未找到明确裂孔的原发性视网膜脱离的术式选择

目的探讨孔源性视网膜脱离术前找不到裂孔如何选择手术方式。方法回顾分析2001年1月～2004年3月我院收治的屈光间质较透明,瞳孔能散大、PVRC3级以下的原发性视网膜脱离患者,选择巩膜扣带术及玻璃体视网膜手术的术前术后视力及视网膜复位情况。结果54例54眼中,33例行巩膜扣带术,第一次手术解剖复位率有84.8%(29/33眼),21例行玻璃体视网膜手术,第一次手术解剖复位率有90.5%(19/21只眼),两组第一次手术解剖复位率在统计学上无显著性差异(p=0.437)。在巩膜扣带术组和玻璃体视网膜手术组两组术前术后矫正视力无显著性差异(p=0.392)。术后随访(3～27)月,平均8.5月,巩膜扣带术组并发症明显少于玻璃体视网膜手术组。结论对未找到明确裂孔的孔源性视网膜脱离患者,尽可能用损伤最小、操作简单的巩膜扣带术来获得最大成功机会。     

巩膜扣带术治疗孔源性视网膜脱离的临床观察

目的:观察巩膜扣带术治疗孔源性视网膜脱离的效果。方法:孔源性视网膜脱离患者94例96眼,术中直视下定位、冷凝视网膜裂孔。91眼行巩膜表面节段性外加压,其中37眼联合环扎术,另5眼单纯行环扎术。67眼进行了视网膜下液引流术,19眼在手术结束时行玻璃体腔气体充填。结果:90眼单次手术视网膜解剖复位,首次手术复位率94%,4眼再次手术后复位,手术最终解剖复位率98%。术中及术后无严重并发症发生。结论:巩膜扣带术治疗孔源性视网膜脱离安全有效。     

孔源性视网膜脱离术后黄斑形态和视力的研究

目的 观察孔源性视网膜脱离修复术后黄斑区视网膜形态及术后视力恢复情况并研究影响术后视力的相关因素.方法 收集行玻璃体手术或巩膜扣带术成功复位病例,所有病例病程少于1个月,按术前视网膜脱离是否累及黄斑区进行分类,术前和术后均行眼科常规检查和光学相干断层扫描(OCT)检查,随访半年.结果 共收集孔源性视网膜脱离101只眼,其中脱离累及黄斑区为78只眼.行玻璃体手术为36只眼,巩膜扣带术为65只眼,术后半年内均未发生并发症.术后一个月时复查OCT,在玻璃体手术组和巩膜扣带术组分别有55.56％和72.31％的患眼存在黄斑区视网膜形态异常,其中神经上皮层下积液多见.两种手术方式对术后黄斑区视网膜形态有影响(x2=23.65,P＜0.01).在巩膜扣带术组,术前视网膜脱离是否累及黄斑对术后黄斑区视网膜形态有影响(x2=30.331,P＜0.01),对术后视力提高程度有影响(F =8.150,P＜0.01).结论 视网膜脱离修复术的手术方式对术后黄斑区视网膜形态有影响.行巩膜扣带术病例如术前视网膜脱离累及黄斑,术后出现黄斑区视网膜形态异常的可能性大,术后视力恢复差.     

充气性视网膜固定术治疗巩膜扣带术后残留视网膜脱离

目的 观察充气性视网膜固定术治疗巩膜扣带术后残留视网膜脱离的疗效.方法 回顾分析我科经充气性视网膜固定术治疗巩膜扣带术后残留视网膜脱离13例(13眼)孔源性视网膜脱离或合并增生性玻璃体视网膜病变(PVR),其中PVR A级3眼,B级6眼,C1级3眼,C2级1眼;黄斑部脱离4眼.眼轴长度21.45-28.47 mm.前次手术采用单纯巩膜外加压8眼,环扎联合加压3眼,环扎联合加压、注气2眼.患眼于本次术中玻璃体腔内注入纯全氟丙烷(C3F8)气体0.5-1.0ml,术后严密观察,保持适当体位,确保气泡封闭裂孔.结果 手术后随访2-13月,12眼视网膜完全复位.1眼因PVR进展视网膜下液增多,视网膜未复位,后行玻璃体手术.手术后9眼视力提高,3眼视力不变,1眼视力下降.结论 巩膜扣带术后残留视网膜脱离可以通过充气性视网膜固定术获得视网膜解剖复位,视力改善.     

巩膜扣带术治疗孔源性视网膜脱离

目的 观察巩膜扣带术治疗孔源性视网膜脱离的疗效。方法 160例（168眼）行巩膜扣带术，术中均在双目间接检眼镜直视下定位裂孔、冷凝封闭裂孔。术后随访，观察视网膜复位情况。结果 本组病例初次手术视网膜解剖复位率94．0％。二次巩膜扣带术后视网膜解剖复位率为97．6％。结论 巩膜扣带术是治疗孔源性视网膜脱离的有效方法。合理联合视网膜下液引流、玻璃体气体填充及眼底激光光凝可提高手术成功率。     

人工晶状体眼伴有PVR C1以下孔源性视网膜脱离的手术方式选择

目的 观察比较巩膜扣带术(SB)和经睫状体平部玻璃体切除术(PPV)对伴有增生性玻璃体视网膜病变(PVR)C1级以下的孔源性视网膜脱离的人工晶状体眼的术后效果,并对该类患者的手术方式选择进行分析。设计回顾性病例系列。研究对象北京同仁医院南区就诊伴有PVR C1以下孔源性视网膜脱离的人工晶状体眼患者156例(156眼)。方法回顾患者病历资料,按手术方式分为SB组(44眼)和PPV组(112眼),记录两组患者的一般资料、眼别、视网膜脱离时间、视网膜裂孔数量及形态、PVR分期等,观察并比较两组术后6个月时视网膜解剖复位情况(首次手术复位率及最终复位率)、最佳矫正视力(BCVA)及二次手术的情况,并分析二次手术的原因。主要指标视网膜脱离复位率、BCVA及二次手术情况。结果术前SB组和PPV组在性别、眼别、视网膜脱离时间、视网膜裂孔数量及形态、PVR分期均无统计学差异(P均>0.05)。SB组和PPV组首次术后视网膜复位率分别为77.3%(34/44眼)和92.9%(104/112眼)(χ²=7.52,P=0.006)。视网膜未成功复位的患者均行二次玻璃体切除术,最终...     

充气性视网膜固定术治疗下方裂孔RRD的疗效观察

目的:评价充气性视网膜固定术联合冷凝治疗下方裂孔的孔源性视网膜脱离(rhegmatogenous retinal detachment,RRD)的疗效。方法:选取下方裂RRD 22眼纳入研究。患者术前均行最佳矫正视力(BCVA)、裂隙灯显微镜、间接检眼镜及三面镜检查确诊。所有患者行充气性视网膜固定术联合经结膜冷凝术,手术后随访6～24(平均12)mo。观察BCVA及视网膜复位率。结果:手术后经一次眼内充气性视网膜固定术,视网膜复位17眼(77%),2眼行再次眼内注气术联合视网膜激光光凝术视网膜完全复位,充气性视网膜固定术总的视网膜复位率达86%。3眼需要再次巩膜扣带术获得视网膜复位。所有病例最终复位率达100%。术后视力较术前视力明显提高(P<0.01)。结论:充气性视网膜固定术是治疗下方裂孔RRD的一种有效方法。     

急诊充气性视网膜固定联合气体下激光光凝术治疗视网膜脱离

目的: 探讨充气性视网膜固定术联合气体下激光光凝急诊治疗视网膜脱离的临床疗效、治疗适应证、并发症处理及操作技巧。方法: 分析2011-09/2012-06在我科住院治疗的,PVR级别低于C级、裂孔位于上方6个钟点位的单纯孔源性视网膜脱离患者45例45眼,行充气性视网膜固定术,术后24～48h行气体下裂孔激光光凝术。观察视网膜复位率、最佳矫正视力和并发症。结果: 平均随访10mo。一次手术成功率40眼(88.9%)。术后视网膜下小气泡2眼(4.4%),视网膜下液吸收延迟3眼(6.7%)。新发视网膜裂孔5眼(11.1%),发展为牵拉性视网膜脱离2眼(4.4%),白内障加重1眼(2.2%)。结论: 充气性视网膜固定术联合气下光凝术适用于上方6个钟点位视网膜裂孔和PVR低于C级的病例。与玻璃体视网膜手术或巩膜扣带术相比,该术式能在发现孔源性视网膜脱离后迅速进行视网膜裂孔封闭,治疗环境及医疗设备要求相对宽松,手术技巧难度较低,治疗费用低。其缺点是一次手术成功率较低,术后需要精确的体位控制和密切随访。     

直接检眼镜下行巩膜扣带术治疗视网膜脱离

目的观察直接检眼镜下行巩膜扣带术治疗原发性(孔源性)非增生性视网膜脱离的疗效。方法42例孔源性非增生性视网膜脱离行巩膜扣带术。手术均在直接检眼镜直视下进行,术中给予准确的裂孔定位,适度的冷凝,放液或不放液和恰当的放置外垫压物。术后随访,观察视网膜复位情况、视力、眼压及并发症。结果视网膜复位40眼(95.24%),失败2眼(4.76%)。术后视力提高39眼,不变2眼,下降1眼。眼压升高3眼,服药后恢复正常。冷凝过度1眼。结论巩膜扣带术治疗原发性(孔源性)非增生性视网膜脱离简单可靠。直接检眼镜直视下手术成功率较高。     

巩膜扣带术治疗孔源性视网膜脱离的临床观察

目的:观察巩膜扣带术治疗孔源性视网膜脱离的效果。方法:孔源性视网膜脱离患者192例195眼,术中直视下定位、冷凝视网膜裂孔。131眼行巩膜表面节段性外加压,其中37眼联合环扎术;另64眼单纯行环扎术。145眼进行了视网膜下液引流术;16眼在手术结束时行玻璃体腔气体充填。结果:单次手术视网膜解剖复位185眼,首次手术复位率94.9%。术后视力较术前显著提高,且差异有统计学意义(P<0.05)。术中及术后无严重并发症发生。结论:巩膜扣带术治疗孔源性视网膜脱离安全有效。     

Pneumatic buckle for the repair of primary rhegmatogenous retinal detachment

OBJECTIVES: This prospective study examines the effectiveness of the pneumatic buckle procedure (nondrainage scleral buckle with pneumatic retinopexy) for repair of primary rhegmatogenous retinal detachments. METHODS: We studied 58 consecutive patients with primary rhegmatogenous retinal detachments who underwent a pneumatic buckle with air or SF6. The procedures were performed at 2 centers. Retinal reattachment and visual acuity were examined. RESULTS: The single operation reattachment rate for patients undergoing a pneumatic buckle procedure was 95%. Eighty eight percent of patients with macula-on detachment had unchanged or improved final visual acuity. Sixty seven percent of patients with macula-off detachments had a final visual acuity between 20/20 and 20/50. Twenty nine percent had final visual acuity between 20/60 and 20/200. Two patients developed a new retinal hole postoperatively. CONCLUSION: Pneumatic buckle is an effective technique for repair of primary rhegmatogenous retinal detachments caused by breaks in the superior 8 o'clock segment. This technique avoids the complications associated with the drainage portion of the traditional scleral buckle operation and results in a high rate of retinal reattachment and stable or improved visual acuity. The rate of new retinal hole formation in this study is much lower than those reported for pneumatic retinopexy.     

Pneumatic retinopexy. A multicenter randomized controlled clinical trial comparing pneumatic retinopexy with scleral buckling. The Retinal Detachment Study Group

Pneumatic retinopexy was compared with scleral buckling in a multicenter (7 centers), randomized, controlled, clinical trial with 198 patients. Admission criteria included detachments with retinal break(s) no greater than 1 clock hour in size, within the superior two thirds of the fundus, without significant proliferative vitreoretinopathy (PVR). All patients were followed for at least 6 months. Scleral buckling was compared with pneumatic retinopexy with regard to single-operation reattachment (82 versus 73%), reattachment with one operation and postoperative laser/cryotherapy (84 versus 81%), overall reattachment with reoperations (98 versus 99%), final visual acuity of 20/50 or better in eye with preoperative detachment of the macula for 2 weeks or less (56 versus 80%), PVR (5 versus 3%), and new retinal breaks (13 versus 23%). Complications, including reoperations, as measured by the "score" system, were similar. The anatomic results of the two operations were not significantly different (P greater than 0.05), but pneumatic retinopexy had less morbidity and better postoperative visual acuity (P = 0.01). Pneumatic retinopexy is recommended for cases meeting the admission criteria.     

An evidence-based analysis of surgical interventions for uncomplicated rhegmatogenous retinal detachment

PURPOSE: To evaluate the various surgical interventions available for uncomplicated rhegmatogenous retinal detachment. METHODS: Reports of controlled clinical trials of surgical interventions (pneumatic retinopexy, scleral buckling and vitrectomy) for uncomplicated rhegmatogenous retinal detachment indexed in MEDLINE from 1968 to January 2006 were included. The primary outcomes evaluated included single-operation reattachment rates, multiple reoperation reattachment rates and improvements in visual acuity (VA). RESULTS: We found five controlled trials (two randomized) comparing the efficacy of pneumatic retinopexy versus scleral buckling. The single-operation reattachment rates were higher for scleral buckling, but the final reattachment rates were similar. We found nine controlled trials (four randomized) evaluating vitrectomy. There were no statistically significant differences between retinal reattachment rates or final visual acuities, except in one randomized and one non-randomized controlled trial in which the VAs were significantly better in the vitrectomy than the scleral buckling group. CONCLUSIONS: Pneumatic retinopexy is a possible alternative to scleral buckling in the treatment of uncomplicated rhegmatogenous retinal detachment. The rates of missed or new retinal breaks after pneumatic retinopexy, however, are higher than following scleral buckling. The clinical outcomes of vitrectomy for rhegmatogenous retinal detachment compare favourably.     

Inverted pneumatic retinopexy: a method of treating retinal detachments associated with inferior retinal breaks

PURPOSE: To introduce the new approach of inverted pneumatic retinopexy for the management of rhegmatogenous retinal detachments with inferior retinal breaks. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Eleven patients presenting with rhegmatogenous retinal detachments with causative inferior retinal breaks. INTERVENTION: Sterile gas/air injection, cryopexy/laser retinopexy, with inverted positioning. MAIN OUTCOME MEASURES: Postoperative primary and final anatomical outcome, visual acuity, and complications. RESULTS: Patients were followed for a minimum of 3 months (mean, 5.1 months). Primary retinal reattachment was obtained in 10 of 11(91%) patients. One patient sustained a redetachment secondary to proliferative vitreoretinopathy, resulting in a single operation reattachment rate of 82%. Final reattachment was obtained in 11 of 11 (100%) patients. Mean visual acuity improved about 3 lines from 20/60 to 20/30, with 11 of 11 patients experiencing improvement in their visual acuity. Two patients required an additional surgical procedure to achieve final anatomic success. No new breaks were identified in the postoperative period, and no complications resulted from the pneumatical procedure. CONCLUSIONS: Inverted pneumatic retinopexy can successfully repair retinal detachments with inferior retinal breaks under appropriate conditions.     

Pneumatic retinopexy, scleral buckling, and vitrectomy surgery in the management of pseudophakic retinal detachments

BACKGROUND: To review the indications for and results of pneumatic retinopexy, scleral buckling, combined pars plana vitrectomy and scleral buckling surgery, and primary pars plana vitrectomy in the management of pseudophakic retinal detachment. METHODS: We retrospectively reviewed a series of 100 pseudophakic retinal detachments in 98 patients who were referred to a tertiary care centre for management over a 3-year period. RESULTS: Forty-one cases were treated with retinopexy procedures; 38 underwent scleral buckling surgery; 19 underwent combined pars plana vitrectomy and scleral buckling procedures; and 2 cases underwent vitrectomy only. Pneumatic retinopexy resulted in primary reattachment in 21 out of 41 cases (51%). Scleral buckling surgery resulted in primary reattachment in 32 out of 38 cases (84%). Combined pars plana vitrectomy and scleral buckling surgery was successful in 18 out of 19 cases (95%), and vitrectomy alone was successful in 2 out of 2 cases (100%). Seventy-three cases were successfully repaired after 1 procedure. In the 27 primary failures, subsequent surgery was successful in 26 cases, with a final reattachment rate of 99%. Seventy-four percent of all cases regained 20/50 or better vision. In the 61 cases of macula-off detachments, 35 (57%) regained 20/50 or better vision. INTERPRETATION: Pseudophakic retinal detachments can be successfully managed with pneumatic retinopexy, scleral buckling, and combined vitrectomy and buckling procedures with good anatomic and visual results.     

Pneumatic retinopexy. A two-year follow-up study of the multicenter clinical trial comparing pneumatic retinopexy with scleral buckling

The authors report 2-year follow-up information on 179 of 198 eyes (90%) enrolled in a previously published multicenter, randomized, controlled clinical trial comparing pneumatic retinopexy (PR) with scleral buckling (SB) for the management of selected retinal detachments. Scleral buckling was compared with PR with regard to redetachment after the initial 6-month follow-up period (1% versus 1%), overall attachment (98% versus 99%), subsequent cataract surgery (18% versus 4%; P less than 0.05), preoperative visual acuity (no significant difference), and final visual acuity of 20/50 or better in eyes with macular detachment for a period of 14 days or less (67% versus 89%; P less than or equal to 0.05). Reoperations after a failed PR attempt did not adversely affect visual outcome. After 2 years, PR continues to compare favorably with SB.     

Chronic macular detachment following pneumatic retinopexy

In a consecutive series of 73 retinal detachments managed with pneumatic retinopexy, three (4.1%) of 73 eyes sustained chronic detachment of the posterior retina involving the macula even though all retinal breaks were closed. This shallow subretinal fluid persisted for 12 to 21 months but reabsorbed spontaneously. Two cases presented with a detached macula, one of which had pre-existing macular degeneration. The other case presented with an attached macula but it became detached immediately after pneumatic retinopexy. The visual acuities in the two patients who did not have macular pathology before the development of retinal detachment were 20/50 and 20/40 even with persistent subretinal fluid under the macula. In both cases the visual acuity improved to 20/30 after resolution of the subretinal fluid. Patients with a longstanding component to the retinal detachment and small retinal breaks may be at risk of developing chronic macular detachment following pneumatic retinopexy. Pockets of subretinal fluid can persist following scleral buckling, with or without drainage of subretinal fluid. However, it is unknown whether scleral buckling has a lower incidence of this complication than pneumatic retinopexy.     

Pars plana vitrectomy,scleral buckle,and pneumatic retinopexy for the management of rhegmatogenous retinal detachment: a meta-analysis

We reviewed the literature on the efficacy and safety of pars plana vitrectomy (PPV), scleral buckle (SB), and pneumatic retinopexy (PR) for the management of rhegmatogenous retinal detachments (RRDs). A systematic search was performed on three databases from inception to September 2020. Randomized controlled trials (RCTs) comparing RRD management options were included. Meta-analysis was performed using a random effects model. Eighteen RCTs and 2,751 eyes were included. For PPV versus SB, early postoperative corrected distance visual acuity (CDVA) favored SB (weighted mean <1 month postoperatively: ~counting fingers for PPV versus ~20/260 for SB, P = 0.02), but differences were nonsignificant at other time points. There was no difference for primary reattachment (P = 0.08). PPV had a lower incidence of choroidal detachment (P = 0.004), hypotony (P = 0.01), and strabismus/diplopia (P = 0.04) but a higher incidence of iatrogenic breaks (P = 0.003) and cataract development/progression (P = 0.05) relative to SB. Combination management was nonsignificantly different relative to PPV alone for CDVA, complications and reattachment rate.In closing, PPV is associated with a slower visual recovery, but similar final visual acuity and primary reattachment rate relative to SB. Combination procedures did not improve primary reattachment rates or vision relative to standalone PPV. Heterogeneity was seen across the included trials, and further randomized trials are needed to reduce the uncertainty of these estimates.     

Laser pneumatic retinopexy for repair of recurrent retinal detachment after failed scleral buckle--ten years experience

BACKGROUND: Although pneumatic retinopexy was introduced for the repair of primary retinal detachments, we have had excellent long-term success in employing this technique along with laser photocoagulation following failure of routine scleral buckle surgery in nonvitrectomized eyes over the last 10 years. PATIENTS AND METHODS: We categorized a consecutive series of 40 eyes that failed primary scleral buckling surgery and had at least six months follow-up. Eyes were separated into two groups: those with 1) subretinal fluid persisting or developing during the first 14 days after surgery or 2) those accumulating subretinal fluid at least 14 days after initially successful anatomic reattachment of the retina. RESULTS: In these groups, 36 of the 40 eyes (90%) were successfully reattached using outpatient pneumatic retinopexy alone. Complications were limited to the production of new retinal breaks in 5 patients. The 4 pneumatic retinopexy failures were all subsequently treated successfully with either scleral buckle revision or vitrectomy. CONCLUSION: We believe that laser pneumatic retinopexy repair of recurrent retinal detachments following scleral buckle and without significant proliferation vitreoretinopathy (PVR) should be considered ahead of conventional surgical intraoperative techniques. Laser pneumatic retinopexy may be a very successful procedure for the treatment of recurrent retinal detachments after failed scleral buckle surgery. In a consecutive series of 40 eyes with recurrent retinal detachment, we were able to repair 36 with pneumatic retinopexy alone.