25G微创玻璃体切除联合内界膜剥除治疗PVR-C级视网膜脱离

目的:观察25G微创玻璃体切除联合内界膜剥除治疗增殖性玻璃体视网膜病变(PVR)-C级视网膜脱离的效果。方法:收集2015-08/2018-07在我院就诊的PVR-C级视网膜脱离患者37例37眼,对所有患者行25G微创玻璃体切除联合硅油填充术治疗,术中吲哚菁绿染色后剥除血管弓大小范围内界膜。3~6mo根据视网膜复位情况行硅油取出,术后随访12mo,观察视力、眼压、视网膜复位、黄斑前膜情况并进行回顾性分析。结果:术后视力均有不同程度提高;术后2wk内眼压增高者6眼,经过治疗,眼压均恢复正常;所有患者到随访末期均未出现黄斑前膜;2眼因下方视网膜周边部出现PVR致再次视网膜脱离,余35眼均成功取出硅油。结论:25G微创玻璃体切除联合内界膜剥除治疗PVR-C级视网膜脱离安全有效,并有效防止了黄斑前膜的出现。     

玻璃体切割术联合或不联合内界膜剥除治疗严重PDR伴黄斑皱褶移位

目的:观察性研究25G微创玻璃体切割联合内界膜剥除治疗严重增殖性糖尿病视网膜病变(PDR)伴黄斑皱褶移位的临床疗效。方法:收集2016-01/2017-12在江苏省人民医院眼科病房接受玻璃体切割手术的严重PDR伴黄斑皱褶移位的患者36例36眼的临床资料,其中2016-01/12入院的患者18例18眼纳入对照组,行25G微创玻璃体切割术,2017-01/12入院的患者18例18眼纳入联合组,行25G微创玻璃体切割联合内界膜剥除术。观察术前,术后7d,1、3、6mo最佳矫正视力(BCVA)、黄斑中心区厚度(CMT)、眼压及并发症。结果:术后6mo,两组患者BCVA较术前显著提高(均P<0.05);联合组CMT小于对照组(P<0.001)。术后6mo内,联合组中2眼(11%)高眼压、1眼(6%)黄斑水肿;对照组1眼(6%)高眼压,1眼(6%)黄斑前膜,1眼(6%)玻璃体积血,两组并发症发生率无差异(均P=1.000)。结论:采用25G微创玻璃体切割联合内界膜剥除术治疗严重PDR伴黄斑皱褶移位能安全有效地提高患者视力及降低黄斑中心区厚度。     

23G微创玻璃体切割术治疗Valsalva视网膜病变

目的 探讨23G微创玻切手术对Valsalva视网膜病变的临床效果.方法 回顾性分析了2007年3月至2010年3月在眼科就诊的10例(10只眼)Valsalva视网膜病变病例,经过1月保守治疗无效后接受23G微创玻璃体切割手术联合内界膜剥除,分析术后的治疗效果.结果 术后1周患者最佳矫正视力BCVA 0.3～0.5者7例,0.6～0.8者3例.最后一次随访时BCVA在0.6～0.8者9例,1.0者1例.除3例患者术后出现少量结膜下出血外未见其他并发症.结论 23G微创玻璃体切割手术联合ILM剥除对于保守治疗无效、范围较大的黄斑区ILM下积血为主要表现的Valsalva视网膜病变,是安全有效的.     

玻璃体切割联合内界膜剥除术治疗高度近视继发黄斑劈裂的观察

目的：探讨和评价玻璃体切割联合内界膜剥除治疗高度近视继发黄斑劈裂的疗效和安全性。
　　方法：将2011-03/2013-03高度近视继发黄斑劈裂患者30例30眼随机分为治疗组(16眼)和对照组(14眼),治疗组给予玻璃体切割联合内界膜剥除,对照组给予玻璃体切割但未联合内界膜剥除,观察术后2 mo视网膜复位率、视力提高率。
　　结果：治疗组视网膜复位率、视力提高率均高于对照组(P<0.05)。
　　结论：玻璃体切割联合内界膜剥除是治疗高度近视继发黄斑劈裂的有效手段。     

内界膜剥离治疗高度近视黄斑孔性视网膜脱离的临床效果

目的 评价高度近视黄斑孔性视网膜脱离行玻璃体切除联合内界膜剥离的术后效果.方法 回顾分析高度近视黄斑孔性视网膜脱离23眼,其中13眼行玻璃体切除,10眼行玻璃体切除联合内界膜剥离,所有术眼均填充C<,3>F<,8>气体,术后随访观察黄斑孔封闭、视网膜解剖复位情况和视力变化.随访8～46个月,平均21.7个月.结果 内界膜剥离组术后视网膜复位9/10(90.00%),内界膜保留组视网膜复位7/13(53.85%),两组中视网膜复位的患眼视力改善无显著差异.结论 内界膜剥除可以解除视网膜前膜的切线牵引力而提高高度近视黄斑孔性视网膜脱离的复位率.     

玻璃体切除联合内界膜剥除治疗黄斑孔

目的 探讨玻璃体切除联合内界膜剥除治疗黄斑孔的临床疗效。方法 采用玻璃体切除结合内界膜剥除治疗黄斑孔16例(16眼)，术中使用吲哚青绿(ICG)染色内界膜。结果 内界膜可被ICG染成均匀的淡绿色，而黄斑前膜不被ICG染色，16眼均能安全地剥离内界膜。本组16眼中13眼(81．25％)术后黄斑孔完全封闭。8眼(50．00％)术后较术前视力提高2行以上。结论 玻璃体手术联合黄斑孔周围内界膜剁除可有效地封闭黄斑孔，提高视力。视网膜内界膜可被ICG染色，术中使用ICG染色有助于内界膜及黄斑前膜的辨认和剥除。     

内界膜翻转填塞治疗高度近视黄斑裂孔性视网膜脱离的初步疗效分析

目的观察内界膜翻转填塞治疗高度近视黄斑裂孔视网膜脱离的初步疗效。方法接受23G微创玻璃体切除联合内界膜剥除的高度近视黄斑裂孔视网膜脱离的患者37例(38只眼)纳入研究。其中,成功施行玻璃体切除联合内界膜剥除及内界膜翻转填塞16只眼(内界膜填塞组),其余21例(22只眼)行常规玻璃体切除联合内界膜剥除手术(内界膜剥除组)。两组患者均行硅油填充。手术后随访时间3~6个月,平均随访时间4个月。对比分析两组患眼黄斑裂孔闭合率、最佳矫正视力(Log MAR视力)、视网膜复位情况。结果内界膜剥除组,术后3个月视网膜复位者20只眼占90.91%,黄斑裂孔闭合者7只眼占31.82%。内界膜填塞组,术后3个月视网膜复位者16只眼占100%,黄斑裂孔闭合者16只眼占100%;内界膜剥除组术眼Log MAR视力由术前的1.95±0.44增加到术后的1.57±0.46,内界膜填塞组由术前的1.98±0.39增加到术后的1.48±0.33。两组术后视网膜复位率比较,差异有统计学意义(χ~2=7.06,P<0.05)。两组裂孔闭合率比较,差异有统计学意义(χ~2=6.31,P<0.05)。内界膜剥除组及内界膜填塞组手术后Log MAR视力均较手术前明显提高,差异有统计学意义(t=4.02、4.43,P<0.05)。两组手术后Log MAR视力比较,差异无统计学意义(t=0.17,P>0.05)。结论高度近视黄斑裂孔视网膜脱离行内界膜反转填塞手术较单纯内界膜剥除,黄斑裂孔闭合率及视网膜复位率均高,但术后两组视力恢复无明显差异。     

玻璃体切除联合内界膜剥除治疗外伤性黄斑孔

目的回顾性分析对外伤性黄斑孔行玻璃体切除联合内界膜剥除治疗的结果。方法分析本院2004年7月～2005年5月期间收治外伤性黄斑孔病人8例8眼,均进行闭合式玻璃体切除、吲哚青绿辅助下的视网膜内界膜剥除及过氟化碳眼内填充术。观察黄斑孔愈合和视功能恢复情况。结果8例均为全层黄斑孔。术前视力范围CF/30cm～0.2,低于0.01者3眼,0.01～0.1者3眼,0.1以上者2眼。挫伤直接造成黄斑孔3眼,陈旧伤、伴随黄斑前膜等改变者5例5眼。8例均顺利剥除内界膜。随访3m～6m,1眼因发生增殖性视网膜病变而再次手术,其余7眼(87.5%)黄斑孔闭合。术后视力范围眼前数指～0.5。视力<0.01者1眼,0.01～0.1者2眼,0.1～0.3者1眼,0.3以上者4眼,较术前明显提高(P<0.01)。结论玻璃体切除联合内界膜剥除及气体填充能有效促进外伤性黄斑孔闭合、提高视力。     

内界膜剥除联合玻璃体腔注气术治疗黄斑孔

目的探讨视网膜内界膜剥除联合玻璃体腔注气治疗黄斑孔的手术效果。方法对于经前置镜和荧光造影确诊的黄斑孔进行玻璃体切除内界膜剥除联合玻璃体腔注气术28例(30眼),追踪观察其视力及黄斑孔闭合情况。结果术后全部黄斑孔均成功闭合,24眼视力提高,6眼无变化。结论内界膜剥除联合玻璃体腔注气术可有效地封闭黄斑孔,提高视力。     

PPV术后玻璃体后界膜残留与PVR

目的：描述玻璃体切割术后玻璃体后界膜残留的一些临床特征,探讨其在复发性PVR的作用。方法：玻璃体切割术后复发性PVR和视网膜脱离接受再次玻璃体切割36眼,术中发现玻璃体后界膜残留28眼：有硅油充填21眼,充填时间2～26mo;无充填7眼。首次病变：RRD合并CD、巨大裂孔、黄斑裂孔11眼、早期外伤玻璃体积血10眼、视网膜血管病变玻璃体积血7眼、特发性玻璃体病变2眼。追踪观察6～34mo。结果：B超发现玻璃体内有一层较为完整的膜状结构6眼。玻璃体后界膜残留所致的复发性PVR和视网膜脱离,多发生在术后4～12wk。PPV术中发现较为完整膜结构23眼,部分膜结构5眼,组织学和免疫组化证实为后界膜。再次手术后7眼PVR再生,5眼再次手术,2眼经历3次手术,最终21眼(75％)视网膜获得功能复位,2眼获解剖复位,2眼拒绝再手术,3眼眼球萎缩。结论：玻璃体后界膜残留是PPV手术常见并发症,易发生于PDR、无明显PVR的RRD和早期外伤性玻璃体积血患;玻璃体后界膜残留是PPV术后产生PVR和视网膜脱离的重要原因之一。     

糖尿病视网膜病变玻璃体手术中应用曲安奈德的并发症观察

目的:讨论糖尿病视网膜病变玻璃体手术中应用曲安奈德的并发症.方法:回顾性分析2005-02/2007-01在我院进行的18例玻璃体手术中应用曲安奈德的增生性糖尿病视网膜病变患者手术后的反应.结果:手术后随访3～6(平均4.6)mo,出现高眼压2例;假性前房积脓1例;手术后玻璃体再出血3例;3例视网膜表面及黄斑区曲安奈德沉积.结论:手术后出现的假性前房积脓、视网膜表面及黄斑区曲安奈德沉积等并发症可不用特殊处理,自行吸收.术后出现的高眼压可通过降眼压药物治疗.手术后出现的玻璃体再出血可在药物不能吸收时通过再次手术治疗.     

Krypton laser membranotomy for premacular hemorrhage

BACKGROUND: To evaluate the safety and effectiveness of krypton laser membranotomy. METHODS: Eleven patients (12 eyes) with premacular hemorrhage were enrolled from April 1998 to November 2002. The causes of premacular hemorrhage were proliferative diabetic retinopathy (7 patients, 8 eyes), Valsalva retinopathy (3 patients) and leukemia (1 eye). Krypton laser was used to create a membranotomy on the sloping edge of the premacular hemorrhage. Five eyes with proliferative diabetic retinopathy were treated with inferior panretinal photocoagulation and laser membranotomy simultaneously. After intravitreal dispersion of premacular blood, fundus examinations were performed in all eyes and fluorescein angiography in 5 patients to evaluate the retinal damage. RESULTS: Vision was improved within 2 weeks after surgery in all eyes with premacular hemorrhage, which received krypton laser membranotomy. No retinal damage was seen at the site of membranotomy. No eye needed vitrectomy postoperatively during the follow-up (mean, 17 months). CONCLUSION: Krypton laser membranotomy appears to be a safe and simple alternative procedure for treating selected cases of premacular hemorrhage. Further trials are necessary to evaluate its benefit.     

糖尿病视网膜病变玻璃体切割术前激光治疗

目的:观察糖尿病视网膜病变(diabetic retinopathy,DR)玻璃体切割术前视网膜光凝治疗的结果。方法:2004-08/2007-08,观察44例(66眼)伴有广泛视网膜水肿和黄斑水肿的增殖前期和增殖期DR患者,均在我院做过玻璃体切割术,根据术前1mo是否行过视网膜光凝将其分为A组(术前视网膜光凝组)36眼,B组(术前无视网膜光凝组)30眼。年龄45～70岁,治疗后随诊6～26(平均12.3)mo。比较两组患者术中并发症,术后视力改善情况。结果:A组:术中见视网膜水肿消退30眼,视网膜出血5眼,医源性裂孔2眼,视网膜切开2眼,硅油填充3眼。B组:术中见视网膜水肿消退0眼,视网膜出血15眼,医源性裂孔8眼,视网膜切开8眼,硅油填充9眼。两组术中情况比较差异有统计学意义(P<0.05)。两组患者手术前后视力均有改善,A组视力改善30眼,B组视力改善19眼,两组视力改善情况比较差异有统计学意义(P<0.05)。结论:选择在玻璃体切割手术前近期行视网膜光凝对合并广泛视网膜水肿的DR,手术预后明显好于无视网膜光凝组,建议在玻璃体切割手术前尽可能使用光凝治疗。     

Krypton laser membranotomy in the treatment of dense premacular hemorrhage

BACKGROUND: Neodymium:YAG (Nd:YAG) laser and argon laser membranotomy have been used in patients with premacular hemorrhage to drain premacular blood into the vitreous cavity and rapidly clear the hemorrhage. However, the Nd:YAG laser appears to be difficult to use, and argon laser energy may be more likely to be absorbed by the ocular media. We performed a study to evaluate the safety and effectiveness of krypton laser membranotomy in selected cases of premacular hemorrhage. METHODS: Sixteen patients (17 eyes) with dense premacular hemorrhage for 2 weeks or less were enrolled from April 1998 to February 2004. The causes of premacular hemorrhage were proliferative diabetic retinopathy (PDR) in 12 eyes, Valsalva retinopathy in 3 eyes, leukemia in I eye and retinal arterial macroaneurysm in I eye. Krypton laser was used to create a membranotomy on the sloping edge of the premacular hemorrhage. Five eyes with PDR were treated with inferior panretinal photocoagulation and laser membranotomy simultaneously. After intravitreal dispersion of premacular blood, fundus examination was performed in all eyes and fluorescein angiography in five eyes to evaluate retinal damage. RESULTS: All eyes had visual improvement within 2 weeks postoperatively. No retinal damage was seen at the site of membranotomy in any eye. No eye needed vitrectomy postoperatively during a mean follow-up duration of 18.6 months. INTERPRETATION: Krypton laser membranotomy appears to be a safe and simple alternative procedure for treating selected cases of premacular hemorrhage. Further trials are necessary to evaluate its benefit.     

糖尿病患者玻璃体积血病因分析

目的:分析糖尿病患者玻璃体出血的原因,为相关疾病的诊治提供资料。方法:对2004-04/2007-06我科收治的126例(142眼)玻璃体积血的糖尿病患者情况进行回顾性分析。结果:增殖性糖尿病视网膜病变(proliferative diabetic reti-nopathy,PDR)122眼(85.9%),视网膜静脉阻塞(retinal vein occlusion,RVO)10眼(7.0%),视网膜裂孔(retinal hole,RH)6眼(4.2%),玻璃体后脱离(posterior vitreous detachment,PVD)4眼(2.8%);PDR组患者对侧眼糖尿病视网膜病变显著重于其余各组。结论:增殖性糖尿病视网膜病变是糖尿病患者玻璃体出血的主要原因,此外,视网膜静脉阻塞、视网膜裂孔和玻璃体后脱离也占有一定比例;通过对侧眼情况的评估,有助于玻璃体出血原因的判断。     

药物辅助下玻璃体切除术治疗增生性糖尿病视网膜病变

目的:探讨曲安奈德联合Bevacizumab(Avastin)辅助玻璃体切除术治疗严重糖尿病视网膜病变的临床应用价值。方法:回顾性分析药物辅助下玻璃体切除治疗的严重增生性糖尿病视网膜病变13例15眼,15眼均于术前3~14d行Bevacizumab(Avastin)1.25mg/0.05mL玻璃体腔注射,常规玻璃体切除术中使用曲安奈德辅助切除残留的玻璃体皮质、视网膜增殖膜,其中9例合并牵拉性视网膜脱离及黄斑水肿者硅油填充并留置4mg/0.1mL曲安奈德,4眼未使用硅油填充眼因合并黄斑水肿大量硬性渗出予曲安奈德留置。2眼单纯玻璃体积血者未注射曲安奈德。结果:除1例玻璃体腔注射Avastin 3d后术中出血较多特别是在剥离纤维新生血管膜过程中,其余病例术中出血很少,并能迅速自凝。联合曲安奈德辅助可清晰地辨别残留皮质、视网膜前膜甚至内界膜,黄斑水肿术后明显减轻,所有病例术后炎症反应轻,眼压控制良好,硅油眼中留置曲安奈德无明显并发症。结论:严重的增生性糖尿病视网膜病变玻璃体切除术前7~14d玻璃体腔注射Bevacizumab(Avastin),明显减少术中出血,术中使用曲安奈德辅助可视性良好。术毕留置4mg曲安奈德可有效减轻黄斑水肿及术后反应。     

25G+玻璃体切割联合玻璃体腔注射康柏西普治疗严重PDR

目的:对比25 G+玻璃体切割联合玻璃体腔注射康柏西普及单纯行25 G+玻璃体切割术治疗严重增生性糖尿病视网膜病变(PDR)的临床疗效.方法:回顾性临床病例对照研究.选取2014-10/2016-08在我院行25 G+玻璃体切割术的严重PDR患者35例42眼,其中行25 G+玻璃体切割术前玻璃体腔注射康柏西普眼用注射液18例22眼为A组;仅行25 G+玻璃体切割术患者17例20眼为B组,比较两组患者手术时间、术中并发症的发生情况、观察两组患者术后3 mo时玻璃体再积血(RVH)发生率、黄斑中心凹厚度(CFT),术后6 mo时BCVA(LogMAR)、CFT.结果:术中A、B两组患者的手术时间分别为58.23±8.18和72.41±10.31min,差异有统计学意义(t=2.9,P=0.002).术中主要并发症为医源性裂孔和术中撕膜时较大量出血,A组分别为2眼、1眼,B组为7眼、6眼,差异均有统计学意义(P=0.041、0.027).RVH发生率:术后3 mo时A组为2眼、B组为8眼,两组RVH发生率比较差异有统计学意义(P=0.030).BCVA(LogMAR):术后6mo时A组为0.92±0.35,B组为1.04±0.43,两者比较差异无统计学意义(t=0.241,P=0.212),但均较术前(A组为1.86±0.64,B组为1.73±0.82)明显提高,差异有统计学意义(t=4.614、7.355,均P<0.01).CFT:术后3 mo时,A组为273.42±25.21μm、B组为284.58±27.44μm,两者比较差异无统计学意义(t=0.488,P=0.179),但均较术前(A组为351.6±34.4μm、B组为358.2±37.1μm)明显下降,差异有统计学意义(t=3.152、4.933,均P<0.01);术后6mo时A组为238.16±16.35μm,B组为247.04±17.43μm,两者比较差异无统计学意义(t=0.571,P=0.133),但均较术前明显下降,差异有统计学意义(t=2.474、4.802,均P<0.01).结论:严重PDR患者行25 G+玻璃体切割联合术前玻璃体腔注射康柏西普治疗可有效改善视力,减轻黄斑水肿症状,相比较单纯玻璃体切割术还可缩短手术时间,减少术中并发症的发生,显著降低术后3 mo的RVH发生率.     

内界膜剥除术在复杂视网膜脱离手术中的应用

目的 观察玻璃体手术中应用内界膜剥除术治疗视网膜脱离合并增生性玻璃体视网膜病变的效果.方法 回顾性分析视网膜脱离合并严重增生性玻璃体视网膜病变行玻璃体视网膜手术40例（40只眼）的临床资料.以术中是否联合内界膜剥除分为两组：剥膜组19例,未剥膜者为对照组21例.术毕均填充硅油.于玻璃体手术后3个月及硅油取出术后3个月应用OCT观察两组黄斑区视网膜水肿及视网膜前膜情况,并记录最终随访视力.结果 随访6 ～ 12个月.玻璃体切除术后3个月,OCT见黄斑视网膜前膜形成者剥膜组0眼,对照组6眼（28.57％）（Fisher确切概率法,P=0.021）;出现黄斑水肿者,剥膜组1眼（5.26％）,对照组5眼（23.81％） （x2=1.433,P =0.231）.硅油填充下视网膜复位率剥膜组为89.47％,对照组为90.48％ （x2 =0.011,P=0.916）.硅油取出术后3个月,两组病例均未再发生新的视网膜前膜;出现黄斑水肿者,剥膜组为5.3％,对照组为14.30％（x2=0.178,P=0.673）.最终随访视网膜均复位.两组患者术后视力均较术前视力明显提高,且两组间差异无统计学意义.结论 在玻璃体切除术中应用内界膜剥除术治疗视网膜脱离合并增生性玻璃体视网膜病变,可以降低术后黄斑前膜的发生率,对术后视力、黄斑水肿情况及视网膜复位成功率无明显影响.     

Massive suprachoroidal hemorrhage during pars plana vitrectomy associated with Valsalva maneuver

PURPOSE: To report the intraoperative occurrence of massive intraocular suprachoroidal hemorrhage associated with Valsalva maneuver. METHODS: Retrospective, multicenter study of patients who developed massive choroidal hemorrhage associated with Valsalva maneuver during vitrectomy. RESULTS: Massive intraoperative suprachoroidal hemorrhage in seven patients (seven eyes) involved three men and four women with a median age of 52 years (range, 26 to 82 years). General anesthesia was used in six of seven cases. Coughing or "bucking" on the endotracheal tube during general anesthesia or severe coughing during the one vitrectomy performed under local anesthesia was associated with massive suprachoroidal hemorrhage. In five of seven eyes, this occurred near the end of surgery, after air-fluid exchange but before sclerotomy closure. Scleral plugs were immediately placed, and sclerotomy closure was performed exigently. Immediate posterior sclerotomy was performed on five of seven eyes; an additional patient underwent posterior sclerotomy postoperatively. After median follow-up of 18 months (range, 3 to 36 months), final visual acuity was no light perception in four eyes, light perception in one eye, 20/250 in one eye, and 20/20 in one eye. Four eyes became phthisical. CONCLUSIONS: Valsalva maneuver during pars plana vitrectomy may result in massive suprachoroidal hemorrhage with disastrous visual consequences. Precautionary measures to prevent coughing or "bucking" on the endotracheal tube during general anesthesia, or a prolonged episode of coughing during local anesthesia, may prevent this potentially devastating complication.     

玻璃体切割联合引流阀植入治疗伴玻璃体积血的新生血管性青光眼

目的:评价玻璃体切割联合引流阀植入治疗伴玻璃体积血的新生血管性青光眼的效果。方法:对30例(30眼)伴玻璃体积血的新生血管性青光眼患者采用玻璃体切割联合Ahmed青光眼引流阀植入术治疗,术后随访10~20(平均12)mo。结果:术后眼压控制在6.0~21.0mmHg25眼(其中3例需加用一种降眼压药物),3例眼压>21.0mmHg,2例长期低眼压,成功率83%。结论:玻璃体切割联合引流阀植入治疗伴玻璃体积血的新生血管性青光眼,术后成功率高,视力有所提高,并发症少。