玻璃体积血的病因分析及手术治疗的疗效

目的：探讨玻璃体积血的病因及行玻璃体切割术治疗的临床疗效。

方法：对162例173眼玻璃体积血患者进行病因分析,采用玻璃体切割术治疗。

结果：术后诊断：173眼中增殖期糖尿病视网膜病变83眼(48.0%),视网膜分支静脉阻塞24眼(13.9%),Eales病13眼(7.5%),视网膜中央静脉阻塞10眼(5.8%),外伤性玻璃体积血9眼(5.2%),视网膜裂孔8眼(4.6%),视网膜脱离9眼(5.2%),增生性玻璃体视网膜病变7眼(4.0%),单纯玻璃体积血4眼(2.3%),视网膜大动脉瘤2眼(1.2%),息肉样脉络膜血管病变2眼(1.2%),脉络膜视网膜炎1眼(0.6%),年龄相关性黄斑病变1眼(0.6%)。不同年龄病因分布不同,术后随访3～15mo,术前与术后视力相比,41眼(23.7%)视力不变,115眼(66.5%)视力提高,17眼(9.8%)视力下降。术后视力与术前相比差异具有统计学意义( P<0.05)。

结论：增殖期糖尿病视网膜病变、视网膜分支静脉阻塞、Eales 病是导致玻璃体积血的主要原因。玻璃体切割联合术手术并发症少,能在一定程度上提高患者视力,是治疗玻璃体积血安全有效的方法。     

非外伤性玻璃体积血的发病原因及疗效分析

目的 探讨非外伤性玻璃体积血的发病原因及其治疗效果.方法 对120例非外伤性玻璃体积血患眼进行手术治疗,治疗前均进行B超和视力检查,玻璃体切割术中确认玻璃体积血原因,根据病变情况及范围进行激光或视网膜复位治疗.结果 120例玻璃体积血患眼中,增殖期糖尿病视网膜病变78例;视网膜裂孔(伴或不伴视网膜脱离)23例;视网膜静脉阻塞11例;年龄相关性黄斑变性7例;急性视网膜坏死综合征1例.经过治疗并对比观察术前B超检查结果,完全性玻璃体后脱离B超检测阳性符合率91.30％,视网膜脱离B超检测阳性符合率89.36％,视网膜前增殖膜B超检测阳性符合率99.21％,黄斑区出血B超检测阳性符合率94.74％.治疗后视力为0.237±0.025,与治疗前视力0.039±0.080相比有明显提高(P＜0.001).治疗后视力恢复水平与发病原因及病程呈线性回归相关(均为P＜0.05),与年龄、性别、眼别、术前视力以及并发症无关(均为P＞0.05).结论 非外伤性玻璃体积血的病因多种多样,B超检查对于初步判断玻璃体积血的原因有一定帮助,玻璃体切割术是治疗玻璃体积血的有效手段.     

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。     

全玻璃体切割治疗玻璃体积血疗效分析

目的 探索全玻璃体切割在玻璃体积血中的应用.方法 回顾51只眼手术病例,视网膜静脉阻塞23只眼,糖尿病视网膜病变9只眼,视网膜静脉周围炎2只眼,视网膜孔源性玻璃体积2只眼.眼外伤性玻璃体积血15只眼.采用睫状体平坦部三通闭合式全玻璃体切割术,并通过巩膜压陷结合高斜镜切割基底部玻璃体.结果 术后随诊5～12月,51只眼视力均有不同程度提高,其中视力在4.5者19只眼、4.6～5.0者9只眼4.0～4.4者19只眼、指数4只眼.结论 对玻璃体积血患者掌握好适应证及手术时机,行全玻璃体切割切实有效的减少玻璃体积血残留所致的并发症提高手术效果.     

手术治疗先天性视网膜劈裂症眼后段并发症

目的评价玻璃体视网膜手术治疗先天性视网膜劈裂症眼后段并发症的效果。方法回顾性分析伴有眼后段并发症的先天性视网膜劈裂症7例（10眼）玻璃体视网膜手术的效果。其中玻璃体积血5眼，玻璃体积血合并牵引性视网膜脱离1眼，原发性（孔源性）视网膜脱离2眼，周边劈裂腔进展累及黄斑2眼。所有病例均有周边视网膜劈裂及黄斑中心凹劈裂。1眼孔源性视网膜脱离行巩膜扣带术，其余9眼行玻璃体手术。结果随访12～51月，平均38月，玻璃体积血者术后屈光间质透明，视网膜脱离者术后视网膜复位良好，所有病例术后视力较术前均有不同程度提高，而且视网膜劈裂无明显进展。无严重并发症出现。结论玻璃体视网膜手术用于治疗先天性视网膜劈裂症眼后段并发症，不仅可以清除浑浊的屈光间质，而且可以解除玻璃体牵引，阻止劈裂腔进一步发展，有助于改善和稳定视功能。     

玻璃体手术治疗中间葡萄膜炎玻璃体视网膜并发症的临床效果

目的 探讨玻璃体手术治疗中间葡萄膜炎玻璃体视网膜并发症的临床效果.方法 为系列病例研究.选择16例(16只眼)并发玻璃体视网膜疾病的中间葡萄膜炎患者进行玻璃体手术治疗.术后随访5～32个月,平均(14.25±7.90)个月.随访期间观察患者视力、术后并发症及中间葡萄膜炎的复发情况.结果 16例(16只眼)患者中,有4例分别患有肺结核、多发性硬化、Beheet综合征及风湿性关节炎等全身性疾病,其余12例无系统性疾病.术前所有患者均有糖皮质激素治疗史,使用时间为6～16个月,平均(9.94±2.67)个月.玻璃体视网膜并发症包括重度玻璃体混浊伴机化5只眼,牵引性视网膜脱离6只眼,孔源性视网膜脱离1只眼,玻璃体积血2只眼,黄斑前膜伴玻璃体机化2只眼,所有患眼均出现周边部视网膜新生血管.术后并发白内障3只眼,牵引性视网膜脱离1只眼.术后4例患者需长期服用糖皮质激素或联合免疫抑制剂治疗.术后视力提高或保持不变14只眼,视力下降2只眼,与术前视力比较差异有统计学意义(x2=4.923,P＜0.05).术后未见中间葡萄膜炎复发者.结论 对严重或药物控制不佳而出现玻璃体视网膜并发症的中间葡萄膜炎患者采用经平坦部的玻璃体手术治疗,可以明显改善患者视力,减少长期使用免疫抑制剂治疗的不良反应.     

玻璃体积血与玻璃体劈裂

目的：观察玻璃体积血后玻璃体的形态变化及玻璃体劈裂的影像特征。探讨玻璃体劈裂形成的机制及术前认识玻璃体劈裂的意义。方法：总结玻璃体积血88例(97只眼)，其中增殖性糖尿病性视网膜病变(PDR)32例38只眼：视网膜血管炎28例30只眼；视网膜静脉阻塞28例29只眼。术前进行B型超声波检查，部分进行彩色超声多普勒检查，将超声图像与玻璃体切除术中所见相对比。结果：PDR组玻璃体劈裂发生率为18／38(47．4％)，视网膜血管炎组为10／30(33％)，视网膜静脉阻塞组为4／29(13．8％)。结论：不同原因所致的玻璃体积血均可能发生玻璃体劈裂，对玻璃体劈裂的认识有助于成功完成玻璃体切除术和减少术后并发症。     

玻璃体手术治疗顽固性葡萄膜炎的临床观察

目的探讨玻璃体手术治疗顽固性葡萄膜炎的效果。方法回顾性病例系列研究。收集北京大学第三医院2011年4月至2019年1月反复发作葡萄膜炎并发玻璃体视网膜病变39例(44眼)的临床资料。所有患者行玻璃体手术联合局部或全身糖皮质激素治疗比较术前及术后视力、炎症反应、糖皮质激素用量及手术后并发症, 并重点观察葡萄膜炎的复发情况。术后随访5～32个月。结果术后视力提高有38眼(86.36%, 38/44), 视力稳定4眼(9.09%, 4/44), 术前光感术后仍是光感2眼(4.55%, 2/44)(Z=2.45, P<0.001)。所有患者术前应用糖皮质激素, 术后仅8例合并全身综合征的患者服用维持剂量激素, 术前反复发作的葡萄膜炎均得以控制。术后葡萄膜炎发作次数明显少于术前(P<0.05)。结论玻璃体手术可改善视力, 明显减少葡萄膜炎的复发, 降低全身糖皮质激素及免疫抑制剂使用频率, 术后不良反应少。     

玻璃体切除治疗复发性出血性玻璃体视网膜疾病

目的探讨玻璃体切除术对复发性出血性玻璃体视网膜疾病的临床效果。方法对43例(44眼)玻璃体积血施行三通道经睫状体平坦部玻璃体切除术,联合膜剥离,水下透热,眼内光凝(或经巩膜冷凝),并根据病情选用眼内长效填充材料。结果视网膜静脉阻塞18眼,外伤性玻璃体积血9眼,视网膜裂孔致玻璃体积血6眼,静脉周围炎5眼,增生性糖尿病视网膜病变3眼,蛛网膜下腔出血合并玻璃体积血(综合症)2眼,老年性黄斑变性1眼。术后随访2～24月,44眼视力均有不同程度的提高,随访视力较术前相比差异有统计学意义(P<0.05),视力0.05以上者36眼(81.82%),0.2～0.8者27眼(61.36%)。结论复发性出血性玻璃体视网膜疾病经药物治疗无效,B超显示出现玻璃体后脱离或B超显示伴有牵引性视网膜脱离者,玻璃体切除术是消除玻璃体积血并使视网膜复位的有效方法。     

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。     

非外伤非糖尿病视网膜病变性玻璃体积血病因分析及手术疗效

目的 分析非外伤性非糖尿病视网膜病变性玻璃体积血的病因及手术疗效.方法 2006年3月至2009年7月期间住院手术的174例(176只眼)出现大量玻璃体积血的非糖尿病视网膜病变、非眼外伤患者的出血原因及手术情况进行了回顾性分析.结果 视网膜静脉阻塞(retinal vein occlusion,RVO)73只眼;视网膜静脉周围炎25只眼;视网膜裂孔或脱离(retinal hole/retinal detachment,(RH/RD)25只眼;渗出型年龄相关性黄斑变性(exudative age-related macular degeneration,EAMD)22只眼;息肉状脉络膜血管病变(polypoidal choroidal vasculopathy,PCV)15只眼;共占90.9%,为非外伤性非糖尿病视网膜病变性玻璃体积血的主要原因.术后视力提高者达90%以上.结论 RVO,Eales病,视网膜裂孔,EAMD,PCV是非外伤非糖尿病视网膜病变性玻璃体积血的主要病因,玻璃体切割手术是治疗玻璃体积血的有效方法.

Abstract：

Objective To analyze the etiological factors in non-traumatic non-diabetec retinopathic vitreous hemorrhage and to investigate the clinical outcomes of vitrectomy in such patients.Methods The etiologic factor and recovery rate of visual functions in a total of 174 patients (176 eyes) undergoing vitrectomy with follow-up records from March 2006 to July 2009 in our department were analyzed retrospectively.Results Vitreous hemorrhage was found in 73 eyes of retinal vein occlusion (RVO),25 eyes of Eales' disease,25 eyes of retinal hole or retinal detachment (RH/RD),22 eyes ofexudative age-related macular degeneration (EAMD),and 15 eyes ofpolypoidal choroidal vasculopathy (PCV),amounting to 90.9% of total eyes.The visual improvement rate after vitrectomy was more than 90%.Conclusions RVO,Eales' disease,RH/RD,EAMD and PCV are main causes of non-traumatic non-diabetec retinopathic vitreous hemorrhage.Vitrectomy is an effective way for vitreous hemorrhage.     

玻璃体切割联合白内障超声乳化及IOL植入术中运用飞秒激光的临床研究

目的：分析玻璃体切割联合白内障超声乳化及人工晶状体(IOL)植入术中应用飞秒激光的临床价值。
　　方法：收集2013-10-31/2015-10-31在我院就诊需行玻璃体切割联合白内障超声乳化及 IOL 植入术的患者100例102眼,分为两组：常规手术组50例52眼和飞秒激光组50例50眼。比较两组患者总的手术时间、术后并发症(眼压升高、葡萄膜炎、玻璃体出血、视网膜脱离),比较术后6mo 的眼压、近视力、远视力、裸眼视力、矫正视力。
　　结果：两组患者总的手术时间有统计学差异(P<0.05),两组患者术后眼压升高、葡萄膜炎、玻璃体出血、视网膜脱离差异均无统计学意义(P>0.05);术后6mo 眼压、近视力、远视力、裸眼视力、矫正视力比较,差异均无统计学意义(P>0.05)。
　　结论：飞秒激光辅助的玻璃体切割联合白内障超声乳化及 IOL 植入术同常规手术一样,有较高的安全性和疗效,且具有精确、高效等优点。     

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。     

玻璃体切割术治疗高度近视视网膜劈裂的临床观察

目的 观察玻璃体切割手术伴与不伴内界膜剥离治疗高度近视黄斑部视网膜劈裂的疗效.方法 回顾分析29例29只眼高度近视黄斑视网膜劈裂患者的临床资料.根据治疗方法 分为2组.A组为单纯玻璃体切割手术,15例15只眼;B组为玻璃体切割手术加吲哚青绿染色内界膜剥离,14例14只眼.所有患者行惰性气体填充,手术后保持面朝下体位2周.术后观察患者的最佳矫正视力、黄斑部结构变化及术后并发症.术后平均随访时间9个月(6～14个月).结果 A组患者术后平均最佳矫正LogMAR视力0.51±0.19,与手术前比较,差异有统计学意义(t=3.901,P=0.001);B组患者手术后平均最佳矫正LngMAR视力0.50±0.27,与手术前比较,差异有统计学意义(t=3.130,P=0.004).两组间手术后视力差异无统计学意义(t=0.1160,P=0.909).A组15只眼中,10只眼手术后黄斑劈裂复位,占66.7%,改善5只眼,占33.3%,随访期内黄斑部视网膜劈裂复发2只眼;B组14只眼中12只眼首次手术视网膜复位,占85.7%,改善1只眼,占7.1%,术中黄斑裂孔形成1只眼.A、B两组手术视网膜复位率差异无统计学意义,(x2=1.435,P=0.238).结论 玻璃体切割联合惰性气体眼内填充治疗视网膜劈裂疗效确切,内界膜剥离对术后视力和视网膜劈裂的复位无显著影响.

Abstract：

Objective To evaluate the efficacy of vitreous surgery with/without internal limiting membrane (ILM) peeiing for highly myopic eyes with macular retinoschisis. Methods The clinical data of 29 high myopia patients (29 eyes) with macular retinoschisis were retrospectively analyzed. The patients were divided into two groups according to the treatment: 15 patients in group A had undergone conventional vitrectomy; 14 patients in group B had undergone vitrectomy and ILM peeling. All patients had been tamponaded by inert gas and kept in a face-down position for 2 weeks after the operation. The follow up period was 6-18 months (average 9 months). The best corrected visual acuity (BCVA), OCT had been followed up. Results Macular retinoschisis reattachment was found in 10 eyes (66.7%) in group A and 12 eyes in group B (85.7%).The difference was not significant (P >0.05). The postoperative BCVA increased significantly in both groups (P >0.05), the difference of vision improvement was not significant between the two groups (P >0.05). Conclusions Vitrectomy with/without ILM peeling is effective for treating macular retinoschisis in highly myopic eyes, ILM peeling can not significantly improve the postoperative visual acuity and retinoschisis renttachment.     

Vitrectomy for juvenile uveitis: prognostic factors for the long-term functional outcome

PURPOSE: This study evaluated the long-term effect of pars plana vitrectomy (PPV) in children and adolescents with chronic uveitis on visual function, anatomical outcome, and the requirement of systemic treatment. Further, predictive preoperative factors associated with a beneficial visual outcome were assessed. METHODS: Retrospective review of 29 eyes of 23 consecutive paediatric and juvenile patients below 20 years of age with chronic uveitis who underwent a PPV for visually significant opacities in 25 eyes, vitreous haemorrhage in three eyes, and retinal detachment in one eye. The clinical diagnosis was chronic intermediate uveitis in 22 eyes and retinal vasculitis of different origin in seven eyes. RESULTS: LogMAR visual acuity improved from an average of 0.91 to 0.33 (P<0.001). Cystoid macular oedema (CME) was significantly reduced in eight of 10 eyes postoperatively (P=0.021). In the multiple regression analysis, a low preoperative logMAR visual acuity and the presence of a CME had a negative influence on the final logMAR visual acuity. Furthermore, the appearance of chronic uveitis relapses was significantly reduced from 15 eyes before to seven eyes after surgery (P=0.042). CONCLUSIONS: PPV has a beneficial effect on the course and the complications of chronic uveitis in paediatric and juvenile patients with respect to the anatomical and visual outcome. Preoperative logMAR visual acuity and clinically significant CME were the most accurate predictors for the functional outcome.     

Vitreous surgery for highly myopic eyes with foveal detachment and retinoschisis

PURPOSE: To evaluate the efficacy of vitreous surgery for highly myopic eyes with foveal detachment and retinoschisis. DESIGN: Retrospective comparative interventional case series. PARTICIPANTS: Seven patients (nine highly myopic eyes) with posterior staphyloma with foveal detachment and retinoschisis without macular hole. Preoperative best-corrected visual acuity in nine eyes ranged from 0.02 to 0.4 (average, 0.17). METHODS: Vitreous surgery performed on all nine eyes consisted of core vitrectomy, surgically induced posterior vitreous detachment (three eyes), removal of the premacular vitreous cortex and internal limiting membrane in the posterior staphyloma, and 30% SF(6) gas tamponade. Patients were instructed to maintain a prone position for at least 1 day after surgery. The postoperative follow-up period ranged from 6 to 42.5 months (average, 20.4 months). MAIN OUTCOME MEASURES: Visual acuity, retinal tomography monitored by optical coherence tomography. RESULTS: In eight of the nine eyes, foveal detachment and retinoschisis gradually decreased in height, and these eyes finally attained foveal attachment and visual improvement within 6 months postoperatively. The postoperative best-corrected visual acuity of these eight eyes ranged from 0.4 to 0.6 (average, 0.48). One eye developed a full-thickness macular hole during vitreous surgery, and its postoperative best-corrected visual acuity was 0.08. CONCLUSIONS: Foveal detachment and retinoschisis in highly myopic eyes resolved after vitrectomy. Vitreous surgery might have a rationale as prophylactic treatment for highly myopic eyes at high risk of macular hole development.     

玻璃体手术治疗自发性玻璃体积血

目的观察玻璃体手术治疗非糖尿病性自发玻璃体积血的疗效及其与手术时机的关系。方法45例(46眼)非糖尿病性自发玻璃体积血行标准三通道闭合式玻璃体切除并联合眼内激光光凝等手术,并对不同时机手术的患者术后视力及并发症进行分析。结果1月以内手术者术后视力均提高。1月以上手术者14眼中术后视力提高者2眼,不变8眼,下降3眼。手术并发症主要为术中出血和医源孔及术后高眼压。术中医源孔和术后视网膜脱离均为1月以上手术者。结论玻璃体手术治疗非糖尿病性自发玻璃体浓密积血者疗效佳,并发症少。考虑玻璃体积血为视网膜裂孔所致者应及时手术。     

Histopathological findings in proliferative membrane from a patient with sarcoid uveitis.

BACKGROUND: Sarcoid uveitis is occasionally accompanied by proliferative changes, such as retinal neovascularization and vitreous hemorrhage. Steroid administration, retinal photocoagulation, and vitrectomy may be indicated in such proliferative cases. CASE: A 19-year-old woman presented with proliferative sarcoid uveitis accompanied by recurrent vitreous hemorrhage. OBSERVATIONS: At the initial examination, bilateral vitreous opacity, retinal exudates, mild vitreous hemorrhage, retinal vasculitis, and neovascularization of the retina and optic disc were observed. Although prednisolone was administered and panretinal photocoagulation was performed several times, recurrent vitreous hemorrhage continued. Since the vitreous hemorrhage was not absorbed, pars plana vitrectomy and lensectomy were performed. After surgery, neovascularization and intraocular inflammation decreased, and the corrected visual acuity in the right eye improved to 20/50. Histopathologic analysis of the proliferative membrane removed during surgery revealed substantial neovascularization and numerous neutrophils in the vessels. CONCLUSIONS: Based on these findings, an inflammatory reaction as well as retinal ischemia were thought to be involved in the proliferative changes in this patient.