视网膜裂孔伴玻璃体积血的临床分析

目的探讨急性玻璃体后脱离致视网膜裂孔伴玻璃体积血的治疗方式及疗效。方法回顾性分析31眼视网膜裂孔合并玻璃体积血,早期予双眼包扎、半卧位、止血,出血3d后予活血化瘀、促进玻璃体积血吸收治疗。根据病情变化采用激光封闭裂孔及行20G三通道闭合式玻璃体切除术治疗。所有病例至少随访12个月。结果23眼玻璃体积血在1周～3个月,平均（32．95±12．61）d吸收,采用视网膜激光治疗,裂孔完全封闭,视力无明显变化。4周内,3眼发生孔源性视网膜脱离,行玻璃体切除术治疗,术后1眼矫正视力提高,2眼矫正视力无明显提高。5眼玻璃体积血无明显吸收,2～4周内采用玻璃体切除术,术后视力明显提高,矫正视力0．3—0．6。结论急性玻璃体后脱离引起的视网膜裂孔伴玻璃体积血应引起高度重视。早期诊断并发现裂孔、及时光凝封闭裂孔是获得良好结果的关键。尽早手术是争取较好疗效的重要保障。     

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。     

急性症状性PVD致视网膜裂孔合并玻璃体积血

目的:观察急性症状性玻璃体后脱离致视网膜裂孔合并玻璃体积血的临床特点和治疗效果。方法:回顾分析8例因为急性症状性玻璃体后脱离致视网膜裂孔合并玻璃体积血患者的临床资料。结果:经双眼遮盖、半卧位及应用止血剂等对症处理,眼底可视度增加,及时予激光光凝治疗,视网膜裂孔封闭,无视网膜脱离发生,疗效满意。结论:充分认识急性症状性玻璃体后脱离致视网膜裂孔合并玻璃体积血的临床特点,认真检查、寻找裂孔,及时行激光光凝封孔治疗是争取较好预后的关键。     

视网膜裂孔引起玻璃体积血的临床分析

目的:观察视网膜裂孔引起玻璃体积血的治疗效果。方法:回顾性分析对于视网膜裂孔引起玻璃体积血,给予半卧位、双眼包扎、应用止血剂及裂孔激光光凝封闭等对症处理。结果:经双眼包扎、应用止血剂及半卧位治疗1～14d,眼底可视度增加,行激光光凝封闭视网膜裂孔后,视网膜裂孔封闭,无再出血。结论:视网膜裂孔伴玻璃体积血时,双眼遮盖并及时行激光光凝封闭视网膜裂孔可避免视网膜脱离是争取较好视力预后的关键。     

急性视网膜裂孔伴玻璃体积血早期误诊临床分析

目的分析急性视网膜裂孔伴玻璃体积血的早期误诊原因,探讨对急性视网膜裂孔伴玻璃体积血的早期诊断和治疗方法。方法早期给予急性玻璃体积血的患者药物治疗,一旦发现视网膜裂孔或视网膜脱离,及时根据病情给予激光封闭视网膜裂孔治疗、视网膜脱离外路手术治疗、玻璃体视网膜手术治疗。结果急性玻璃体积血患者早期给予药物治疗,612天发现其中12例视网膜裂孔或视网膜脱离。术后1年随访,12例患者视力均较手术前有所提高,其中3例患者在取出硅油后再次出现视网膜脱离,二次行硅油填充术,至今尚未取出硅油。结论对于Ⅱ级以上的急性玻璃体积血,尤其是老年患者,在早期给予药物治疗的同时,密切观察玻璃体积血吸收情况和视网膜情况,一旦发现视网膜裂孔或视网膜脱离,应尽快给予手术治疗。     

玻璃体切割术治疗孔源性视网膜脱离伴玻璃体积血的临床研究

目的:探讨孔源性视网膜脱离伴玻璃体积血的发病原因、临床特征和玻璃体切割术的治疗效果。方法:回顾分析24例24眼因孔源性视网膜脱离伴玻璃体积血接受玻璃体切割手术治疗患者的临床资料。结果:年龄<45岁的青年组共11例;年龄45～59岁的中年组共9例;年龄>60的老年组4例。21例为马蹄形裂孔,其中马蹄形裂孔<1PD者2例,1PD～<2PD者14例,2PD～<1象限者5例;圆形裂孔者3例,均<1PD。裂孔位于视网膜颞上方者13例,颞下方者8例,鼻上方者3例;视网膜脱离范围:颞上方者10例,鼻上者2例,全脱者1例,下方者11例。病程和术后视力:1mo组16例,视力0.2～0.4者13例,≥0.5者3例;2mo组5例,视力0.01～0.1者3例,0.2～0.4者2例;3mo组1例,视力0.01～0.1;>3mo组2例,视力手动1例,数指1例。结论:孔源性视网膜脱离伴玻璃体积血尽早明确诊断并及时行玻璃体切割手术能够取得较好疗效。     

伴有视网膜裂孔或脱离的玻璃体积血的早期诊治

伴有视网膜裂孔或脱离的玻璃体积血,由于早期屈光间质混浊,难以发现视网膜裂孔及脱离,往往发展到增殖性玻璃体视网膜病变(proliferative vitreoretinopathy,PVR),严重影响预后.我科自2000年6月至2002年2月共收治18例伴有视网膜裂孔或脱离的玻璃体积血患者,采用眼B超和双目间接检眼镜检查早期确诊,并及时予以玻璃体视网膜联合手术,取得较好疗效,现报告如下.     

表现为急性致密玻璃体积血的视网膜裂孔形成

目的:报告4例因视网膜裂孔形成而表现为急性、掩盖眼底观察的致密玻璃体积血的病例。方法:回顾性病例研究,复习各例的临床记录。结果:患者4例为2男2女,年龄38～69岁。患眼为右眼(也为高度近视眼)1例,左眼(近视1例,正视眼2例)3例。病程1d～3wk。首诊时视力为手动～0.04。经过玻璃体手术(3例)和单纯激光光凝(1例)处理视网膜裂孔,最后随访视力均有改善,分别为0.04,0.2,0.6与0.8。结论:对于因视网膜裂孔形成引起的急性玻璃体积血应保持警惕,早期诊断和封闭裂孔可避免视网膜脱离,获得较好的视力恢复。     

玻璃体后脱离导致视网膜裂孔的临床分析

目的:探讨玻璃体后脱离所致视网膜裂孔诊断治疗时间对其预后的影响。方法:对1999/2003收治的92例(92眼)由玻璃体后脱离所致的视网膜裂孔进行临床分析。结果:在92例玻璃体后脱离引起视网膜裂孔的患者中,有39例视网膜裂孔发现及时,无视网膜脱离或仅有局限性的视网膜浅脱离,经光凝治疗后视力恢复到发病前水平;53眼明确诊断时间长,发生视网膜脱离,给予手术治疗,有些患者需多次手术,术后视力只有不同程度的恢复。结论:早期诊断、及时治疗视网膜裂孔是取得良好预后的关键。     

视网膜脱离伴玻璃体积血的手术治疗

目的:探讨视网膜脱离伴玻璃体积血的手术方式及早期手术的意义。方法：11例行玻璃体切除伴常规的环扎加压手术。结果：术后视力提高10眼,未提高1眼,视网膜完全复位,介质清晰,裂孔封闭。术后随访1眼3月后视网膜再次脱离。结论：对于玻璃体积血,应常规行B超检查并定期随访,一旦发现视网膜脱离,应尽早手术,以期取得较好的视力预后。     

Discriminate characteristics of photopsia in posterior vitreous detachment, retinal tears and retinal detachment

Aims:  To characterize photopsia in posterior vitreous detachment (PVD), retinal tears (RT) and rhegmatogenous retinal detachment (RRD).
Methods:  Seventy seven patients presenting to an eye emergency department and vitreoretinal clinic with photopsia had documentation of their symptoms.
Results:  A total of 27 patients had PVD alone, 7 had RTs and 25 RRD. In patients with isolated PVD, photopsia were temporal (94%), lasting seconds (81%) and vertically orientated (59%) flashes. Patients with photopsia located in quadrants other than temporal were more likely to have RRD ( p  = 0.0003). Patients with an oblique or horizontal orientation of their photopsia were likely to have RRD or RT ( p  = 0.001, specificity 96%, sensitivity 40%).
Conclusions:  Most patients with PVD have a typical presentation of photopsia, with temporal, vertically orientated, momentary flashes. Patients with RTs or RRD may describe subtle differences in their photopsia which may raise the index of suspicion for the presence of a complication from PVD.     

急性玻璃体后脱离导致视网膜裂孔的临床分析

目的 探讨玻璃体后脱离所致视网膜裂孔的确诊时间及不同处理对其预后的影响。方法2001年10月～2002年8月对95例(95只眼)由急性玻璃体后脱离所致视网膜裂孔眼进行临床分析，裂孔已导致视网膜脱离的行视网膜复位手术，干性视网膜裂孔行532激光封闭裂孔术。结果 59例伴有视网膜脱离的患者明确诊断时间长，经手术治疗(部分为玻璃体手术)后视功能有一定的恢复。但有些病人需多次手术。35例视网膜干性裂孔患者诊断及时，经光凝治疗后视力无明显改变。结论 玻璃体后脱离导致视网膜裂孔早期诊断、及时光凝是为患眼争取良好预后的关键。     

Association between severity of vitreous haemorrhage and visual outcome in primary rhegmatogenous retinal detachment

Purpose: To elucidate the relationship between the severity of vitreous haemorrhage (VH) and visual outcome in primary rhegmatogenous retinal detachment (RRD) without previous vitreoretinal surgery. Methods: We carried out a retrospective review of patients presenting with RRD and VH between January 1993 and December 2002. Diabetic retinopathy, retinal vessel occlusion and open‐globe injury patients were excluded. Study patients were separated into group 1 (eyes with mild to moderate VH) and group 2 (eyes with severe VH). Results: Our sample included 71 eyes of 71 patients (mean age 48.0 years, range 7–78 years) (median follow‐up period 19 months, range 12–140 months), of which 21 had mild, 17 had moderate and 33 had severe VH. The mean visual acuity (VA) in logMAR (logarithm of minimum angle of resolution) of the 38 eyes in group 1 improved from 1.90 (Snellen equivalent [SE] 20/1589) to 0.68 (SE 20/96). In the 33 eyes in group 2, mean logMAR VA improved from 2.42 (SE 20/5261) to 1.63 (SE 20/853). Group 2 patients were significantly older (p = 0.002), had longer duration of preoperative haemorrhage (p = 0.004), lower presenting VA (p < 0.001), worse final VA (p < 0.001), and a higher incidence of severe (grade C) proliferative vitreoretinopathy (PVR) (p = 0.002). More eyes in group 2 required silicone oil tamponade, although this was not statistically significant (p = 0.133). The overall recurrence rate of retinal detachment after primary surgery was around 21% in both groups. Conclusions: Rhegmatogenous retinal detachment with severe VH is associated with longer duration of preoperative haemorrhage, a higher incidence of severe PVR and worse visual outcome. Close follow‐up and aggressive surgical interventions are suggested in these patients.     

4D label-free proteomic analysis of vitreous from patients with rhegmatogenous retinal detachment

AIM: To identify metabolites, proteins, and related pathways involved in the etiology of rhegmatogenous retinal detachment (RRD) for use as biomarkers in diagnosing and treating RRD. METHODS: Vitreous specimens were collected and liquid chromatography-tandem mass spectrometry analysis was performed using the four-dimensional label-free technique. Statistically significant differentially expressed proteins, gene ontology (GO) terms, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway representations, and protein interactions were analyzed. RESULTS: Nine specimens were subjected to proteomic analysis. In total, 161 proteins were identified as differentially expressed proteins (DEPs), including 53 upregulated proteins and 108 downregulated proteins. GO functional analysis revealed that some DEPs were enriched in neuron-related terms and membrane protein terms. Moreover, KEGG analysis indicated that the cell adhesion molecule metabolic pathway was associated with the greatest number of DEPs. Finally, the evaluation of protein-protein interaction network revealed that DEPs were clustered in neuronal adhesion, apoptosis, inflammation and immune responses, correct protein folding, and glycolysis. CONCLUSION: Proteomic profiling is useful for the exploration of molecular mechanisms that underlie RRD. This study reveals increased expression levels of proteins related to heat shock protein content, glycolysis, and inflammatory responses in RRD. Knowledge regarding biomarkers of RRD pathogenesis may help to prevent the occurrence of RRD in the future.     

Prevalence of retinal tears in an optometric population

The prevalence of fresh retinal tears and acute symptomatic posterior vitreous detachment (PVD) was determined for a metropolitan optometric population by retrospectively examining the records of 2,700 consecutively presenting patients. Twenty-eight cases (one per cent) harboured a retinal tear. Fourteen patients manifested operculated tears and a further 14 were found to have flap tears. Significantly more tears lay in the temporal half of the fundus (p < 0.001). A preponderance of tears lay in the superotemporal retinal quadrant. Twenty-six patients (one per cent) presented with an acute symptomatic PVD. Of these four patients (15 per cent) had a retinal tear related to the onset of the PVD.     

卵磷脂络合碘联合糖皮质激素减轻玻璃体切割术后玻璃体混浊的应用

目的观察卵磷脂络合碘联合糖皮质激素对玻璃体切割术后玻璃体炎症反应的疗效。方法选择非巨大裂孔性视网膜脱离40例（40眼），行标准三切口玻璃体切割、眼内光凝及C3F8填充术。术后随机分为两组，第1组应用糖皮质激素和卵磷脂络合碘，第2组仅应用糖皮质激素。分别于术后2、3、4周对患者进行随访并记录患眼玻璃体混浊的等级。结果玻璃体切割术后2、3、4周，第1组与第2组之间玻璃体混浊的等级均有统计学差异（P〈0．05），第1组低于第2组。结论卵磷脂络合碘联合糖皮质激素治疗可有效地促进玻璃体切割术后早期玻璃体混浊的吸收。     

Ultrasound reliability in detection of retinal tear in acute symptomatic posterior vitreous detachment with vitreous hemorrhage

Cross-sectional study of 75 consecutive patients presenting with acute symptomatic posterior vitreous detachment (ASPVD) and vitreous hemorrhage was conducted at University Eye Clinic, University Hospital “Sveti Duh”, Zagreb, Croatia. To check ultrasound reliability in detecting retinal tears in patients with ASPVD, transpalpebral ultrasound of the eye and the orbit was performed followed by fundus examination initially and in 6wk period. In 13 (17%) patients membranous lesion with ultrasound characteristics of retinal tear was detected. Ophthalmoscopy confirmed the diagnosis in 8/13 patients. In 62/75 patients neither ultrasound nor clinical examination revealed retinal tear. Sensitivity of ultrasound examination was 100%, specificity 92%, positive predictive value 62% and negative predictive value 100%. Ultrasound proved to be a reliable and accurate method for detection of retinal tears in ASPVD. Given the high sensitivity and negative predictive value, negative result on B-scan ultrasound excludes the probability of the retinal tear with a high degree of certainty.     

内皮素-1在裂孔性视网膜脱离玻璃体液中的含量测定

目的　检测内皮素 1(ET 1)在裂孔性视网膜脱离 (RRD)不同病期玻璃体液中的水平。方法　 2 0例RRD患者采取血液和玻璃体液 ,玻璃体液分为视网膜下液 (PVRA/B级 ) ,玻璃体液 (PVRC/D级 )各 10例 ;10例尸眼取玻璃体液 ,10例正常人取血液 ,10例玻璃体积血 (VH)患者取血液和玻璃体液 ;用放射免疫测定的方法检测其质量浓度。用单因素方差分析统计其意义。结果　玻璃体标本中除正常对照 10例、VH的 3例和PVR C/D级的 3例外均检测出ET 1质量浓度。血浆各组间除正常对照组与PVRC/D组、PVRA/B和PVR C/D组外均有显著性差异 (P <0 0 1)。玻璃体各组间除正常对照组与VH组、VH与PVRC/D组外均有显著性差异 (P <0 0 5 )。结论　ET 1在视网膜脱离早期玻璃体内质量浓度较高 ,而在眼内增殖的晚期则下降 ,可能反映了PVR中细胞增殖状态