玻璃体视网膜交界面状态与玻璃体视网膜疾病

本文通过对玻璃体和玻璃体视网膜交界面结构以及玻璃体与视网膜疾病关系的详细描述,阐述了完全性玻璃体后脱离对各类玻璃体视网膜疾病的正面影响,提出了诱导完全性玻璃体后脱离,预防与治疗各类玻璃体视网膜疾病的新型方法即药物溶解术。     

玻璃体酶溶术的研究进展

玻璃体视网膜界面异常与许多玻璃体视网膜病变密切相关。玻璃体内注射酶剂水解玻璃体与视网膜粘连,诱导完全性玻璃体后脱离、解除玻璃体的牵拉治疗玻璃体视网膜界面疾病,是近年来发展的一项新技术。一些酶剂包括纤溶酶、微小纤溶酶、透明质酸酶、中性蛋白酶、软骨素酶及枯草杆菌蛋白酶,已被用于辅助或代替玻璃体切割术来诱导玻璃体后脱离。本文对有关玻璃体酶溶术相关进展进行综述。     

辅助性药物诱导玻璃体后脱离的研究进展

玻璃体视网膜交界面的状态与许多玻璃体视网膜疾病的发生发展密切相关.近年来研究表明,玻璃体切割术前应用药物可使玻璃体液化或使许多增生性玻璃体视网膜疾病玻璃体内的纤维增生膜溶解,解除玻璃体后皮质与视网膜内界膜之间的粘连,形成完全性玻璃体后脱离,不但有利于手术的进行而且有利于玻璃体视网膜疾病的治疗和视力的恢复.本文对目前药物诱导玻璃体后脱离的组织结构、药物的作用机制及其在临床和实验研究方面的进展作简要综述.     

玻璃体视网膜交界面状态与玻璃体视网膜疾病

本文通过对玻璃体和玻璃体视网膜交界面结构以及玻璃体与视网膜疾病关系的详细描述 ,阐述了完全性玻璃体后脱离对各类玻璃体视网膜疾病的正面影响 ,提出了诱导完全性玻璃体后脱离、预防与治疗各类玻璃体视网膜疾病的新型方法即药物溶解术     

玻璃体后脱离及其并发症的发病机制

在衰老过程中,玻璃体液化和玻璃体视网膜界面改变可诱发玻璃体后脱离(posterior vitreous detachment,PVD).不完全PVD及异常PVD通过玻璃体视网膜牵拉作用以及容量和化学转移可引起视网膜裂孔、孔源性视网膜脱离、视网膜前膜、黄斑水肿、年龄相关性黄斑变性、黄斑裂孔、玻璃体黄斑牵拉综合征等一系列并发症.为防止这些并发症进一步加重,减轻疾病恶化的风险,可以提前诱导完全性PVD或者采用玻璃体切除手术.目前药物性玻璃体融解术已进入临床前期研究,非酶试剂等非侵入性的治疗方法也在探索阶段.     

完全性玻璃体后脱离及其药物诱导的研究进展

药物诱导玻璃体后脱离(PVD)后,使许多增生性病变如糖尿病视网膜病变的纤维血管膜无法形成,有利于黄斑裂孔的恢复及PVR的防治。本文对药物诱导完全性PVD的意义、常用药物及可行性进行综述。     

玻璃体后脱离和玻璃体视网膜疾病

由于玻璃体和视网膜密切联系，玻璃体后脱离（PVD）在许多视网膜病变发生发展中扮演了重要角色。本文对PVD和视网膜脱离、糖尿病视网膜病变、黄斑疾病以及其他常见视网膜病变的关系进行了综述。     

纤溶酶和透明质酸酶在诱导猪玻璃体后脱离中对眼前部组织的安全性研究

近年来产生的酶辅助的玻璃体切割术，即应用酶化学作用液化玻璃体并分离玻璃体视网膜交界面，诱导产生完全性玻璃体后脱离（PVD），可用于辅助玻璃体切割术，简化手术，减少并发症，也为微创玻璃体切割术的发展创造了条件，甚至可以替代玻璃体切割术，用于预防和治疗一些玻璃体视网膜疾病，     

完全性玻璃体后脱离及其药物诱导的研究进展

药物诱导玻璃体后脱离(PVD)后，使许多增生性病变如糖尿病视网膜病变的纤维血管膜无法形成，有利于黄斑裂孔的恢复及PVR的防治。本对药物诱导完全性PVD的意义、常用药物及可行性进行综述。     

玻璃体视网膜界面早期变化的研究

在解剖上,玻璃体后皮质与视网膜相邻,玻璃体与视网膜的关系是既相互独立,又紧密联系的。病理状态时,玻璃体的改变为许多玻璃体视网膜疾病的发生、发展提供了一个良好的生长环境,玻璃体在许多玻璃体视网膜疾病的发生发展中起了关键性作用。消除玻璃体改变在疾病中的作用,是近年来眼科界极为关注的一个问题。本文通过对玻璃体和玻璃体视网膜交界面结构和黏连机制、玻璃体与视网膜界面变化的危险因素、对视网膜疾病影响的描述,阐述了玻璃体后脱离对玻璃体视网膜界面疾病的影响及采用的检测方法及意义。     

Anatomical findings of vitreoretinal interface in eyes with asteroid hyalosis

Purpose  To investigate the anatomical features of vitreoretinal interface in eyes with asteroid hyalosis (AH) with optical coherence tomography (OCT) and intravitreal triamcinolone acetonide (TA) during vitreous surgery. Methods  This study was an interventional clinical case series. Records relating to ten eyes from ten patients who underwent a TA-assisted vitrectomy for the treatment of diverse vitreoretinal diseases complicated with AH. The posterior vitreoretinal interface was examined by preoperative OCT and by intraoperative visualization of posterior vitreous cortex utilizing TA. Results  In eight of ten AH eyes, preoperative OCT revealed abnormal vitreoretinal adhesions. In four of these eight eyes, posterior vitreoschisis could be seen on OCT. In the other four of these eight eyes, a clear no posterior vitreous detachment (PVD) pattern could be seen on OCT. Although posterior vitreous cortex could not be clearly identified with preoperative OCT in two of ten AH eyes, a complete PVD was refuted by intraoperative visualization of the posterior vitreous cortex with TA identical to the other eight eyes. Conclusion  These results indicate that complete PVD appears to be unlikely to occur in eyes with AH. In addition, spontaneous PVD in eyes with AH might lead to vitreoschisis or residual whole layer or posterior vitreous cortex, possibly due to anomalous vitreoretinal adhesion.     

Variations of posterior vitreous detachment

AIMS—To identify variations in posterior vitreous detachment (PVD) and establish a clinical classification system for PVD.METHODS—400 consecutive eyes were examined using biomicroscopy and vitreous photography and classified the PVD variations—complete PVD with collapse, complete PVD without collapse, partial PVD with thickened posterior vitreous cortex (TPVC), or partial PVD without TPVC.RESULTS—In each PVD type, the most frequently seen ocular pathologies were as follows: in complete PVD with collapse (186 eyes), age related changes without vitreoretinal diseases (77 eyes, 41.4%) and high myopia (55 eyes, 29.6%); in complete PVD without collapse (39 eyes), uveitis (23 eyes, 59.0%) and central retinal vein occlusion (8 eyes, 20.5%); in partial PVD with TPVC (64 eyes), proliferative diabetic retinopathy (30 eyes, 46.9%); and in partial PVD without TPVC (111 eyes), age related changes without vitreoretinal diseases (62 eyes, 55.9%). This PVD categorisation was significantly associated with the prevalence of each vitreoretinal disease (p<0.0001, χ² test on contingency table).CONCLUSIONS—PVD variations can be classified into four types, which is clinically useful because each type corresponds well to specific vitreoretinal changes.     

Pharmakologische Vitreolyse

Posterior vitreous detachment (PVD) is a physiological ageing process. In many cases PVD is incomplete and pathological adhesions of vitreous collagen may be associated with tractional forces in the periphery where they can cause retinal breaks and lead to detachment of the neurosensory retina. In the macular area such tractional forces at the vitreoretinal interface can contribute to the formation of specific entities such as vitreomacular traction syndrome and macular holes which are associated with an impairment of visual acuity and disturbing metamorphopsia. Currently, pars plana vitrectomy with induction of PVD, peeling of epiretinal membranes and the ILM represents an effective and safe treatment option for these conditions. Pharmacological vitreolysis is a new and alternative, non-surgical approach to release tractional forces at the vitreoretinal interface by injecting an enzyme with proteolytic activity against fibronectin and laminin into the vitreous cavity. Certain forms of vitreomacular traction and smaller macular holes can be successfully treated in this way without surgical manipulation of the retinal surface. The role of the concept of pharmacological vitreolysis as a treatment option even for exudative macular diseases or as an adjunct to assist vitreoretinal surgical procedures is currently under investigation.     

Posterior vitreous detachment rate following intravitreal dexamethasone injection

AIM: To determine whether intravitreal dexamethasone (DEX) implant induces posterior vitreous detachment or not. METHODS: We retrospectively reviewed 810 eyes of 405 patients who underwent intravitreal DEX implantation due to macular edema caused by diabetic and retinal venous occlusion in our clinic. The eyes having no injection were determined as the control group. The examination findings of the patients before the injection and 3mo after the injection and optical coherence tomography (OCT) images were scanned. The pre-injection OCT findings and OCT findings of the patients having no posterior vitreous detachment (PVD) and determined to have partial PVD were compared. RESULTS: The separation in vitreoretinal adhesion and total PVD development of DEX-injected 56/208 (26.9%) eyes were statistically greater in comparison with the 12/129 (9.3%) eyes that had not been injected (P=0.001). PVD development was observed more in the patients that were younger, had larger macula thickness and lower visual acuity. CONCLUSION: It can be stated that intravitreal DEX implant induces PVD development. Prospective, controlled studies are required in order to determine prognosis of vitreoretinal disease in PVD-developed patients and in non-PVD-developed patients.     

环扎加压术后玻璃体的短期改变

目的 分析环扎加压手术后玻璃体的短期改变。方法 采用超声和临床检查分析接受环扎加压术的76眼术前到术后短期内玻璃体的改变。结果41眼（53.9％）术后玻璃体内混浊物质增多。术前超声检查下后极区完全玻璃体后脱离（PVD）、部分PVD和无PVD者分别为20,34和22眼,而术后初次超声检查时则为46,26和4眼。结论在环扎加压术后,相当一部分眼术后短期内出现后极区PVD的范围迅速扩大。与黄斑中心凹周围相比,这种急性的PVD更多地首先发生于视盘区。     

辅助玻璃体视网膜手术的药物研究进展

玻璃体切割术的主要目的是切除病变玻璃体和解除玻璃体对视网膜的牵拉。难度在于玻璃体与视网膜之间存在紧密粘连或有玻璃体后脱离。药物辅助的玻璃体视网膜手术是指先于玻璃体切割操作即应用药物促进玻璃体的液化或使玻璃体内纤维增生膜溶解,以解除玻璃体对视网膜的牵引,从而提高手术效率和安全性。就玻璃体视网膜手术辅助药物的研究进展进行综述。     

Epiretinal membranes and incomplete posterior vitreous detachment in diabetic macular edema, detected by spectral-domain optical coherence tomography

PURPOSE. To present the vitreoretinal interface in diabetic macular edema (DME) associated with both epiretinal membrane (ERM) and incomplete posterior vitreous detachment (PVD), as detected by spectral-domain optical coherence tomography (SD-OCT). METHODS. In a retrospective study, findings were analyzed in one eye in consecutive patients. Excluded were eyes that had undergone vitreoretinal intervention or that had complete PVD or complete vitreous attachment. RESULTS. Of 44 eyes with DME and ERM, incomplete PVD was apparent in 23 (52.2%) eyes. A hyperreflective unified ERM/posterior vitreous cortex (PViC) membrane, or EVi membrane, was apparent in various sizes in 20 (87.0%) of the 23 eyes. This unified membrane (n = 20) was associated with vitreopapillary adherence in 19 (82.6%) of 23 eyes. Two major OCT presentations (n = 23) were encountered: incomplete vitreopapillary detachment (n = 11; 25% of 44), with attachment to the macular ERM, and posterior vitreous detachment from the macula, associated with vitreopapillary adhesion (n = 10; 22.7%), in four different manifestations. In the remaining two eyes, there was no association between the ERM and the PViC. CONCLUSIONS. In eyes with DME, ERM, and incomplete PVD, the posterior cortical vitreous and ERM appeared as one united EVi membrane in various lengths in most eyes, typically associated with vitreopapillary adhesion. These findings may have clinical importance in the context of epimacular membrane characteristics and its removal in DME.     

Vitreomacular interface in patients with familial exudative vitreoretinopathy

Familial exudative vitreoretinopathy (FEVR) is a rare hereditary vitreoretinal disease that occurs in young patients and results in an avascular peripheral retina, retinal neovascularization, and tractinal retinal detachment. Patients occasionally have concurrent macular diseases. However, the vitreomacular relationship in FEVR remains unclear. We report two cases, a 22-year-old woman (case 1) and a 14-year-old boy (case 2) with FEVR who have the characteristic findings of the disease in the vitreomacular interface and the macular morphology, observed using spectral-domain optical coherence tomography (SD-OCT). In case 1, the best-corrected visual acuity (BCVA) was 20/20 bilaterally. SD-OCT showed a perifoveal posterior vitreous detachment (PVD) with vitreofoveal adhesion in the left eye. In case 2, SD-OCT showed a perifoveal PVD in the right eye (BCVA, 20/30) with numerous small deposits that appeared as rod-shaped attachments perpendicular to the parafoveal face without intraretinal and subretinal materials beneath the posterior hyaloid face that corresponded to white material on the fundus examination. Fluorescein angiography showed a circumferential peripheral avascular area and peripheral neovascularization in both cases. These SD-OCT findings suggested that a perifoveal PVD and small deposits, which appeared as rod-shaped attachments perpendicular to the parafoveal face in patients with FEVR, may carry the risk of macular disease and decreased visual acuity.     

Optical coherence tomography assessment of the vitreoretinal relationship in diabetic macular edema

PURPOSE: To study the vitreoretinal relationship in diabetic patients with and without diabetic macular edema (DME) using optical coherence tomography. DESIGN: Retrospective case-control study. METHODS: setting: Institutional practice. patients: Thirty-five consecutive diabetic patients (49 eyes) with DME and 35 sex- and age-matched diabetic control patients without DME (49 eyes). observation procedure: All patients had Early Treatment Diabetic Retinopathy Study visual acuity measurement and biomicroscopic examination of the vitreoretinal interface. OCT was performed to obtain cross-sectional images of the vitreoretinal interface of the macular region. Posterior vitreous detachment (PVD) was staged from 0 to 3 as follows: stage 0: absence of PVD; stage 1: perifoveolar PVD with foveolar attachment; stage 2: incomplete PVD with residual attachment to the optic nerve; and stage 3: complete PVD. Retinal thickness was measured using OCT mapping software in all cases. main outcome measures: Prevalence of the different PVD stages in both groups of eyes. RESULTS: The mean age of the patients was 60 years in both groups. Of the eyes with macular edema, 19 (38.8%) were stage 0, 26 (53.0%) stage 1, 1 (2.0%) was stage 2, and 3 (6.2%) were stage 3. In eyes without DME, the corresponding figures were, respectively, 34 (69.4%), 11 (22.4%), 1 (2.0%), and 3 (6.2%). The prevalence of perifoveolar PVD with foveolar attachment was significantly higher in the group of eyes with DME (P =.006). CONCLUSIONS: These results show the high prevalence of perifoveolar PVD with foveolar attachment in diabetic patients with macular edema. Even though PVD is not the main factor involved in the pathogenesis of DME, perifoveolar PVD may have a role in the development of this complication.     

Vitreomacular adhesion and the defect in posterior vitreous cortex visualized by triamcinolone-assisted vitrectomy

PURPOSE: To study the vitreomacular adhesion and the contractile force of posterior hyaloid, which are shown in triamcinolone acetonide (TA)-assisted pars plana vitrectomy (PPV). DESIGN: Interventional case series. METHODS: Twenty-eight eyes with diabetic macular edema (DME) without posterior vitreous detachment (PVD) received TA-assisted PPV. Surgical PVD was performed by an aspiration of vitrectomy probe, and the dynamic changes of posterior vitreous cortex and residual vitreous cortex were evaluated. RESULTS: A premacular defect was formed in the detached posterior vitreous cortex during surgical PVD in 27 of 28 eyes. Immediately thereafter, the small defect expanded into a large hole in the detached posterior vitreous cortex in all cases. A residual vitreous cortex was left on the macula in 22 eyes. CONCLUSIONS: These observations demonstrate a firm vitreoretinal adhesion in the central macula and suggest that the enlargement of the defect of posterior vitreous cortex may be extrusion of vitreous out through the premacular dehiscence into the preretinal space, or a tangentially contractile force may exist in the posterior vitreous cortex. Both macular adhesion and the traction of vitreous cortex might contribute to the pathogenesis of DME and other vitreomacular disease.