高度近视眼伴后巩膜葡萄肿黄斑裂孔性视网膜脱离治疗的临床研究

目的:研究高度近视眼伴后巩膜葡萄肿黄斑裂孔性视网膜脱离的临床治疗效果及不同手术方式的有效性。方法:回顾性分析2003-05/2008-05诊断治疗的高度近视眼伴后巩膜葡萄肿黄斑裂孔性视网膜脱离91眼,分析视网膜复位情况及最佳矫正视力。结果:在这些视网膜脱离的治疗中,有6种手术方式:单纯黄斑区巩膜外垫压12眼,5眼(42%)首次术后视网膜回贴;单纯玻璃体腔气体充填15眼,6眼(40%)首次术后视网膜回贴;平坦部玻璃体切除联合球内气体充填20眼,14眼(70%)首次术后视网膜回贴;平坦部玻璃体切除、视网膜前膜剥离联合球内气体充填16眼,11眼(69%)首次术后视网膜回贴;巩膜环扎、玻璃体切除、视网膜前膜剥离联合球内气体充填25眼,18眼(72%)首次术后视网膜回贴;巩膜环扎、玻璃体切除联合硅油填充13眼,10眼(77%)首次术后视网膜回贴。64眼(70%)首次手术治疗后视网膜回贴,85眼(93%)视网膜回贴。结论:玻璃体切除联合球内惰性气体或硅油填充是治疗高度近视眼伴后巩膜葡萄肿黄斑裂孔性视网膜脱离的最有效方法。     

近视眼黄斑裂孔性视网膜脱离211例

目的 探讨近视眼黄斑裂孔性视网膜脱离的手术方式的选择。方法 对211例216近视眼黄斑裂孔视网膜脱离采用单纯玻璃体腔注气术39眼,巩膜环扎和/或外垫压联合注气术118眼,玻璃体切割环扎注气术36眼,玻璃体切割环扎注油术23眼。结果 216眼中1次手术后29眼视网膜未复位,经2-3次手术后仍有9眼视网膜未复位。视力提高151眼(69.9％),不变50眼(23.2％),退步15眼(6.9％)。结论 对近视眼黄斑裂孔性视网膜脱离应根据其是否并发周边裂孔、黄斑前膜、PVR及视网膜脱离的范围选择手术方式。     

重视病理性近视眼牵拉性黄斑病变玻璃体手术时机及术式选择

黄斑病变是导致病理性近视眼患者不可逆视力损伤的主要原因, 其中牵拉性黄斑病变常需要玻璃体手术治疗。牵拉性黄斑病变包括黄斑前膜、黄斑劈裂、黄斑裂孔及黄斑裂孔性视网膜脱离等。建议对Ⅱ型黄斑前膜行玻璃体切除联合内界膜剥离术, 对黄斑劈裂行保留黄斑中心凹的内界膜剥离术, 对黄斑裂孔行内界膜瓣填充术, 对难治性黄斑裂孔性视网膜脱离行玻璃体切除联合黄斑兜带术治疗。病理性近视眼牵拉性黄斑病变是一种慢性发展性疾病, 术者要准确把握手术时机, 选择合适的术式使患者得到的收益最大化。     

重视高度近视眼黄斑裂孔性视网膜脱离的手术治疗

黄斑裂孔性视网膜脱离(MHRD)是高度近视眼的严重并发症,也是高度近视眼患者致盲的主要原因之一。手术治疗的主要目的是使视网膜解剖复位、黄斑裂孔闭合及保持或提高中心视力。巩膜外手术、内外联合手术、玻璃体腔注气术、玻璃体切除术(PPV)及玻璃体切除联合内界膜移植、翻转或填塞等手术方式在选择与应用方面仍存在较多争议。本文中笔者拟对不同MHRD手术方式的特点、预后及如何选择等方面进行探讨。     

高度近视眼黄斑裂孔性视网膜脱离手术疗效的临床分析

目的 探讨高度近视眼黄斑裂孔性视网膜脱离手术治疗的临床疗效。 方法 回顾分析149例高度近视眼黄斑裂孔性视网膜脱离患者的临床资料，将其是否伴有玻璃体后脱离（posterior vitreous detachment,PVD）分两组比较手术方式及视网膜解剖复位率和视力变化。 结果 视网膜解剖复位：两组用玻璃体手术治疗的复位率为77.9% ，非玻璃体手术为2 5.9%（P＜0.001）；不完全PVD组用玻璃体手术治疗复位率为75.5%，非玻璃体手术治疗为15.0%（P＜0.001）；用非玻璃体手术治疗完全PVD组复位率为57.1%，不完全PVD组为 15.0%（P=0.05）。视力进步：完全PVD组为68.6%，不完全PVD组为57.0%（P＞0.05）。 结论 高度近视眼黄斑裂孔性视网膜脱离应用巩膜外手术联合玻璃体切割、眼内气体填充和手术后激光光凝封闭黄斑裂孔可提高视网膜复位率。 （中华眼底病杂志，2003，19：8-10）     

高度近视眼黄斑裂孔性视网膜脱离手术的临床观察

目的探讨高度近视眼黄斑裂孔性视网膜脱离手术治疗的临床疗效.方法回顾性分析高度近视眼黄斑裂孔性视网膜脱离患者86例98眼,行4种不同手术方式的疗效,手术后随诊6～12个月,以视网膜复位情况、最佳矫正视力、术后并发症作为疗效观察的指标.结果1.单纯玻璃体腔注气术:视网膜复位率63.33％,视力改善率50.00％,并发症发生率16.67％.2.巩膜环扎和(或)外加压联合注气术:视网膜复位率76.88％,视力改善率75.00％,并发症发生率28.13％.3.玻璃体切割联合剥膜注气术:视网膜复位率80.00％,视力改善率60.00％,并发症发生率55.00％.4.玻璃体切割联合剥膜硅油充填术:视网膜复位率87.50％,视力改善率37.50％,并发症发生率87.50％.结论根据PVR(proliferative vitreoretinopathy)程度、黄斑前膜、视网膜脱离范围等合理选择术式,均能达到较好的解剖复位及功能改善.     

曲安奈德在近视性黄斑裂孔性视网膜脱离手术中的临床应用

目的:探讨近视性黄斑裂孔性视网膜脱离患者行玻璃体切割术联合视网膜复位术时利用曲安奈德识别玻璃体后皮质的临床作用。方法:对24例近视性黄斑裂孔性视网膜脱离患者,术前经前置镜、三面镜、间接眼底镜、B超等检查确定为黄斑裂孔性视网膜脱离,均伴近视,其中伴高度近视16例,伴玻璃体后脱离19例,伴脉络膜脱离3例,伴PVRC1-37例,D12例,伴视网膜下增殖条3例,伴黄斑前膜5例,其中伴后极部大片脉络膜萎缩即"白孔"18例。术中切除中轴部玻璃体后注入曲安奈德0.1mL于玻璃体腔,以此识别玻璃体后皮质及黄斑前膜,并有效清除。同时联合硅油填充18例,C2F6填充6例,手术后随访6mo～1a。结果:对24例近视性黄斑裂孔性视网膜脱离术中用曲安奈德识别玻璃体后皮质及黄斑前膜,其中19例为术前被诊为玻璃体后脱离,其中有9例黄斑区2～4PD不等的玻璃体后皮质残留,6例整个视网膜前玻璃体后皮质残留,4例为完全玻璃体后脱离。经过手术清除,术后黄斑裂孔闭合率88%,视网膜复位率88%。结论:利用曲安奈德在玻璃体切割术中的良好可视性能有效识别玻璃体后皮质残留及玻璃体后皮质劈裂,鉴别是完全的玻璃体后脱离还是玻璃体后皮质劈裂;对临床上玻璃体中weiss环的出现而确定为玻璃体后脱离须重新认识。     

高度近视眼黄斑裂孔性视网膜脱离的治疗

目的:探讨玻璃体手术治疗高度近视眼黄斑裂孔引起的视网膜脱离的疗效。方法:回顾性分析2001-03/2007-02的1组病例31例(32眼)。纳入标准为屈光不正≥-6.00D,黄斑下视网膜脉络膜萎缩的白色黄斑裂孔引起的原发性视网膜脱离,经过玻璃体手术联合硅油填充术治疗的病例,随访时间≥6mo。结果:随访时间6～12(平均8.4)mo。所有病例均行玻璃体切除联合硅油填充术、自体浓缩血小板封黄斑裂孔。8眼进行了内界膜剥除。术后最终视网膜复位29眼(91%),未复位3眼;术后视力提高22眼(69%),不变7眼(22%),下降3眼(9%)。结论:玻璃体切除术,自体浓缩血小板封孔是治疗高度近视眼黄斑裂孔性视网膜脱离的一种有效方法。     

非增生型较复杂裂孔性视网膜脱离单纯玻璃体手术后黄斑前膜形成的多因素分析

目的探讨孔源性视网膜脱离单纯玻璃体手术后黄斑前膜形成的相关因素。方法92例（92只眼）不伴有增生的复杂裂孔性视网膜脱离采用玻璃体手术治疗,观察其术后3个月和12个月后黄斑前膜的发生率,分析其与术前视力、屈光状态、病程、年龄、性别、黄斑脱离与否、气体选择等7项因素的关系。结果术后黄斑前膜的发生率3个月为8.7%,12个月为13%,黄斑前膜的发生在3个月和12个月时与术前病程、年龄、黄斑脱离与否有关。结论不伴有增生的复杂裂孔性视网膜脱离首次采用玻璃体手术,术后黄斑前膜的发生率并不低于传统巩膜扣带手术,黄斑前膜的形成与术前年龄、病程和黄斑脱离与否关系密切。     

黄斑裂孔性视网膜脱离的手术治疗进展

黄斑裂孔性视网膜脱离是危害视力最大的疾病之一。随着高度近视人群的增加,近年来黄斑裂孔性视网膜脱离的手术治疗受到越来越多的关注。本文就玻璃体腔气体填充术、玻璃体切除术、硅油填充术、黄斑裂孔周边激光光凝术、黄斑扣带术、巩膜扣带术、巩膜环扎术、视网膜前膜和内界膜剥除术、内界膜填塞术、内界膜覆盖术等应用于黄斑裂孔性视网膜脱离的方式进行综述,着重探讨其疗效和特点。     

高度近视黄斑孔性视网膜脱离手术探讨

目的 评价黄斑加固联合内界膜剥离、注气治疗早期高度近视黄斑孔性视网膜脱离的效果.方法 10例10只眼早期高度近视黄斑孔性视网膜脱离进行了黄斑加固、玻璃体切除、内界膜剥离、玻璃体腔注气治疗.均有黄斑部视网膜脱离,眼轴长度均超过27.0 mm,均有黄斑全层破孔.视网膜已僵硬者排除在外.术后随访6～18个月.结果 10只眼初次手术后,视网膜全部复位.但1只眼1月后视网膜再次脱离,再次行玻璃体腔注气术后视网膜复位,黄斑孔未闭合.10只眼中有5只眼黄斑孔闭合;5只眼黄斑孔部分区域闭合,部分组织缺损（1个月后黄斑孔周围行激光封闭）.术中未见医源性裂孔形成,术后1只眼玻璃体积血,2周后自行吸收.余术后无眼内出血或眼内炎等严重并发症发生.结论 黄斑加固联合内界膜剥离注气术是治疗早期高度近视黄斑孔性视网膜脱离安全有效的手术方法.能提高视网膜解剖复位率、黄斑孔闭合率.     

玻璃体手术治疗黄斑孔性视网膜脱离的初步报告

本文对１５例伴有玻璃体视网膜异常粘连的黄斑孔性视网膜脱离进行了玻璃体切除、视网膜前膜剥离、玻璃体注惰性气体及巩膜扣带术。术中重点在于玻璃体后界膜的分离。追踪观察６￣１２个月，视网膜解剖及功能复位率为９３．３％。根据术中所见，本文提出针对其发病机制进行有目的、有选择的治疗方案，同时注射到玻璃体后界膜对黄斑孔的形成、视网膜脱离的发生，以及增殖性玻璃体视网膜病变中的决定性作用。     

三维光学相干断层扫描在高度近视黄斑裂孔视网膜脱离复位术后的应用

目的探讨三维光学相干断层扫描（3D-OCT）在高度近视黄斑裂孔视网膜脱离复位术后的应用价值。方法应用3D-OCT观察12例12眼高度近视黄斑裂孔视网膜脱离术后黄斑裂孔的愈合状况。手术采用玻璃体切割、气液交换、硅油填充复位视网膜,术中黄斑裂孔均不行激光封闭。9例均行晶状体切除,保留晶状体前囊膜。术后1周,1、2、3、4、5、6个月应用3D-OCT观察黄斑裂孔愈合情况。黄斑裂孔未完全愈合者,在3D-OCT定位模式引导下确认裂孔位置,给予激光封闭。结果随访6～24个月,6例术后1～4个月黄斑裂孔愈合,其中2例术后1.5～2个月出现黄斑前膜;6例术后黄斑裂孔未完全愈合,其中4例黄斑裂孔边缘翘起,在3D-OCT定位模式引导下激光封闭未愈合黄斑裂孔边缘。所有患者在确认黄斑裂孔愈合后2～5个月行硅油取出术,硅油取出眼已随访3～20个月,视网膜在位。结论 3D-OCT可清晰观察黄斑裂孔全周的愈合状况。     

高度近视黄斑裂孔性视网膜脱离的玻璃体手术疗效观察

目的 研究玻璃体视网膜手术对高度近视黄斑裂孔性视网膜脱离的疗效及手术并发症.方法 回顾性分析2009年4～9月连续住院诊断为高度近视黄斑裂孔性视网膜脱离的病例,共17例17只眼,其中男6例,女11例.手术采用玻璃体切除联合长效气体或砖油充填术,术后患者保持头低位7～14d,术后随访1～6月,平均4个月.结果 黄斑裂孔闭合,视网膜解剖复位15只眼(88.2%).术后视力提高13只眼(76.5%),无变化2只眼.结论 玻璃体视网膜手术术中松解玻璃体牵引,剥除黄斑前膜,联合膨胀气体或硅油填充,提高了高度近视黄斑裂孔性视网膜脱离手术成功率.

Abstract：

Objective To investigate the efficacy ofvitreoretinal surgery for retinal detachment with macular hole caused by high myopia and surgical complication. Methods A total of 17 patients (17 eyes)with retinal detachment of macular hole caused by high myopia underwent vitrectomy from Apr. 2009 to Sep.2009 were analyzed retrospectively. Of 6 cases were male while 11 cases were female. The pars plana vitrectomy with long acting gas of silicon oil tamponade was used. After the surgery, the patients were kept lying face down at least 7-14 days. The follow-up ranged from 1 to 6 months (4 months in average). Results Macular hole closed in 15 cases, retina reattached in 15 out of 17 eyes (88.2%). Postoperative visual acuities of 13 eyes(76.5%) were improved while the other 2 eyes ofmacular hole did not change after surgery. Conclusions Vitreoretinal surgery can relax vitreous traction, peel preretinal membrane. The therapy of vitrectomy combined with C3F8 or silicon oil tamponade is safe and available to cure retinal detachment of macular hole caused by high myopia and increase the rate of success.     

Vitreoretinal surgery for macular hole after laser assisted in situ keratomileusis for the correction of myopia

AMS: To describe the characteristics and surgical outcomes of full thickness macular hole surgery after laser assisted in situ keratomileusis (LASIK) for the correction of myopia. METHODS: 13 patients (14 eyes) who developed a macular hole after bilateral LASIK for the correction of myopia participated in the study. RESULTS: Macular hole formed 1-83 months after LASIK (mean 13 months). 11 out of 13 (84.6%) patients were female. Mean age was 45.5 years old (25-65). All eyes were myopic (range -0.50 to -19.75 dioptres (D); mean -8.4 D). Posterior vitreous detachment (PVD) was not present before and was documented after LASIK on 42.8% of eyes. Most macular hole were unilateral, stage 4 macular hole, had no yellow deposits on the retinal pigment epithelium, had no associated epiretinal membrane, were centric, and had subretinal fluid. The mean diameter of the hole was 385.3 microm (range 200--750 microm). A vitrectomy closed the macular hole on all eyes with an improvement on final best corrected visual acuity (VA) on 13 out of 14 (92.8%) patients. CONCLUSIONS: This study shows that vitreoretinal surgery can be successful in restoring vision for most myopic eyes with a macular hole after LASIK.     

Disappearance of myelinated retinal nerve fibers after pars plana vitrectomy

PURPOSE: To describe a case of extramacular myelinated retinal nerve fibers disappearing after pars plana vitrectomy for an epiretinal membrane and macular edema. DESIGN: Interventional case report. METHODS: A 61-year-old African-American man with extramacular myelinated retinal nerve fibers underwent pars plana vitrectomy for an epiretinal membrane. A posterior vitreous detachment was present preoperatively. Humidified air was used. A gas bubble was placed for an intraoperative macular hole. RESULTS: Nine months after surgery, the myelinated retinal nerve fibers had disappeared. CONCLUSIONS: Loss of myelinated retinal nerve fibers may occur after vitreoretinal surgery. Possible mechanisms include postoperative nerve fiber layer atrophy or ischemia.     

Efficacy of intravitreal triamcinolone acetonide in the visualization of the vitreous during pars plana vitrectomy

PURPOSE: To retrospectively evaluate the efficacy of triamcinolone acetonide (TA) injection during pars plana vitrectomy, to facilitate the visualization of the internal limiting membrane (ILM), residual vitreous cortex (RVC) and preretinal membranes. MATERIAL AND METHODS: Pars plana vitrectomy was performed in 164 patients due to rhematogenous retinal detachment, vitreous hemorrhage, macular hole, lens luxation, endophthalmitis, intraocular foreign body, malignant glaucoma, preretinal membrane and proliferative diabetic retinopathy. After surgical separation of the posterior vitreous and removal of any visible epiretinal membrane, TA suspension was injected over the posterior pole into the vitreous cavity. Then, visualized RVC was removed and ILM peeling was performed. RESULTS: Upon intravitreal injection of TA, vitreous and ILM could be visualized by numerous particles of TA dispersed as white specks. RVC and ILM were completely removed in all patients. No complications related to the use of TA were encountered, even after complex procedures such as, vitrectomy combined with scleral buckling or phakoemulsification surgery in a long term follow up. CONCLUSIONS: Intraoperative visualization of RVC and ILM with intravitreal TA was found to be a useful adjunct to pars plana vitrectomy. This technique may facilitate both removal of epiretinal membrane and separation of vitreous, especially in patients with undetached vitreous.     

Delineation of the vitreous and posterior hyaloid using bromophenol blue

PURPOSE: To describe visualization of the vitreous and the posterior hyaloid membrane using bromophenol blue during vitrectomy for macular hole and retinal detachment. PATIENTS AND METHODS: Six patients with macular holes and four with retinal detachments were included in the study. Before and after surgery, complete clinical examination, including funduscopy and measurements of best-corrected visual acuity and intraocular pressure, was performed. Additional functional tests, such as fluorescein angiography, optical coherence tomography (Stratus OCT; Carl Zeiss Meditec, Jena, Germany, Germany), Goldmann perimetry, and multifocal electroretinography as well as photography of the posterior pole, were performed for macular hole patients. Bromophenol blue was used in concentrations of 0.2%. During macular hole surgery, the dye was injected into the air-filled globe, while during surgery for retinal detachment, the globe was partially filled with perfluorocarbon before dye injection after induction of a posterior vitreous detachment to stain the vitreous peripherally. RESULTS: Bromophenol blue provided sufficient staining of the attached posterior hyaloid membrane and vitreous remnants in the periphery. This was especially helpful for patients in whom a posterior vitreous detachment could not be induced mechanically by suction using the vitrectomy probe alone, as seen in three of six interventions for a macular hole in this series. In addition, staining of the vitreous or vitreous remnants in the periphery and at the vitreous base was seen in all patients and helped to completely remove the vitreous in a controlled fashion. After macular hole surgery, increase of visual acuity from 20/100 (mean) to 20/40 was seen during follow-up up to 6 months. In one case, the hole persisted and required a second operation. Finally, closure of the hole was achieved in all patients. After retinal detachment surgery, reattachment was achieved in all cases. No dye-related adverse events were seen during follow-up as shown by the functional tests (visual acuity measurement, electroretinography, and perimetry) applied. CONCLUSION: Delineation of the vitreous and the posterior hyaloid using bromophenol blue staining greatly facilitates vitreoretinal procedures. Bromophenol blue appeared to be a very helpful and safe tool to visualize the posterior hyaloid membrane in macular hole surgery and assured its complete separation from the retinal surface. The dye also helped to remove vitreous at the vitreous base during retinal detachment surgery. Therefore, bromophenol blue appears as a very good alternative to triamcinolone, which has been used for this purpose, because the dye has no pharmacological properties and no side effects are likely to occur such as cataract formation and increase in intraocular pressure. Further studies including larger numbers of patients are mandatory.     

玻璃体切割联合黄斑加固术治疗高度近视合并黄斑裂孔性视网膜脱离

目的　观察玻璃体切割联合黄斑加固术治疗高度近视合并黄斑裂孔性视网膜脱离患者术后视网膜的解剖复位率和黄斑裂孔的闭合率。方法　收集自２０１２年１月至２０１４年１２月在我院手术的高度近视合并黄斑裂孔性视网膜脱离的患者６４例（６４眼）,根据手术方式不同分成２组:一组行单纯玻璃体切割术为单纯玻切组,另一组行玻璃体切割联合黄斑加固术为联合手术组,观察两组视力及视网膜解剖复位率和黄斑裂孔闭合率。结果　６４例６４眼中,单纯玻切组３６例,术前视力平均为０．９０ｌｏｇＭＡＲ,术后平均为０．４１ｌｏｇＭＡＲ;联合手术组２８例,术前视力平均为０．８９ｌｏｇＭＡＲ,术后平均为０．６２ｌｏｇＭＡＲ;两组术前视力差异无统计学意义,术后差异有统计学意义（Ｐ＝０．０４）。两组患者术后视网膜复位均率为１００％;联合手术组的黄斑裂孔闭合率较高,为９２．９％,单纯玻切组为４１．７％,两组比较差异有统计学意义（Ｐ＝０．０２）。结论　在高度近视合并黄斑裂孔性视网膜脱离的患者中,联合行黄斑加固术较单纯玻璃体切割术患者的黄斑裂孔闭合率要高。