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.     

复方血栓通对糖尿病白内障患者超乳术后黄斑水肿的预防作用

目的：观察复方血栓通胶囊对糖尿病白内障患者超声乳化吸除术后发生黄斑水肿的预防作用。 方法：采用随机对照临床研究方法。收集180例180眼糖尿病老年性白内障患者,排除术前有眼内手术史、葡萄膜炎、玻璃体视网膜疾病、青光眼,角膜白斑,术后出现严重角膜水肿、葡萄膜炎、前房出血、继发性青光眼等并发症的患者,随机分为研究组和对照组。研究组（90例）术后立即口服复方血栓通胶囊1.5g,连续服用2wk;对照组（90例）患者不使用复方血栓通胶囊,观察两组术后1,7d;1,3,6,12mo的视力及黄斑水肿发生情况。 结果：研究组术后1,7d;1,3,6,12mo的视力均值明显高于对照组（P<0.01）;研究组术后12例发生黄斑囊样水肿,对照组术后26例发生黄斑囊样水肿, 研究组发生黄斑水肿几率(13.3%)明显低于对照组(28.9%,P<0.01）。 结论：复方血栓通胶囊能改善糖尿病患者白内障超声乳化吸除术后视神经视网膜缺血和缺氧状态,减少黄斑中心凹周围毛细血管渗漏,预防黄斑水肿的发生。     

黄斑前膜剥除术联合视网膜下注液对黄斑皱褶并发中心凹内层视网膜增厚的疗效评估

黄斑皱褶是黄斑区视网膜前膜增厚和收缩引起的一种黄斑疾病,以前膜形成、黄斑内层视网膜增厚、视力下降为特点,其引起视力下降的主要原因是黄斑前膜遮挡中心凹、黄斑区视网膜变形和黄斑水肿[1]。因此,剥除黄斑前膜以恢复黄斑区解剖结构是临床治疗的主要目标,黄斑前膜剥除术或联合内界膜剥除术是目前治疗黄斑皱褶的主要手术方式[2]。     

特发性黄斑部前膜不同玻璃体视网膜手术疗效分析

目的 观察人工玻璃体后脱离（PVD）、黄斑前膜剥除术、内境界膜剥除术三种玻璃体视网膜手术治疗特发性黄斑部前膜（IMEM）疗效.方法 特发性黄斑前膜41例（43只眼）,视力从0.1～0.8不等,35只眼低于0.3 所有患者均行标准三切口玻璃体切除,视玻璃体视网膜界面情况（浅、中、深层）分别采用人工玻璃体后脱离、黄斑前膜撕除、内界膜剥除三种手术方法,平均随访10.2个月.结果 随访3个月后40只眼视力提高,39只眼视物变形消失,以视力≥3行为界,人工PVD、黄斑前膜撕除术明显高于内境界膜剥除术,二者对比均有显著性差异（P＜0.05）.术后OCT及眼底彩照显示所有患者的前膜均已消除,黄斑水肿逐渐减轻,视网膜平复.结论 特发性黄斑前膜据病变部位浅、中、深可以分别采用人工PVD、黄斑前膜撕除术、内境界膜剥离术三种手术方法.随诊视力前二者提高幅度较大,在黄斑前膜位置较浅未对黄斑部视网膜造成严重牵拉的情况下尽早的将其剥除,可使视功能得到良好恢复,提示玻璃体后脱离发展过程与黄斑前膜关系密切.     

视网膜内界膜剥除在特发性黄斑前膜的应用

目的 描述视网膜内界膜剥离在特发性黄斑前膜眼中的应用效果及其临床特点.方法 回顾2004～2006年因特发性黄斑前膜需行玻璃体视网膜手术患者31例(31只眼),男性3例,女性28例;年龄56～71岁,平均59.6岁.病程3～49个月.术前视力0.02～0.3.术中行前膜剥除后再行视网膜内界膜剥除.追踪观察6～38个月.结果 病程短者的视网膜内界膜能很容易剥除,病程长的内界膜不易剥除.术后矫正视力0.05～0.7,较术前均有不同程度的提高.病程短者术后获解剖和功能的成功,视力提高显著(P<0.05);病程较长者虽获解剖成功但功能上的恢复不显著(P>0.05).尚未发现由视网膜内界膜剥离所致的严重并发症.结论 视网膜内界膜剥离在特发性黄斑前膜中应用不但可以松解黄斑区视网膜皱褶,还可以清除紧密附着在黄斑前视网膜表面的炎性物质,改善黄斑区局部的代谢,有利于黄斑功能的恢复.     

内界膜剥除术在复杂视网膜脱离手术中的应用

目的 观察玻璃体手术中应用内界膜剥除术治疗视网膜脱离合并增生性玻璃体视网膜病变的效果.方法 回顾性分析视网膜脱离合并严重增生性玻璃体视网膜病变行玻璃体视网膜手术40例（40只眼）的临床资料.以术中是否联合内界膜剥除分为两组：剥膜组19例,未剥膜者为对照组21例.术毕均填充硅油.于玻璃体手术后3个月及硅油取出术后3个月应用OCT观察两组黄斑区视网膜水肿及视网膜前膜情况,并记录最终随访视力.结果 随访6 ～ 12个月.玻璃体切除术后3个月,OCT见黄斑视网膜前膜形成者剥膜组0眼,对照组6眼（28.57％）（Fisher确切概率法,P=0.021）;出现黄斑水肿者,剥膜组1眼（5.26％）,对照组5眼（23.81％） （x2=1.433,P =0.231）.硅油填充下视网膜复位率剥膜组为89.47％,对照组为90.48％ （x2 =0.011,P=0.916）.硅油取出术后3个月,两组病例均未再发生新的视网膜前膜;出现黄斑水肿者,剥膜组为5.3％,对照组为14.30％（x2=0.178,P=0.673）.最终随访视网膜均复位.两组患者术后视力均较术前视力明显提高,且两组间差异无统计学意义.结论 在玻璃体切除术中应用内界膜剥除术治疗视网膜脱离合并增生性玻璃体视网膜病变,可以降低术后黄斑前膜的发生率,对术后视力、黄斑水肿情况及视网膜复位成功率无明显影响.     

视网膜脱离晶状体切除术中保留前囊膜的临床观察

目的观察视网膜脱离晶状体切除术中保留前囊膜的疗效。方法视网膜脱离34例(34眼)患者行视网膜脱离晶状体切除术,术中切除晶状体及玻璃体,保留前囊膜,同时行硅油填充。术后随访6～24个月,平均18.5个月,观察患者随访末期视网膜复位、视力及并发症情况。结果术后视网膜裂孔封闭、视网膜复位21例,复位率61.8%。术后视力高于术前,差异有统计学意义(P<0.05)。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。结论视网膜脱离晶状体切除术中保留前囊膜可减少并发症的发生,有利于视力提高。     

黄斑视网膜前膜的临床分析

目的 探讨特发性及继发性黄斑视网膜前膜的临床特点、光学相干断层(OCT)检查及手术效果.方法 对2005年11月至2009年4月于眼科进行玻璃体切割术、黄斑前膜剥除术的36例患者38只眼,其中特发性黄斑前膜25只眼,继发性13只眼,分别对其眼部情况、OCT检查、手术方法、术后疗效进行分析.结果 OCT显示36例38只眼术后1个月及术后3个月黄斑区中心凹厚度均比术前明显减少;36例38只眼术后随访矫正最佳视力提高2行者27只眼,占71.1%;特发性黄斑前膜25只眼比继发性黄斑前膜13只眼术后随访视力提高明显.结论 光学相干断层(OCT)检查对于黄斑前膜诊断、术后观察具有十分重要的价值;玻璃体切割手术剥除黄斑前膜对达到手术指征的黄斑前膜患者是一种有效治疗手段.     

黄斑视网膜前膜的临床分析

目的 探讨特发性及继发性黄斑视网膜前膜的临床特点、光学相干断层(OCT)检查及手术效果.方法 对2005年11月至2009年4月于眼科进行玻璃体切割术、黄斑前膜剥除术的36例患者38只眼,其中特发性黄斑前膜25只眼,继发性13只眼,分别对其眼部情况、OCT检查、手术方法、术后疗效进行分析.结果 OCT显示36例38只眼术后1个月及术后3个月黄斑区中心凹厚度均比术前明显减少;36例38只眼术后随访矫正最佳视力提高2行者27只眼,占71.1%;特发性黄斑前膜25只眼比继发性黄斑前膜13只眼术后随访视力提高明显.结论 光学相干断层(OCT)检查对于黄斑前膜诊断、术后观察具有十分重要的价值;玻璃体切割手术剥除黄斑前膜对达到手术指征的黄斑前膜患者是一种有效治疗手段.     

黄斑视网膜前膜的临床分析

目的 探讨特发性及继发性黄斑视网膜前膜的临床特点、光学相干断层(OCT)检查及手术效果.方法 对2005年11月至2009年4月于眼科进行玻璃体切割术、黄斑前膜剥除术的36例患者38只眼,其中特发性黄斑前膜25只眼,继发性13只眼,分别对其眼部情况、OCT检查、手术方法、术后疗效进行分析.结果 OCT显示36例38只眼术后1个月及术后3个月黄斑区中心凹厚度均比术前明显减少;36例38只眼术后随访矫正最佳视力提高2行者27只眼,占71.1%;特发性黄斑前膜25只眼比继发性黄斑前膜13只眼术后随访视力提高明显.结论 光学相干断层(OCT)检查对于黄斑前膜诊断、术后观察具有十分重要的价值;玻璃体切割手术剥除黄斑前膜对达到手术指征的黄斑前膜患者是一种有效治疗手段.     

Peeling of epiretinal macular membranes. Results and conclusions of the Geneva Clinic]

Epiretinal macular membranes can cause a lowering of visual acuity and may even lead to a total loss of foveal function in the absence of surgical procedure. The only surgical treatment is vitreo-retinal surgery with peeling of the membrane. In Geneva, we studied 23 patients, all of whom were operated for epiretinal membrane even though visual acuity was greater as 0.2, 10 membranes were idiopathic et 13 secondary. Six patients from this second group had recently undergone cataract surgery. The results were good: 83% of the patients showed an improvement in post-operative visual acuity and 60% gained 2 or more lines on the Snellen scale. The main factors for prognosis were preoperative macular cystoid edema and duration before surgery. The principal post-operative complication encountered was a secondary opacification of the lens with, to a lesser extent, cystoid edema of the macula.     

Vitrectomy for traction macular edema

Purpose: Traction macular edema may develop through contraction of macular epiretinal membranes (ERM), or due to persistant vitreomacular traction during the evolution of vitreomacular traction syndrome (VMS). The purpose of this retrospective study was to determine the effect of vitreous surgery and the release of the vitreomacular traction or the removal of epiretinal membranes, on the evolution of traction induced macular edema. Material and methods: Fourteen eyes from 14 patients presenting with idiopathic or secondary epiretinal membranes, and 11 eyes from 10 patients presenting with vitreomacular traction syndrome, underwent vitrectomy for reduced vision and cystoid macular edema, identified by slit-lamp examination and fluorescein angiography. No coexistent ocular conditions that might have caused macular traction were present. History, preoperative eye examination, operative findings, postoperative course and final examination as well as pre- and postoperative fluorescein angiography were reviewed. Results: In the ERM group, cystoid macular edema disappeared in all cases during the postoperative period and the mean visual acuity (VA) at the end of the follow-up (0.48 ± 0.23) significantly increased compared to the preoperative one (0.29 ± 0.2) (p=0.004). In the group of patients suffering from VMS, the posterior vitreous traction on the macula was released and macular edema disappeared in all cases but one. The mean v.a. at the end of the follow-up (0.42 ± 0.24) significantly increased compared to the preoperative one (0.18 ± 0.1) (p=0.01). Complications included intraoperative small petechias and postoperative progressive nuclear sclerosis, retinal detachment and retinal pigment epitheliopathy. Conclusions: Cystoid macular edema may develop secondary to vitreomacular traction syndrome or epiretinal membrane contraction. Vitrectomy is effective in releasing macular traction which, in turn, may induce a decrease of the macular edema with improvement of visual acuity. This revised version was published online in July 2006 with corrections to the Cover Date.     

Cystoid macular edema after scleral buckling responsive to acetazolamide.

A 64-year-old man had an epiretinal membrane and cystoid macular edema two months after an uneventful scleral buckling procedure. The cystoid macular edema resolved after treatment with systemic acetazolamide, and there was marked visual improvement.     

Clinicopathologic results of vitreous surgery for epiretinal membranes in patients with combined retinal and retinal pigment epithelial hamartomas

Two patients (a 44-year-old woman and a 26-year-old man) with progressive visual loss associated with macular combined retinal-retinal pigment epithelial hamartomas underwent pars plana vitrectomies with peeling of macular epiretinal membranes. Histopathologic findings for one of the membranes were similar to those in idiopathic or other secondary epiretinal membranes. Although the epiretinal membranes were satisfactorily removed, visual acuity improved in neither eye. Fluorescein angiography showed persistence of vascular tortuosity and leakage and cystoid macular edema after surgery in both cases. One eye developed a late postoperative operculated retinal tear which was successfully treated with cryopexy. The role of vitrectomy and membrane removal in cases of macular combined retinal-retinal pigment epithelial hamartomas appears to be limited.     

Long-term results of treatment of macular complications in eyes with immune recovery uveitis using a graded treatment approach

PURPOSE: To evaluate the results of a graded treatment approach in a cohort of eyes with macular complications of immune recovery uveitis. METHODS: A cohort of 18 eyes of 13 patients representing all eyes with these complications at the University of California, San Diego AIDS Ocular Treatment Unit was studied. Eyes were classified into three groups and treated according to a graded protocol. RESULTS: Eyes with mild disease (macular edema and vision of 20/30 or better) were observed. These six eyes maintained good vision with only one dropping to 20/40. In eyes with worse macular edema and vision of 20/30 or worse (10 eyes of 9 patients), repository sub-Tenon steroid injections were used repeatedly. There were no complications of steroid use but visual improvement occurred in only 40% of eyes. Macular edema persisted. In eyes with structural macular changes, such as epiretinal membrane, vitrectomy resulted in vision improvement in three of four eyes. The cystoid macular edema persisted despite surgery. CONCLUSION: Mild cases of immune recovery uveitis and macular edema may be observed. In eyes with reduction of vision due to cystoid macular edema, there was only a modest treatment effect using repository corticosteroids. Eyes with immune recovery uveitis that develop epiretinal membrane undergo some visual improvement after removal of the membrane. The macular edema of immune recovery uveitis is resistant to corticosteroid treatment.     

Pars plana vitrectomy for cystoid macular edema secondary to sarcoid uveitis

OBJECTIVE: To examine the results of pars plana vitrectomy for cystoid macular edema secondary to sarcoid uveitis resistant to medical treatment. DESIGN: Retrospective, interventional, noncomparative case series. SUBJECTS: Fourteen consecutive subjects (18 eyes) with cystoid macular edema associated with sarcoid uveitis resistant to medical treatment. INTERVENTION: All eyes underwent pars plana vitrectomy. Nine eyes also underwent peeling of the epiretinal membrane or removal of the posterior vitreous cortex. MAIN OUTCOME MEASURES: Status of macular edema, visual acuity, and complications. RESULTS: Ten eyes (56%) improved 2 or more lines of Snellen visual acuity within 12 months. Six eyes (33%) remained unchanged, within a line of preoperative Snellen visual acuity, and two eyes (11%) worsened by 2 or more lines of Snellen visual acuity. Slit-lamp biomicroscopy showed that cystoid macular edema had resolved in 14 eyes (78%) within 9 months postoperatively. One eye (6%) had minimal edema, whereas three eyes (17%) remained unchanged biomicroscopically at the final visit. Postoperative complications included cataract formation, glaucoma, optic nerve atrophy, epiretinal membrane formation, and tractional retinal detachment. No severe postoperative inflammation was noted. CONCLUSIONS: Pars plana vitrectomy seems to have a beneficial effect on cystoid macular edema caused by sarcoidosis resistant to medical treatment.     

Course of macular edema in uveitis under medical treatment

OBJECTIVE: To describe the response of uveitic macular edema to various treatment methods using optical coherence tomography (OCT). METHODS: This is a prospective study of consecutive uveitis patients with macular edema in at least one eye. The patients received medical treatment. Best corrected Snellen Visual Acuity (BCVA) and tomographic features of the macula, including macular thickness measurement, were obtained at one, three, six, and 12 months after commencing treatment. RESULTS: Eighty-one eyes of 58 patients were analyzed. Complete resolution of macular edema occurred in 38 eyes (47%). The average BCVA was 20/34 logarithm of minimum angle of resolution (-logMAR, 0.2 +/- 0.3) upon study entry and 20/27 (-logMAR, 0.13 +/- 0.29) upon study completion. The difference was statistically significant (p = 0.04). The corresponding mean retinal thickness at the central fovea was 319 +/- 150 microm at the beginning of the study compared to 241 +/- 125 microm at 12 months (p < 0.001). A weak but statistically significant correlation between the reduction of macular thickness and the improvement of BCVA (r = 0.3, p = 0.01) was found. Thirteen of the 43 eyes (30%) with persistent macular edema had a more than 15% reduction of macular thickness compared to baseline, whereas 10 eyes (23, 3%) had a more than 15% increase in macular thickness. Statistical analysis indicated that the presence of an epiretinal membrane and an OCT pattern of diffuse macular edema was a significant factor associated with medical treatment failure. CONCLUSION: This study demonstrates the overall favorable visual prognosis of uveitic macular edema under medical treatment. The presence of an epiretinal membrane is an important factor associated with medical treatment failure.     

Detecting vitreomacular adhesions in eyes with asteroid hyalosis with triamcinolone acetonide

Background To report the incidence of posterior vitreous detachments (PVDs) and the surgical results of vitrectomy with intravitreal triamcinolone acetonide (TA) to detect vitreomacular adhesions in eyes with asteroid hyalosis (AH). Methods Ten eyes of nine patients with AH underwent vitrectomy, six eyes with TA and four without TA. The presence of a PVD was determined preoperatively by ultrasound echography (USE) and intraoperatively by microscopic observations. The postoperative best-corrected visual acuities (BCVA) were evaluated. Results The BCVA was improved by >2 Snellen lines in nine eyes and maintained at 20/20 with symptomatic improvements in the other eye. A vitreomacular adhesion was clearly seen during TA-assisted vitrectomy, and none was seen when TA was not used, even though preoperative USE showed an incomplete PVD in all eyes. The BCVA was not significantly better in eyes with TA-assisted vitrectomy than without TA-assisted vitrectomy. In one eye with vitrectomy without TA, a second surgery was required for a persistent cystoid macular edema and an epiretinal membrane. The BCVA and the edema in this eye improved after removing the epiretinal membrane. Conclusions All (ten) of the eyes with AH were found to have a vitreomacular adhesion by preoperative USE and intraoperative microscopic observations. The residual vitreous over the macula is more easily detected and removed after intravitreally injected TA, but the visual acuities were not significantly different from eyes without TA.     

Early postoperative retinal thickness changes and complications after vitrectomy for diabetic macular edema

PURPOSE: To determine the early postoperative changes in retinal thickness and complications after pars plana vitrectomy for diabetic macular edema. DESIGN: Consecutive interventional case series. METHODS: Studied retrospectively, pars plana vitrectomy was performed on 65 consecutive eyes of 63 patients with diabetic macular edema. The follow-up interval ranged from 6 to 36 months (12.6 +/- 7.4 months [mean +/- standard deviation (SD)]). The indications of pars plana vitrectomy in this study were (1) diffuse diabetic macular edema, (2) preoperative visual acuity less than 20/40, and (3) noneffective macular photocoagulation therapy. Preoperative and postoperative examinations by stereoscopic biomicroscopy, color fundus photography of the macula and optical coherence tomography (OCT) were performed on all eyes. Preoperatively, direct photocoagulation to microaneurysms in the macula had been performed in 48 eyes, and focal/grid photocoagulation had been performed in five eyes. Preoperative examination showed that epiretinal membranes were observed in 20 eyes, cystoid macular edema in 40 eyes, and 23 eyes had a complete posterior vitreous detachment (PVD). Epimacular membranes, removed during surgery, were examined histopathologically. RESULTS: The postoperative mean best-corrected visual acuity (logarithm of the minimum angle of resolution [logMAR] = 0.696 +/- 0.491 [mean +/- SD]) was significantly better than the preoperative mean best-corrected visual acuity (0.827 +/- 0.361; P <.0001; Wilcoxon signed-rank test). The final visual acuity improved by 2 or more lines in 32 of 65 eyes (45%), remained unchanged in 32 of 65 eyes (49%), and exacerbated after the surgery in 4 of 65 eyes (6%) due to neovascular glaucoma (2 eyes) and residual cystoid macular edema (2 eyes). The postoperative foveal retinal thickness (224.9 +/- 116.9 microm) at the last visit was significantly thinner than the preoperative foveal retinal thickness (463.7 +/- 177.3 microm; P <.0001; Wilcoxon signed-rank test). The foveal retinal thickness did not decrease linearly but fluctuated: The mean postoperative retinal thickness had decreased significantly 7 days after surgery, then remained unchanged for approximately 1 month, and thereafter gradually decreased until 4 months. The intraoperative and postoperative complications included peripheral retinal tear in 3 of 65 (4.6%) eyes, postoperative rhegmatogenous retinal detachment in 1 of 65 (1.5%) eyes, neovascular glaucoma in 3 of 65 (5%) eyes, recurrent vitreous hemorrhage in 1 of 65 (1.5%) eyes, hard exudates in the center of the macula in 3 of 56 (4.6%) eyes, postoperative epiretinal membrane formation in 9 of 65 (13.8%) eyes, and a lamellar macular hole in 1 of 65 (1.5%) eyes. CONCLUSIONS: Vitrectomy for diabetic macular edema is an effective procedure for reducing the edema and improving visual acuity. Because the postoperative reduction in retinal thickness is not complete until 4 months, the assessment of vitrectomy on foveal thickness should not be made until this time. In addition, there are severe complications from vitrectomy for diabetic macular edema, and careful preoperative and postoperative examinations and surgical methods are required.     

Long-term visual outcomes of vitrectomy for cystoid macular edema due to nonischemic central retinal vein occlusion

PURPOSE: To report the long-term surgical outcome of vitrectomy for cystoid macular edema due to nonischemic central retinal vein occlusion (CRVO). METHODS: A retrospective chart review of 25 consecutive eyes (25 patients) with cystoid macular edema due to nonischemic CRVO treated with vitrectomy was performed. All patients underwent a pars plana vitrectomy with the creation of a posterior vitreous detachment if still attached. Simultaneous phacoemulsification with intraocular lens implantation was also performed in phakic eyes. The main outcome measures were best-corrected visual acuity (BCVA) and changes in macular edema shown by contact-lens biomicroscopy. The mean follow-up time was 49 months (range, 16-108). RESULTS: The median BCVA before surgery was 0.31 and the median BCVA at last follow-up was 0.67. The BCVA at the last follow-up improved at least two Snellen lines in 17 (68%), remained unchanged in 4 (16%), and worsened in 4 (16%). The BCVA was 20/40 or better in 3 eyes (12%) preoperatively and in 18 eyes (72%) at the last follow-up. During the follow-up, four patients progressed to ischemic CRVO; one of them had neovascular glaucoma requiring surgical intervention. CONCLUSION: The data indicate that vitrectomy appears to be a possibly effective treatment in some eyes with cystoid macular edema associated with nonischemic CRVO.