先天性视网劈裂伴玻璃体积血漏诊3例

先天性视网膜劈裂是男性儿童的致盲眼病之一,早期症状隐匿,多以反复玻璃体积血、牵拉性视网膜脱离就诊。此病多易因屈光间质混浊被漏诊。笔者遇3例,现报告如下。     

玻璃体切除治疗严重外伤性玻璃体积血

目的 观察玻璃体切除术治疗严重外伤性玻璃体积血的效果。方法 玻璃体切除术治疗严重外伤性玻璃体积血51例(51眼)，并对因积血导致的并发症联合相关手术同时进行治疗。结果 术后视力提高36眼(70．59％)；不变13眼(25．49％)；下降2眼(3．92％)。结论 玻璃体切除术是治疗严重外伤性玻璃体积血的有效方法，伤后10～14天为适宜的手术时机。     

玻璃体切割术治疗玻璃体积血的疗效观察

目的观察玻璃体切割术治疗玻璃体积血的疗效。方法分析我院自2004年以来收治的玻璃体积血患者25例（25眼），其中视网膜静脉阻塞（RVO）10例（10眼），糖尿病视网膜病变（DR）8例（8眼），眼外伤5例（5眼），孔源性视网膜脱离（RD）2例（2眼），全部患者均经睫状体平坦部行闭合式巩膜三通道玻璃体切割术，其中20眼联合行视网膜光凝术，3眼联合硅油填充术，5眼行C3F8注气术，5眼联合巩膜外环扎术。结果术后随访6个月以上，25例患者仅1例视力无提高，其余24例术后视力均较术前提高，其中1例DR患者术后发生孔源性视网膜脱离二次玻切术网膜复位。2例DR患者发生视网膜再次出血，予药物治疗，出血渐吸收。结论玻璃体切割术治疗玻璃体积血疗效明显。     

玻璃体切除术治疗玻璃体积血临床分析

玻璃体积血是多种眼病的常见并发症 ,严重影响视力。大量而长期的玻璃体积血对眼部组织造成破坏而致视功能损害。由于玻璃体切除术的开展 ,使这类疾病的预后有了明显改善。回顾 1996年 8月～ 1999年 9月共收治玻璃体大量积血且视力严重低下的患者 4 3例( 4 4眼 ) ,经玻璃体切除术治疗后 ,取得较好的疗效。现将临床资料分析如下。临床资料1 一般情况 :男 2 5例 ,女 18例。年龄 2 2～ 68岁 ,平均 ( 4 2 8± 12 6)岁。单眼 4 2例 ,双眼 1例 ,共 4 4眼 ;右眼18眼 ,左眼 2 6眼。病程 1月至 2 6月 ,平均 3 8月。术前患者均经过全身常规检查以及…     

玻璃体切除术在外伤性玻璃体积血中的应用

玻璃体积血是眼外伤常见的并发症,预后不佳,致盲率高.由于玻璃体切除术的开展使预后大大改观.我院从1988年起采用玻璃体切除术治疗外伤性玻璃体积血41例,报告如下:一般资料:本组41例41眼,右眼25例,左眼16例.男35例,女6例.年龄:4～73岁,平均28.2岁.41眼中眼球钝挫伤19眼,角膜巩膜穿孔伤9眼,眼内异物9眼,爆炸伤3眼,眼球贯通伤1眼.同时伴有外伤性白内障16眼,晶体脱位3眼.41眼术前均经过急诊处理包括修补和异物摘出等.随访期6～60月,平均11月.     

玻璃体切割手术治疗不同类型玻璃体积血的临床研究

目的:观察不同原因导致玻璃体积血玻璃体切割的疗效及年龄等相关因素对玻璃体切割手术疗效影响。方法:回顾性分析76例通过玻璃体切割手术治疗的玻璃体积血患者76眼的资料,按玻璃体积血原因、发病年龄和玻璃体积血时间分组,并进行统计学分析。结果:在导致玻璃体积血原因中,糖尿病性视网膜病变（增生性）患者31例(41%),孔源性视网膜脱离24例(32%),视网膜分支静脉阻塞10例(13%),视网膜中央静脉阻塞3例(4%)。视网膜血管炎2例(3%),眼球钝挫伤2例(3%),单纯玻璃体积血2例(3%),增生性玻璃体视网膜病变1例(1%),息肉样脉络膜血管病变1例(1%)。各年龄组病因构成存在统计学差异（χ2=21.89,P<0.01）。年龄<45岁的青年组中,有26例,孔源性视网膜脱离导致玻璃体积血患者最多,共11例,占42%。年龄在45~59的中年组中,有19例,孔源性视网膜脱离导致玻璃体积血患者最多,共9例,占47%。年龄>60的老年组中,有31例,糖尿病性视网膜病变（增生性）导致玻璃体积血患者最多,共24例,占77%。在玻璃体积血时间分组中,各时间组术后视力存在统计学差异（χ2=2037,P<001）。1mo组共26例,术后视力主要为>0.3,共13例,占50%。2mo组共24例,术后视力主要为0.1~0.3,共10例,占42%。3mo组共11例,术后视力主要为0.01~0.09,共5例,占45%。>3mo组共15例,术后视力0.01~0.09和0.1~0.3,各6例,分别占40%。结论：糖尿病性视网膜病变（增生性）、孔源性视网膜脱离和视网膜分支静脉阻塞是导致玻璃体积血的主要原因。玻璃体切割手术治疗玻璃体积血安全有效,可以在一定程度上提高患者视力。玻璃体积血患者在1~2mo内手术,疗效较好。     

玻璃体劈裂研究进展

玻璃体劈裂常见于各种玻璃体视网膜疾病.术前准确诊断出玻璃体劈裂对相关眼底疾病的手术操作及预后分析有重要的指导意义.随着检测技术的发展,玻璃体劈裂的检出率逐渐增加,本文就玻璃体劈裂的病因、发生机制、诊断方法、临床意义等作一综述.     

玻璃体切割治疗玻璃体积血的临床疗效观察

目的:探讨玻璃体切割治疗玻璃体积血的临床疗效。方法:对72例75眼玻璃体积血患者采用玻璃体切割手术治疗,术中根据具体病情联合单纯白内障摘除或白内障摘除联合人工晶状体植入术、眼内异物取出、膜剥离、水下透热、眼内光凝或/和巩膜外冷凝及眼内注气或硅油充填。结果:选取75眼中外伤性玻璃体积血(穿孔性眼外伤19眼,眼球钝挫伤8眼)27眼,视网膜静脉阻塞15眼,增殖期糖尿病视网膜病变12眼,Eales病9眼,视网膜裂孔合并玻璃体积血9眼,年龄相关性黄斑病变3眼。术后随访6～48(平均18±5.6)mo,75眼中72眼视力有不同程度的提高,>0.05者65眼(87%),>0.2者54眼(72%),>0.5者23眼(31%),术后视力没有提高3眼(4%),术后视力与术前相比差异具有统计学意义(P<0.05)。结论:严重的眼外伤合并玻璃体积血、大量玻璃体积血药物治疗不吸收,反复发生的玻璃体积血和B超检查发现视网膜脱离者应及时行玻璃体切割术以改善和保护视功能。     

玻璃体切除治疗外伤性严重玻璃体积血的研究

目的：探讨治疗严重外伤性玻璃体积血适宜的手术时机。方法：分别对早期2－4周和晚期5周－3月的严重外伤性玻璃体积血各62例作研究组与对照组,采用玻璃体切除术进行治疗,并对因积血导致的并发症同时联合相关手术治疗,进行对比研究。结果：研究组视力比术前有明显提高,达到有用视力者占70.9％,并发症较少。而对照组视力较术前提高较差,达到有用视力者59.6％,并发症较多。结论：玻璃体切除术治疗早期外伤性玻璃体积血是有效的治疗方法,在伤后2-4周进行手术为适宜的手术时机。术后视力恢复好,并发症少。相反晚期手术视力恢复较差,并发症国较多。     

玻璃体积血的形态结构与玻璃体后脱离的图像特征

目的探讨玻璃体积血的形态结构和治疗特点.方法对74例(79只眼)增生性糖尿病视网膜病变、视网膜血管炎、视网膜静脉阻塞所致玻璃体积血的临床资料进行比较分析.术前超声检查、术中手术显微镜观察患者的玻璃体形态特点,分析玻璃体与视网膜的关系.结果所有患者均有不同程度的玻璃体后脱离,根据图像的形态特征可归纳为完全后脱离和部分后脱离两种.部分后脱离又分为"V"型、"L"型及后部玻璃体劈裂型,劈裂型多见于视网膜缺血性疾病的增生期.结论了解和掌握玻璃体后脱离及玻璃体劈裂的形态特点,可提高手术治疗的成功率并改善其预后.     

Infantile Vitreous Hemorrhage as the Initial Presentation of X-linked Juvenile Retinoschisis

The authors report two cases of X-linked juvenile retinoschisis (XLRS) manifested as bilateral vitreous hemorrhage as early as in an 1-month-old infant and in a 3-month-old infant. The one-month-old male infant showed massive bilateral vitreous hemorrhage. During vitrectomy, thin membrane representing an inner part of schisis cavity was excised and intraschisis hemorrhage was evacuated. As intraschisis cavities were cleared, the stump of inner layer appeared as the demarcation line between the outer layer of the schisis retina and non-schisis retina. The other three-month-old male infant presenting with esodeviation also showed bilateral vitreous hemorrhage. Typical bilateral retinoschisis involving maculae could be seen through vitreous hemorrhage in both eyes on fundus examination. Spontaneous absorption of hemorrhage was observed on regular follow-up. XLRS could be manifested as massive hemorrhage inside or outside of the schisis cavity early in infancy.     

严重眼外伤的玻璃体切除手术

目的：总结玻璃体手术治疗严重眼外伤的疗效。方法：回顾性分析1999年6月－2000年10月行闭合式玻璃体切除手术的46例（47眼）严重眼外伤患者的资料。结果：术后视力提高33眼（70．2％），不变9眼（19．2％），下降5眼（10．6％），27眼（57．5％）术后和达到0．02以上，15眼（31．9％）视网膜解剖复位，5眼（10．6％）失败，结论：选择适当时机行玻璃体手术可使大多数严重眼外伤患者视力提高。     

伴玻璃体出血的视网膜脱离

目的:探讨伴玻璃体出血的视网膜脱离的及时诊断及手术时机的选择。方法:收集68例68眼伴玻璃体出血的视网膜脱离病列进行回顾性总结和分析。结果:伴玻璃体出血的视网膜脱离发生PVR的危险性大,用单纯巩膜扣压术成功率低,往往要结合玻璃体切除术来提高成功率。结论:玻璃体出血影响眼底观察,易造成诊断困难,加之易引起眼内炎症反应和发生严重的PVR,一旦确诊应尽早手术。眼科学报 1995;11:224—226。     

復方丹参针劑治療糖尿病玻璃體積血

目的 探讨复方丹参针剂治疗糖尿病玻璃体积血的效果。方法 在51例(51眼)糖尿病玻璃体积血的病人中随机抽出33例为A组,依积血量多少分为轻、中、重三型,给予静滴复方丹参针剂 另18例为B组,同样分型并给予安妥碘肌注 分别比较两组治愈率及积血吸收时间等 结果 A组治愈率明显高于B组、尤以中型为高且两组间有显著性差异 A组轻,中型积血吸收平均时间均较B组为短、两组中型患者积血吸收时间亦有显著性差异 给论 复方丹参针剂对轻、中型糖尿病玻璃体积血是一种疗效较好的药物、优于传统促吸收药     

Vitreous hemorrhage in diabetic eyes previously treated with panretinal photocoagulation

Background Vitreous hemorrhage (VH) is a major cause of severe vision loss in diabetic patients. The aim of this study was to assess the incidence and risk factors for new VH in diabetics previously treated with panretinal photocoagulation (PRP) for proliferative retinopathy (PDR) in community base center. Methods Records of 192 diabetics (35 type 1, 157 type 2), undergoing PRP for diabetic retinopathy were retrospectively reviewed. Eyes presenting initially with high-risk PDR received PRP without delay, and eyes presenting initially with severe non proliferative retinopathy (NPDR) or early PDR had undergone central retinal photocoagulation (CRP), and then, when high risk PDR developed, received PRP treatment. Results VH had developed in 39% of the eyes despite PRP. Risk factors for VH in type 1 diabetes were: early onset and long duration of disease (23.8 versus 39.0 years of age, P = 0.007, and 25.8 versus 16.0 years, P = 0.002, respectively). In type 2, VH occurred with less follow-up and angiographic examinations (7.4% versus 3.8%, P = 0.027, and 33% versus 47%, P = 0.07, respectively). CRP decreased the risk for VH from 43 to 15%, P = 0.013. Conclusions In type 2 diabetes, regular ophthalmic follow-up and intensive PRP may reduce the risk for VH in eyes previously treated by PRP. In type 1, early onset disease and long duration are associated with higher incidence of VH.     

Nonrecordable Electroretinogram in Vitreous Hemorrhage

A 32-year-old male sustained a dense vitreous hemorrhage following a scleral buckle procedure for a traumatic retinal detachment in his right eye. The bright-flash ERG was nonrecordable on two occasions. At pars plana vitrectomy, a dense vitreous hemorrhage was removed, and the retina was noted to be attached. The patient sub-sequently regained good vision with progressive recovery of the ERG over several months. Although a nonrecordable bright-flash electroretinogram is usually a reliable indication of a detached or severely impaired retina, recordings should be interpreted with caution in cases of dense vitreous hemorrhage, particularly if ocular penetration has occurred.     

Modified Vitreous Surgery for Subretinal Neovascularization and Hemorrhage

Purpose:To modify vitreous surgery for subretinal neovascularization(SRNV)and to detrmine the effects of this operation.Methods:Six patients with SRNV were performed with this operation,The meth-ods of examination before and after operation included;testing the best-corrected visual acuity before operation and 1,3or6months after operation;30degrees and visual acuity before operation and 1,3or6months after operation;30degrees and macular 10degrees Humphrey visual field examination:FFA examination preop-eratively and 1,3or6months postoperatiely.Modified surgery procedureis;a preventive buckling;pars plana vitrectomy;peeling the vitreous cortical;no in-traocular diathermy;small retinotomy;subretinal surgery;air-fluid exchang.Results:SRNV was taken off in4cases.Subretinal hemorrhage was washed in2cases.After4to7months follow-up,the visual acuity was improved in 4cases,unchanged in 2cases.The visual field was improved in 4cases.unchanged in 1case,decraesed in 1case,The complications included macular hole due to surgery in lcase and subretinal hemorrage in 1case.Conclusion;The surgery criteria were:1)massive subretinal hemorrhage;2)some patients of SRN V included;FFA evidence they showed the membrane is beneath fovea,the bestV.Ais20/100orlower.and can‘t be treated by laser and the pa-tient consent.This modified subretinal operation is safe,and effective for massive hemorrhage and some SRNVS.     

严重眼球外伤的玻璃体手术治疗

目的总结玻璃体手术治疗严重眼球外伤的视力后果。方法回顾性分析1996年11月至1998年4月间经玻璃体手术治疗的严重眼外伤188例191只眼的临床资料。结果191只眼中眼球穿通伤56只眼,眼后节异物70只眼,眼球钝挫伤41只眼,眼球破裂24只眼。其中合并眼内炎35只眼,脉络膜出血20只眼,视网膜脱离60只眼,玻璃体积血97只眼。玻璃体手术后,除3只眼因患者年幼不能测视力外,其余的188只眼中,133只眼视力提高,占70.7%,其中0.02-1.0者占45.2%;46只眼不变,占24.5%;9只眼下降,占4.8%。术前34只无光感眼中,12只眼恢复光感以上视力。结论经过适时、恰当的玻璃体手术治疗,大多数严重外伤眼的视力可得到相当程度的挽救。(中华眼底病杂志,1999,15:4-6)     

玻璃体内注射T—PA治疗实验性新鲜玻璃体积血

制作新鲜兔眼玻璃体积血模型，将t－PA、尿激酶（UK）及注射用水分别注入玻璃体内，观察眼底、测定玻璃体出血指数、测定玻璃体液纤维蛋白（原）降解产物（FDP）含量、进行鱼精蛋白副凝固（3P）试验，结果：t－PA可促进玻璃体积血吸收，作用快速，且优于UK，同对照组、UK组比较统计学上有非常显著差异；未发现毒副作用。