分析了单纯马蹄形裂孔性视网膜脱离手术失败的101眼,病例分为PVR组和无PVR组,两组病例对照比较.结果表明:玻璃体液化和后脱离是马蹄形裂孔发生PVR的基本原因.玻璃体出血、葡萄膜炎、脉络膜脱离、多次手术是PVR发生的促进因素,而裂孔后缘卷边固定与前瓣比其下暴露的色素上皮区小是PVR己发生的临床证据.因此当临床上出现玻璃体出血、葡萄膜炎、脉络膜脱离及第一次手术没成功时要警惕术后发生严重的PVR.     

Severe proliferative vitreoretinopathy and retinal detachment. I. Initial clinical findings

We studied 716 eyes of 697 patients with retinal detachment associated with the more advanced stages of proliferative vitreoretinopathy (PVR). The factors that influenced the severity of PVR and our criteria for surgical treatment were analyzed using statistical methods. The more severe cases of PVR showed a higher prevalence of cases with (1) retinal detachment exceeding 12 months' duration, (2) no retinal breaks observed, (3) the largest retinal break of a size equal to or exceeding one clock hour, and (4) poor initial visual acuity. Compared with the unoperated group, the eyes on which we subsequently operated were characterized by a greater prevalence of (1) patients with bilateral retinal detachment complicated by PVR, (2) cases with relatively recent onset of retinal detachment, (3) phakic eyes, (4) eyes without vitreous hemorrhage, (5) eyes with one or more visible retinal breaks and with smaller breaks, (6) relatively better initial visual acuity, and (7) less severe degrees of PVR.     

实验性增生性玻璃体视网膜病变动物模型的建立

增生性玻璃体视网膜病变是神网膜脱离复位术后导致视网膜再脱离的常见原因,其发病机制并未完全清楚。设计一种类似于人类增生性玻璃体视网膜病变的动物模型将有利于对其发病机制的研究。本文将对常用的PVR动物模型的机制、方法及特点进行综述。