儿童玻璃体切割术后无晶状体眼行人工晶状体睫状沟缝线固定术的临床观察

目的　评价玻璃体切割术后儿童无晶状体眼行人工晶状体睫状沟缝线固定术的有效性及安全性。方法　回顾分析２００５年至２０１５年在河北省眼科医院眼外伤科行玻璃体切割术后人工晶状体睫状沟缝线固定术４８眼（男２８眼,女２０眼）的术后并发症、眼压、人工晶状体位置,并比较手术前后视力、屈光状态。结果　术后出血８眼（１６．７％）,低眼压３眼（６．３％）,一过性高眼压及角膜水肿４眼（８．３％）,经保守治疗后均恢复,没有出现明显的人工晶状体倾斜和偏心以及人工晶状体襻缝线脱落。术后末次随访时视力较术前提高（Ｐ＜０．０５）。屈光度数预测值与术后３个月实际屈光度数无显著差异（Ｐ＞０．０５）。屈光度数预测值与实际屈光度数偏差:４０眼（８３．３％）＜１．５０Ｄ,６眼（１２．５％）１．５０～２．００Ｄ,２眼（４．２％）＞２．００Ｄ。结论　人工晶状体睫状沟缝线固定术对玻璃体切割术后的儿童无晶状体眼的治疗安全有效,但仍不能忽视其并发症的出现。     

晶状体或人工晶状体脱入玻璃体腔伴视网膜脱离手术疗效

目的探讨玻璃体切除术治疗晶状体或人工晶状体脱入玻璃体腔伴视网膜脱离的临床疗效和并发症。方法对在我院进行标准睫状体平坦部三切口闭合式玻璃体切除术的26例（26只眼）晶状体或人工晶状体脱入玻璃体腔伴视网膜脱离者行回顾性分析。其中眼挫伤后晶状体脱位7只眼,白内障术中晶状体脱位和术后人工晶状体脱位19只眼。对人工晶状体脱人玻璃体腔者术中经角膜缘摘出人工晶状体,对晶状体脱入玻璃体腔者直接在玻璃体腔内行晶状体核超声乳化吸出。其中14只眼行硅油填充,12只眼行C3F8填充,16只眼联合巩膜外加压。术后随访6-18个月,平均（11．50±2．67）月。结果26只眼均顺利摘出人工晶状体或超声乳化吸出玻璃体腔内晶状体核,视网膜最终完全复位23只眼（88．46％）,部分复位2只眼（7．69％）,失败1只眼（3．85％）,后者系由病程长,增生性玻璃体视网膜病变（PVR）严重所致,术后大部分患者视力有不同程度的提高。结论玻璃体切除术治疗晶状体或人工晶状体脱入玻璃体腔伴视网膜脱离可获得较好解剖效果,但功能恢复较差。     

晶状体玻璃体切除联合人工晶状体植入三联或多联手术

目的 探讨晶状体玻璃体切除联合人工晶状体植入三联或多联手术的可行性和安全性。方法对３２例（３２只眼）患者进行上述联合手术治疗,其中２９例眼外伤,包括引伤引起白内障或晶状体脱位及玻璃体积血,部分患者伴球内异物、虹膜损害或根部断离,１例老年性白内障中晶状体核和２例术后人工晶状体落入玻璃体腔内。结果 随访１～１４个月（平均５．６个月）,术后最佳矫正视力≥０．５者１５例（４６．９％）,０．１～０．４者１１     

玻璃体切除术治疗增殖型糖尿病性视网膜病变

目的 回顾性分析玻璃体切除治疗增殖型糖尿病性视网膜病谱（ｐｒｏｌｉｆｅｒａｔｉｖｅ ｄｉａｂｅｔｉｃ ｒｅｔｉｎｏｐａｔｈｙ,ＰＤＲ）的疗效。方法 对３４例（４０眼０ＰＤＲ患者（ＩＶ期１０眼,Ｖ期１４眼,ＶＩ期１６眼）行常规扁平部三切口闭合式玻璃体切除术,同时根据病情分别行晶状体超声粉碎晶状体切除、视网膜复位、眼内激光、硅油注入等。结果 随访３～３６ｍｏ（平均１８．５ｍｏ）,术后脱盲率４７．５０％     

人工晶体植入术中后囊破裂和玻璃体脱出的处理

白内障摘除合并人工晶体植入３３１只眼中，有３３只眼（１０．０％）发生后囊破裂，１６只眼（４．８％）发生玻璃体脱出。用剪刀－海绵或棉签行玻璃体切除后，囊袋内植入人工晶体３只眼，睫状沟植入２４只眼，前房植入６只眼。术后３２只眼（９７．０％）矫正视力≥０．５。     

人工晶体植入术中玻璃体脱出的处理

目的 观察人工晶状体植入术中发生玻璃体脱出的处理及其效果。方法 ３７眼人工目标植入手术中发生玻璃体脱出，使用剪刀－棉签４行开放式前段玻璃体切除术，Ⅰ期植入后房型人工晶状体。结果 成功植入或缝线固定植入后房型人工晶状体３６眼（９７．３％），术后矫正视力≥０．５者２８眼占７６％。结论 术中玻璃体脱出者施行玻璃体切除术并Ⅰ期植入后房型人工晶状体，仍可获得良好效果。     

玻璃体切除术治疗人工晶状体眼视网膜脱离

目的探讨以玻璃体切除术治疗人工晶状体眼视网膜脱离的临床效果。方法对50例（50眼）人工晶状体眼视网膜脱离施用玻璃体切除术。其中16眼行硅油填充术，34眼行C3F8眼内填充。术后随访6～24月。结果术后视网膜最终完全复位49眼（98．00％）。15眼（30．00％）术中新发现裂孔。术后视力均有不同程度的提高。结论玻璃体切除术治疗人工晶状体眼视网膜脱离具有术野清晰、易于寻找隐匿性裂孔、提高视网膜复位率及复发率低的优点。     

眼外伤玻璃体手术38例分析

目的：探讨玻璃体切除术在眼外伤中的治疗作用。方法：1999年以来我院收治的眼外伤后需行玻璃体切除术病例38例38眼，15眼行晶状体摘出或切除及前段玻璃体切除，23眼行玻璃体切除术。15眼联合人工晶状体植入，4眼行晶状体切除＋玻切＋异物摘出＋环扎＋冷凝，9眼行晶状体玻璃体切除＋气液交换＋硅油充填。结果：术后视力较术前提高者30眼（78．9％），术后视力不变或下降者8眼（21．1％），本组最终视力≥0．05者28眼（73．7％），≥0．5者5眼（13．1％）。结论：玻璃体切除术对眼外伤有重要治疗价值。     

晶状体手术对增生型糖尿病视网膜病变患者玻璃体切割术后虹膜新生血管形成的影响

目的 探讨晶状体手术对增生型糖尿病视网膜病变（ＰＤＲ）患者玻璃体切割术后虹膜亲手血管（ＩＮＶ）形成的影响。方法 总结行玻璃体切割手术的１８２例病例（１９８只眼）,采用卡方检验对数据进行统计学分析。结果 在１９８只眼中有２３只眼（约１１．６％）发生ＩＮＶ,其中无晶状体后（ＰＣ）缺失或后囊不完整１４只眼（占６０．９％）。ＰＣ缺失或不完整与ＰＣＰ完整比较ＩＮＶ形成有显著性差异,晶状体手术后后囊完整与有晶     

一期玻璃体切除术治疗人工晶状体眼视网膜脱离

目的探讨一期玻璃体切除术治疗人工晶状体眼视网膜脱离（retinal detachment，RD）的临床疗效。设计回顾性、非对照研究。研究对象54例（54眼）人工晶状体眼（EOL2E＋IOL45眼，PHACO＋IOL9眼）RD患者。方法均采用一期玻璃体切除术。其中12眼行硅油填充，其余42眼行C3F8填充，术中同时取出人工晶状体者14眼。术后随访6～18个月。主要指标视网膜复位情况、视力。结果一期玻璃体切除术中发现新裂孔17跟（31．48％），视网膜最终完全复位48眼（88.89％），部分复位4眼（7．41％），未复位2眼（3．70％），后者系严重PVR所致，术后视力均有不同程度的提高。结论对人工晶状体眼RD行一期玻璃体切除术，可提高患眼视功能，手术安全有效。     

Primary vitrectomy for pseudophakic retinal detachment.

AIM/BACKGROUND: Viewing the peripheral retina is the major problem in the repair of pseudophakic retinal detachments. Conventional buckling procedures in pseudophakic eyes are complicated by persistent retinal (re-) detachment and proliferative vitreoretinopathy (PVR) more often than in phakic eyes. METHODS: Primary vitrectomy was performed in 33 consecutive cases for pseudophakic retinal detachment with the help of liquid perfluorocarbons and a wide angle viewing system, following a standardised procedure. All eyes have passed the 12 month follow up examination. RESULTS: The primary reattachment rate was 94%. PVR was observed in one case (3%). Seventy nine per cent (26 eyes) regained vision of 20/50 or better, with a median visual acuity of 20/30. The most frequent complication was transient glaucoma during the early postoperative period in 48% (16 eyes) requiring carboanhydrase inhibitors. CONCLUSION: The main advantage of primary vitrectomy over conventional buckling seems to be the better intraoperative sight to the most peripheral retinal holes, controlled removal of vitreous traction, and focused endolaser coagulation. This may explain the low rate of PVR after primary vitrectomy. Also, visual results tended to be better compared with conventional surgical techniques possibly because of removed vitreous opacities, and because of a superior retinal reattachment rate as well as the reduced rate of PVR.     

Severe proliferative vitreoretinopathy and retinal detachment. II. Surgical results with scleral buckling

Prior to the era of vitrectomy, scleral buckling was used to treat 521 eyes with total retinal detachment and proliferative vitreoretinopathy (PVR) of various degrees of severity. The retina was reattached for at least six months in 46.9% of eyes; the anatomic success rate decreased with increasing severity of PVR. Within each grade of PVR, the reattachment rate was higher for eyes with smaller breaks than for eyes with larger breaks, and the prognosis was not worse when smaller breaks were found than when no breaks were found. The cumulative success rate rose with increasing number of reoperations. None of the anatomically successful cases had a final visual acuity of no light perception; 82.9% of them achieved a visual acuity of counting fingers or better. The prognosis for visual improvement after successful scleral buckling was unrelated to the preoperative severity of PVR. Severe intraoperative complications occurred in 5.0% of the eyes, all of which resulted in failure.     

Pseudophakic inferior retinal detachment or detachment with inferior breaks: clinical outcome and recurrences after primary vitrectomy-gas

BACKGROUND: This study aims to evaluate the outcome of primary vitrectomy/gas for pseudophakic retinal detachment (RD) located inferiorly or associated to inferior breaks. PATIENTS AND METHODS: We performed a retrospective, non-randomised study comprising 18 pseudophakic RD eyes with inferior RD (group A) and 19 pseudophakic RD eyes with inferior breaks (group B) treated with primary vitrectomy and gas tamponade (SF (6) 20 %). Pre- and postoperative characteristics were analysed, focusing on RD recurrences. RESULTS: In group A, RD recurred in 2/18 eyes (11 %) and was associated to proliferative vitreoretinopathy (PVR) both at first intervention and on recurrence. In group B, RD recurred in 4/19 eyes (21 %). One eye presented PVR at first intervention and all at re-intervention. Anatomic reapplication was achieved after second vitrectomy/gas in 2/4 eyes of group B, whereas long-term silicon oil tamponade was needed in 2 eyes of each group. CONCLUSIONS: This series shows a high success rate of primary vitrectomy/gas in pseudophakic RD patients with inferior RD or detachment associated to inferior breaks. Recurrences after vitrectomy are most often related to the presence of PVR.     

Management of pseudophakic retinal detachment with undetectable retinal breaks

BACKGROUND AND OBJECTIVE: Difficulties encountered during the repair of pseudophakic retinal detachment are related to difficulties in peripheral retinal visualization and identification of retinal breaks. The implication of nonvisualized breaks in patients with pseudophakic retinal detachment is associated with lower rates of surgical success. This report decribes the results of a prospective trial to evaluate the efficacy of both scleral buckling surgery in the treatment of pseudophakic retinal detachment with undetected retinal breaks and pars plana vitrectomy techniques in the management of the cases that redetected after primary buckling surgery. PATIENTS AND METHODS: This study represents 25 cases of pseudophakic retinal detachment with undiagnosed retinal breaks. In each case, we performed a scleral buckling that extended over the circumference of the retinal detachment. Pars plana vitrectomy with internal subretinal fluid drainage and long-term tamponade were performed on 7 patients with uncomplicated recurrent retinal detachments after primary buckling surgery. The mean duration of follow up was 32 months. RESULTS: There were 25 eyes (24.5%) of pseudophakic retinal detachment with undiagnosed retinal breaks represented in our pseudophakic retinal detachment cases. Anatomic success was achieved after the initial scleral buckling surgery in 18 eyes (72%). The overall success rate was 92%. The visual acuity was 20/40 or better in 8 patients (32%), 20/80 to 20/40 in 6 patients (24%), 5/200 to 20/80 in 7 patients (28%), and light perception to hand movement in 4 patients (16%). Complications included vitreous hemorrhage, macular pucker, cystoid macular edema, and hypotony with proliferative vitreoretinopathy. CONCLUSION: Scleral buckling surgery in conjunction with cryotherapy is effective in the initial treatment of pseudophakic retinal detachment with undetectable retinal breaks. Pars plana vitrectomy with internal fluid-gas exchange and long-term tamponade can be used to treat these patients with recurrent retinal detachment after primary buckling surgery to get a higher overall success rate.     

Recurrent retinal detachment more than 1 year after reattachment

PURPOSE: Little information exists regarding recurrent retinal detachment after 1 or more years of complete retinal reattachment. To better understand this uncommon problem, we evaluated late recurrent retinal detachments in relation to the contemporary classification of proliferative vitreoretinopathy (PVR). DESIGN: Retrospective consecutive noncomparative case series. PARTICIPANTS: Nine patients (10 eyes) with late recurrent retinal detachment after 1 or more years of complete reattachment. METHODS: We retrospectively analyzed the clinical and operative records of one surgeon over a 9-year period to identify late recurrent retinal detachments that occurred 1 or more years after complete retinal reattachment. The study group was derived from a total of 453 consecutive cases of rhegmatogenous retinal detachment repair not associated with proliferative diabetic retinopathy, uveitis, or penetrating ocular trauma. MAIN OUTCOME MEASURES: Late recurrent retinal detachments after 1 or more years of complete retinal reattachment. RESULTS: The study group consisted of 10 eyes (2.2% of total) in nine patients. Redetachment occurred from 12 to 126 months (average, 46.8 months) after the initial detachment surgery. Late recurrent retinal detachments were associated with new retinal breaks (five eyes), reopening of old breaks (three eyes), or both (two eyes). In all, 13 open breaks were identified, nine of which were on or anterior to the scleral buckle. Eight eyes had grade C PVR, including four eyes with anterior PVR, three eyes with posterior PVR, and one eye with both anterior and posterior PVR. The retina was reattached after additional vitreoretinal surgery in eight eyes of seven patients; two patients (two eyes) declined reoperation. Visual acuity improved in seven of eight eyes after repair of the late recurrent retinal detachment. Postoperative follow-up after late recurrent detachment repair ranged from 69 to 140 months (average, 101.7 months, or 8.5 years). CONCLUSIONS: Vitreous base traction seems to be an important factor in late recurrent retinal detachments occurring 1 or more years after complete retinal reattachment, and the associated PVR was probably a secondary phenomenon and not a causative factor in most cases. Reoperation for such late recurrent retinal detachments can successfully reattach the retina and improve visual acuity in most cases.     

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。     

C3F8填充眼视网膜脱离复发再手术临床分析

目的探讨全氟丙烷（C3F8）填充眼复发视网膜脱离的原因、手术方式选择及其临床疗效。方法回顾分析52例（56眼）玻璃体切除手术联合C3F8填充眼复发视网膜脱离的临床资料,寻找复发原因,并根据复发原因,进行再次手术,术后随访至少6个月。结果C3F8填充眼的视网膜下方脱离占57．14％,复发原因有：增生性玻璃体视网膜病变（PVR）,特别是前段PVR的发展牵引致新孔形成或原孔开放占62．50％（35／56）,气体顶压不良裂孔重新开放占21．43％（12／56）,单纯原裂孔未封闭或封闭不好占8．93％（5／56）,其他原因占7．14％（4／56）。再次手术出院时视网膜均解剖复位,随访过程中出现复位术后视网膜再脱离5例（6眼）,最终成功率为89．29％（50／56）。术后矫正视力提高28例（30眼）,矫正视力不变11例（12眼）,矫正视力下降13例（14眼）。结论C3F8填充眼视网膜再脱离多以下方为主,再脱离与术后PVR发展再牵引、术中未充分松解对视网膜的牵引等密切相关。要术前正确评定玻璃体状态及可能的发展方向,根据视网膜裂孔及PVR情况,彻底清除PVR增生膜,恢复视网膜活动度,选择适当的封孔方法和眼内填充物,仍可取得较为理想的疗效。     

Primary retinal reattachment surgery: anatomical and functional outcome in phakic and pseudophakic eyes

AIM: To compare the anatomical and functional success of primary scleral buckling, performed either alone or in combination with vitrectomy, for primary retinal detachment (RD) in phakic eyes and in eyes had undergone uneventful phacoemulsification and had received posterior chamber lens implantations. METHODS: A total of 243 consecutive patients were included in this retrospective, nonrandomized comparative study. In all, 165 phakic and 78 pseudophakic individuals with primary RD underwent scleral buckling alone or in combination with vitrectomy and were followed up for 6 months. Pre-, intra- and postoperative findings including anatomical success, best-corrected visual acuity (BCVA), complications, and the development of proliferative vitreoretinopathy (PVR), macular pucker, or secondary cataracts were recorded. Cases requiring more than one surgical intervention were defined having failed, although further surgical intervention might have led to success. RESULTS: At 6 months after scleral buckling alone, the anatomical success was similar in phakic (88.98%) and pseudophakic (87.65%) eyes (log rank=0.310). The corresponding results after scleral buckling with vitrectomy were 82.13 and 77.63% for phakic and pseudophakic eyes, respectively (log rank=0.799). At 6 months after scleral buckling alone, BCVA was similar in phakic and pseudophakic eyes (0.62+/-0.30 vs 0.70+/-0.29; P=0.227). Likewise, after scleral buckling with vitrectomy, BCVA did not differ significantly (P=0.322) between phakic (0.34+/-0.32) and pseudophakic eyes (0.50+/-0.27). CONCLUSION: The anatomical and functional outcome of primary retinal reattachment surgery, involving scleral buckling alone or in combination with vitrectomy, is similar in phakic and pseudophakic eyes.     

Primary vitrectomy with perfluoro-n-octane use in the treatment of pseudophakic retinal detachment with undetected retinal breaks

PURPOSE: This report describes the results of a prospective trial to evaluate the efficacy of pars plana vitrectomy (PPV) in conjunction with perfluoro-n-octane (PFO) as initial treatment of pseudophakic retinal detachment (RD) with no breaks diagnosed preoperatively. METHODS: Fourteen consecutive eyes presenting with pseudophakic RD in which retinal breaks could not be identified preoperatively underwent primary PPV, internal microsurgical identification of the retinal breaks with endoillumination and noncontact wide angle viewing system, PFO retinal reattachment, transscleral cryopexy or endolaser treatment of breaks, PFO-air exchange, and final injection of 20% sulfur hexafluoride. In five eyes, a scleral buckle was also used. Mean follow-up period was 18 months. RESULTS: In 13 of the 14 eyes in which no breaks had been identified preoperatively, breaks were diagnosed during surgery. Perfluoro-n-octane retinal attachment facilitated accurate microscopic treatment of retinal breaks. The retina was reattached with a single operation in all eyes. Eleven eyes had final visual acuity of 20/60 or better. Complications were minimal. CONCLUSIONS: Pars plana vitrectomy in conjunction with PFO expression of subretinal fluid is effective in the initial treatment of pseudophakic RD with no preoperative diagnosis of retinal breaks.     

Pseudophakic retinal detachment: treatment by vitrectomy and scleral buckling. Pilot study

INTRODUCTION: Localization of retinal tears generating a pseudophakic retinal detachment (RD) is not always possible; subsequently, segmental indentation by external compression often causes a residual RD. Vitrectomy enables a detailed view of the peripheral part of the retina and better detection of small size retinal breaks. Our pilot survey report anatomic and functional results of a surgical treatment of pseudophakic RD, associating vitrectomy and scleral buckling. MATERIAL AND METHODS: Twenty three consecutive pseudophakic eyes showing an RD were operated on with scleral buckling, vitrectomy, internal subretinal fluid drainage, endolaser and fluid-air exchange by SF(6) 20%. Preoperative findings, intraoperative and postoperative complications, and final results were analyzed. RESULTS: The retina was successfully reattached with a single operation in 21 eyes (92%). One eye presented a recurrence of RD due to a preexisting retinal tear. PVR was observed in one case with the recurrence of the RD. In both cases, a second operation achieved the retinal reattachment. After surgery, visual acuity improved on an average of 3 lines. The most frequently occurring complication was a transitory hypertony in 6 cases (26%). CONCLUSION: Surgical treatment of the pseudophakic RD, combining vitrectomy and scleral buckling shows very good anatomic and functional results; it seems to offer the advantage of a better localization of peripheral retina tears, which enables a recovery with a lower recurrence rate than by extra-ocular surgery only.