中间型葡萄膜炎并发复杂性视网膜脱离的玻璃体手术治疗

目的:探讨中间型葡萄膜炎并发复杂性视网膜脱离的临床特征及玻璃体切除联合眼内填充术的治疗效果。方法:回顾性分析我院2000-01/2005-06收治的11例(共11眼)中间型葡萄膜炎并发复杂性视网膜脱离病例术前及术后详细的临床资料。所有患者均接受巩膜外环扎,玻璃体切除联合眼内填充术治疗,术中9眼行硅油充填,2眼填充长效惰性气体。术后随访12～66mo。结果:术后11眼均获视网膜良好复位及视力增进。随访期中有7眼于6～12mo取出硅油,硅油取出后2眼因周边部PVR或葡萄膜炎复发导致视网膜脱离复发,未取硅油的4眼(包括2只再手术眼)视网膜平伏。结论:中间型葡萄膜炎并发的复杂性视网膜脱离,尤其存在周边部纤维及血管膜的牵引时,玻璃体切除联合眼内填充术效果确切,周边部PVR和葡萄膜炎复发是术后限制视网膜复位的主要原因。     

玻璃体切除联合眼内填充治疗复杂视网膜脱离

目的　探讨复杂性视网膜脱离应用玻璃体切除联合眼内填充手术的效果及并发症的发生情况。方法　对2 9例伴有眼球破裂伤、眼内炎、玻璃体积血、白内障、PVR或糖尿病性视网膜病变等的复杂性视网膜脱离进行玻璃体视网膜手术的连续病例临床资料进行回顾性分析。结果　玻璃体切除联合玻璃体腔注气术12眼,1次手术视网膜复位8眼(66.67%) ;玻璃体切除联合玻璃体腔内硅油填充术2 0眼(包括注气失败的3眼) ,1次手术完全复位13眼(65 .0 0 %)。统计学检验两组1次手术视网膜复位率的差异无显著意义。术后视力较术前提高者2 1眼(72 .41%)。常见的并发症有复发性视网膜脱离、并发性白内障及继发性青光眼等。结论　玻璃体切除联合眼内填充能有效地治疗复杂性视网膜脱离,PVR仍然是术后视网膜脱离复发的主要因素。     

玻璃体切除联合重硅油填充治疗下方PVR视网膜脱离

目的探讨玻璃体切除联合重硅油眼内填充治疗下方严重PVR视网膜脱离的效果。方法对26例（26眼）诊断为合并下方PVR视网膜脱离者行玻璃体切除联合眼内重硅油填充,并同时随机抽取26眼患相似类型的视网膜脱离者,在玻璃体切除术后给予眼内硅油填充作为对照治疗。术后随访7～12月,观察其视网膜复位、视力、眼压及硅油乳化等情况。结果重硅油组视网膜一次性完全复位者24眼,占92．30％,硅油组一次性视网膜完全复位者18眼,占69．23％,（P〈0．05）。视网膜完全复位者绝大部分视力有不同程度提高。所有患者均未见明显炎症反应。结论玻璃体切除联合重硅油眼内填充是治疗下方PVR视网膜脱离的有效方法,可以降低术后视网膜脱离的复发率。     

晶体玻璃体视网膜手术联合硅油填充治疗复杂性视网膜脱离

目的：探讨晶体玻璃体视网膜手术（Lenticular-retinovetinal surgery,LVR)联合硅油填充治疗复杂性外伤性视网膜脱离的效果。方法：对38例（38眼）应用晶体玻璃体视网膜手术联合硅油填充治疗的外伤性视网膜脱离进行回顾性分析。结果：解剖必忝功者35眼（92 11%),功能成功者32眼(84.21%).结论:LVR联合硅油填充是治疗复杂性外伤性视网膜脱离的主要方法.显著影响手术预后的因素是前部PVR和术中术后眼内出血及角膜外伤性病变.     

硅油填充术后视网膜再脱离临床分析

目的:探讨玻璃体切除联合硅油填充治疗复杂性视网膜脱离术后 ,硅油填充期间发生视网膜再脱离的原因及处理方法。方法 :回顾总结分析 2 8眼硅油填充期间发生视网膜再脱离的原因 ,对不同眼底表现分别采取巩膜外顶压联合眼外激光封孔 ,硅油取出、剥膜、再次眼内填充 ,硅油下视网膜剪开等术式 ,观察治疗效果。结果 :2 8眼有 2 5眼解剖复位 ,3眼复位后再脱离 ,成功率为 89 3%。其中一次手术成功率 78 6 %。结论 :术后增殖膜形成牵引是硅油填充期间视网膜再脱离的主要原因 ,对不同类型的视网膜再脱离 ,应采取不同治疗措施     

玻璃体切除眼内填充治疗人工晶状体眼视网膜脱离

目的观察玻璃体切除术联合眼内填充治疗人工晶状体眼视网膜脱离的疗效.方法对10例10眼人工晶状体眼视网膜脱离实施了玻璃体切除术,其中2例填充了硅油,8例行 C3F8 气体填充,对术后视网膜复位及视力恢复情况进行了回顾性分析.结果随访2～16个月,所有病例视网膜均复位,9例视力得到了提高,1例无改善.结论玻璃体切除术联合眼内填充是治疗人工晶状体眼视网膜脱离的有效方法.     

重硅油玻璃体腔充填治疗复杂性视网膜脱离的临床研究

目的 评价重硅油作为眼内填充剂治疗复杂性视网膜脱离的有效性和安全性.方法 采用标准的玻璃体切割联合重硅油Oxane HD充填术治疗复杂性视网膜脱离患者13例13只眼,术中根据病情联合白内障摘除、巩膜环扎、增殖膜剥除、视网膜切开、重水压平视网膜行眼内激光光凝等.观察重硅油充填期及取出后术眼的最佳矫正视力、视网膜解剖复位情况、手术后并发症等.结果 重硅油充填期平均为93d,取出后平均随访170d.13只眼中有12只眼最佳矫正视力提高,1只眼视力无改善.有10只眼在眼内充填重硅油至取出后保持稳定的视网膜复位至随访结束.术后主要并发症包括轻至中度的眼压升高、眼前段炎症反应、晶状体混浊、增殖膜形成和硅油乳化等.结论 重硅油Oxane HD作为眼内填充物可以有效安全地治疗复杂性视网膜脱离,尤其是伴下方或后极部裂孔的视网膜脱离.     

儿童复杂性视网膜脱离的手术治疗

目的　探讨儿童复杂性视网膜脱离病因、特点及手术方法和疗效。方法　对采用玻璃体切割联合眼内填充术治疗的儿童复杂性视网膜脱离患者 71例 (74眼 )进行临床分析。结果　 9眼膨胀气体填充 ,术后近期 5眼 (5 5 6% )视网膜复位 ;66眼硅油填充 ,近期 5 5眼 (83 3 % )视网膜复位。随访 2～ 3 0月 ,其中 5 1眼随访时间超过 6个月 ,最终视网膜完全复位 3 4眼 (66 7% ) ,视力在 0 0 5以上者 2 8眼 (5 4 9% )。结论　玻璃体切割联合眼内填充术是治疗儿童复杂性视网膜脱离的有效方法之一 ,儿童复杂性视网膜脱离的手术成功率比成年人低 ,手术失败的主要原因是PVR复发     

光学相干断层扫描对黄斑"白孔"性视网膜脱离的疗效评价

目的使用光学相干断层扫描(opticalcoherencetomography,OCT)观察用不同眼内填充物(C3F8气体或硅油)治疗伴随视网膜脱离的高度近视性黄斑“白孔”的预后。方法对由于高度近视性黄斑“白孔”而发生视网膜脱离,并接受玻璃体切除联合眼内填充物注入术的29眼(C3F8填充的10眼、硅油填充的19眼)进行随访,使用OCT评价黄斑孔的愈合情况。结果经OCT检查证实,19眼经玻璃体切除联合硅油填充术治疗后黄斑裂孔成功闭合,其中8眼是在以C3F8填充后未愈,而再次行玻璃体切除手术并改用硅油填充治疗获成功。10只患眼以玻璃体切除联合C3F8填充手术后视网膜复位,但8只患眼黄斑孔未闭合。结论使用OCT检查可以帮助评价手术疗效。适当采用玻璃体切除联合眼内硅油填充手术有助于提高黄斑裂孔的闭合成功率。     

玻璃体切割治疗复杂视网膜脱离45例临床分析

目的：分析玻璃体切割术治疗复杂性视网膜脱离的效果。方法：对45例45眼复杂性视网膜脱离眼行闭合式玻璃体切割术,术毕玻璃体腔行C3F8气体或硅油填充。结果：玻璃体切割联合玻璃体腔注气术15眼,1次手术视网膜复位13眼（87%）;玻璃体切割联合玻璃体腔内硅油填充术30眼,1次手术完全复位27眼（90%）。统计学检验两组1次手术视网膜复位率的差异无显著意义。术后视力：数指/眼前者2眼,0.02～0.05者3眼,0.06～0.1者10眼,0.12～0.25者19眼,≥0.3者11眼。术中常见的并发症有医源性视网膜裂孔,术后并发症最多见是继发性青光眼和白内障。结论：玻璃体切割联合眼内填充能有效地治疗复杂性视网膜脱离,术后大部分患者视力能得到改善。     

Silicone oil in the surgical treatment of retinal detachment--indications and clinical experience]

Silicone oil is being used with increased frequency for retinal tamponade during vitreous surgery for complicated retinal detachments. Though it is now possible to reattach most detached retinas, the visual outcome of the silicone oil procedure is often disappointing. This is due to the well known complications of silicone oil (i.e. cataract, glaucoma, corneal opacification), and the necessity to remove the silicone oil in a second surgical procedure with a certain risk of redetachment. Possible toxicity to retina and optic nerve has not yet get been completely evaluated. An alternative method is the use of expanding gases for internal retinal tamponade. Expanding gases are not as effective as silicone oil in advanced stages of proliferative vitreoretinopathy (PVR), but are afflicted with much less complications. We reviewed the charts of our patients, operated on for retinal detachment, to analyse the anatomical and functional results with silicone oil versus gas tamponade. Regarding the last 421 consecutive surgical procedures for retinal detachment (368 eyes), silicone oil has been used in 5%, expanding gases in 14%. The silicone oil procedure was restricted to the most advanced cases of PVR. The anatomic success rate with silicone was 72%, with gas tamponade 87%. Visual acuity of 0.05 and better achieved 19% of the eyes treated with silicone oil versus 61% of the eyes with gas tamponade. These results confirm the findings of other investigators: despite of the high anatomic success rate with silicone oil, the functional results are poor. Because many complicated cases of retinal detachment can also be treated successfully with gas tamponade, silicone oil should remain the last step in retinal detachment surgery.     

Extended retinal tamponade in the treatment of retinal detachment with proliferative vitreoretinopathy.

We have used intraocular sulphur hexafluoride or liquid silicone as an adjunct to vitreous surgery in the treatment of a non-randomised sequential series of 19 eyes with retinal detachment complicated by proliferative vitreoretinopathy. We have studied the surgical results and complications of these two tamponades and drawn preliminary conclusions on their use in retinal reattachment surgery. After a seven-month minimum follow-up 13 (68%) of the eyes have reattached retinas. Six (60%) of 10 eyes treated only with silicone have reattached retinas, and four (67%) of six eyes treated only with sulphur hexafluoride gas tamponade have reattached retinas. An additional three eyes treated initially with silicone oil subsequently developed retinal detachments; all were successfully reattached with sulphur hexafluoride tamponade after silicone oil removal. Intraoperative pneumatic retinal reattachment to assess relief of retinal traction combined with the production of widespread chorioretinal adhesions to wall off persistent anterior traction and detachment, as well as extended postoperative gas tamponade of the retina, appears to enhance the surgical results in retinal detachment complicated by proliferative vitreoretinopathy. Silicone oil tamponade of the retina appears to be useful in cases where retinal traction cannot be entirely relieved and in patients who are unable to tolerate the head positioning required for effective gas tamponade of the retina. A controlled clinical study recently begun will be required to define further the precise role of these methods of retinal tamponade.     

The combined use of perfluorohexyloctane (F6H8) and silicone oil as an intraocular tamponade in the treatment of severe retinal detachment

Background The purpose of this study was to investigate the combined use of perfluorohexyloctane (F6H8) and 1,000-centistoke silicone oil as a long-term intraocular tamponade in the treatment of complicated retinal detachment.Methods Sixty consecutive eyes affected by complicated retinal detachment with (1) retinal breaks of the lower two quadrants and severe proliferative vitreoretinopathy, (2) inferior giant retinal tear, (3) penetrating trauma or (4) choroidal detachment underwent pars plana vitrectomy using a combined internal tamponade of F6H8 and silicone oil. The double filling (DF) was removed after 40–50 days. The anatomical outcome and the complications due to the DF are reported.Results Retinal reattachment was achieved in all but one patient. Thirty-eight (63%) eyes needed further surgery with silicone oil tamponade. Silicone oil was successfully removed in 22 eyes. Sixteen (27%) eyes had retained silicone oil at the last follow-up examination. One eye showed persistent retinal detachment despite further surgery. Main complications of the DF were recurrent retinal detachment of the upper retina in six (10%) eyes and membrane formation in 25 (42%) eyes.Conclusions A combined internal tamponade of F6H8 and silicone oil may be a useful tool in the treatment of complicated retinal detachment involving the lower quadrants of the retina.     

巨大裂孔视网膜脱离手术的探讨

目的探讨玻璃体视网膜手术治疗巨大裂孔视网膜脱离的手术方法和效果。方法巨大裂孔视网膜脱离11例（11眼）。其中10眼行闭合式三通道玻璃体切除联合巩膜扣带术和眼内视网膜光凝,另1眼未做巩膜扣带。6眼手术中采用全氟化碳液（重水）-硅油置换,硅油眼内填充;5眼为气体-液体交换,硅油填充。结果 11眼手术后视网膜均完全复位。随访观察中视网膜复位良好,2眼已取出硅油。但其中1眼取出油后又发生了视网膜脱离,并出现新裂孔,又做了硅油填充术。2眼发生继发性青光眼,2眼发生了并发性白内障,其中1眼已做了白内障手术。未发生全氟化碳液（重水）眼内残留或角膜变性等并发症。结论玻璃体切除术联合巩膜扣带、硅油眼内填充、视网膜激光光凝能有效治疗有巨大裂孔的视网膜脱离。     

硅油取出联合外路显微手术治疗硅油填充眼视网膜脱离

目的:探讨同期行硅油取出联合外路显微手术治疗硅油填充眼视网膜脱离的适应证及临床效果。方法:回顾性系列病例研究。收集2014-07/2018-07间在我院眼科同期行硅油取出联合外路显微手术治疗的硅油填充眼视网膜脱离患者21例21眼的临床资料。分析视网膜脱离的原因、视网膜复位的效果、视力改善情况以及手术并发症等。结果:所有病例手术后随访4~12(平均5.48±1.53)mo;一次手术视网膜解剖复位19眼,手术成功率90%,其它2眼需再次行内路玻璃体切除联合硅油填充术;术后最佳矫正视力(BCVA)≥0.4者4眼,0.06~0.3者9眼,≤0.05者8眼,术后LogMAR视力(1.10±0.58)与术前(1.66±0.74)相比有差异(t=3.58,P<0.05)。术后发生黄斑前膜1眼,继发青光眼2眼,并发性白内障5眼,未见其他严重并发症发生。结论:对于增殖性玻璃体视网膜病变(PVR)≤C1、裂孔位于赤道及以前的硅油填充眼视网膜脱离可采用同期硅油取出联合外路显微手术治疗,具有操作方便、视网膜复位率高、并发症少等优点,同时可减少再次玻璃体切除术或硅油填充的机会。     

Silicone oil-RMN3 mixture ("heavy silicone oil") as internal tamponade for complicated retinal detachment

PURPOSE: To evaluate the efficacy and safety of a silicone oil-RMN3 mixture ("heavy silicone oil") as heavier as water internal retinal tamponade after vitrectomy for complicated retinal detachment. The relative density of the heavier-than-water silicone oil was 1.03 g/cm3, and the viscosity was 3,800 cSt. Heavy silicone oil is designed to tamponade the inferior retina in complicated retinal detachment. METHODS: Patients with a complicated retinal detachment involving the inferior part of the retina requiring internal tamponade with silicone oil were recruited for this prospective study. Inclusion criteria were retinal detachment secondary to proliferative vitreoretinopathy (stage > or = C2), inferior or posterior tears, or penetrating trauma. The heavy silicone oil was injected at the end of surgery after peeling of retinal membranes or retinotomy. Follow-up examinations were scheduled at 1, 3, 6 months, and 1 year after the initial surgery. RESULTS: A total of 33 eyes of 33 patients aged from 20 to 84 years (mean, 56 +/- 18 years) were treated with heavy silicone oil. Follow-up ranged from 12 to 16 months. Rhegmatogenous retinal detachment with significant proliferative vitreoretinopathy accounted for 17 cases, inferior holes for three, and trauma with retinal detachment for three. Initial visual acuity ranged from 20/50 to hand motions. Initial retinal reattachment was achieved in all cases. Complications included increased intraocular pressure in six eyes (18%), intraocular inflammation and synechia formation in one eye (3%), a central retinal artery occlusion after heavy oil removal in one eye, and scattered retinal hemorrhages during follow-up in two eyes (6%). Significant emulsification was not observed during intraocular tamponade with heavy silicone oil. At the last follow-up, all eyes had macular attachment, and 24 eyes had a visual acuity better than or equal to 20/400. CONCLUSIONS: The results of this prospective study show the good intraocular tolerance of heavy silicone oil as tamponade in complicated retinal detachment. Its specific gravity allows for sufficient tamponade of inferior retinal tears for at least 3 months without significant side effects.     

睫状体平坦部硅油取出术联合超声乳化白内障摘除术短期效果观察

目的:观察硅油填充眼的白内障超声乳化联合睫状体平坦部硅油取出手术的治疗效果。方法:对2005-01/2007-01我院收治的24例24眼玻璃体切除术后硅油填充眼患者,实施白内障超声乳化联合睫状体平坦部硅油取出术,观察术后视力、并发症等。结果:术中发生视网膜脱离3例3眼(12%)。术后3mo最佳矫正视力>0.3者1眼(4%);0.12～0.3者16眼(67%);≤0.1者7眼(29%);植入人工晶状体21眼(88%);未植入人工晶状体3眼(12%)。结论:硅油填充眼的白内障超声乳化联合睫状体平坦部硅油取出术是安全有效的手术方式。     

急性视网膜坏死综合征硅油填充术后硅油取出时机选择

目的观察急性视网膜坏死综合征(ARN)行玻璃体切除联合硅油填充术后硅油充填期间及硅油取出术后并发症,进而探讨硅油取出的适宜时机。方法对连续就诊的伴有视网膜脱离的48例(48只眼)ARN患者实施玻璃体切除视网膜复位联合硅油填充术,对于确认视网膜已经复位,没有活动性的增生病变及视网膜裂孔,并在视网膜变性区域补充激光光凝的所有患者经不同时长的硅油填充期后实施硅油取出术,回顾分析其硅油填充期间及硅油取出术后并发症如视网膜脱离、并发性白内障、继发性青光眼、角膜变性等的发生情况。结果硅油填充术后视力总体上较术前有明显提高;硅油填充时间为3~15个月,平均5.8个月。取出硅油之后,总体视力无明显改变;8例于取硅油术后随访期内发生视网膜再脱离;1例角膜变性的病例,在硅油取出之后无明显改变;5例并发性白内障取油时实施超声乳化联合人工晶状体植入术;6例发生脉络膜脱离经药物治疗后痊愈;24例在硅油取出之后晶状体混浊程度较硅油取出术前无明显改变;3例无晶状体眼患者取油术后裸眼视力下降,但最佳矫正视力同硅油取出术前。结论硅油填充及硅油取出术的并发症主要为视网膜再脱离、脉络膜脱离、并发性白内障、继发性青光眼、硅油乳化、角膜变性、低眼压等。对于ARN而言,硅油填充时限4~6月时取油术后视网膜再脱离的发生率较低,取油较为适宜。     

玻切联合硅油填充术后并发性白内障的手术治疗

探讨白内障超声乳化吸除+硅油取出+人工晶状体植入+后囊膜环形切除术治疗玻璃体切割联合硅油填充术后并发性白内障的疗效。 方法：回顾分析2007-11/2011-11玻璃体切割联合硅油填充术后白内障患者102例102眼,距离玻璃体手术时间3~9（平均6.1）mo,采用玻璃体腔灌注,先行白内障超声乳化手术,前房注入黏弹剂,行硅油置换,然后人工晶状体植入,环形后囊切开,观察术中、术后并发症,术后视力等。 结果：术后 4wk,102例102眼中,97眼视力不同程度提高,5眼术后视力无改善;后囊破裂2例,无晶状体核坠入玻璃体,无脉络膜脱离。 结论：玻璃体切割联合硅油填充术后行白内障超声乳化吸除+硅油取出+人工晶状体植入+后囊膜环形切除术治疗玻璃体切割联合硅油填充术后并发性白内障,可有效减少术中、术后并发症,同时避免二次手术所带来的风险。