Transpupillary thermotherapy (TTT) of occult choroidal neovascularization: A retrospective,noncomparative case series of fifty-seven eyes

Purpose. To evaluate the efficacy of transpupillary thermotherapy (TTT) for the treatment of occult choroidal neovascularization. Methods. A retrospective, noncomparative case series of 57 eyes of 52 patients who presented with occult subfoveal CNV and were treated with TTT. Results. 83% of eyes were either stable (+/? one line) or showed improvement in visual acuity. 83% of eyes showed stabilization of their exudative process after one TTT treatment as evidenced by resorption of subretinal and/or intraretinal exudate or hemorrhage. Nine percent of eyes developed classic CNV during the mean follow-up time of ten months. Conclusions. TTT appears to stabilize the exudative process in eyes with occult CNV. A prospective, sham-controlled, randomized study (TTT4CNV Clinical Trial) is currently underway to directly compare TTT to the natural history of occult CNV     

视网膜脱离合并脉络膜脱离的治疗效果分析

目的　评价视网膜脱离合并脉络膜脱离不同治疗方法的效果。方法　回顾分析 1998年 1月～ 2 0 0 0年 12月我院收治的视网膜脱离合并脉络膜脱离共 114例 (114只眼 )患者的治疗方法及其预后。结果　 5 5例采用环扎加压术的患者中 ,一次手术成功 40例 (90 .9%) ;采用环扎加压 +放液术的 2 0例患者中 ,一次手术成功 14例(70 %) ;采有玻璃体切割 +环扎加压 +剥膜术 +气液交换 39例中 ,一次手术成功 36例 (92 .1%)。其玻璃体切割组与环扎加压组、环扎加压 +放液组差别有统计学意义 (x2 =5 .84,P <0 .0 5 )。结论　对视网膜脱离合并脉络膜脱离患者 ,玻璃体手术是一种比较有效的治疗方法。     

青年性前部视网膜劈裂锯齿缘断离及视网膜脱离

目的：探讨青年性前部视网膜劈裂锯齿缘断离及视网膜脱离的临床特点、治疗及其预后。方法：对青年性前部视网膜劈裂锯齿缘断离合并视网膜脱离患者10例20只眼进行常规检眼镜眼底及Goldmann三面镜联合巩膜压陷检查，根据不同情况进行激光光凝，或巩膜冷凝外加压手术治疗，并随访1～5年。结果：共lO例，年龄17～32岁，8例为双眼患病，病变位于颞下，双侧对称。11眼同时患有前部视网膜劈裂、锯齿缘断离及视网膜脱离，3眼患有前部视网膜劈裂及锯齿缘断离，1眼仅有前部视网膜劈裂，3眼仅有锯齿缘断离其中2眼合并视网膜脱离。13眼合并视网膜脱离者采用巩膜冷凝外加压术，全部一次治愈，5眼行激光封闭锯齿缘断离及劈裂区。随访期间未见视网膜脱离，视力均有不同程度提高。结论：青年性前部视网膜劈裂锯齿缘断离及视网膜脱离有典型的临床特点，尽早发现、适宜治疗，预后良好。     

Discriminate characteristics of photopsia in posterior vitreous detachment, retinal tears and retinal detachment

Aims:  To characterize photopsia in posterior vitreous detachment (PVD), retinal tears (RT) and rhegmatogenous retinal detachment (RRD).
Methods:  Seventy seven patients presenting to an eye emergency department and vitreoretinal clinic with photopsia had documentation of their symptoms.
Results:  A total of 27 patients had PVD alone, 7 had RTs and 25 RRD. In patients with isolated PVD, photopsia were temporal (94%), lasting seconds (81%) and vertically orientated (59%) flashes. Patients with photopsia located in quadrants other than temporal were more likely to have RRD ( p  = 0.0003). Patients with an oblique or horizontal orientation of their photopsia were likely to have RRD or RT ( p  = 0.001, specificity 96%, sensitivity 40%).
Conclusions:  Most patients with PVD have a typical presentation of photopsia, with temporal, vertically orientated, momentary flashes. Patients with RTs or RRD may describe subtle differences in their photopsia which may raise the index of suspicion for the presence of a complication from PVD.     

合并脉络膜脱离的孔源性视网膜脱离临床特点及手术疗效分析

目的:分析合并脉络膜脱离的裂孔性视网膜脱离的临床特点及手术治疗效果。方法:合并脉络膜脱离的裂孔性视网膜脱离患者64例64眼,26例行巩膜扣带术,38例行玻璃体视网膜手术,术中均不行巩膜外冷凝,观察眼部表现及手术复位率等情况,分析合并脉络膜脱离的裂孔性视网膜脱离临床特点。结果:本组病例>-6.00D高度近视占总病例数的41%。64例合并脉络膜脱离的孔源性视网膜脱离均有葡萄膜炎反应,眼压2.00～8.00mmHg;26例行巩膜扣带术,19例视网膜复位,复位率73%,行玻璃体视网膜手术38例,32例视网膜复位,一次手术复位率84%。结论:合并脉络膜脱离的孔源性视网膜脱离高度近视眼、人工晶状体眼及无晶状体眼多发,视网膜光凝替代术中巩膜外冷凝可能提高视网膜复位率及减少术后复发率。     

Vitrectomy, lensectomy and silicone oil tamponade in the management of retinal detachment associated with choroidal detachment

AIM:To report the results of combined vitrectomy, lensectomy and silicone oil (SO) tamponade in treating primary rhegmatogenous retinal detachment (RRD) associated with choroidal detachment (CD).METHODS:A retrospective, consecutive and case series study of 21 subjects with concurrent RRD associated with CD was conducted. All subjects underwent a standard three-port 20G pars plana vitrectomy (PPV) with lensectomy and silicone oil tamponade. Mean follow-up time was 8 months (rang from 4 to 19 months). The primary and final anatomic success rate, visual acuity and final intraocular pressure(IOP) were recorded and analyzed.RESULTS:Of 21 subjects, 8 were women and 13 were men. Age at presentation ranged from 22 to 75 years (mean 57.4 years). The presenting vision ranged from light perception to 0.15. The initial IOP ranged from 3mmHg to 12mmHg (mean 6.2mmHg). All eyes were phakic except one pseudophakic. No intraocular lens was implanted during the primary surgical intervention. Fifteen of 21 (71.4%) eyes had retina reattached after one operation. Six eyes had recurrent inferior retinal detachment due to proliferation. Five of them were successfully reattached after one or more additional operations. Mean IOP at final follow-up was 15.2mmHg (range from 8mmHg to 20mmHg). One case declined for further operation. The final reattachment rate was 95.2%. Visual acuity improved in 19 (90.5%) eyes, was unchanged in 1 (4.8%) eye and decreased in 1 (4.8%) eye.CONCLUSION:Combination of vitrectomy, lensectomy and silicone tamponade is an effective method in treating RRD associated with CD, reducing the incidence of postoperative hypotony.     

伴脉络膜脱离的孔源性视网膜脱离复位术

目的 探讨伴脉络膜脱离孔源性视网膜脱离的手术方法。方法 术前不用糖皮质激素治疗。以低眼压，视网膜下液少为手术时机不放液手术。结果 手术一次性复位率91.66%，裂孔封闭后炎症消退，玻璃体改善，眼压回升，视力提高。结论 术前不同糖皮质激素治疗。有利于不放液手术和术中顶压找孔，缩短了术前等待的时间。     

140例老年人孔源性视网膜脱离的临床分析

目的：探讨老年人孔源性视网膜脱离的临床特点。方法：回顾性分析了140例（144眼）50岁以上老年人孔源性视网膜脱离病例。结果：发病年龄以50－65岁居多,PVCC级和D级发病率较高,临床脱离时间较长。脉络膜脱离型视网膜脱离发病率高（14．0％）,与高度近视（42．0％）、无锡状体眼（26．31％）关系密切。明确外伤史者少见（8．57％）,无一例锯齿缘断高,视网膜裂孔形态以马蹄孔居多,结论：PVR较严重,脉络膜脱离型视网膜脱离发病率高,马蹄形裂孔居多是老年人孔源性视网膜脱离的临床特点。     

孔源性视网膜脱离伴脉络膜脱离的手术治疗

目的探讨不同的手术方式对伴脉络膜脱离(脉脱)的孔源性视网膜脱离病例的预后影响.方法139例140眼中Ⅱ级膜57眼(40.7%),ⅡA级膜62眼(44.3%).ⅢB级膜21眼(15.0%).64眼行环扎加压手术(scleralbucklingsurgery,SB),76眼行闭合式玻璃体切除手术(closedvirteoussurgery.CV).结果术后随访时间均大于3月,最长达2年,平均3.7月,一次手术复位109眼(77.9%),最终复位率89.3%(125/140).Ⅱ级膜中SB、CV一次手术复位率分别为82.1%、94.4%(P＞0.05),其中裂孔大小合计＞3PD的SB、CV一次手术复位率分别为58.3%、92.3%(P＜0.05);ⅢA级膜中SB、CV一次手术复位率分别为64.0%、86.4%(P＜0.05);ⅢB级膜均采用CV手术,一次手术复位率57.1%.结论对于膜形成不严重的Ⅱ级膜行SB手术比较合适,但裂孔合计＞3PD的宜行CV手术,对于ⅢA级膜及以上的行CV手术更合适.     

视网膜切开、切除及缝合术在复杂视网膜脱离手术中的应用

总结17例复杂视网膜脱离应用视网膜切开，切除及缝合术治疗的结果。其中视网膜巨大裂孔6例，外伤牵引性视网膜脱离4例，糖尿病增殖性视网膜病变2例，复发性视网膜脱离3例，间部增殖性玻璃体病变2例。手术采用视网膜切开8例，视网膜切除4例，视网膜切开加缝合3例，视网膜切除加缝合2例。全部病例均行闭合式玻璃体切除、环扎及完全性气液交换等。术后随访16例，时间3个月~3.5年，视网膜复位10例，占62.5%，视力≥0.05者8例，占50.0%，术后低眼压及眼球萎缩4例，占25.0% （中华眼底病杂志，1996，12：7-9）       

视网膜脱离并发脉络膜脱离40例手术疗效分析

目的 提高视网膜脱离并发脉络膜脱离手术成功率。方法 根据视网膜脱离并发脉络膜脱离的不同类型,采用不同的手术方法。结果 40例40眼,出院时复位33眼（83％）;未复位7眼（18％）,2－14胡访结果复位32眼（80％）;未复位8眼（20％）。结论 术前术后早用皮质类固醇,同时尽早手术,提高成功率;花边型脉络膜脱离组手术成功率高,与其它两型差异具有非常显著性意义（P＜0.01）;视功能的恢复与脉络膜、视网膜脱离时间长短有关;严格放液原则,预防术后脉络膜脱离、视网膜脱离复发,减少未复位率。     

伴脉络膜脱离的孔源性视网膜脱离的研究进展

伴脉络膜脱离孔源性视网膜脱离是一种特殊类型的孔源性视网膜脱离,具有原因不明和自发的特性。就其发生、表现和治疗存在很多的争议,在此结合文献讨论相关问题,希望增进对疾病的了解。     

Scleral depressed vitreous shaving, 360 laser,and perfluoropropane (C3 F8) for retinal detachment

Purpose:

To review the characteristics and outcomes of patients who underwent pars plana vitrectomy (PPV) with scleral depressed vitreous shaving, 360 degree peripheral endolaser, and 14% C3F8 gas for rhegmatogenous retinal detachment (RRD).

Materials and Methods:

A retrospective review of a consecutive series of patients who underwent primary repair of RRD by PPV with scleral depressed vitreous shaving, 360 degree peripheral endolaser, and 14% perfluoropropane (C₃F₈) was conducted. Patients with less than 3 months follow-up, previous retinal surgery, and higher than grade B proliferative vitreoretinopathy were excluded.

Results:

Ninety-one eyes were included in the study. The mean age was 60.1 years. The mean follow-up was 13.7 months. The macula was detached in 63% (58/91) of the eyes. The reattachment rate after one surgical procedure was 95% (86/91) while overall reattachment rate was 100%. There was no statistically significant difference between reattachment rates of superior, nasal/temporal, or inferior RRDs. The mean final best corrected visual acuity (BCVA) was 20/40. Of all the patients, 66% of patients with macula-off RRDs had a final BCVA of 20/40 or better.

Conclusions:

PPV with scleral depressed vitreous shaving, 360 degree peripheral endolaser, and 14% C₃F₈ leads to successful anatomical reattachment with visual improvement in patients with primary RRD.     

2019年《玻璃体后脱离、视网膜裂孔和格子样变性眼科临床指南》解读

玻璃体后脱离(PVD)、视网膜裂孔和格子样变性是眼科临床工作中的常见问题,存在视网膜脱离、玻璃体视网膜牵拉的风险,对患者生活质量造成较大影响。2019年9月美国眼科学会发布了《玻璃体后脱离、视网膜裂孔和格子样变性眼科临床指南》,基于循证医学对玻璃体后脱离、视网膜裂孔和格子样变性的定义、流行病学资料、诊断和治疗进行了阐述...     

The Incidence of Nontraumatic Phakic Rhegmatogenous Retinal Detachment in Split-Dalmatia County, Croatia

We studied the incidence of nontraumatic phakic rhegmatogenous retinal detachment (RRD) in a defined population of Split-Dalmatia County, Croatia. In this clinic-based study, 272 of a population of 465,947 developed RRD during an 11-year period (1988–1998). The annual incidence was, therefore, 5.3 per 100,000 population. The highest risk for RRD was between the ages of 60 and 69 years. This revised version was published online in July 2006 with corrections to the Cover Date.     

脉络膜脱离型视网膜脱离的手术疗效分析

目的　探讨脉络膜脱离型视网膜脱离的手术疗效。方法　回顾 2 0 0 0年 10月～ 2 0 0 1年 10月间 ,本院收治的 12例 (12只眼 )脉络膜脱离型视网膜脱离的临床资料 ,分析手术方式、术前激素的治疗、PVR等因素与手术疗效的关系。结果　 15 9例 (92 % )本组 12只眼随访 3～ 6个月 ,10只眼治愈 ,2只眼复发。治愈率为 83.3% ,低于一般孔源性视网膜脱离的治愈率。结论　脉络膜脱离型视网膜脱离是一种复杂性视网膜脱离 ,PVR发展快 ,术前应及时给予激素治疗 ,PVRA、B级及部分 C1 级可行巩膜扣带术 ,术中尽量不放视网膜下液 ,PVR部分 C1～ 3、D级应行玻璃体切除术     

玻璃体切除术治疗合并脉络膜脱离的孔源性视网膜脱离18例

目的：探讨玻璃体切除术治疗孔源性视网膜脱离并发脉络膜脱离的方法和疗效。方法：18例18眼并发脉络膜脱离的孔源性视网膜脱离,行玻璃体切除术治疗,术后观察视力、视网膜复位情况及手术并发症等,随访2～6(平均3．3)mo。结果：在18眼中13眼(72％)术后视网膜复位,大部分视力均有不同程度的提高;5眼视网膜未复位,其中3眼经再手术后复位,2眼眼球萎缩,未再手术。手术并发症主要有术后葡萄膜炎、玻璃体积血、术后高眼压等。结论：及时的玻璃体手术治疗合并脉络膜脱离的孔源性视网膜脱离,大多数视网膜能够获得复位,部分恢复视功能。     

Retinal detachment after cataract surgery

Background: A study of the characteristics and the results obtained in 99 consecutive eyes operated on for rhegmatogenous retinal detachment associated with aphakia or pseudophakia in order to find the predictive factors of poor anatomical and functional results. Methods: The authors retrospectively reviewed the files of 99 consecutive cases of aphakic and pseudophakic retinal detachment operated on by the same surgeon between January 1992 through July 1993 with a minimum follow-up of 6 months. Multivariate and chi square analysis were carried out. Results: Of the pseudophakic eyes, 25 had an anterior chamber lens and 48 had a posterior chamber lens. The posterior capsule was disrupted using a Yag laser in 58% of those with an posterior chamber lens but only 14% of them developed detachment within 6 months. The rate of vitreous loss was 27% with 5% in case of intracapsular extraction, 31% in case of extracapsular extraction and 54% in case of phacoemulsification. PVR was present in 30% of the patients and 51% of detachments occurred more than 24 months as a mean after cataract surgery. The overall anatomic reattachment rate was 88% with no significant difference between the aphakic and the pseudophakic patients, either with an anterior chamber of posterior chamber lens. Visual results were significantly worse in the anterior chamber lens group and in the aphakic eyes (P < 0.02). Negative prognostic indicators for reattachment included poor preoperative vision, extension of the retinal detachment to the macula (P < 0.05) and grades B, C or D proliferative vitreoretinopathy (P < 0.01). In addition to the above factors, eyes with vitreous loss, anterior chamber lens, aphakia and a larger extent of the retinal detachment had a poor visual outcome. Conclusion: Most aphakic or pseudophakic retinal detachment can now be reattached with either scleral or vitreo retinal surgery. The main difficulties are the localisation of the breaks and the treatment of PVR. Indirect ophthalmoscopy associated with vitrectomy does well in cases of an opacified posterior capsule. In cases of severe PVR long term internal tamponade either with C3F8 or silicone oil improves anatomical results but the functional results remain inferior.     

Massive Exudative Retinal and Choroidal Detachments Following Scleral Buckling Surgery

Three aphakic male patients underwent successful scleral buckling surgery for unilateral rhegmatogenous retinal detachment. Within a two-week postoperative period, each developed severe ocular pain with massive exudative retinal and choroidal detachments resembling recurrent rhegmatogenous or traction retinal detachment or implant infection. Systemic prednisone therapy resulted in prompt resolution of ocular pain and reabsorption of subretinal and suprachoroidal fluid. It is important to recognize this uncommon postoperative syndrome so that proper medical therapy may be initiated and unnecessary additional retinal or vitreous surgery can be avoided.     

合并脉络膜脱离的视网膜脱离的临床观察

目的:探讨合并脉络膜脱离的视网膜脱离手术治疗方法和手术时机的选择并观察疗效。方法:总结、分析2010-01/2012-01因视网膜脱离合并脉络膜脱离在我院住院的患者45例45眼,其中原发性裂孔源性视网膜脱离合并脉络膜脱离38例,复发性视网膜脱离合并脉络膜脱离7例。手术方法包括巩膜环扎、经巩膜穿刺口脉络膜上腔引流、玻璃体视网膜手术、眼内光凝、C3F8填充术或硅油填充术。结果:患眼45眼均行巩膜环扎术,均于手术中成功引流脉络膜上腔液体,6眼行C3F8填充,39眼行硅油填充术,45眼视网膜脉络膜全部复位,视网膜裂孔封闭。其中23眼术后视力≥0.1。结论:合并脉络膜脱离的视网膜脱离,采用巩膜环扎和玻璃体视网膜手术联合经巩膜穿刺口脉络膜上腔积液引流的联合手术方式有效。