松弛性视网膜切开术治疗视网膜脱离合并严重前增殖性玻璃体视网 …

目的 探讨松弛性周边视网膜切开术联合眼内激光治疗视网膜脱离合并严重前增殖性玻璃体视网膜病变的效果。方法 对４４例视网膜脱离合并严重前增殖性玻璃体视网膜病变的患者行松弛性周边视网膜切开术,联合眼内激光和硅油填充治疗。观察术后视网膜解剖复位,视功能及术后眼压变化情况。其中２２例取出了硅油。结果 ４４例全部获得视网膜复位（其中８例合并皱褶）,３８例获得不同程度的视力改善。２２例取出硅油后,有２１例视网膜     

玻璃体切除治疗无严重增殖性玻璃体视网膜病变的视网膜脱离

目的:探讨后段玻璃体切除术(PPV)在非严重性增殖性玻璃体视网膜病变(PVR)性视网膜脱离中的作用。方法:研究15眼有裂孔边缘卷曲的PVR—B级网脱,11眼裂孔在赤道后的PVR—C1或C2级网脱及28眼眼底可视度差的网脱共54眼,用玻璃体切除治疗的效果。结果:一次手术成功率为76％,总成功率96％。术后视力提高43眼(79.6％),不变9眼(16.7％),变坏2眼(3.7％)。结论:PPV是治疗一些非复杂性网脱的有效及安全的方法。眼科学报1998;14:97—99。     

前部增殖性玻璃体视网膜病变的视网脱离及其手术治疗

目的 探讨前部增殖性玻璃体视网膜病变（ｐｒｏｌｉｆｅｒａｔｉｖｅ ｖｉｔｒｅｏｒｅｔｉｎｏｐａｔｈｙ,ＰＶＲ）视网膜脱离的临床特点及其手术治疗效果,方法 分析Ｃ～Ｄ级ＰＶＲ视网膜脱离患者８３例（８３只眼）;并针对其前部和后部病变,采用不同的手术方法进行治疗。结果 ８３例视网膜脱离患者中,前部ＰＶＲ３４只眼,占４１．０％;后部ＰＶＲ４９只眼,占５９．０％,发病年龄前者较轻,平均２８．５岁;后者３８．     

松弛性视网膜切开术治疗复杂性视网膜脱离

探讨松弛性视网膜切开联合眼内激光和硅油或C3F8气体填充治疗复杂性视网膜脱离的效果及并发症。方法 :对 5 8例复杂性视网膜脱离患者行松弛性视网膜切开术 ,联合眼内激光和硅油或C3F8气体填充进行治疗。观察术后视网膜解剖复位、视功能及术后眼压变化情况。结果 :随访 6月 ,5 8例患者中有 42例视网膜仍在位 ,38例视力获得改善 ,5例眼压≤ 5mmHg。结论 :松弛性视网膜切开术是治疗复杂性视网膜脱离的有效方法。部分患者会出现术后眼压降低 ,因此应严格掌握手术适应症。     

玻璃体视网膜联合手术治疗伴玻璃体积血的牵拉性视网膜脱离

本文创用玻璃体视网膜联合手术方法,对29例伴周边部增殖性玻璃体视网膜病变的非糖尿病性玻璃体积血进行治疗。根据术前B 超形态学检查和玻璃体手术中直视观察,判断增殖病变的部位,同时采用对抗增殖区放射状牵拉点和缓解玻璃体基底部环状收缩的治疗原则,将网脱型玻璃体积血手术治愈率和总治愈率分别提高至82.8%和94.1%,大大减少了医源性并发症。这种手术方法对眼组织损伤小、操作简单、疗效确切,基本上解决了因牵拉性视网膜脱离导致的玻璃体手术失败。     

增殖性玻璃体视网膜病变性视网膜脱离的手术治疗

报告189例189眼严重增殖性玻璃体视网膜病变(PVR)性视网膜脱离，单纯巩膜扣带术和玻璃体切除术的结果，平均解剖成功率63%，从C₁87.5%至D₃30.4%。术后复位成功的病例95.8%有指数以上的视力，但仅26.9%达0.1以上，且多集中于C₁和C₂组。手术失败的主要原因是新的或复发的前段PVR形成(51.4%)，其次为后部视网膜前膜增殖，将原裂孔拉开或形成新裂孔(25.7%)。就PVR性视网膜脱离的手术时机，手术方式及前段PVR的形成进行了讨论。 （中华眼底病杂志，1994，10：199-202）     

孔源性视网膜脱离伴增生性玻璃体视网膜病变视网膜切开术后预后因素分析

目的 研究孔源性视网膜脱离伴增生性玻璃体视网膜病变(PVR)患者视网膜切开术后视网膜解剖和功能结果与预计影响冈素之间的关系.设计同顾性病例系列.研究对象99例(102眼)孔源性视网膜脱离伴PVR行视网膜切开术者.方法 采用多元Logistic回归分析法分析术前视力、术前手术次数、视网膜脱离范围、PVR病变程度、硅油填充时间、视网膜切丌范围、硅油取出与否与术后视力、术后视网膜复位情况及低眼压的相关性.主要指标多种因素的OR值.结果 术前视力、术前手术次数、硅油填充时间、硅油取出与否、视网膜切开范围对术后视力的影响有统计学意义(OR:1.13-5.33,P均＜0.05);术前手术次数、硅油取出与否对术后视网膜复位的影响有统计学意义(OR:2.55～3.79,P均＜0.05);硅油取出与否对术后低眼压的影响有统计学意义(OR:0.26,P=0.001).结论 适时地硅油取出、小范围的视网膜切开、较少的术前操作和较好的术前视力是孔源性视网膜脱离伴PVR患者视网膜切开术后获得较好视网膜解剖和功能结果的影响因素,建议应在PVR进展早期行视网膜切开手术.(眼科,2008,17:262-264)     

前部增殖性玻璃体视网膜病变的手术治疗

为探讨前部增殖性玻璃体视网膜病变（ａｎｔｅｒｉｏｒｐｒｏｌｉｆｅｒａｔｉｖｅｖｉｔｒｅｏｒｅｔｉｎｏｐａｔｈｙ，ａＰＶＲ）的手术效果，对３９例伴有ａＰＶＲ的复杂性视网膜脱离３９只眼进行玻璃体视网膜手术治疗；依手术日期先后顺序将３９只眼分为前期手术组（Ⅰ组，１９只眼）和后期手术组（Ⅱ组，２０只眼），分析不同时期的手术效果。结果：Ⅰ组和Ⅱ组视网膜完全复位分别为４只眼（２１．０５％）和１７只眼（８５％，Ｐ＜０．００５）；合计复位２１只眼（５３．８５％）。手术失败１８只眼中９只眼（５０％）为前部增殖松解不足所致。结论：对ａＰＶＲ的认识和处理能力的提高是后期手术组（Ⅱ组）视网膜复位成功率高的主要原因。     

伴严重增殖性玻璃体视网膜病变视网膜脱离的玻璃体手术及失败原因探讨

本文报导采用现代玻璃体手术结合巩膜扣带、空气或硅油填塞治疗81例伴严重增殖性玻璃体视网膜病变(PVR)视网膜脱离的手术效果.经过6～28个月(平均14个月)的随访,视网膜完全平伏者54例,成功率66.7%,对极严重的PVR D(?)(闭斗状脱离)也取得50%的成功率.硅油填塞初步应用于极严重病例尤其是巨大裂孔的治疗,取得明显的效果.本文病例术后视力提高者50例,不变19例,下降12例,术后视力在0.05以上者共34例.认为玻璃体手术结合其它技术是伴严重PVR手术治疗的有效方法,提出进一步提高PVR治疗成功率的方法:彻底清除增殖膜及寻找一种有效抑制膜增殖而对眼内其它组织无毒性的药物。指出旧的PVR分级法存在的不足,推荐用于硅油研究的PVR新的分级法.     

瘦素在增殖性糖尿病性视网膜病变和增殖性玻璃体视网膜病变中的表达

目的 通过检测瘦素在增殖性糖尿病性视网膜病变（proliferative diabetic retinopathy,PDR）和增殖性玻璃体视网膜病变（proliferative vitreous retinopathy,PVR）中的表达,探讨瘦素在PDR、PVR发生、发展过程中可能的调节机制。方法 分别用免疫组织化学染色的方法和酶联免疫吸附实验检测30例PDR患者、20例PVR病变患者眼内视网膜前膜中瘦素的表达,以及患者的血清、眼前房水、玻璃体液中瘦素的浓度。用Chi－Square Tests统计学方法分析和比较PDR、PVR与对照组之间瘦素表达的差异。结果 免疫组织化学染色结果：30例PDR患者中,有18例患者眼内视网膜前膜的瘦素受体呈阳性表达,阳性率为60%,与对照组比较,差异有统计学意义;20例PVR患者中,有3例患者眼内视网膜前膜的瘦素受体呈阳性表达,其中2例为血管纤维性视网膜前膜,1例为细胞纤维性视网膜前膜,阳性率为15%,与对照组比较,差异无统计学意义。ELISA结果：检测30例PDR患者的血清、眼前房水、玻璃体液中瘦素的浓度,与对照组之间差异有统计学意义（P＜0.05）;检测20例PVR患者的血清、眼前房水、玻璃体液中瘦素的浓度,与对照组之间差异无统计学意义（P＞0.05）。结论 瘦素可能主要是通过促进新生血管的生成参与到增殖性糖尿病性视网膜病变的发生、发展中,与增殖性玻璃体视网膜病变的发生、发展无明显相关性。     

视网膜脱离伴前部增生性玻璃体视网膜病变的手术

目的：探讨视网膜脱离中病变严重,伴前部增生性玻璃体视网膜病变（anterior proliferative vitreoretionopalthy,APVR)的手术治疗方法。方法：对57例（57眼）复杂性视网膜脱离伴APVR患者行巩膜环扎,硅胶外加压、玻璃体切除,视网膜前膜分离、切除、视网膜松解性切开、切除、过氟化碳液体注入,眼内排液及硅油眼内填充等,崆春治疗效果。结果：痊愈45例,成功率79％,8眼好转,占14％,4眼无效,占75,术后视力除手术失败者外,均有所提高。结论：运用各种玻璃体视网膜显微手术技术,对APVR的认识和处理能力提高,可以使部分严重,复杂的视网膜脱离复位手术成功率提高。     

Tug of war: A bimanual technique for anterior circumferential proliferative vitreoretinopathy in recurrent retinal detachment

Purpose:To describe a bimanual technique, “tug of war” for managing anterior circumferential proliferative vitreoretinopathy (PVR) in eyes with recurrent retinal detachment (RRD).Methods:We retrospectively analyzed outcomes from eyes with RRD that underwent reattachment surgery using this maneuver and had a minimum of 6 months follow-up. A chandelier light was inserted for endo-illumination and the circumferential anterior PVR was tackled with two 25-gauge forceps stretching circumferential tractional membranes in opposite direction (tug of war) till they snapped.Results:Eleven eyes of 11 patients with a mean age of 38.2 ± 19.7 years underwent surgery. All eyes had advanced PVR of Grade C A Type 4 (Circumferential). The median duration of RD from the time of first surgery was 6 months (interquartile range = 3–8 months). The tug of war maneuver was successful in relieving the anterior retinal traction leading to retinal reattachment in all eyes without the need for relaxing retinotomies or retinectomies. Small iatrogenic retina tears occurred at the time of tug of war maneuver in 3 (27%) eyes at the site of maximum traction. The mean best-corrected visual acuity (BCVA) improved from 1.87 ± 0.2 logarithm of minimum angle of resolution (logMAR) to 1.3 ± 0.4 logMAR at 6-months follow-up (P = 0.04).Conclusion:The ''tug of war'' maneuver is useful for relieving circumferential anterior traction and reattaching the retina in eyes with RRD without having to resort to large relaxing retinotomies or retinectomies.     

外伤性视网膜脱离眼发生严重增生性玻璃体视网膜病变的危险因素研究

目的 探讨外伤性视网膜脱离眼发生严重增生性玻璃体视网膜病变(prolifera-tive vitreoretinopathy,PVR)的危险因素.方法 回顾性分析2003年3月至2006年7月我科就诊的开放性眼外伤后视网膜脱离患者43例(43眼),均曾在我科或外院行裂伤缝合手术并存在视网膜裂孔.对性别、年龄、视力和眼压、开放性眼外伤分类、外伤分区、外伤时程、前房出血、晶状体缺如、玻璃体出血、视网膜脱离范围、视网膜下出血、脉络膜脱离性质等行Logistic回归分析,并部分采用χ2检验进行验证.结果 所有开放性眼外伤导致的外伤性视网膜脱离眼均存在一定程度的PVR表现,其中PVR D级所占比例最大(46.5%),46.5%的患眼并不存在明显的前部PVR表现,25.6%患眼4个象限均存在前部增生性改变.Logistic回归分析结果显示:严重PVR危险因素仅视网膜脱离范围和晶状体缺如2项被保留于方程中,其中前者为正相关因素(B=18.853),后者为负相关因素(B=-1.946).严重PVR发生率在年龄<18岁组和年龄≥18岁组分别为41.67%和48.39%(P=0.692),破裂伤组的D级PVR发生率(48.15%)较裂伤组(43.75%)更高,但差异无显著统计学意义(P=0.780).玻璃体出血对严重PVR的影响差异无显著统计学意义(P=0.114),但前房有/无出血组间和视网膜下有/无出血组间差异却有显著统计学意义(P=0.043,0.037).结论 开放性眼外伤导致的外伤性视网膜脱离眼存在特发性PVR特征,视网膜脱离范围和晶状体缺如是影响PVR发生的重要因素,后者为保护性因素.     

Formation of proliferative vitreoretinopathy in primary rhegmatogenous retinal detachment

Proliferative vitreoretinopathy (PVR) is the only cause of ultimate failure following retinal detachment surgery. This study aimed to review the rate of postoperative PVR in a series of 186 consecutive patients with primary rhegmatogenous retinal detachments. All 186 detachments were repaired with a scleral buckling procedure combined with cryotherapy. Drainage of subretinal fluid was done at the discretion of the surgeon. The mean follow-up was 12 months. In this series 152 (82%) of primary detachments were repaired succesfully with a single operation. Sixty-eight percent of patients regained 0.3 or better visual acuity, and 3% of patients were left with visual acuity of 1/60 or less. After two or more operations the retina was attached in 96% of the cases. In 12 (6%) eyes PVR was responsible for the initial surgical failure. In 4 cases PVR (grade B and limited C) was present prior to surgery. In 3 cases PVR developed within 2 days postoperatively, in 3 cases after 3–6 weeks and in another 2 cases after 8–l0 months. Eight out of 12 (66%) PVR patients had undergone cataract surgery. One PVR case had preoperative intraocular inflammation. An association between the duration of retinal detachment, or drainage of subretinal fluid and the development of PVR could not be demonstrated. In conclusion, the rate of postoperative PVR in primary rhegmatogenous retinal detachments was low. PVR preoperatively present and pseudophakia may be risk factors.     

Myopic macular hole-associated retinal detachment with proliferative vitreoretinopathy

PurposeThe objective of this study was to report the clinical characteristics and surgical results of patients suffering from retinal detachment, which was induced by a myopic macular hole and complicated by proliferative vitreoretinopathy, but without previous vitreoretinal surgery.MethodsInterventional case series of 22 eyes in 20 patients with excessive myopia and macular hole-associated retinal detachment complicated with proliferative vitreoretinopathy were scrutinized retrospectively. All eyes had undergone par plana vitrectomy, including peeling of the epiretinal membrane, internal limiting membrane around the macular hole, and silicone oil or perfluoropropane (C₃F₈) retinal tamponade. An encircling buckle was also inserted in some of the eyes. Eyes with previous vitreoretinal surgery were excluded from this review.ResultsThe average age of patients was 68.3 ± 7.17 years, average duration of symptoms prior to seeing an ophthalmologist 8.36 ± 4.14 months, and average axial length 30.01 ± 1.81 mm. Nine of the 20 patients had bilateral retinal detachment. The average number of operations performed was 1.36 ± 0.58. The success rate of the initial surgery was 63.3%, which improved to 90.9% in subsequent procedures.ConclusionA macular hole with proliferative vitreoretinopathy is associated with retinal detachment for a long duration. Retinal reattachment and improved visual acuity could be achieved in most eyes after a surgical intervention.     

孔源性视网膜脱离术后增生性玻璃体视网膜病变形成的危险因素

目的 分析孔源性视网膜脱离玻璃体手术后增生性玻璃体视网膜病变(PVR)形成的危险因素。方法 孔源性视网膜脱离110例(112眼)行玻璃体切割术，术后随访6—32个月(平均8．4个月)。结果 112眼中34眼(30.4％)形成术后PVR。多因素逐步回归分析显示，术前PVR为影响术后PVR形成的重要危险因素(P＝0．001)，而硅油填充、巨大视网膜裂孔、合并脉络膜脱离等因素与术后PVR的形成无显著相关。术前PVR者手术成功率明显降低。结论 影响术后PVR形成的重要危险因素为术前PVR。对于有术前PVR可能导致术后PVR形成的高危人群可行预防性治疗。