卵磷脂络合碘辅助治疗玻璃体积血临床观察

目的:观察卵磷脂络合碘片剂辅助治疗玻璃体积血临床疗效。方法:随机将32例32眼眼部病变引起的玻璃体积血患者分两组:治疗组16例患者常规止血、活血、扩血管治疗并接受卵磷脂络合碘片剂口服1.5mg(含碘量100μg),3次/d,共60d。对照组16例患者常规止血、活血、扩血管治疗。观察期3mo,于治疗后2,4,8,12wk复诊。观察视力、裂隙灯检查、前置镜眼底检查并记录玻璃体积血等级。结果:治疗组在服药后4wk患者玻璃体积血的等级比同对照组在第8wk时玻璃体积血的等级比。观察期末治疗组视力0.15~0.3者3例,>0.3者13例。对照组视力光感~0.1者2例,0.15~0.3者7例,>0.3者7例。两组对比差异有显著统计学意义(P<0.05)。结论:卵磷脂络合碘片剂可以促进出血、渗出的吸收,用于辅助治疗玻璃体积血疾病,可以缩短玻璃体积血恢复时间,恢复较好的视功能。     

玻璃体积血的超声诊断及临床疗效观察

目的：探讨玻璃体积血的声像图特征,以助于临床诊断治疗。

方法：回顾性分析62例各种原因导致玻璃体积血患者的临床资料。

结果：因外伤引起玻璃体积血者11例,占18%(11/62); 由于高度近视、高血压病、糖尿病等原因引起视网膜病变导致玻璃体积血者51例,占82%(51/62)。

结论：超声诊断玻璃体积血,图像比较清晰,对临床治疗的选择及预后监测起到了辅助作用,同时可以随访观察玻璃体积血治疗前后变化情况,对临床有一定的实用价值。     

玻璃体切除在早期外伤性玻璃体积血中的应用

玻璃体积血是眼外伤中最常见的并发症,其治疗分为药物和手术2大类.前者在于加速血液的吸收,后者为直接清除血块.由于药物治疗的效果欠佳,目前多数学者主张在外伤后2周内施行手术治疗.近20年来玻璃体手术的开展,为严重的外伤性玻璃体积血提供了行之有效的治疗手段.综述如下:(一)影响玻璃体积血的吸收因素:由于玻璃体没有血管,一旦发生积血则吸收缓慢.临床观察发现,玻璃体对血液的吸收快慢不一.外伤性玻璃体积血完全吸收,常需要1～ 24个月,平均 8个月.血液吸收的速度与出血量的多少、出血部位和玻璃体及其周围组织有无损伤有关.少量的出血、视网膜前出血常能很快吸收.一般地说,玻璃体积血的吸收     

玻璃体切割术治疗玻璃体积血21例临床分析

目的:探讨玻璃体切割术治疗玻璃体积血的临床效果。方法:采用玻璃体切割术治疗玻璃体积血患者21例21眼。观察玻璃体切割术后视力改善情况及分析导致玻璃体积血的原因。结果:本组21例患者中末次随访最佳矫正视力:数指/眼前～者4例,0.05～者12例,≥0.3者5例,脱盲率(视力≥0.05)81%,脱残率(视力≥0.3)24%;导致玻璃体出血的前三位病因分别是分支静脉阻塞、无脱离视网膜裂孔和糖尿病视网膜病变,三者共占76%。结论:玻璃体切割术治疗玻璃体积血安全有效,大部分患者术后视力可得到明显提高。     

基层医院视网膜静脉阻塞致玻璃体积血的治疗

目的:分析基层医院视网膜静脉阻塞致玻璃体积血的治疗方法。方法:将50例视网膜静脉阻塞患者随机分成两组:治疗组(药物治疗)和联合治疗组(药物及激光治疗),各25例,观察玻璃体积血的发生率。结果:治疗组发生玻璃体积血的病例数明显高于联合治疗组。结论:注重造影检查,应用药物联合激光光凝治疗对防止基层医院视网膜静脉阻塞致玻璃体积血有明显的治疗作用。     

视网膜光凝术治疗视网膜静脉阻塞所致玻璃体积血的临床体会

目的:应用视网膜光凝术治疗视网膜静脉阻塞(RVO)所致的玻璃体积血,观察其保存视力、阻止病变发展为增殖性视网膜病变的临床效果。方法:选择RVO致玻璃体积血患者15例15眼,根据出血量多少决定光凝治疗时机,逐步完成全部阻塞区的激光治疗;术后观察视力、出血吸收及新生血管性青光眼消退等情况。结果:患者15例完成光凝时间历时1wk~6mo,光凝次数1~8次。14例玻璃体积血全部吸收,视力稳定或提高,达到临床治愈;1例发生反复出血,未愈;2例新生血管性青光眼消退。结论:对于适当病例,视网膜光凝术可有效治疗RVO所致玻璃体积血,并使已发生的继发性青光眼消退。     

糖尿病性视网膜病变所致玻璃体积血早期手术的效果

目的:评价增生型糖尿病性视网膜病变(PDR)所致玻璃体积血早期手术的效果。方法:回顾性分析2016年6月至2020年6月甘肃省人民医院玻璃体切除手术治疗PDR所致玻璃体积血73例(78眼)的临床资料。根据玻璃体积血时间分为三组：A组,病程<1个月,28眼;B组,病程为1~3个月,26眼;C组,病程>3个月,24眼。所有...     

糜蛋白酶治疗玻璃体积血效果观察

糜蛋白酶治疗玻璃体积血效果观察月山铁路医院苏如峰对于玻璃体积血病人，在没有条件做玻璃体手术而一般治疗无效的情况下。选用糜蛋白酶结膜下注射治疗十一例玻璃体积血患者，效果明显。现将结果报告如下．．、临床资料！、近二年来在门诊和医院遇到的玻璃体积血患者。共...     

t-PA治疗玻璃体积血眼底出血疗效分析

目的:观察组织型纤维蛋白溶解酶原激活剂 (t PA)玻璃体腔内注射对玻璃体积血 ,眼底出血的治疗效果。方法 :应用t PA 12 5 μg注射于 36人 38只眼玻璃体腔内 ,治疗不同病期、年龄、形态的玻璃体积血 ,眼底出血。结果 :t PA治疗效果与病程、混浊物形态有关 ,病程在 16～ 90天时显效率为 41 2～ 90 % ,混浊物为块状或膜状时显效率为37 5～ 2 8 6 % ,眼底出血显效率为 6 6 7%。结论 :玻璃体积血已形成凝块 ,应向玻璃体腔内注入 12 5 μgt PA促进纤溶 ,加速积血清除 ,部分病人可免于玻璃体切除手术 ;玻璃体积血合并视网膜脱离者应尽快治疗视网膜脱离 ;对眼底出血 ,黄斑尚无囊样变性 ,视力较差者 ,可试行治疗     

玻璃体积血合并视网膜裂孔或脱离的玻璃体切割手术疗效观察

目的:探讨玻璃体积血合并视网膜裂孔或脱离采用玻璃体切割手术治疗的疗效及必要性。 方法:对28例28眼玻璃体积血合并视网膜裂孔或脱离患者采用玻璃体切割手术治疗,观察治疗前后视力改变,并分析玻璃体积血与视网膜裂孔或脱离的关系。 结果:不同原因所导致的玻璃体积血28例中,7例术前B超未发现视网膜脱离,而在术中发现3例裂孔,4例伴裂孔周围浅脱;28例患者术后视力（包括术后随访最佳视力）均有不同程度的提高,数指/眼前以上者27例(96%),≥0.05者20例(71%),≥0.3者5例(18%),手术前后视力比较,具有统计学差异(P＜0.05)。 结论:玻璃体积血合并视网膜裂孔或脱离采用玻璃体切割手术治疗,安全有效,且能尽早发现视网膜裂孔及浅脱离,阻止视网膜脱离进一步扩大。     

Glycosaminoglycan and collagen distribution in the developing human vitreous

· Background: We determined the distribution of glycosaminoglycans and collagens in the developing human vitreous. · Methods: Eighty human eyes from 5 gestational weeks to 2 postnatal years of age were used. Glycosaminoglycan components were determined by enzyme digestion with hyaluronidase or chondroitinase AC and ABC and immunohistochemistry for chondroitin, chondroitin-4-sulfate, chondroitin-6-sulfate, and dermatan sulfate. Collagen distribution was determined by immunohistochemistry for types I, II, and III collagens. · Results: Enzyme digestion showed that throughout development hyaluronic acid is the main glycosaminoglycan in the vitreous and in the extraocular space at 5–7 gestational weeks. Both areas were filled with mesenchymal cells. Immunohistochemistry showed chondroitin-6-sulfate in the vitreous between 6 and 40 gestational weeks, and chondroitin-4-sulfate between 12 and 40 gestational weeks. Hyaluronic acid and chondroitin sulfate appeared in the retina and around the hyaloid vessels at 12–40 weeks. Immunohistochemistry showed type III collagen in the vitreous and around the mesenchymal cells at 5–7 weeks that was replaced by type II collagen after 8 weeks. · Conclusions: Hyaluronic acid is the major glycosaminoglycan in the vitreous throughout development, except for the transient appearance of chondroitin sulfate at 6–40 gestational weeks. Type III is the main collagen in the early developing vitreous that converts to type II collagen at 8 weeks. The primary and secondary vitreous has the same components as these macromolecules. These vitreous glycosaminoglycans and collagens seem to be produced by mesenchymal cells at an early stage and by the retina and hyaloid vessels during middle and late development. Received: 7 November 1997 Revised version received: 5 January 1998 Accepted: 7 January 1998     

Characteristics and outcomes of anterior hyaloidal fibrovascular proliferation in lasered retinopathy of prematurity. The Indian Twin Cities Retinopathy of Prematurity Study (ITCROPS) report number 4

To describe the characteristics and treatment outcomes of an unreported, late vitreous hemorrhage due to anterior hyaloidal fibrovascular proliferation in laser-regressed retinopathy of prematurity (ROP). Interventional case series. In the ongoing Indian Twin Cities ROP study database, consecutive cases with isolated late vitreous hemorrhage at least one year after laser-regressed disease were analyzed retrospectively. Anterior hyaloidal fibrovascular proliferation was diagnosed primarily using scleral depression. Anterior retinal cryopexy with adjunctive treatments was performed. The main outcome measure was clinical resolution of new vessels with no recurrent hemorrhage over a 1-year period. Vitreous hemorrhage, at two to eight years of age, developed in three eyes of three children out of 1,168 ROP lasered eyes. All had received laser for zone I disease as neonates, with no subsequent sequelae. Evaluation revealed filiform new vessels at the posterior vitreous base involving inferior 180° with absence of any other source of hemorrhage. All underwent anterior retinal cryopexy to the affected area. Simultaneous additional treatment, based on intraoperative findings, included one case each of peripheral laser photocoagulation, lens-sparing vitrectomy and intravitreal bevacizumab. All three showed successful regression and non-recurrence of vitreous hemorrhage with improvement of vision >20/40 at an intermediate follow-up of two years. Anterior hyaloidal fibrovascular proliferation is an unreported and rare cause of vitreous hemorrhage, appearing years after laser-regressed ROP. It has a good response to interventional treatment. Meticulous scleral depression of the vitreous base under anesthesia is useful to detect this rare source of vitreous hemorrhage.     

糖尿病视网膜病变的治疗进展

针对糖尿病视网膜病变（diabetic retinopathy,DR）的不同的阶段,我们可以采取多种方式对疾病进行治疗和控制。DR早期的治疗主要为控制血糖、血压以及血脂,并在此基础上应用适当的药物治疗。而当DR进入中后期时则主要依靠激光治疗和玻璃体手术。新的药物如曲安奈德的应用为治疗中晚期DR提供了新的手段,药物性玻璃体切割为预防和减少玻璃体视网膜黏连、减轻新生血管的生成提供了新方法,也为玻璃体手术中完全清除玻璃体后皮质提供了帮助。本文就DR的治疗进展作一综述。     

护网明目散治疗玻璃体积血对视网膜保护作用的形态观察

目的:观察护网明目散对实验性玻璃体积血的视网膜组织的影响。方法:将兔实验性玻璃体积血模型分成正常组,模型对照组,中药(护网明目散)治疗组,西药治疗对照组。分别于4,8wk随机处死各组之中的6只,取视网膜组织,送光镜检查。结果:护网明目散治疗组病理改变较模型对照组、西药治疗对照组视网膜各层组织损伤轻微。结论:护网明目散能够明显的减轻和防止积血对视网膜组织造成的损害。     

23G玻切术治疗PDR术后早期出血的危险因素分析

目的：分析23G玻璃体切割术治疗增生型糖尿病视网膜病变(PDR)术后早期发生出血的危险因素。

方法：回顾性分析2016-06/2018-01于我院行23G玻璃体切割术治疗的PDR患者100例100眼的临床资料,根据术后早期(1mo内)是否发生玻璃体出血分为早期玻璃体出血组(27例)和无玻璃体出血组(73例),分析术后早期发生玻璃体出血的危险因素。

结果：两组患者年龄、术前抗VEGF治疗、术前存在纤维血管膜增殖、术中视盘新生血管出血、术中注入气体情况有明显差异(P<0.01),其中术前存在纤维血管膜增殖、术中存在视盘新生血管出血是导致术后早期出血的独立危险因素。

结论：23G玻璃体切割术治疗PDR术后早期玻璃体出血主要发生于眼底病变严重者,术前存在纤维血管膜增殖及术中视盘新生血管出血会增加其发生风险。     

三七粉治疗玻璃体切除术后再出血的疗效观察

目的：观察三七粉对于玻璃体切除术后再出血患者的疗效,为该类患者的药物治疗提供新的方向。

方法：纳入2010-01/2017-12在我院眼科就诊的玻璃体切除术后再出血的增殖性糖尿病视网膜病变患者共32例32眼,予三七粉口服,1.5g/次,2次/d,7d为一疗程,连续服用3个疗程后进行观察评估。统计治疗前后患者视力情况、光学相干断层扫描成像质量、玻璃体出血等级,从而判断其疗效。

结果：经过3个疗程的治疗后,所有患者均未出现服药后不良反应,总体视力改善率为88%,最佳矫正视力(LogMAR)治疗前为1.93±0.46,治疗后为1.42±0.5。其中治疗前小数视力≥0.02、指数～<0.02、光感的患者治疗后视力改善率为100%,治疗前手动的患者治疗后视力改善率为60%。所有患者光学相干断层扫描成像质量总体改善率为94%,玻璃体出血等级总体改善率为94%。

结论：三七粉能有效治疗玻璃体切除术后再出血患者,其能促进玻璃体腔积血吸收,使患者视力尽快提高并且降低二次手术概率。     

色素失禁症患者的眼底表现及治疗

目的:探讨色素失禁症(IP)患者的眼底荧光素血管造影特征及其辅助治疗的意义。方法:回顾性研究,收集2019-03/08确诊的IP患儿10例18眼的临床资料纳入研究,均为女性患儿,就诊年龄2周~42月龄,详细记录患儿的病史及家族史,均行眼底彩色照相及眼底荧光素血管造影检查。结果:纳入患儿眼底检查结果提示:1期病变1例1眼,FFA提示视网膜散在异常血管,晚期无渗漏,定期随访。2期病变4例6眼,FFA提示视网膜可见异常血管吻合,无明显新生血管生成,均行视网膜光凝。3期病变7例9眼,FFA提示视网膜新生血管荧光渗漏、视网膜前出血性荧光遮蔽,均行玻璃体腔注药(雷珠单抗注射液2mg∶0.2mL,注射量每眼0.25mg/0.025mL)联合视网膜光凝;其中2例为单眼发病,对侧眼正常。4期病变2例2眼,4a期病变1眼,FFA显示视盘、黄斑向颞侧牵拉连至周边部视网膜、局部浅脱离,行玻璃体切割手术;4b期病变1眼,眼前节照相提示晶状体后白色机化膜,眼部B超提示视网膜脱离,行玻璃体切割手术。结论:初步证实了眼底荧光素血管造影可辅助IP相关性视网膜病变的分期及治疗,对其治疗随访有指导意义,但对于各期病变的治疗目前尚无统一标准,有待更多临床资料。     

Pooled efficacy results from two multinational randomized controlled clinical trials of a single intravitreous injection of highly purified ovine hyaluronidase (Vitrase) for the management of vitreous hemorrhage

PURPOSE: To evaluate the efficacy of intravitreous ovine hyaluronidase for the management of vitreous hemorrhage. DESIGN: Two prospective, randomized, placebo-controlled, double-masked studies. Safety data are presented in a companion article in The Journal. METHODS: Eligible patients with vitreous hemorrhage > or = 1 month duration; severe at entry with best corrected visual acuity (BCVA) worse than 20/200 were randomized to 55 IU or 75 IU ovine hyaluronidase or saline. Primary efficacy (clearance of hemorrhage sufficient to see the underlying pathology and completion of treatment when indicated) was measured at months 1, 2, and 3. Key secondary endpoints were: > or = 3-line improvement in BCVA; hemorrhage density reduction; and therapeutic utility assessment. RESULTS: The intent-to-treat population for common dose groups (55 IU, 75 IU, saline) consisted of 1125 patients. At baseline, 76.3% had diabetes, 90.4% were not able to read any letters on the eye chart, and mean hemorrhage duration was 120 days. Statistical significance was reached in the 55 IU dose group by months 1 and 2 for the primary efficacy endpoint based on an adjusted P-value. By months 1, 2, and 3, 13.2%, 25.5%, and 32.9% of patients (55 IU) reached primary efficacy compared with 5.5%, 16.2%, and 25.6% of saline-treated patients (P < .001; P = .002; P = .025, respectively). Key secondary endpoints confirmed the treatment effect at both doses and all timepoints (P < or = .01). CONCLUSIONS: Fifty-five IU ovine hyaluronidase showed statistically significant efficacy as early as months 1 and 2. These results were supported by outcomes for three key secondary endpoints. These results suggest a therapeutic utility of ovine hyaluronidase in the management of vitreous hemorrhage.     

岛状膜手术在晚期增殖性糖尿病视网膜病变中的应用

目的 探讨晚期增殖性糖尿病视网膜病变伴有视盘表面或上、下血管弓表面生长的大片新生血管膜,同时合并玻璃体出血或牵拉性视网膜脱离或牵拉孔源混合性视网膜脱离的玻璃体手术,探究手术中的剥膜技巧及对此类患者玻璃体手术治疗的价值.方法 选择晚期增殖性糖尿病视网膜病变患者106例(106眼),男性47例(47眼),女性59例(59眼),年龄44-69岁.早期对膜的处理采用传统的膜钩钩膜及撕膜技术,共55例(55眼),后期采用岛状膜技术,共51例(51眼).结果 两种剥膜技术对术后视力提高岛状膜组好于撕膜组,但因为两组患者都属于晚期患者,最好视力都不超过0.12,多数视力在0.02-0.08之间.但岛状膜技术组术中、术后并发症明显减少,减少了硅油填充率,减少了二次手术的可能.结论 岛状膜清除技术处理晚期增殖性糖尿病视网膜病变优于传统撕膜技术,晚期增殖性糖尿病视网膜病变合并大片增殖膜、玻璃体出血及视网膜脱离患者行玻璃体手术后大部分仍能恢复一定视功能,仍有极大的治疗价值.