Combined surgery, phacoemulsification, implantation of intraocular lens and pars plana vitrectomy

PURPOSE: To evaluate the effectiveness, technical feasibility and incidence of complications after combining pars plana vitrectomy, phacoemulsification and intraocular lens implantation. MATERIAL AND METHODS: The results of combined vitreoretinal and cataract surgery in 100 eyes of 96 patients were retrospectively and prospectively analyzed. The mean follow-up period was 8.4 months. All patients had clinically significant lens opacities and vitreoretinal pathology requiring pars plana vitrectomy. Indications for vitreoretinal surgery included: persistent vitreous haemorrhage (28 eyes), vitreous hemorrhage combined with tractional retinal detachment (50 eyes), tractional retinal detachment without vitreous haemorrhage caused by proliferative diabetic retinopathy (7 eyes), rheumatogenous retinal detachment with proliferative vitreoretinopathy (10 eyes) and dislocated crystalline lens in the vitreous (5 eyes). RESULTS: Postoperatively, best corrected visual acuity improved in 81 eyes (81%)- by two lines or more in 31 eyes (31%) - by less than two lines in 50 eyes (50%). In 14 eyes (14%) visual acuity was unchanged and was worse in 5 cases (5%). Postoperative complications included fibrin reaction, posterior synechias of the iris, vitreous hemorrhage, neovascular glaucoma, posterior capsule opacification, redetachment of retina. CONCLUSIONS: Our cases confirm previous study, that performing phacoemulsification, IOL implantation and vitrectomy in one operation is safe and allows visual recovery with good technical results.     

玻璃体手术治疗自发性玻璃体积血

目的观察玻璃体手术治疗非糖尿病性自发玻璃体积血的疗效及其与手术时机的关系。方法45例(46眼)非糖尿病性自发玻璃体积血行标准三通道闭合式玻璃体切除并联合眼内激光光凝等手术,并对不同时机手术的患者术后视力及并发症进行分析。结果1月以内手术者术后视力均提高。1月以上手术者14眼中术后视力提高者2眼,不变8眼,下降3眼。手术并发症主要为术中出血和医源孔及术后高眼压。术中医源孔和术后视网膜脱离均为1月以上手术者。结论玻璃体手术治疗非糖尿病性自发玻璃体浓密积血者疗效佳,并发症少。考虑玻璃体积血为视网膜裂孔所致者应及时手术。     

严重PDR玻璃体切割术后雷珠单抗注射的效果观察

目的：对严重增殖性糖尿病视网膜病变的患者行玻璃体切割术后行雷珠单抗注射的效果观察。方法：回归性分析。12例严重增殖性糖尿病视网膜病变患者(12眼)接受睫状体平坦部玻璃体切割术,同时给予硅油、惰性气体或者平衡液的玻璃体腔填充。在手术结束的同时给予雷珠单抗的玻璃体腔注射。结果：随访时间平均为2.75 mo。这12眼中分别包括玻璃体积血(1眼);玻璃体积血伴纤维血管化增生(1眼);玻璃体积血伴牵拉性视网膜脱离(3眼);纤维血管化增生伴牵拉性视网膜脱离(2眼);玻璃体积血伴新生血管性青光眼伴牵拉性视网膜脱离(1眼);玻璃体积血伴纤维血管化增生伴牵拉性视网膜脱离(2眼);玻璃体积血伴纤维血管化增生伴新生血管性青光眼伴牵拉性视网膜脱离(1眼);玻璃体积血伴牵拉性孔源性视网膜脱离(1眼)。12眼中,8眼行玻璃体腔硅油填充,2眼行惰性气体填充,2眼行平衡液填充。所有的患者之前均未接受任何治疗。视网膜脱离复位率为10/10(100%)。1眼术后出现前房积血。9眼术后最佳矫正视力较术前提高,2眼无明显变化,1眼较术前下降。 OCT检查显示8眼术后未见黄斑水肿。结论：玻璃体切割术后雷珠单抗注射对严重增殖性糖尿病视网膜病变患者有明显的治疗效果：手术成功率明显提高;患者视力显著提高;糖尿病黄斑水肿的发生概率减少;术中及术后并发症的发生率降低。     

Early vitrectomy for fundus-obscuring dense vitreous haemorrhage from presumptive retinal tears

Background Published literature on the management of patients with fundus-obscuring dense vitreous haemorrhage due to presumptive retinal tears is sparse and advocates waiting for spontaneous resolution. Surgery is indicated only when a definite retinal tear or retinal detachment is identified. Methods A retrospective review of all patients who underwent early vitrectomy for vitreous haemorrhage associated with posterior vitreous detachment was carried out. A comparison of initial visual acuity versus final visual acuity after vitrectomy was performed. The number of eyes that were found to have retinal tears and retinal detachment were documented. Initial and final Snellen acuities were used for statistical analysis. Categorical data were analysed using Fisher’s exact test and statistical significance was considered to be p<0.05. Results Sixteen eyes were identified and all these patients presented or were referred soon after the onset of vitreous haemorrhage. Associated ocular pathology (choroidal neovascular membrane, retinal branch vein occlusion, macroaneurysm) was suspected to be the source of the haemorrhage in 4 eyes. Vitrectomy was carried out in 12 eyes soon after presentation (mean time 6.3 days, range 1–28 days). Nineteen retinal breaks were seen in these eyes and 5 eyes had more than two breaks. None of the eyes were found to have proliferative vitreo-retinopathy at the time of surgery. Two eyes needed repeat surgery for new retinal breaks. Excluding the eyes found to have an ocular pathology as the cause of vitreous haemorrhage, the mean visual acuity improved from hand movements to 6/12 (p<0.001). Conclusions Early vitrectomy for spontaneous dense fundus-obscuring vitreous haemorrhage and posterior vitreous detachment is safe. Since the number of patients in this study was small, a prospective randomised controlled study comparing early versus late vitrectomy is needed to see whether early surgery also prevents proliferative vitreoretinopathy formation.     

Vitrectomy for nondiabetic vitreous hemorrhage. Not associated with vascular disease

Forty-nine consecutive eyes with nonclearing vitreous hemorrhage not associated with retinal or choroidal vascular disease underwent vitrectomy. Etiologies included vitreous hemorrhage during anterior segment surgery (22 eyes), blunt trauma (8 eyes), retinal tears with and without retinal detachment (8 eyes), Terson's syndrome (2 eyes), avulsed retinal vessel (1 eye), and idiopathic cases (8 eyes). The final visual acuity improved in 48 eyes (98%). Follow-up was 6-91 months (mean, 20 months). Of the 49 eyes, 40 eyes (82%) had a best postoperative visual acuity of 20/100 or better, 31 eyes (63%) had visual acuity of 20/40 or better, and 12 eyes (24%) had visual acuity of 20/20. The major complications included intraoperative iatrogenic retinal breaks (5 eyes), postoperative progressive cataract (7 eyes), late retinal detachment (4 eyes) and recurrent vitreous hemorrhage (2 eyes). The major complication associated with later visual loss was progressive cataract.     

Late Retinal Complications in Former Preterm Infants with Regressed ROP

BACKGROUND: The purpose of this study is to evaluate late retinal complications in former preterm infants with regressed stages of acute retinopathy of prematurity (ROP). PATIENTS AND METHODS: Between 1995 and 2002 a consecutive series of 15 patients (16 eyes) with loss in visual acuity were examined. Gestational age was < 32 weeks, birth weight < 1500 g. The reason for visual disturbances was: RD (n = 14), vitreous haemorrhage (n = 3) and posterior vitreous detachment (n = 1). RESULTS: Two eyes recovered spontaneously. Surgery was performed in 14/16 eyes, with a pars plana vitrectomy (n = 14), or buckling procedure (n = 2). Four eyes with a severe form of regressed ROP needed multiple procedures for reattachment At last follow-up in 13/14 (93.0 %) eyes the retina was completely attached. Visual acuity ranged from light projection to 20/25. CONCLUSIONS: Former premature patients with vitreoretinal changes due to regressed ROP may develop vitreous traction and subsequent late-onset retinal detachment. Surgery with primary vitrectomy technique in eyes with retinal detachment can remove the vitreoretinal adhesions and is an effective treatment technique. In eyes without retinal detachment the natural course can be awaited.     

玻璃体切除联合不同眼内填充物治疗增性糖尿病视网膜病变的效果分析

目的 评估增殖型糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)行玻璃体切割术的治疗效果.对PDR不同分期以及联合不同填充物的视力和并发症情况进行观察和比较,探讨其预后的差别.方法 对因PDR行玻璃体手术的病例300例(384只眼)进行随访,根据玻璃体切割术后不同填充物分为硅油填充组、全氟丙烷填充组和平衡盐水组三组,比较各组间的视力预后及并发症发生情况.结果 (1)术后视力:在观察的384只眼中,随访时视力较术前提高者有271只眼(70.6%);其中保留BSS灌注液患者中有78只眼(84.8%),填充气体患者有58眼(70.7%),填充硅油患者135只眼(64.3%)视力提高.经x2检验,各组间视力提高比例的差别无统计学意义(均P>0.05).(2)术后并发症:玻璃体再出血发生率以填充BSS组最高(23.9%),与硅油填充组(10.5%)比较差异有统计学(P<0.05);并发性白内障以硅油填充组(26.4%)最高,与填充BSS组相比差异具有统计学意义(P<0.05);视网膜脱离发生率以硅油填充组最高,与填充BSS组相比差异具有统计学意义(P<0.05);不同填充物各组间虹膜红变发生率未显示统计学差异.结论 (1)玻璃体切割联合不同填充物能有效地控制病情,及时有效的玻璃体手术是挽救严重PDR患者有用视功能的关键.(2)玻璃体出血、视网膜脱离、并发性白内障和青光眼是PDR患者玻璃体切割术后主要的并发症.硅油填充组的玻璃体出血发生率少于其他组,但并发性白内障发生率较其他组高;(3)尽管玻璃体切割术联合硅油填充会引起一些并发症,但硅油有屏障、限制出血扩散和视网膜复位的作用,为进一步完成全视网膜激光光凝创造了条件,巩固了手术治疗的效果,明显提高视网膜复位率及手术治疗成功率     

无玻璃体眼经巩膜睫状沟后房型人工晶状体固定术

目的 探讨玻璃体切割术后无玻璃体眼经巩膜睫状沟后房型人工晶状体固定手术方法并评价其疗效。方法 对8例(8眼)玻璃体切割术后无玻璃体眼行经巩膜睫状沟后房型人工晶状体固定术(PC-IOL)。术后随访3～56个月。结果 术后裸眼视力均较术前提高，术后最佳矫正视力均达到或接近术前最佳矫正视力，其中≥0．5者1眼，≥1．O者3眼。术中低眼压2眼、眼球塌陷1眼，术后前房积血3眼，玻璃体积血3眼，人工晶状体脱位1眼，一过性高眼压3眼，黄斑囊样水肿3眼，视网膜脱离1眼。结论 经巩膜睫状沟PC-IOL固定术是无玻璃体并伴有眼前段结构紊乱眼恢复视力的补救手术。术中注意稳定眼压，可减少或避免术中、术后并发症。     

Phacoemulsification and lens implantation after scleral buckling surgery

PURPOSE:To determine the intraoperative and postoperative complications and best-corrected visual acuity outcomes of eyes undergoing phacoemulsification and intraocular lens implantation after retinal detachment repair by the scleral buckling technique. METHODS:The charts of all patients who underwent phacoemulsification and intraocular lens implantation between July 1991 and May 1998 in two surgical practices were reviewed to identify eyes with a history of retinal detachment repaired by the scleral buckling technique. Eyes with a history of pars plana vitrectomy were excluded. Demographic and surgical data, preoperative and postoperative best-corrected visual acuity, and intraoperative and postoperative complications were recorded.RESULTS:We identified 34 eyes of 32 patients. The mean interval from retinal detachment repair to phacoemulsification was 12.4 years. The mean interval from phacoemulsification to final examination was 20 months. Risk factors for retinal detachment included isolated myopia (82%), myopia with lattice retinal degeneration (5.9%), and myopia with trauma (8.8%). One eye (2.9%) had no identifiable risk factors. Final best-corrected visual acuity of 20/40 or better was attained in 29 (85%) of 34 eyes and 20/20 or better in 18 (53%) of the eyes. Of the five eyes with the lowest best-corrected visual acuity, three had a macula-off retinal detachment; one had a posterior capsule opacity, epiretinal membrane, and corneal edema secondary to ocular ischemia; and one had advanced glaucoma. All five eyes still experienced an improvement in best-corrected visual acuity. With regard to complications, one eye had a posterior capsular tear with vitreous loss and another developed a postoperative retinal tear. Posterior capsule opacification requiring laser capsulotomy developed in 13 eyes (38%). No eye developed a retinal redetachment. CONCLUSION:Phacoemulsification and intraocular lens implantation can be performed safely after scleral buckling surgery and excellent best-corrected visual acuity results can be attained in most eyes. No modification of surgical technique is necessary. No retinal redetachment occurred in this series.     

玻璃体手术治疗继发于视网膜分支静脉阻塞的视网膜脱离

目的 探讨继发于视网膜分支静脉阻塞（BRVO）的视网膜脱离（RD）的临床特点和玻璃体手术的治疗效果。方法 回顾分析45例（45眼）继发于BRVO的RD的临床特点、治疗方法和预后。结果 45眼RD患者术前和术中检查发现，合并视网膜裂孔25眼，完全玻璃体后脱离（PVD）16眼。44眼均完成玻璃体手术，术后随访6—84个月。视力提高28眼（63．64％），稳定11眼（25．00％），下降5眼（11．36％）。手术后视力与手术前视力比较，差别有显著统计学意义（χ^2=4．04，P〈0．01）；完全PVD组与无或仅部分PVD组的手术后视力比较，差别有显著统计学意义（χ^2=2．97，P〈0．01）。第1次手术后视网膜成功复位39／45眼（88．64％），最终视网膜成功复位44／45眼（97．78％）。结论 继发于BRVO的RD有其独特的临床表现。玻璃体手术能有效地治疗继发于BRVO的RD，术后绝大多数患者视力改善，视网膜成功复位。     

广角观察系统在外伤性玻璃体手术中的应用

目的探讨广角观察系统(wide_angle viewing system)在外伤性玻璃体手术中应用的意义。方法2003年8月~2005年2月期间在手术显微镜下应用广角观察系统完成45例(45眼)外伤性玻璃体切除手术。45眼中11眼为眼内异物,6眼为眼内炎,17眼为视网膜脱离,其余眼均有严重玻璃体积血并且2周以上无明显吸收者。结果45眼经过3~18月随访,视力增加者38眼(84.44%),不变者5眼(11.11%),视力减退者2眼(4.44%)。结论外伤性玻璃体视网膜手术应用广角观察系统有许多优越性。     

Vitrectomy in 125 eyes with diabetic vitreous haemorrhage.

A total of 125 consecutive eyes, all registered blind with diabetic vitreous haemorrhage, underwent pars plana vitrectomy with the vitrophage. Sixty-six per cent experienced some improvement in their visual acuity; 24 per cent were unchanged and 10 per cent were worse postoperatively. The major surgical complication was controllable haemorrhage (23 per cent). No retinal dialysis occurred. Significant postoperative complications were transient (71 per cent) and persistent (11 per cent) corneal oedema, early (8 per cent) and late (13 per cent) vitreous haemorrhage, transient (30 per cent) and persistent (6 per cent) rise in intraocular pressure, and rubeosis iridis (5 per cent).     

玻璃体手术治疗中间葡萄膜炎玻璃体视网膜并发症的临床效果

目的 探讨玻璃体手术治疗中间葡萄膜炎玻璃体视网膜并发症的临床效果.方法 为系列病例研究.选择16例(16只眼)并发玻璃体视网膜疾病的中间葡萄膜炎患者进行玻璃体手术治疗.术后随访5～32个月,平均(14.25±7.90)个月.随访期间观察患者视力、术后并发症及中间葡萄膜炎的复发情况.结果 16例(16只眼)患者中,有4例分别患有肺结核、多发性硬化、Beheet综合征及风湿性关节炎等全身性疾病,其余12例无系统性疾病.术前所有患者均有糖皮质激素治疗史,使用时间为6～16个月,平均(9.94±2.67)个月.玻璃体视网膜并发症包括重度玻璃体混浊伴机化5只眼,牵引性视网膜脱离6只眼,孔源性视网膜脱离1只眼,玻璃体积血2只眼,黄斑前膜伴玻璃体机化2只眼,所有患眼均出现周边部视网膜新生血管.术后并发白内障3只眼,牵引性视网膜脱离1只眼.术后4例患者需长期服用糖皮质激素或联合免疫抑制剂治疗.术后视力提高或保持不变14只眼,视力下降2只眼,与术前视力比较差异有统计学意义(x2=4.923,P＜0.05).术后未见中间葡萄膜炎复发者.结论 对严重或药物控制不佳而出现玻璃体视网膜并发症的中间葡萄膜炎患者采用经平坦部的玻璃体手术治疗,可以明显改善患者视力,减少长期使用免疫抑制剂治疗的不良反应.     

玻璃体切割手术治疗增生型糖尿病视网膜病变的疗效观察

目的 评估玻璃体切割手术治疗1型糖尿病(diabetes mellitus,DM)所致增生型糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)的临床疗效及并发症特点.方法 回顾性分析2010年1月至2016年1月于我院确诊为PDR并行玻璃体切割手术治疗的18例(28眼)小于30岁的1型DM患者的临床资料,观察术后视力改善程度及术中、术后并发症.结果 术后随访6 ～ 72(平均43.0)个月,23眼(82.1％)术后视力维持或改善,5眼(17.9％)视力下降,其中无光感2眼(7.1％);1次手术复位视网膜脱离12眼(92.3％);术中并发症为医源性视网膜裂孔3眼;术后并发症:前房炎症反应9眼,前房积血5眼,复发性玻璃体积血2眼,复发性视网膜脱离3眼,虹膜红变5眼,新生血管性青光眼4眼.结论 玻璃体切割手术可以很好地恢复年轻1型DM所致PDR患者的视网膜解剖结构及功能,术后新生血管相关性并发症重,需行充足全视网膜光凝及术前抗VEGF注药治疗.     

玻璃体手术治疗视网膜静脉周围炎并发症的疗效

目的 观察视网膜静脉周围炎合并玻璃体积血和(或)牵引性视网膜脱离行玻璃体切割术的疗效及并发症。 方法 回顾性分析1989～2001年行玻璃体切割术治疗合并玻璃体积血和(或)牵引性视网膜脱离的视网膜静脉周围炎患者69例的临床和随访资料。随访时间为手术后6个月～12年，平均随访时间45个月。 结果 (1)手术后视力较手术前显著提高。(2)11只眼有手术中并发症，占14.3%，其中医源性裂孔7只眼，手术中出血3只眼，晶状体损伤1只眼。(3)手术后1个月内20只眼有并发症，占260%，其中玻璃体再积血14只眼，一过性高眼压6只眼，视网膜脱离5只眼，前房出血2只眼，前房机化膜形成1只眼。(4)远期并发症主要为白内障(9只眼)及黄斑病变(6只眼)。 结论 玻璃体切割术联合眼内激光光凝、剥膜等是治疗视网膜静脉周围炎合并玻璃体积血和(或)牵引性视网膜脱离的有效手段。 (中华眼底病杂志, 2002, 18: 215-217)     

Vitrectomy in Terson syndrome. Report of 18 cases]

A vitrectomy was performed in 18 eyes (15 patients) with vitreous hemorrhages due to Terson's syndrome. The average age of the patients was 46.5 +/- 14.4 years. The mean interval between the acute event of an intracranial hemorrhage and the vitrectomy was 6.8 +/- 4.9 months. The vitreous hemorrhage was associated with epiretinal membranes in 3, PVR in 2, and retinal breaks and/or rhegmatogenous retinal detachment in 3 eyes. The vitrectomy had to be combined with membrane peeling in 2, encircling procedures or exoplants in 4, cryotherapy in 5, endolaser in 1, and air/SF6 gas filling in 3 eyes. A missing or incomplete posterior vitreous detachment in 8 eyes was associated with a higher risk of PVR and retinal detachment. Two eyes with this condition needed 3 secondary operations. The mean follow-up duration was 32 (1 to 126) months. Two patients died 4 and 11 months after the operation. The visual acuity improved significantly following vitrectomy in all 18 eyes. The final visual acuity was better than 20/40 in 73% and 20/25 to 20/20 in 56%. The initial postoperative visual acuity decreased later on due to nuclear cataract in 7 of 10 eyes of patients over 45 years of age. A complicated cataract developed in only 1 of 8 eyes of younger patients who maintained a mean visual acuity of 20/25. Vitrectomy for Terson's syndrome is recommended in bilateral cases without spontaneous clearing of the vitreous within 3 months, as well as in cases with PVR and imminent retinal detachment.(ABSTRACT TRUNCATED AT 250 WORDS)     

进展型增生性糖尿病视网膜病变玻璃体 切割手术的价值与意义

目的了解有不同并发症的进展型增生性糖尿病视网膜病变眼进行玻璃体手术的结果。方法将患有Ⅰ、Ⅱ型糖尿病进展型增生性糖尿病视网膜病变的314只眼分为玻璃体积血合并局限牵拉性视网膜脱离组;广泛纤维血管膜合并牵拉性视网膜脱离组;牵拉孔源混合性视网膜脱离组;玻璃体积血视网膜脱离合并老年性白内障行玻璃体手术联合白内障摘除及人工晶状体植入组,分别进行回顾性分析。结果玻璃体积血合并局限牵拉性视网膜脱离组中Ⅰ、Ⅱ型糖尿病患 者手术后获得0.1以上视力的分别占39.4%和66.7%,广泛纤维血管膜合并牵拉性视网膜脱离组中Ⅰ、Ⅱ型糖尿病患者手术后获得0.1以上视力的分别占31.6%和51.6%,牵拉孔源混合性视网膜脱离组手术后获得0.1以上视力者占31.6%,玻璃体积血视网膜脱离合并老年性白内障行玻璃体手术联合白内障摘除及人工晶状体植入组手术后获得0.1以上视力者占62.5%。首要的术中 并发症是医源性视网膜裂孔,术后视力丧失的主要原因包括新生血管性青光眼、视网膜脱离和视网膜中央动脉阻塞。结论玻璃体切割手术联合全视网膜光凝术,能有效地改善进展性糖尿病视网膜病变患者的视力。(中华眼底病杂志,2001,17:171-174)     

玻璃体切除治疗复发性出血性玻璃体视网膜疾病

目的探讨玻璃体切除术对复发性出血性玻璃体视网膜疾病的临床效果。方法对43例(44眼)玻璃体积血施行三通道经睫状体平坦部玻璃体切除术,联合膜剥离,水下透热,眼内光凝(或经巩膜冷凝),并根据病情选用眼内长效填充材料。结果视网膜静脉阻塞18眼,外伤性玻璃体积血9眼,视网膜裂孔致玻璃体积血6眼,静脉周围炎5眼,增生性糖尿病视网膜病变3眼,蛛网膜下腔出血合并玻璃体积血(综合症)2眼,老年性黄斑变性1眼。术后随访2～24月,44眼视力均有不同程度的提高,随访视力较术前相比差异有统计学意义(P<0.05),视力0.05以上者36眼(81.82%),0.2～0.8者27眼(61.36%)。结论复发性出血性玻璃体视网膜疾病经药物治疗无效,B超显示出现玻璃体后脱离或B超显示伴有牵引性视网膜脱离者,玻璃体切除术是消除玻璃体积血并使视网膜复位的有效方法。     

Studies on vitrectomy cases associated with complicated branch retinal vein occlusion

PURPOSE: To study the preoperative factors leading to vitrectomy, and to demonstrate the postoperative conditions causing the decreased visual acuity that results from branch retinal vein occlusion (BRVO). METHODS: In 113 patients (114 eyes) with BRVO, the following data were analyzed: age, general complications, distribution of occluding vessels, location of retinal breaks, classification of vitreoretinal pathology, and the number of cases, period from onset of BRVO to vitreous hemorrhage and from vitreous hemorrhage to vitrectomy, number of operations, relationship between posterior vitreous detachment (PVD) and number of operations, preoperative photocoagulations, pre- and postoperative visual acuity, and cases with poor visual outcome. RESULTS: The visual prognosis was much better in cases with vitreous hemorrhage only than in those with proliferative membrane and retinal detachment (P =.0023). Repeated surgeries were needed in the cases where there was only partial PVD (P =.0029). Macular disorders and optic nerve atrophy were the main causes of postoperative visual acuity < 0.1. CONCLUSIONS: Early vitrectomy before development of vitreo retinal proliferation and retinal detachment, especially in cases where there is only partial PVD, seems to be essential for case management and treatment to attain better visual acuity for the patient.     

玻璃体积血的病因分析及手术治疗的疗效

目的：探讨玻璃体积血的病因及行玻璃体切割术治疗的临床疗效。

方法：对162例173眼玻璃体积血患者进行病因分析,采用玻璃体切割术治疗。

结果：术后诊断：173眼中增殖期糖尿病视网膜病变83眼(48.0%),视网膜分支静脉阻塞24眼(13.9%),Eales病13眼(7.5%),视网膜中央静脉阻塞10眼(5.8%),外伤性玻璃体积血9眼(5.2%),视网膜裂孔8眼(4.6%),视网膜脱离9眼(5.2%),增生性玻璃体视网膜病变7眼(4.0%),单纯玻璃体积血4眼(2.3%),视网膜大动脉瘤2眼(1.2%),息肉样脉络膜血管病变2眼(1.2%),脉络膜视网膜炎1眼(0.6%),年龄相关性黄斑病变1眼(0.6%)。不同年龄病因分布不同,术后随访3～15mo,术前与术后视力相比,41眼(23.7%)视力不变,115眼(66.5%)视力提高,17眼(9.8%)视力下降。术后视力与术前相比差异具有统计学意义( P<0.05)。

结论：增殖期糖尿病视网膜病变、视网膜分支静脉阻塞、Eales 病是导致玻璃体积血的主要原因。玻璃体切割联合术手术并发症少,能在一定程度上提高患者视力,是治疗玻璃体积血安全有效的方法。