眼内填充物的有效性及安全性评价的Meta分析

目的：系统评价国内临床上玻璃体视网膜手术时常见眼内填充物的有效性和安全性。
　　方法：通过计算机检索 CNKI、万方全文数据库、维普文献数据库收录的玻璃体切除手术与眼内填充物的随机对照和回顾性对照临床试验。在得到相关文献后,我们按照预先设定的标准纳入能够用来做分析的数据。最后,采用Comprehensive meta - analysis software version 2软件进行Meta 分析,以评估针对眼内填充物修复视网膜脱离的有效性和安全性。
　　结果：纳入分析的文献有36篇,共计5092眼。 Meta 分析结果显示：(1)玻璃体切除术后修复视网膜脱离所采用的眼内填充物,硅油的视网膜修复效果比 C3 F8和 SF6都好,且有统计学意义( OR =1.76,95% CI：1.19~2.60,P =0.0047;OR=4.68,95% CI：1.48~14.81,P =0.0087)。(2)在填充术后所引起的白内障风险上,硅油填充物明显高于 BBS(OR=3.24,95% CI：2.10~4.99,P =1.09E-7)和 C3 F8(OR =3.03,95% CI：1.50~6.10,P =0.0019)。(3)在填充物增加术后眼压升高风险上,硅油比 BBS 具有显著升高的风险( OR =6.74,95% CI：3.38~13.41,P =5.67E-08),同时 C3 F8也比 BBS 具有显著升高的风险(OR=4.79,95% CI：2.37~9.68,P =1.29E-05)。另外,硅油与重硅油相比风险则显著得小一些(OR =0.16,95%CI：0.08~0.53,P=0.0026)。
　　结论：治疗视网膜脱离的玻璃体视网膜手术所采用的眼内填充物,主要分为液体和气体两大类;其中以硅油为主的液体填充物在修复视网膜脱离的有效率高于以 C3 F8和SF6为主的气体。但是硅油填充术后并发症风险高于其他类型的眼内填充物。     

Vitreon眼内短期填充的并发症分析

目的：评价过氟氢菲（Perfluoroperhydrophenanthrene,PFPh.又名Vitreon）液体作为眼内短期填充物在复杂性玻璃体视网膜手术中应用的临床疗效、并发症。方法：分析6例（6只眼）复杂性视网膜脱离的患者，行经睫状体平坦部玻璃体切除、Virteon眼内填充，裂孔周边部的激光光凝等手术治疗。Vitreon眼内填充4周后行取出术后，随访6个月以上的临床资料。结果：手术中，所有患眼视网膜均解剖复位成功。术后4周取出Vitreon，所有患眼视网膜均保持解剖复位。术后患者视力均有不同程度的提高。Vitreon眼内填充期间，产生的并发症包括Vitreon进前房（2例）、晶状体后囊下沉着物形成（3例）、高眼压（2例）、葡萄膜炎（2例）等。其中1例高眼压患者的病理结果显示Vitreon能引起房水结晶样改变和小梁网变性。取出Vitreon后，以上部分并发症可获得好转或消除。结论：Vitreon眼内短期填充能提高复杂性玻璃体视网膜手术中视网膜复位的成功率，但填充4周会产生一定的并发症。其临床应用应慎重考虑其适应证。     

前房残留全氟化碳液临床分析

目的：探讨全氟化碳液前房内残留的临床表现、预后及引起角膜损害的原因。方法：分析7例行全氟化碳液辅助的玻璃体视网膜手术手前房内全氟化碳液残留的病例。其中裂孔性视网膜脱离5眼,外伤性视网膜脱离2眼。结果：全部7眼中左右眼出现了角膜水肿,经取出后角膜全部恢复透明,其中1眼远期有角膜深层新生血管形成,4眼角膜及前房无异常反应。结论：全氟化碳液残留于前房易引起角膜毒害,术后应有时取出,防止引起更严重的并发症。     

全氟化碳液的临床应用及并发症

全氮化碳液具有良好的理化性质，在眼科应用广泛，可用做一些复杂的眼内手术辅助工具，又可用于眼内短期填充。但大多全氟化碳液对眼组织具有毒性作用，长期眼内存留可引起严重并发症。     

玻璃体切割联合内界膜剥离术治疗IMEM不同眼内填充物的临床观察

目的:探讨玻璃体切割联合视网膜内界膜剥离手术治疗特发性黄斑前膜(idiopathic macular epiretinal membrane,IMEM)术不同眼内填充物术后疗效及并发症的观察。方法:回顾性分析特发性黄斑前膜患者44例44眼。患者随机分成A、B两组,其中A组20例;B组24例,两组患者均行玻璃体切割联合视网膜内界膜剥离手术,A组玻璃体腔内行平衡盐溶液(BSS)填充,B组行气体填充(13眼填充滤过空气,11眼填充100mL/LC3F8),术后随访12～16(平均13)mo。术前、术后1,3,6,12mo检查最佳矫正视力(BCVA),光学相干断层扫描(OCT)测量黄斑中心凹厚度(CFT),术后1,7d;1,3mo行眼压(IOP)检查,对比观察手术前后视力,间接检眼镜,CFT,IOP检查结果。结果:末次随访时两组患眼BCVA较术前显著提高,提高0.2logMAR及以上者29眼(66%)。两组间logMARBCVA的差异手术前(0.53±0.18vs0.52±0.14)及末次随访时(0.31±0.14vs0.28±0.09)均无统计学意义(P>0.05)。末次随访时A、B组患眼CFT较术前明显降低,从407.82±97.00μm下降到285.25±70.07μm(Z=4.29,P<0.05)。两组间CFT的差异术前(409.45±108.40μmvs406.46±88.76μm)及末次随访时(287.60±66.94μmvs283.29±73.95μm)均无统计学意义(P>0.05)。术后1d,A组眼压(14.25±3.06mmHg)低于B组(17.71±3.20mmHg),差异有统计学意义(Z=3.12,P<0.05),但两组眼压均值均未超过正常范围(10～21mmHg)。术前、术后7d;1,3mo两组间眼压差异均无统计学意义(P>0.05)。A组患者术后无需俯卧位,B组患者填充滤过空气者术后俯卧位1～3d,填充100mL/LC3F8者俯卧位至少7d。结论:玻璃体切割联合视网膜内界膜剥离手术治疗特发性黄斑前膜手术末填充BSS或气体均能显著提高视力、降低黄斑中心凹厚度,两者的临床疗效无显著差异,但填充BSS可避免术后俯卧位,减轻患者术后身体及精神负担,同时手术更加快捷、安全。     

全氟全氢菲在猕猴玻璃体腔内充填的实验研究

目的:评估 全氟全氢 菲(perfluoroperhydrophenan-threne,即 vitreon)在猕猴玻璃体腔内充填对视网膜的毒性作用和眼前段的影响。方法:对 4 只猕猴 8 眼进行三通道玻璃体切除术,术毕于 1 眼玻璃体腔内注入平衡盐液作为对照,在7 眼内注入 vitreon1mL 分别达术后 2,4wk (各 2眼),,,9wk(各 1 眼)。观察术后眼前段和玻璃体 5 6腔内炎症反应,测量术前、术后眼压,并做荧光素眼底血管造影检查,最后对视网膜组织行光镜和透射电镜检查。结果:所有眼在术后1wk内均表现为轻度的炎症反应,vitreon在玻璃体腔内形成分散的小泡。整个实验过程角膜和晶状体均透明。术后眼压与术前相比无显著变化。各时期荧光素眼底血管造影显示无血管渗漏,光镜检查视网膜大体结构和房角结构正常,透射电镜显示vitreon在玻璃体腔内存留2wk时上、下方视网膜内节即出现线粒体肿胀,下方视网膜双极细胞和神经节细胞轻度肿胀,且随充填时间延长损害加重。经统计学分析,上、下方视网膜损害差别无显著性意义(P >0.05)。结论:全氟全氢菲在猕猴玻璃体腔内存留9wk对眼前节和视网膜微循环没有影响。充填2wk可致视网膜超微结构的改变,损害主要累及视网膜内节和双极细胞、神经节细胞,故不适于术后较长时间的充填。     

兔眼玻璃体切割术后不同填充物晶状体混浊情况的实验研究

目的 观察兔眼单纯玻璃体切割术(平衡盐溶液填充)及玻璃体切割联合玻璃体腔硅油或C3F8气体填充后晶状体的混浊情况.方法 选用30只日本大耳白兔,左眼为术眼,随机分为3组,每组10只,A组为玻璃体切割联合玻璃体腔填充硅油组;B组:玻璃体切割联合玻璃体腔填充C3F8气体组;C组玻玻璃体切割联合玻璃体腔填充平衡盐溶液组;D组:随机抽取10只对侧未手术眼作为正常对照组.观察术后第3天、第7天、第15天、第30天、第60天各组兔眼压变化及晶状体混浊情况.结果 A组在术后7d时眼压明显升高为(16.49±2.67) mmHg(1 kPa=7.5 mmHg),与术前眼压比较差异有统计学意义(P＜0.05),B组在术后3d时眼压升高至(15.45±2.29)mmHg,与术前眼压比较差异有统计学意义(P＜0.05),C组各时间与术前眼压比较差异均无统计学意义(均为P＞0.05).A组在术后7d有3眼出现晶状体混浊,随着时间的推移最终有7眼出现晶状体混浊;B组在术后3d时有2眼出现晶状体混浊,术后7d时为7眼,术后30d后有3眼混浊的晶状体逐渐转为透明;C组在术后15 d和30d时有2眼出现晶状体混浊,正常对照组未发现晶状体混浊.A组和B组与其他两组术后晶状体混浊率比较差异有统计学意义(均为P＜0.05).结论 兔眼玻璃体切割联合玻璃体腔硅油或C3F8气体填充后眼压均有不同程度的升高;玻璃体腔填充物及眼压的改变导致眼内微环境的改变,造成晶状体混浊的发生.     

全氟萘烷液在眼内应用的实验研究

目的 探讨全氟萘烷(PFDL)在眼内存留不同时期眼组织结构、电生理改变及相关损伤机制.方法 选择白兔前房及玻璃腔内填充不同数量的PFDL,分别于术后6h、24h、72h、7d、30d、60d,对角膜和视网膜进行透射电镜检查,及角膜内皮镜和电生理检查.结果 术后24h到术后7d,观察到的病理改变为细胞水肿等变性反应;术后第30d、60d出现角膜内皮细胞密度显著下降,b波的振幅显著降低,角膜上皮及实质细胞坏死,细胞内质网扩张、脱颗粒,视网膜感光细胞膜盘变性、萎缩和坏死,细胞间及神经纤维层树突水肿等严重的不可逆的病理改变,在角膜内皮细胞和视网膜感光细胞发现有髓磷体的存在.结论 PFDL在眼内存留24h以上对视网膜及角膜有一定的毒性作用,其毒性作用机制与PFDL的重力压迫作用、产生自由基和PFDL破坏组织细胞的能量代谢有关,临床上不宜作眼内长期填充物.     

全氟萘烷液在眼内应用的实验研究

目的 探讨全氟萘烷(PFDL)在眼内存留不同时期眼组织结构、电生理改变及相关损伤机制.方法 选择白兔前房及玻璃腔内填充不同数量的PFDL,分别于术后6h、24h、72h、7d、30d、60d,对角膜和视网膜进行透射电镜检查,及角膜内皮镜和电生理检查.结果 术后24h到术后7d,观察到的病理改变为细胞水肿等变性反应;术后第30d、60d出现角膜内皮细胞密度显著下降,b波的振幅显著降低,角膜上皮及实质细胞坏死,细胞内质网扩张、脱颗粒,视网膜感光细胞膜盘变性、萎缩和坏死,细胞间及神经纤维层树突水肿等严重的不可逆的病理改变,在角膜内皮细胞和视网膜感光细胞发现有髓磷体的存在.结论 PFDL在眼内存留24h以上对视网膜及角膜有一定的毒性作用,其毒性作用机制与PFDL的重力压迫作用、产生自由基和PFDL破坏组织细胞的能量代谢有关,临床上不宜作眼内长期填充物.     

Early experiences with soft intraocular implants

The author recounts his early experience with implants for the posterior chamber made of silicone. While the numbers are small the visual results appear to be satisfactory. The results, however, are marred by an as yet unacceptable rate of post-operative complications.     

Characterizing reflections from intraocular lens implants

OBJECTIVE: To develop a test method for characterizing glare from intraocular lenses (IOLs) and to confirm a clinical finding that the haptic insertion in the optic of a three-piece IOL produces extraneous line images. METHOD: The method consists of directing a collimated Gaussian laser beam to various parts of the IOL to be tested in a water-filled model eye. Reflected images produced in the retinal plane are photographed with a digital camera. RESULTS: A test method was developed to characterize the source of glare images from IOLs. The test method developed was used to confirm a clinical finding that the haptic insertion in the optic of a three-piece IOL produces extraneous line images. CONCLUSIONS: The method developed can be used to characterize and pin point the source of extraneous glare images from intraocular lens implants. The haptic insertion in the optic of a three-piece IOL has been identified as a source of line images.     

Tissue toxicity of laser-damaged intraocular lens implants

Because of close proximity to the posterior capsule, the posterior chamber intraocular lens is frequently damaged when capsulotomy is performed using the Nd:YAG laser. Damage to the optic or haptics of an intraocular lens may release substances potentially toxic to intraocular tissues. We found that injection molded intraocular lenses experimentally damaged using multiple YAG laser burst at energy levels of 10 mJ or greater released compounds which caused cell death to cultures of human conjunctival epithelial cells, retinal pigment epithelial cells, choroidal cells, and retinoblastoma cells. No cytotoxic effect was seen at energy levels of 2 and 5 mJ.     

Correction of aphakia with intraocular lens implants

40 cases of intraocular lens implants are reported. 33% had an optimal post-operative vision of greater than 1.0; 56% and larger than or equal to 0.9 and 84% 0.5 or better. After a postoperative follow-up of 1 month to 32 months, mean 15.1 months, the patients were all satisfied with the pseudophakic eye, and no endothelial corneal dystrophy, chronic uveitis or glaucoma was detected. Several minor post-operative complications were seen, most without consequence. One case had recurrent iridial haemorrhages.     

Folding and inserting silicone intraocular lens implants

A two-forceps system for folding and inserting silicone lens implants and the method for using them is described. Other methods and instruments currently available are reviewed, and requirements for folding and inserting silicone intraocular lenses are discussed.     

Direct vitreous reaction to intraocular lens implants

Three intraocular lens implants removed during keratoplasty between 1 1/2 and 5 years after implantation revealed attachments of reactive vitreous strands and membranes contained bundles of fibers with associated small bipolar cells, pigment, and blood remnants. Some of the fibrous vitreous strands were wound around the haptics of the implants for firm anchoring. The usual reactive cell membranes on the surface of the implants were interrupted in the areas of the attachment of formed vitreous and vitreous membranes.     

Initial clinical studies with silicone intraocular implants

Initial clinical studies with 117 silicone implants are presented. Techniques of implantation including flat insertion, bar-style folder, and syringe-style inserter are discussed. Visual results were compared with results after polymethylmethacrylate (PMMA) lens implantation and were equal if not better. Eliminating patients with preoperative pathology, best corrected visual results of 20/40 or better occurred in 96% of eyes with silicone implants and 88% with PMMA implants. Complications included "Z" dislocations because of inadvertent haptic placement in the bag and one case of severe uveitis and common transient pigment in the anterior chamber. In 37.5% of cases, posterior capsular opacities significant enough to require YAG laser capsulotomy occurred.