玻璃体切割术中联合内界膜剥除治疗糖尿病性黄斑水肿

目的探讨增生性糖尿病性视网膜病变（PDR）伴有黄斑水肿患者行玻璃体切割联合内界膜剥除术的疗效。方法选择19例（21只眼）严重PDR伴黄斑水肿患者行常规玻璃体切割联合黄斑区内界膜剥除术。结果本组19例（21只眼）均未发生手术并发症,视力提高15只眼,视力不变4只眼,下降2只眼。结论严重PDR伴黄斑水肿患者施行常规玻璃体切割术中联合内界膜剥除,有利于改善黄斑水肿,提高视力,疗效满意。     

玻璃体切割联合内界膜剥除术治疗顽固性糖尿病黄斑水肿

目的：观察玻璃体切割术(PPV)联合内界膜(ILM)剥除术治疗顽固性糖尿病黄斑水肿的临床疗效。

方法：回顾性分析顽固性糖尿病黄斑水肿并行PPV联合ILM剥除术患者56例56眼,根据有无后极部玻璃体后脱离分为A组(无玻璃体后脱离,35例35眼)和B组(有玻璃体后脱离,21例21眼)。对比分析手术前及手术后1、3、6mo时患眼最佳矫正视力(BCVA)、黄斑中心视网膜厚度(CMT)变化情况。

结果：A组手术后1、3、6mo平均CMT和BCVA与手术前比较均有差异(P<0.05)。B组手术后1、3、6mo平均BCVA与手术前比较均无差异(P>0.05); 手术后1mo平均CMT与手术前比较有差异(P<0.05),术后3、6mo平均CMT与手术前比较均无差异(P>0.05)。术后1、3、6mo,两组CMT、BCVA比较均有差异(P<0.05)。

结论：PPV联合ILM剥除术能有效治疗无玻璃体后脱离的顽固性糖尿病黄斑水肿,提高患者视力; 但当患者玻璃体已经后脱离且没有牵拉时,PPV联合ILM剥除术治疗效果不佳。     

玻璃体切割手术联合内界膜剥除治疗难治性黄斑水肿的研究进展

玻璃体腔注射抗血管内皮生长因子药物、糖皮质激素以及视网膜激光光凝、玻璃体切割手术（PPV）是治疗黄斑水肿（ME）的主要手段。但仍有部分患者经上述治疗后ME反复发作或视网膜前膜形成而对治疗无应答,这类ME被称为难治性ME。PPV联合内界膜剥除（ILMP）可治疗缓解难治性ME,其通过去除玻璃体后皮质,或手术中同时剥除视网膜...     

玻璃体切割术治疗糖尿病黄斑水肿疗效的循证评价

糖尿病黄斑水肿是引起糖尿病患者视力损害的常见原因之一.目前关于玻璃体切割术治疗弥漫性糖尿病黄斑水肿的文献中,有些病例存在黄斑部玻璃体不全后脱离或黄斑前膜等牵拉性因素,有些则不存在明显牵拉,且各篇报道的疗效不一.本文通过对近年来关于玻璃体切割术治疗糖尿病黄斑水肿的相关论著进行归类和分析,以探讨并提高对此病的手术适应证及疗效的认识.     

内界膜剥除治疗糖尿病黄斑水肿

糖尿病黄斑水肿是糖尿病的眼部并发症之，严重危害视力，我们对一组糖尿病黄斑水肿患者以内界膜剥除进行治疗，现将其视力结果分析报道如下。     

玻璃体切割联合内界膜剥除术治疗高度近视黄斑劈裂患者的临床研究

目的　观察玻璃体切割联合内界膜剥除术治疗高度近视黄斑劈裂的临床效果。方法　选择2016年1月至2017年5月在我院诊断为高度近视黄斑劈裂者23例（30眼）,所有患者均行23G玻璃体切割术,吲哚菁绿染色后剥除黄斑区内界膜2～3 PD。术后随访6个月,比较术前与术后最佳矫正视力、眼轴长度、黄斑区视网膜劈裂的最高值（MxFT）、b波振幅及黄斑区最小及最大视网膜厚度,评估手术效果。结果　23例（30眼）均顺利完成手术。术后6个月,30眼最佳矫正视力均较术前明显提高,差异具有统计学意义（P=0.006）。术后6个月患眼眼轴长度明显短于术前,差异有统计学意义（P=0.033）。与术前MxFT相比,术后6个月MxFT明显降低,差异具有统计学意义（P=0.001）,其中6眼（20.0％）基本恢复正常。术后6个月患眼b波振幅高于术前,差异具有统计学意义（P=0.040）,其中24眼（80.0％）较术前显著提高,三维地形图中央峰逐步恢复,位于旁中心凹区域的不规则低反应区变少或消失。与术前相比,术后6个月黄斑中心区最小、最大视网膜厚度均明显减小（均为P<0.05）。末次随访时,VFQ-25评分高于术前,差异具有统计学意义（P=0.021）。结论　玻璃体切割联合内界膜剥除术可显著提高高度近视黄斑劈裂患者视力及改善视物变形。     

玻璃体切割术联合或不联合内界膜剥除治疗严重PDR伴黄斑皱褶移位

目的:观察性研究25G微创玻璃体切割联合内界膜剥除治疗严重增殖性糖尿病视网膜病变(PDR)伴黄斑皱褶移位的临床疗效。方法:收集2016-01/2017-12在江苏省人民医院眼科病房接受玻璃体切割手术的严重PDR伴黄斑皱褶移位的患者36例36眼的临床资料,其中2016-01/12入院的患者18例18眼纳入对照组,行25G微创玻璃体切割术,2017-01/12入院的患者18例18眼纳入联合组,行25G微创玻璃体切割联合内界膜剥除术。观察术前,术后7d,1、3、6mo最佳矫正视力(BCVA)、黄斑中心区厚度(CMT)、眼压及并发症。结果:术后6mo,两组患者BCVA较术前显著提高(均P<0.05);联合组CMT小于对照组(P<0.001)。术后6mo内,联合组中2眼(11%)高眼压、1眼(6%)黄斑水肿;对照组1眼(6%)高眼压,1眼(6%)黄斑前膜,1眼(6%)玻璃体积血,两组并发症发生率无差异(均P=1.000)。结论:采用25G微创玻璃体切割联合内界膜剥除术治疗严重PDR伴黄斑皱褶移位能安全有效地提高患者视力及降低黄斑中心区厚度。     

玻璃体切割联合内界膜剥除术治疗高度近视继发黄斑劈裂的观察

目的：探讨和评价玻璃体切割联合内界膜剥除治疗高度近视继发黄斑劈裂的疗效和安全性。
　　方法：将2011-03/2013-03高度近视继发黄斑劈裂患者30例30眼随机分为治疗组(16眼)和对照组(14眼),治疗组给予玻璃体切割联合内界膜剥除,对照组给予玻璃体切割但未联合内界膜剥除,观察术后2 mo视网膜复位率、视力提高率。
　　结果：治疗组视网膜复位率、视力提高率均高于对照组(P<0.05)。
　　结论：玻璃体切割联合内界膜剥除是治疗高度近视继发黄斑劈裂的有效手段。     

玻璃体切割联合内界膜剥离术治疗特发性黄斑裂孔

目的评价玻璃体切割联合内界膜剥离术治疗特发性黄斑裂孔的临床疗效。方法采用玻璃体切割联合内界膜剥离术治疗特发性黄斑裂孔17例17眼,对患者术前术后视功能、术后黄斑裂孔闭合及手术主要并发症等进行检查和随访。结果本组17眼均成功剥离内界膜。随访5～24个月,其中13眼黄斑裂孔完全闭合,4眼裂孔直径缩小,裂孔封闭成功率为76.47%;17眼中14眼视力提高,视力提高率为82.35%;视物变形等症状也有明显改善。并发症主要有术中毛细血管性出血、术后一过性高眼压及晶状体后囊下混浊。结论玻璃体切割联合内界膜剥离术可有效封闭特发性黄斑裂孔,提高视功能。     

自体游离内界膜移植术治疗玻璃体切割联合内界膜剥除术后未闭合黄斑裂孔患者的临床疗效

目的　评价自体游离内界膜移植术治疗玻璃体切割联合内界膜剥除术后未闭合黄斑裂孔患者的临床疗效。方法　本研究为回顾性病例研究。收集2016年3月至2018年6月14例（14眼）玻璃体切割联合内界膜剥除术后未闭合黄斑裂孔患者，行自体游离单层内界膜移植术，将黄斑区外残留的内界膜剥除一片略大于黄斑裂孔直径的游离植片，放置于黄斑裂孔中，并将植片边缘置于裂孔边缘下，起到固定作用，然后行气液交换，术后严格俯卧位3～5 d。术前，术后1 d、2周、1个月、3个月通过频域光学相干断层扫描图像观察黄斑裂孔直径及是否闭合，记录患者最佳矫正视力（best corrected visual acuity，BCVA）和眼压。结果　术后3个月，13眼黄斑裂孔完全闭合，裂孔闭合率为92.9%；1眼黄斑裂孔直径较术前明显缩小，裂孔周围视网膜贴附良好，但黄斑中心凹可见裸露的RPE层，未见神经上皮层组织。术后各时间BCVA较术前明显提高，差异均有统计学意义（均为P<0.05），其中11眼较术前提高，3眼无变化，但所有患者自诉视物变形症状较术前明显好转。术后2周，仅有1眼眼压高，为33.4 mmHg（1 kPa=7.5 mmHg），给予降眼压滴眼液后恢复正常。术后2周所有患者气体均完全吸收。14眼均未出现手术相关并发症。结论　自体游离内界膜移植术治疗玻璃体切割联合内界膜剥除术后未闭合黄斑裂孔，术后裂孔闭合率高，患者视功能改善明显。     

Effects of Internal Limiting Membrane Peeling in Vitrectomy on Diabetic Cystoid Macular Edema Patients

Purpose We evaluated the effects of the peeling of the internal limiting membrane (ILM) during vitrectomy in diabetic cystoid macular edema (CME) patients.Methods Visual outcome and intraoperative and postoperative complications were evaluated retrospectively in 84 CME patients (100 eyes), all of whom had been followed for at least 1 year postoperatively. Before January 2001, we did not perform ILM peeling at our hospitals; 57 patients (66 eyes) treated before 2001 were included in this retrospective study as the non-peeling group. After January 2001, ILM peeling was performed in 27 (34 eyes) CME patients, who were included in this study as the peeling group. In the peeling group, indocyanine green (ICG) staining was performed at the time of ILM peeling.Results Visual acuity improved significantly after vitrectomy regardless of ILM peeling. Visual acuity improved gradually from 6 months to 1 year after the operation, and improved further at the final observation point in both groups. Visual acuity did not differ significantly between the two groups at any time point. There was no difference in the incidence of intraoperative and postoperative complications between the two groups. There were no adverse events associated with ICG-assisted ILM peeling.Conclusions Visual acuity improved with vitrectomy for diabetic cystoid macular edema in both groups. ILM peeling was not found to improve visual acuity postoperatively. Jpn J Ophthalmol 2005;49:297–300 © Japanese Ophthalmological Society 2005     

Visual Acuity Comparison of Vitrectomy with and without Internal Limiting Membrane Removal in the Treatment of Diabetic Macular Edema

Purpose To evaluate whether internal limiting membrane (ILM) peeling during vitrectomy affects vision outcome in patients with diabetic macular edema. Material and method Fifty-eight eyes of 49 patients were included in the study. Patients with persistent diffuse clinically significant macular edema were divided into two groups according to the surgical method used. Group I subjects (15 patients; mean age 56.60±8.50 years; 17 eyes total) underwent vitrectomy with ILM peeling. Group II subjects (34 patients; mean age 57.52±11.54 years; 41 eyes total) underwent vitrectomy without ILM peeling. The data recorded for each case were type and duration of diabetes, insulin treatment (yes/no), presence of arterial hypertension, stage of diabetic retinopathy, lens status, history of macular laser treatment, and detection of posterior vitreous detachment during surgery. Visual acuity was measured preoperatively and 1 year postoperatively in decimal notation, and values were converted to logarithm of minimal-angle-of-resolution (logMAR) scores. Mean pre- and postoperative visual acuity were compared within each group, and the mean change in visual acuity in Group I was compared to that in Group II. Results There were no significant differences between the groups with respect to age; sex distribution; diabetes type; duration of diabetes; numbers of patients on insulin treatment; frequencies of hypertension, proliferative diabetic retinopathy, previous macular laser treatment; or frequency of intraoperatively confirmed posterior vitreous detachment (chi-square, P>0.05 for all). Comparison of pre- and post-operative visual acuity revealed significant improvement in both Group I (1.15±0.307 vs. 0.764±0.355 logMAR, respectively; Wilcoxon rank test, P<0.01) and Group II (1.22±0.516 vs. 0.829±0.436 logMAR, respectively; Wilcoxon rank test, P<0.001). The change in visual acuity for Group I was not significantly different from that observed in Group II (0.391±0.335 vs. 0.393±0.273 logMAR, respectively; Mann–Whitney U test, P>0.05). Conclusion The visual acuity outcomes in the study indicate that vitrectomy without ILM peeling is just as effective as vitrectomy with ILM peeling in the treatment of diabetic macular edema. Both techniques led to significant and similar degrees of improvement in visual acuity.     

内界膜剥离治疗特发性黄斑裂孔的早期愈合观察

目的：探讨玻璃体切除联合内界膜剥离治疗特发性黄斑裂孔的早期愈合情况。方法：回顾分析了2001年1月～2003年10月在我院行手术治疗的特发性黄斑裂孔25例(25只限),所有病人均采用经平坦部玻璃体切除联合黄斑前膜和(或)内界膜剥离,气-液交换和16％全氟丙烷(C3F8)充填。术后保持面朝下体位至少2周。采用裂隙灯、前置镜,光学相干断层扫描(OCT)检查观察手术后1个月内的黄斑裂孔的关闭情况。手术后第1周内每天检查,14、21和28d行常规裂隙灯前置镜检查;根据手术后玻璃体腔气体吸收的情况行OCT检查,当气体吸收超过50％,黄斑部露出时即行OCT检查。结果：25只眼中23只眼术中完整的撕除黄斑裂孔周围内界膜,2只眼未能完整撕除裂孔旁的内界膜。在手术后24—48h,23只眼裂隙灯及裂隙灯前置镜检查未发现黄斑裂孔的形态,1个月内的OCT检查证实23只眼黄斑裂孔均闭合．裂孔闭合率为92％,随访期间未发现裂孔再裂开现象。未闭合的2只眼均为手术中未能完整撕除内界膜眼,其中1只眼为3期黄斑裂孔,1只眼为4期黄斑裂孔,在随访期间未见裂孔关闭。术后早期黄斑裂孔关闭的23只眼的OCT形态主要表现为：正常的中心凹形态(简单闭合)15只眼(65,2％),桥样结构8只眼(34．8％)。结论：大部分特发性黄斑裂孔在手术后早期即已关闭,提示特发性黄斑裂孔在形成过程中不伴局部的视网膜组织缺损或缺损极少,手术解除玻璃体,特别是内界膜的机械牵拉后视网膜可复位,裂孔闭合。     

Long-term Retention of Dye After Indocyanine Green-Assisted Internal Limiting Membrane Peeling

Purpose

To evaluate dye retention in the fundus after indocyanine green (ICG)-assisted internal limiting membrane peeling.

Methods

Ten eyes with stage 3 or 4 nondiabetic idiopathic macular hole (MH group) and six eyes with diffuse diabetic macular edema (DM group) were studied. The fundus was examined with 780-nm infrared illumination by a scanning laser ophthalmoscope (SLO) after ICG-assisted internal limiting membrane peeling. The postoperative follow-up period ranged from 6 to 12 months (mean ± SD, 3.7 ± 2.6 months).

Results

Fluorescence from ICG was detected in all studied eyes in both groups up to 6 months after surgery. At 9 months after surgery, ICG fluorescence was visible in all eyes of the DM group, but in only one-third of eyes of the MH group. No fluorescence was detected in fellow eyes that had not been operated on.

Conclusion

The present study using SLO revealed that ICG remains in the fundus for over 6 months after surgery. The results also suggested that a longer time might be required for dye clearance from the diabetic retina than from the nondiabetic retina.?Jpn J Ophthalmol 2006;50:349–353 © Japanese Ophthalmological Society 2006     

玻璃体切割联合内界膜剥除和空气填充治疗特发性黄斑裂孔

观察玻璃体切割手术联合内界膜剥除和空气填充治疗特发性全层黄斑裂孔（IMH）的疗效。方法：回顾性系列病例研究。收集2017年1月至2018年1月在温州医科大学附属眼视光医院杭州院区确诊并行玻璃体切割术治疗的连续IMH患者32例（32眼），年龄47～78（60.7±12.2）岁，其中男9例，女23例。术中均采用消毒空气进行眼内填充。根据术后早期首次光学相干断层扫描（OCT）提示裂孔是否闭合分为闭合组和未闭合组，对2组患者术前、术后的最佳矫正视力（BCVA）、裂孔直径等采用秩和检验及独立样本t检验进行比较；2组患者裂孔闭合率及外界膜和光感受器连续性比较采用卡方检验。结果：术后末次随访时所有患者LogMAR BCVA为0.40（0.30，0.73），较术前[0.80（0.70，1.00）] 明显提高（Z=-3.439，P<0.001）。术后早期OCT扫描显示24例黄斑裂孔闭合，8例黄斑裂孔未闭合，予再次玻璃体腔空气填充治疗，术后1个月及术后末次随访所有患者黄斑裂孔均闭合。术后1个月 OCT扫描外界膜（ELM）连续的患者有16例，无一例椭圆体层（EZ）连续；末次随访时18例患者ELM 连续，6例EZ连续。未闭合组术前黄斑裂孔直径为（532±104）μm，明显大于闭合组黄斑裂孔直径 [（352±180）μm]（t=-2.656，P=0.013）。闭合组术后1个月ELM均存在连续性，末次随访ELM和EZ 连续性均高于未闭合组，2组差异具有显著的统计学意义（χ2 =4.23，P=0.040；χ2 =3.89，P=0.048）。结论：玻璃体切割联合ILM剥除和空气填充治疗IMH具有较好的疗效，对于大于400 μm的裂孔部分患者需要再次玻璃体腔空气填充治疗。     

Pars Plana Vitrectomy with Removal of Posterior Hyaloid Face in Treatment of Refractory Diabetic Macular Edema Resistant to Triamcinolone Acetonide

Background Triamcinolone acetonide (TA) has recently been used to treat diabetic macular edema (DME) but its effectiveness is limited. Cases Three patients (three eyes) with unresolved diffuse DME who did not respond to a posterior sub-Tenon's injection of TA underwent vitrectomy. Observations Intraoperatively, it was found that all of the eyes had a posterior hyaloid face that was adherent to a large area of the posterior pole retina, although this had not been detected by slit-lamp biomicroscopy or optical coherence tomography. After vitrectomy and removal of the posterior hyaloid face, there was a significant reduction in the central macular thickness of all three eyes and an improvement in the visual acuity of the patients. Conclusions When TA treatment is not effective for DME, vitrectomy with the complete removal of the posterior hyaloid face, including removal of the internal limiting membrane, should be considered.     

Results of Visual Acuity and Foveal Thickness in Diabetic Macular Edema after Vitrectomy

Purpose

To report results of an investigation of visual acuity (VA) and foveal thickness in diabetic macular edema (DME) patients after vitrectomy.

Methods

A retrospective study was performed of the records of 47 patients (61 eyes) who received pars plana vitrectomy (PPV) for DME. All eyes were followed up for over 6 months (mean, 24.8 months; range, 6–60 months). VA and foveal thickness evaluated by optical coherence tomography were reviewed preoperatively and postoperatively.

Results

Twenty-four-month follow-up data were available for 46 of the 61 eyes (75%). VA at the final examination had improved by 0.2 log units or more in 34 of the 61 eyes (56%), remained unchanged in 21 eyes (34%), and worsened in six eyes (10%). Mean foveal thickness decreased by more than 20% of the preoperative value in 50 of the 61 eyes (82%), remained unchanged in ten eyes (16%), and increased by more than 20% in one eye (2%) at the final examination. Postoperative best-corrected visual acuity (BCVA) at both 12 and 24 months was significantly better than preoperative BCVA (P < 0.0001). Foveal thickness at 3 months or later significantly decreased from the preoperative value (P < 0.0001), but remained unchanged in comparison with postoperative 12 months and 24 months values (P = 0.19). Preoperative VA and presence of cystoid macular edema (CME) were independently associated with final visual acuity (P = 0.001).

Conclusions

PPV for DME effectively improved VA and reduced foveal thickness for a longer postoperative period. Better preoperative VA was associated with better final postoperative VA. The eyes without CME tended to have better final postoperative VA.?Jpn J Ophthalmol 2007;51:204–209 © Japanese Ophthalmological Society 2007

     

Recurrence of Diabetic Macular Edema After Intravitreous Injection of Triamcinolone Following Vitrectomy

Purpose To evaluate the effects of intravitreous triamcinolone acetonide (TA) after pars plana vitrectomy (PPV) for diabetic macular edema (DME). Methods We studied a prospective interventional case series. TA was injected intravitreously after PPV in 28 eyes (PPV+TA group). Eyes with DME that met the same criteria and had been treated with PPV alone (29 eyes) were used as controls. The best-corrected visual acuity (VA) and foveal thickness determined by optical coherence tomography were followed up for over 12 months in both groups. Chronological changes of VA and foveal thickness between the groups were evaluated. Results In the PPV+TA group, VA had improved at 1 month, but worsened after 3 months. Improvement of foveal thickness was found until 3 months, but not after 6 months. In controls, both VA and foveal thickness continued to improve. The VA of the PPV+TA group was significantly better than that of the controls at 1 and 3 months (P = 0.007 and 0.015, respectively). The foveal thickness of the PPV+TA group was significantly less than that of controls at 1 month (P = 0.0004). These differences became insignificant thereafter, and foveal thickness became significantly worse in the PPV+TA group than in the controls at 12 months (P = 0.0002). Conclusion Although adjunctive use of TA after PPV for DME improved VA and foveal thickness, the effect was transient and foveal thickness increased significantly compared with the PPV alone group at 12 months postoperatively. Jpn J Ophthalmol 2007;51:278–284 @ Japanese Ophthalmological Society 2007     

Long-term Follow-up Results of Pars Plana Vitrectomy for Diabetic Macular Edema

Purpose To analyze the long-term effects of pars plana vitrectomy for diabetic macular edema. Methods Sixty-nine patients (73 eyes) with diabetic macular edema were examined retrospectively after pars plana vitrectomy. The mean follow-up time was 24.6 ± 7.3 months. Results The postoperative best-corrected visual acuity (BCVA) at 12 months was significantly better than the preoperative BCVA, and the improvement was maintained for at least 24 months. The mean central retinal thickness (RT) at 3 months after surgery was significantly thinner than the preoperative central RT, and was maintained for at least 24 months in the cases followed for this period. The postoperative BCVA was significantly worse than the preoperative BCVA at 2 years after surgery in eyes with a preoperative BCVA of ≤0.05. In addition, there was lower probability that the postoperative BCVA would be ≥0.5 in eyes with a preoperative BCVA of <0.3. Conclusions The results indicate that the improvement in the BCVA is attained by 12 months postvitrectomy, and is maintained for at least 24 months. The reduction in RT can be maintained for up to 24 months. The results also indicate that vitrectomy should be performed when the preoperative BCVA is >0.05 at worst. Jpn J Ophthalmol 2007;51:285–291 @ Japanese Ophthalmological Society 2007     

Anterior Vitrectomy for Chronic Aphakic Cystoid Macular Edema

This report describes a series of 13 patients who underwent anterior vitrectomies for chronic aphakic cystoid macular edema (CME). All eyes had formed vitreous adherent to the intracapsular wound, vision of 20/50 or worse, and fluorescein angiographically documented CME for six months or more. Following the presentation of the results (success rate of 69%) and a discussion of this form of treatment, the beginning of a national, randomized, prospective study designed to evaluate the effectiveness of this treatment is described.