早产儿视网膜病变全视网膜脱离的玻璃体视网膜手术治疗预后

目的：评价玻璃体视网膜手术治疗早产儿视网膜病变(ROP)视网膜全脱离的临床效果。方法:回顾分析接受玻璃体视网膜手术治疗的56例5期（视网膜全脱离）ROP患儿73只眼的临床资料。手术时患儿年龄为3～84个月，平均年龄(13.02±14.64)个月，出生胎龄为25～36周，平均胎龄(29.5±2.22)周；出生体重为900～2500 g，平均体重(1400.19 ±300.05) g；吸氧时间为2～90 d，平均吸氧时间为(20.53±18.91) d。手术包括开放玻璃体切割手术和闭合晶状体切除、玻璃体切割手术。视网膜解剖复位的标准以黄斑复位为视网膜复位成功，视网膜复位黄斑脱离为部分成功，视网膜未复位为手术失败。结果:手术后10只眼视网膜复位成功，占13.69%；20只眼视网膜复位部分成功，占27.39%；43只眼视网膜复位失败 ，占58.9%。手术后视力为手动者9只眼，占12.33%；条栅视力＞0.004者6只眼,占8.21% 。结论:ROP 视网膜全脱离的玻璃体视网膜手术治疗手术难度较大，手术后仅少数患儿视网膜复位成功 ，部分患儿视功能有一定恢复。     

闭合式三切口玻璃体视网膜手术治疗4期和5期早产儿视网膜病变

目的：探讨闭合式三切口玻璃体视网膜手术治疗4期和5期早产儿视 网膜病变（ROP）的临 床效果。方法：回顾性分析26例ROP患儿32只眼行闭合式玻璃体视网膜手 术治疗的临床资料。其中， 男性18例，女性8例；出生孕周27~35周，平均孕周29.4周；出生体重960~2200 g，平均体 重 1434.6 g。手术时年龄为出生后50~705 d，平均158.3 d。32只眼中ROP5期病变13只眼 ， 4期病变19只眼（4A期10只眼，4B期9只眼）。其中11只眼因ROP阈值病变或阈值前病变1型接 受间接检眼镜激光光凝治疗，1只眼再次接受冷冻治疗，病变未能控制进展至4期或5期。玻 璃体视网膜手术采用闭合式三切口入路，其中11只眼保留晶状体，21只眼行晶状体切除。手 术后随访 2~24个月，主要随访视网膜复位情况。结果：所有患儿手术过程顺利。4 期的19只眼中，4A期 的10只眼视网膜均完全复位，占100%。3只眼有视盘黄斑牵引；4只眼分别于视盘前、鼻侧视 网膜前及颞侧周边部残余机化增生膜；1只眼手术后玻璃体少量积血，2周后吸收；1只眼手 术 后并发白内障。4B期的9只眼，视网膜完全复位6只眼，占66.7%。但均周边广泛瘢痕机化 ，1只眼有视盘黄斑牵引；另外3只眼视网膜未复位，手术后即有玻璃体积血，其中2只眼合 并前房积血。5期的13只眼，3只眼视网膜完全复位，占23.1%。其中2只眼周边广泛瘢痕机 化，视网膜血管细，视盘色淡；1只眼颞侧视网膜皱襞；1只眼视网膜大部分复位，占7.7% ，鼻侧视网膜有增生膜和浅脱离；另外7只眼视网膜均未复位。结论：4 期ROP 通过保留或不保留晶状 体的闭合式三切口玻璃体视网膜手术治疗，能够使视网膜有效解剖复位，手术成功率较高； 但对于5期ROP，玻璃体视网膜手术效果差，成功率较低。     

4期早产儿视网膜病变巩膜扣带手术与玻璃体视网膜手术治疗疗效评价

目的 评价巩膜扣带手术与玻璃体视网膜手术治疗4期早产儿视网膜病变（ROP）的疗效。 方法回顾性分析接受巩膜扣带手术与玻璃体视网膜手术治疗的39例4期ROP患儿50只眼的临床资料。其中,4a期20只眼,4b期30只眼。患儿年龄2~18个月,平均年龄（6.0±3.4）个月;胎龄26~33周,平均胎龄（30.0±1.6）周;出生体重800~1900 g,平均体重（1404.5±237.6）g。行巩膜扣带手术19只眼,玻璃体视网膜手术31只眼。手术治疗后随访时间6~84个月,平均随访时间（26.0±21.7）个月。观察视网膜复位及屈光情况。 结果 行巩膜扣带手术的19只患眼视网膜全部复位,复位率占接受巩膜扣带手术患眼的100.0%。行玻璃体视网膜手术的31只眼中,27只视网膜复位,占接受玻璃体视网膜手术患眼的87。1%;4只眼手术后视网膜脱离继续进展,占接受玻璃体视网膜手术患眼的12.9%。行巩膜扣带手术的19只患眼中,5只眼随访期间拆除扣带加压物,占26.3%。行玻璃体视网膜手术的患眼屈光度为-1.25~11.00 D,平均屈光度为（-4.46±2.49） D;行巩膜扣带手术患眼屈光度为-1.25~9.25 D,平均(-3.21±1.96) D。两种手术患眼手术后屈光度比较,差 异无统计学意义（F=2.76,P=0.103）。结论玻璃体视网膜手术及外加压手术对4期ROP患儿的视网膜复位均有良好效果。     

玻璃体切割手术治疗永存胚胎血管的疗效观察

目的 观察玻璃体切割手术治疗永存胚胎血管(PFV)的临床效果.方法 回顾分析11例PFV患儿14只眼的临床资料.患眼中,后部PFV 1只眼,联合PFV 13只眼.所有患儿均行玻璃体切割手术.其中,同时行晶状体切除手术7只眼,视网膜切开切除手术5只眼,视网膜切开切除及巩膜外环扎手术1只眼.观察手术中及手术后并发症发生情况.手术后随访时间8～74个月,平均随访时间44个月.对比分析患儿手术前后视力和眼压变化情况.结果 手术中所有患儿均未发生并发症.14只患眼中,手术成功12只眼,占86.0%;手术失败2只眼,占14.0%.手术后视力较手术前视力提高5只眼,占35.7%;视力不变4只眼,占28.6%;视力下降5只眼,占35.7%.手术后眼压较手术前眼压升高2只眼,占14.3%;眼压不变11只眼,占78.6%;眼压下降1只眼,占7.1%.手术后持续性低眼压1只眼,占7.1%;复发性视网膜脱离1只眼,占7.1%.结论 玻璃体切割手术治疗PFV可防止并发症发生,使部分患儿视力提高.     

视网膜内界膜剥离手术治疗高度近视黄斑裂孔视网膜脱离的疗效观察

目的 观察视网膜内界膜剥离治疗高度近视黄斑裂孔视网膜脱离的疗效. 方法 回顾分析25例25只眼高度近视黄斑裂孔伴视网膜脱离患者的临床资料.根据治疗方法 分为2组,A组为单纯玻璃体切割手术,13例13只眼;B组为玻璃体切割手术加吲哚青绿染色内界膜剥离,12例12只眼.所有患者行惰性气体填充,手术后保持面朝下体位7～15 d.观察最佳矫正分辨角对数(LogMAR)视力,检查眼底,光相干断层扫描(OCT)、B型超声检查视网膜复位及黄斑裂孔闭合情况,比较两组间疗效差异.手术后随访6～18个月,平均随访时间10个月. 结果 A组13只眼中,7只眼手术后视网膜复位,占53.8%;B组12只眼中,11只眼手术后视网膜复位,占91.7%.B组视网膜复位率明显优于A组(X2=4.427,P=0.046);25只眼中,手术后黄斑裂孔闭合者17只眼,占68.0%.其中,A组13只眼中,6只眼黄斑裂孔闭合,占A组患者的46.2%;B组12只眼中,11只眼黄斑裂孔闭合,占B组患者的91.7%.两组患者手术后黄斑裂孔闭合率比较,差异有统计学意义(X2=5.940,P=0.020).A组手术后最佳矫正LogMAR视力提高平均0.32,与手术前比较,差异有统计学意义(Z=-2.045,P=0.041),B组手术后最佳矫正LogMAR视力提高平均0.53,与手术前比较,差异有统计学意义(Z=-2.481,P=0.012).两组间手术后视力差异无统计学意义(U=51.5,P=0.16). 结论玻璃体切割联合视网膜内界膜剥离手术可能通过完全解除玻璃体黄斑牵引、增加视网膜顺应性而提高高度近视黄斑裂孔视网膜脱离的治疗效果.显著增加视网膜复位率及黄斑裂孔闭合率.     

视网膜内界膜剥离手术治疗高度近视黄斑裂孔视网膜脱离的疗效观察

目的 观察视网膜内界膜剥离治疗高度近视黄斑裂孔视网膜脱离的疗效. 方法 回顾分析25例25只眼高度近视黄斑裂孔伴视网膜脱离患者的临床资料.根据治疗方法 分为2组,A组为单纯玻璃体切割手术,13例13只眼;B组为玻璃体切割手术加吲哚青绿染色内界膜剥离,12例12只眼.所有患者行惰性气体填充,手术后保持面朝下体位7～15 d.观察最佳矫正分辨角对数(LogMAR)视力,检查眼底,光相干断层扫描(OCT)、B型超声检查视网膜复位及黄斑裂孔闭合情况,比较两组间疗效差异.手术后随访6～18个月,平均随访时间10个月. 结果 A组13只眼中,7只眼手术后视网膜复位,占53.8%;B组12只眼中,11只眼手术后视网膜复位,占91.7%.B组视网膜复位率明显优于A组(X2=4.427,P=0.046);25只眼中,手术后黄斑裂孔闭合者17只眼,占68.0%.其中,A组13只眼中,6只眼黄斑裂孔闭合,占A组患者的46.2%;B组12只眼中,11只眼黄斑裂孔闭合,占B组患者的91.7%.两组患者手术后黄斑裂孔闭合率比较,差异有统计学意义(X2=5.940,P=0.020).A组手术后最佳矫正LogMAR视力提高平均0.32,与手术前比较,差异有统计学意义(Z=-2.045,P=0.041),B组手术后最佳矫正LogMAR视力提高平均0.53,与手术前比较,差异有统计学意义(Z=-2.481,P=0.012).两组间手术后视力差异无统计学意义(U=51.5,P=0.16). 结论玻璃体切割联合视网膜内界膜剥离手术可能通过完全解除玻璃体黄斑牵引、增加视网膜顺应性而提高高度近视黄斑裂孔视网膜脱离的治疗效果.显著增加视网膜复位率及黄斑裂孔闭合率.     

严重眼雷管爆炸伤特点及玻璃体切割手术疗效观察

目的 观察眼球严重雷管爆炸伤的特点以及2期玻璃体切割手术治疗的效果。方法 回顾分析37例雷管爆炸伤患者65只眼的临床资料。男性36例,女性1例;平均年龄28.6岁。双眼伤31例,占83.8%;单眼伤6例,占16.2%。48只眼为严重爆炸伤眼,视力无 感9只眼,其中3只眼明显萎缩;光感28只眼;眼前手动4只眼;数指/33cm 7只眼。46只眼行玻璃体切割手术治疗,其中41只眼为严重爆炸伤眼。未行手术治疗的19眼中13只眼无玻璃体手术指征;6只眼因眼球萎缩或经济原因放弃手术治疗。就诊时间在伤后1周以内者7例,占18.9%;1周～1个月者13例,占35.2%;1个月以上者17例,占45.9%。手术后随访6个月～2年,平均随访时间8.6个月。结果 65只眼中结膜异物占66.2%;角膜异物占46.2%;玻璃体积血占70.8%;球内异物占69.2%。视网膜震荡伤或视神经冲击伤占56.9%。视力提高33只眼;不变25只眼;下降7只眼。46只玻璃体切割手术眼中,眼球内异物伤35只眼,占76.1%。视力提高26只眼,占59.5%;未提高13只眼,占28.3%;未治愈7只眼,占15.2%,其中眼球摘除2只眼,眼球萎缩5只眼。就诊时间超过1个月的患者手术后视力提高率低。单眼盲51.4%;双眼盲8.1%。结论 严重眼雷管爆炸伤大部为多发球内异物伤,就诊晚,伤情严重致盲率高,加强视网膜震荡和视神经冲击伤的诊治,尽早玻璃体切割手术可提高预后视功能。     

805例无晶状体眼和人工晶状体眼视网膜脱离的临床特征及治疗效果

目的　观察无晶状体状眼视网膜脱离(ARD)和人工晶状体眼视网膜脱离(PPRD）的临床特征及其治疗效果。方法　回顾性分析ARD和PPRD患者798例805只眼的临床资料。手术前对患者进行视力、屈光度、眼压检查,以及裂隙灯显微镜、直接和（或）间接检眼镜检查。805只眼中,ARD 321只眼,PPRD 484只眼,手术前最佳矫正视力为光感~0.6。主要根据患眼增生性玻璃体视网膜病变（PVR）分级和视网膜裂孔情况对患者采取巩膜外手术或玻璃体视网膜手术结合巩膜手术。根据手术时间将805只眼分成1995～1999年和2000～2007年两组,前者243只眼,后者562只眼。手术后随访3~25个月,平均随访时间12.3个月,以最后一次随访作为疗效判断时间点,以视网膜解剖复位作为疗效判断标准。每次随访都采用手术前同样方法进行检查,并记录手术并发症。采用Mantel-Haenszel 卡方检验比较不同时间组中PPRD的构成比例,手术前患眼的视力、眼部病变、手术方式、手术结果和手术后视力等差异。结果　805只眼中,晶状体摘除至视网膜脱离发病的平均时间间隔为：PPRD眼15.4个月,ARD眼39.1个月。手术后视网膜解剖复位率为95.9%。只作巩膜外手术眼复位率93.5%,玻璃体手术眼复位率97.2%。805只眼中,手术后矫正视力在0.3以上者11.9%,与手术前相比提高2行以上者67.3%。PPRD与ARD比较,症状发生早,全玻璃体后脱离比例高,PVR更严重,视网膜脱离范围更广泛,手术前视网膜裂孔检出率低,解剖复位率略低。2000~2007年组患者中,PPRD比例、采用玻璃体手术比例、总体复位率、最后一次随访时较佳视力比例均高于1995~1999年组。结论　ARD和PPRD眼内病变临床特征较为复杂,其治疗效果正在不断提高。     

早产儿视网膜病变七年筛查治疗结果临床分析

目的 观察遵循我国早产儿视网膜病变(ROP)防治指南进行ROP筛查和及时治疗对ROP预后的影响。方法 2003~2010年7年间筛查确诊的1379例ROP患儿纳入研究。所有患儿均由经验丰富的小儿视网膜专科医生用双目间接检眼镜或二代广角数码视网膜成像系统（RetCamⅡ）检查确诊,并密切随访记录病变发展过程。对于1期病变,2周复查1次,直至病变完全退化、视网膜血管长到锯齿缘。对于2期病变或阈值前病变,1周复查1次,若病变程度下降,改为2周复查一次,直至病变完全退化。对于3期病变或怀疑急进性后部型ROP,1周复查2~3次,如达到阈值病变或阈值前病变1型,在72 h内进行激光光凝治疗。激光光凝治疗后每1~2周复查ROP变化,病变退化者随访处理,病变进展者行视网膜激光光凝或视网膜冷冻治疗,出现视网膜脱离的4、5期患者接受巩膜环扎手术、闭合式玻璃体切割手术治疗。本组患儿随访6个月~2年,平均随访时间为152.3 d。结果 7年间筛查确诊ROP 1379例2758只眼。患儿出生孕周26~35周,平均孕周30.6周。出生体重800~2200 g,平均体重1424.6 g。其中,206例400只眼达阈值病变或阈值前病变1型需进行激光光凝治疗,占患眼数的14.5%。激光光凝治疗后,345只眼病变完全退化,占治疗眼数的86.2%;55只眼进展到视网膜结构不良,占治疗眼数的13.8%。其中,10只眼仅有视盘黄斑牵引,32只眼进展至4期,13只眼进展至5期。未达到需要治疗程度的2358只患眼病变均退化。病变自然退化或干预后退化者共2703只,占98.0%;视网膜结构不良55只眼,占2.0%。其中,4期占1.2%,5期占0.5%。进展至4、5期的45只眼中,6只眼行巩膜外环扎或垫压手术治疗,视网膜均复位,但残留视盘黄斑牵引;39只眼行保留或不保留晶状体的闭合式玻璃体切割手术治疗。17只4a期患眼视网膜均复位,15只4b期患眼中10只眼视网膜复位,5只眼未复位,13只5期患眼中仅4只眼视网膜复位,1只眼视网膜大部复位。结论 及时有效的筛查和早期治疗能够减少导致视网膜结构不良的严重ROP的发生。     

玻璃体视网膜手术治疗先天性视网膜劈裂及其并发症的疗效观察

目的 观察玻璃体视网膜手术治疗先天性视网膜劈裂(XLRS)及其并发视网膜脱离和(或)玻璃体积血的疗效.方法 回顾分析接受玻璃体视网膜手术治疗的XLRS并发视网膜脱离和(或)玻璃体积血患者21例27只眼的临床资料.所有患眼眼底及光相干断层扫描(OCT)检查均发现黄斑微囊样劈裂病变合并周边部视网膜劈裂.平均视力0.11±0.09,黄斑劈裂平均面积为(1.09±0.56) mm2.12只眼并发孔源性视网膜脱离,5只眼并发牵拉性视网膜脱离,6只眼并发玻璃体积血,4只眼同时合并视网膜脱离和玻璃体积血.均行经扁平部三通道闭合式玻璃体切割手术.根据情况行内界膜剥离,眼内激光光凝,C3 F8或硅油填充.手术后随访9～122个月,平均随访时间51个月.观察视力以及视网膜解剖结构改善情况.结果 末次随访视力提高者20只眼,占74.1％;维持不变者7只眼,占25.9％.平均视力提高至0.26±0.15.与治疗前平均视力比较,差异具有统计学意义(t=-6.320,P=0.000).27只眼视网膜解剖结构复位良好,视网膜平伏.OCT检查显示,黄斑劈裂平均面积(0.29±0.21) mm2,较治疗前黄斑劈裂平均面积显著缩小(t=10.358,P=0.000);黄斑微囊样病变得到明显的改善.随访期间4只眼出现并发症,占14.8％.其中,2只眼分别在手术后6、8个月并发增生性玻璃体视网膜病变伴牵拉性视网膜脱离;1只眼在手术后4个月出现并发性白内障;1只眼在手术后15个月因新发视网膜裂孔而发生玻璃体积血.给予再次手术治疗后,4只眼视网膜复位良好.结论 玻璃体视网膜手术能有效提高XLRS患者视力,恢复视网膜解剖结构,获得良好的治疗效果.     

Anatomical and visual results of vitreoretinal surgery for stage 5 retinopathy of prematurity

PURPOSE: To provide a historical perspective on outcomes of surgery for infants with stage 5 retinopathy of prematurity (ROP) as performed by a single surgeon over a 24-year period. DESIGN: Retrospective observational cohort study. METHODS: Setting: Clinical practice of the Charles Retina Institute. Patients: The 601 infants with stage 5 ROP in at least one eye who were referred for surgery between 1977 and 2001. Charts were reviewed for demographic data and postoperative anatomical and visual acuity outcomes in eyes that underwent surgery. Main Outcome Measures: The postoperative anatomical status of the retina and visual function were assessed after surgery. Anatomical outcome was categorized as success (macula attached), partial success (macula detached), failure (total retinal detachment), or lost eye (opaque cornea, secluded pupil, or phthisis). Visual function was classified as>20/200, 20/200-5/200, hand movement, light perception, or no light perception. Multivariable logistic regression was used to explore relationships between outcomes and baseline characteristics. RESULTS: Only a minority of eyes had prior cryotherapy (15%) or laser photocoagulation (7%) therapy. The mean follow-up was 44 months for the 956 eyes treated surgically. The 608 eyes with available follow-up data were classified as follows: 28% success, 5% partial success, 55% failure, and 11% lost eye. Visual function of light perception or better was achieved in 74% of the 183 eyes with data on visual acuity. Controlling for other baseline factors, early postpartum age at the time of surgery was a statistically significant predictor of failure/lost eye (OR=2.08, 95% CI 1.09-3.97) and no light perception (OR=5.13, 95% CI 1.45-18.14). Surgery for stage 5 ROP on the fellow eye was also a predictor of failure/lost eye (OR=2.38, 95% CI 1.39-4.08). CONCLUSIONS: Surgery resulted in anatomical success for approximately one third of infant eyes with stage 5 ROP, and only a minority of eyes (8 of 183) achieved visual acuity better than 5/200. However, some initially successfully attached retinas redetached. Although this study is limited by follow-up and may represent a group of patients with a more vascularly active disease state due to the low proportion of patients with prior peripheral ablation, this cohort of infants provides results against which future interventions may be compared.     

Retinopathy of prematurity in practice. II: long-term results following treatment for threshold disease

OBJECTIVE: To determine the long-term outcome of treatment for threshold retinopathy of prematurity (ROP) in one UK unit. METHODS: A total of 35 infants diagnosed with threshold ROP were treated by a single ophthalmologist (DGC) between 1987 and 1998. The parents of the 29 surviving patients were contacted; 21 brought their child for special review of acuity, motility, refraction and fundoscopy (Group 1). Of the eight patients who were unable to attend, six patients (Group 2) had sufficient follow-up detail in their records to be included in the study.RESULTS: A total of 40 eyes in the 21 patients in Group 1 had been treated; 10 had received cryotherapy (eight bilateral) and 11 had bilateral laser. Mean follow-up was 5 years (range 2-12 years). A total of 23 treated eyes (in 16 patients) had an acuity of 6/12+ (57.5% of treated eyes). Four eyes of three patients had no light perception. Seven eyes in four patients had myopia of more than 3 D. Eight patients had a manifest squint: six esotropia, two exotropia. The retinal status of 36 eyes (90%) showed a favourable outcome. The four blind eyes had stage 5 disease. In Group 2, four eyes of two patients (33%) had 6/12+ acuity recorded; five eyes in three patients had stage 5 disease and no perception of light. In total, a favourable structural outcome was achieved in 81.4% and favourable functional outcome observed in 74.6%. CONCLUSION: These results show that the favourable outcomes reported in the CRYO-ROP trial can be achieved in routine practice and maintained after long follow-up.     

Lens-sparing vitrectomy for stage 4 and stage 5 retinopathy of prematurity

PURPOSE: To describe the results of lens-sparing vitrectomy for the correction of retinal detachment associated with retinopathy of prematurity (ROP) and its associated complications. METHODS: Seventeen patients who underwent a lens-sparing vitrectomy for stage 4 and stage 5 ROP with plus disease at Seoul National University Children' s Hospital between 1999 and 2003 were enrolled in this study. The patients who had bilateral retinal detachment of ROP underwent a lens-sparing vitrectomy in one eye and a scleral buckling surgery or lensectomy-vitrectomy in the other eye. The patients who had a retinal detachment in one eye and a regressed ROP in the other eye underwent unilateral lens-sparing vitrectomies. A review of their preoperative clinical findings (including the status of retinal detachment and plus disease), post-operative results, and any complications encountered was performed. RESULTS: In 17 patients, the postoperative success rate of lens-sparing vitrectomy was 58.8%. However, lens-sparing vitrectomy as a treatment for stage 5 ROP (25.0%) produced more negative post-operative results than it did when used to treat either those for stage 4a (75,0%) or 4b (66.7%) ROP. Among the 10 eyes in which the retina was attached, form vision was shown in six eyes, light could be followed by three eyes, and no light perception was present in one eye. Intra- and post-operative complications included retinal break formation, cataracts, vitreous hemorrhages, and glaucoma in patients with stages 4b and stage 5 ROP. CONCLUSIONS: Lens-sparing vitrectomy resulted in encouraging surgical outcomes in the correction of retinal detachment of ROP, especially in stage 4 patients. Therefore, a lens-sparing vitrectomy for stage 4 ROP patient may be beneficial, although it is still associated with some intra- and post-operative complications.     

严重眼球破裂伤无光感眼合并角膜血染的手术治疗

目的 探讨严重眼球破裂伤无光感眼合并角膜血染的手术治疗效果，并分析相关因素。 方法 7例患者7只眼因严重眼球破裂伤无光感合并角膜血染接受2期临时人工角膜下玻璃体切割联合角膜移植手术。2期手术前7只眼均角膜血染，前房及玻璃体积血，视网膜脉络膜脱离。1期与2期手术间隔时间平均18d(12～21d)。手术前视力均无光感，眼压平均3 mm Hg(1mm Hg=0.133 kPa)(2～5 mm Hg)。随访平均时间12个月(6～30个月)。 结果 5只眼恢复光感以上视力，矫正视力从光感至0.05。视网膜复位5只眼(5/7)。眼压平均12 mm Hg(5～15 mm Hg)，明显高于手术前眼压(P＜0.05)。并发症包括一过性高眼压(1 只眼)，角膜新生血管(4只眼)，角膜排斥反应(4只眼)，眼球萎缩(2只眼)。 结论 临时人工角膜下玻璃体切割联合角膜移植手术是挽球严重眼球破裂伤无光感眼合并角膜血染的安全有效的方法。（中华眼底病杂志，2004，20：212-214）     

视网膜血管瘤的临床疗效观察

目的观察探讨视网膜血管瘤的临床治疗效果。方法回顾分析16例20只眼视网膜血管瘤的临床资料。16例中,男5例,女11例,平均年龄23.3岁;其中双眼发病者4例,均属于von Hippel-Lindau(VHL)病。按照血管瘤有无明显滋养血管扩张至瘤体、周围渗出、局限性视网膜脱离、广视网膜脱离最终至晚期并发症的过程,将本病分为5期。治疗的方法有激光、视网膜冷冻合并或不合并放液、巩膜外加压及玻璃体视网膜手术。全部病例均随访12个月以上,平均随访时间37.8个月。结果共有10只眼(Ⅰ期2只眼,Ⅱ期7只眼,Ⅲ期1只眼)采用激光治疗, 激光治疗后,全部血管瘤均得以控制;其中,视力提高2只眼,不变4只眼,下降4只眼。7只眼(Ⅲ期5只眼,Ⅳ期2只眼)进行了冷冻治疗,5只眼出现视力下降,病情稳定的有3只眼(均 为Ⅲ期),病情进展的共4只眼(Ⅲ期2只眼,Ⅳ期2只眼)。进行玻璃体视网膜手术的共有4只眼(包括激 光光凝术后2只眼),术后视力提高2只眼,视力稳定1只眼,视力下降1只眼。未治疗的1只眼随访1.5年后进展至无光感。4例VHL病患者中有3例3只眼随访中发现了新生的视网膜血管瘤。结论激光治疗是Ⅰ～Ⅲ期视网膜血管瘤的有效治疗方法,冷冻治疗可加重眼内的渗出和增生,仅适用于少数Ⅲ期病例,Ⅳ期病例宜采用眼内手术治疗。(中华眼底病杂志,2001,17:296-298)     

广角数码儿童视网膜成像系统引导下激光光凝治疗早产儿视网膜病 变

目的 观察在广角数码儿童视网膜成像系统（RetCam II）在激光 光凝治疗早产儿视网膜病变（ROP）中的应用价值。 方法 回顾分析连续 发现的阈值ROP或阈值前Ⅰ型ROP患儿共30例58只眼， 其中36只眼为阈值前Ⅰ型ROP，19只眼为阈值ROP，3只眼为外院冷冻术后有冷冻遗漏 区ROP；1区ROP 8只眼，2区ROP 50只眼。54只眼 （93.1％）进行了一次激光光凝， 4只眼（6.9％）进行了2次激光光凝。 应用半导体532 nm激光经双目间接检眼镜激光光凝周边视网膜无血管区。手术前后 分别进行RetCam II眼底检查，手术中对激光光凝遗漏区即刻进行补充治疗。治疗后随访时 间3～11个月，平均5-5个月。 结果 54只眼1次激光光凝术后1～3周反 应良好，ROP病变得到控制。4只眼行第2次激光光凝术后，2只眼病变静止、消退；2只眼发 生后极 部局限性牵拉性视网膜脱离。随访结束时2只眼（3.4％）发生视网膜不良结构后果。 结论 激光光凝手术前后行RetCamⅡ检查在治疗ROP时能够有效避免激光光凝 “遗漏区”，提高一次激光光凝成功 率，减少手术后视网膜不良结构后果发生率。     

Advanced cicatricial retinopathy of prematurity--outcome and complications.

AIMS: To assess the outcome and complications of patients with advanced retinopathy of prematurity (ROP). METHODS: All patients with eyes achieving stage 4 or 5 retinopathy of prematurity were reviewed. Twenty one eyes were diagnosed during ROP screening in maternity hospitals and 10 eyes were of infants transferred for treatment. RESULTS: Thirty one eyes of 17 patients were included. Thirteen eyes were treated for acute disease but progressed to stage 4 or 5; seven had cryotherapy and six diode laser photocoagulation. Cataract was found in 17 eyes (54.8%), glaucoma in seven eyes (22.6%), microphthalmos in 15 (48.4%), and corneal opacification in four eyes (12.9%). Fifteen eyes had surgical procedures; two (6.5%) had trabeculectomy, four (12.9%) had lensectomy, and nine (29%) retinal detachment repair. Transferred infants had their initial eye examination later than infants in hospitals screened by the authors and 80% of them had progressed beyond threshold ROP by the time they were transferred for treatment. Twenty nine eyes (93.6%) had visual acuities of 3/60 or less and only two eyes (6.5%) achieved 6/18 or less. CONCLUSION: The visual outcome of the eyes undergoing retinal re-attachment surgery was disappointing. Cataract, microphthalmos, and glaucoma were the most frequent complications, and surgical intervention was often required. The need for children who are blind as a result of ROP to have long term follow up is shown.     

Results of treatment of retinal detachment in active stage-5 retinopathy of prematurity

PURPOSE: To evaluate the surgical and functional results of encircling scleral buckling in treatment of active stage 5 retinopathy of prematurity. MATERIAL AND METHODS: 68 premature infants (121 eyes) with active stage 5 ROP operated with the use of the modified encircling buckling technique. The surgical and functional results were compared with the results observed in 91 unoperated children with active stage 5 ROP. RESULTS: In the operated group total retinal reattachment was observed in 52% and partial reattachment in 24.5% of premature infants. The surgery failed to reattach the retina in 23.5%. Visual acuity was: no light perception in 56.1%, light perception to 0.02 in 24.5% and 0.02 to 0.2 in 19.4% of children. In unoperated group spontaneous reattachment was observed in 6% of infants and visual acuity was: no light perception in 76%, light perception in 20% and finger counting in 4% of them. CONCLUSION: The obtained results indicate, that modified encircling buckling can be an effective treatment in reattaching the retina in stage 5 ROP although useful vision can be obtained in only 20% of operated children.