孤立性脉络膜血管瘤的临床疗效观察

目的：探讨孤立性脉络膜血管瘤的治疗疗效。方法：回顾性分析24例孤立性脉络膜血管瘤的临床资料。24例中，男17人，女7人，平均年龄43．29岁。全部患者均存在渗出性视网膜脱离，其中，6眼视网膜脱离为移动性。患者首选激光治疗，激光治疗无效并存在移动性视网膜脱离者行巩膜外冷冻治疗。患者平均随访21．17月。结果：无移动性视网膜脱离的18眼，激光治疗后视力稳定或提高者占94．5％。瘤体表面仍有少量液体残存的共有3眼(12．5％)均为黄斑中心下的血管瘤。有移动性视网膜脱离的6眼最终均行冷冻治疗，冷冻术后周边液体吸收，5例视力下降。结论：位于黄斑下的及伴有移动性视网膜下液的脉络膜血管瘤预后差。     

氩氯激光治疗孤立性脉络膜血管瘤

报告氩绿激光治疗８例伴有浆液性黄斑视网膜脱离的孤立性脉络膜血管瘤。激光光凝治疗后的血管瘤瘤体大部分或基本消失，脱离的视网膜复位，除黄斑中心凹部位血管瘤者外，患者视力明显提高。随访期内未见肿物复发。激光参数：光斑大小３００μｍ～４００μｍ，暴交时间０．２～１．０ｓ，输出功率０．３～０．５Ｗ。     

伴脉络膜损伤的外伤性视网膜脱离玻璃体手术预后观察

目的 评价玻璃体手术治疗合并脉络膜损伤的外伤性视网膜脱离的效果。 方法 对1995年至2005年间经玻璃体手术治疗1075只外伤眼进行回顾性分析，外伤性视网膜脱离合并浆液性脉络膜脱离、出血性脉络膜脱离（含外伤性脉络膜分离）或视网膜下出血在内的不同类型脉络膜损伤共41例41只眼（3.8％），采用闭合式玻璃体手术进行治疗，统计比较手术预后。 结果 视网膜复位38只眼（92.7％），最终视力大于0.1者10只眼（24.4％）；手术后视力提高者共29只眼（70.7％），其中合并视网膜下出血组14只眼（87.5％,14/16），合并浆液性脉络膜脱离组12只眼（75.0%, 12/16），合并出血型脉络膜脱离组3只眼（33.3%,3/9），三组患眼的视力提高率χ2＝8.394，P＝0.015，P<0.05。最终黑朦6只眼，均为出血型脉络膜脱离者。17只低眼压眼中8只眼（47.1％）需持续硅油填充，出血型脉络膜脱离5只眼（55.6 ％，5/9）。 结论 合并脉络膜损伤的外伤性视网膜脱离玻璃体手术处理得当可获得较好的结果，其中合并视网膜下出血者手术预后较好；合并出血型脉络膜脱离眼预后较浆液型明显差，但也并非眼球摘除适应证。严重外伤性脉络膜分离眼预后较差常 为低眼压需长期硅油填充。 (中华眼底病杂志，2006，22：295-298）     

孤立性脉络膜血管瘤光凝治疗疗效观察

目的 观察探讨脉络血管瘤的临床光凝治疗效果。方法 回顾分析27例27眼脉络膜血管瘤的临床资料。27例中男16例，女11例，平均年龄45．4岁，右眼12例，左眼15例，均为单眼发病，均属于脉络膜血管瘤病(chomidal Hemangioma，CH)，按照瘤体大小、局限性视网膜脱离、广泛性视网膜脱离，将本病分为三期。治疗方法均采用激光治疗，全部病历随访12个月以上，平均随访时问35．5个月。结果 其中25只眼治疗后，全部血管瘤得以控制，其中视力提高者11眼，不变者8眼，下降者7眼，1眼病情进展至无光感。结论 激光是治疗孤立性脉络膜血管瘤的有效治疗方法。     

氩激光类经瞳孔温热疗法治疗黄斑脉络膜新生血管性病变疗效观察

目的 观察氩激光类经瞳孔温热疗法治疗黄斑脉络膜新生血管性疾病(CNV)的疗效和安全性.方法 选择眼科中心2年间确诊为黄斑脉络膜新生血管病并接受氩激光治疗的患者55例(59只眼),观察治疗前后最佳矫正视力、眼底荧光血管造影(FFA)、光相干断层扫描(OCT)的改变情况,以及并发症、复发率并对其结果进行分析.结果 所有患者均经氩绿激光治疗(83.05％治疗1次、16.95％治疗2次).术后随访6～20月,最佳矫正视力提高者21只眼(35.59％),视力稳定者35只眼(59.32％),3只眼(5.08％)视力下降.FFA、OCT显示CNV萎缩、渗出性视网膜脱离、出血性视网膜色素上皮脱离及黄斑水肿吸收,仅有2只眼(3.39％)出现暗点,但不影响视物,无其他并发症出现.结论 氩激光治疗黄斑脉络膜新生血管性疾病安全有效,可使CNV萎缩,出血部位血管闭锁,进而视网膜内积液、积血及视网膜下液吸收,提高或保存患者视力,且经济,被接受范围广.     

氩激光和冷冻疗法治疗脉络膜血管瘤

脉络膜血管瘤是脉络膜的先天性血管畸形，其自然病程结果可因渗出性视网膜脱离与继发性视网膜囊样退行性变的逐渐加重而最终失明，甚至并发顽固性青光眼而摘除眼球。它主要分为两种类型：孤立型和弥漫型。本文６例均为孤立型。我们对其采用氩激光光凝治疗，其中３例合并冷...     

大泡状视网膜脱离治疗方法及疗效分析

目的 探讨大泡状视网膜脱离的治疗方法及效果。方法回顾性分析2005—2008年中山眼科中心经眼底和荧光素或／和吲哚青绿血管造影检查确诊为大泡状视网膜脱离或弥漫性视网膜色素上皮病变者17例,其中2例单纯进行药物治疗,8例氩激光封闭渗漏点,7例进行巩膜外放液或玻璃体切除术加膨胀气体或硅油填充或结合术前或术中术后眼底激光治疗,所有激光和／或手术治疗的病例,均联合药物治疗。随诊6个月以上。结果17例中,2例单纯药物治疗及8例氩激光治疗者视力均有提高,手术治疗的7例中除2例因病情严重经手术及激光治疗视力下降外,5例均有改善或保持原有视力。结论各种治疗方法对大泡状视网膜脱离均有一定的疗效,其中视网膜光凝治疗效果最佳,早期治疗效果好,晚期手术治疗可以挽救一些患者的有用视力。     

巩膜外路手术联合术后眼底激光治疗孔源性视网膜脱离

目的讨论巩膜外路手术联合术后眼底激光治疗单纯孔缘性视网膜脱离的临床疗效。方法对591例592眼单纯性视网膜脱离病人行巩膜外路手术，包括：巩膜外加压、放液或不放液，部分病人联合环扎或玻璃体腔注C，R气体，术后氩激光或532激光治疗视网膜裂孔。结果视力提高414眼，不变166眼，下降12眼。视网膜复位情况：完全复位561眼（成功率95％），部分复位24眼，未复位7眼。接受一次手术558眼，接受二次手术（包括玻璃体手术）29眼，接受三次手术1眼，7例7眼病人自动放弃。视网膜复位不良手术失败的原因依次为：玻璃体出血、脉络膜脱离型网脱、马蹄形视网膜裂孔伴牵引、黄斑裂孔、锯齿缘离断，以上均与PVR关系密切。结论选择适当病例，巩膜外路手术联合术后激光治疗孔源性视网膜脱离是一种安全、可行、简便、易操作、效果良好的方法。     

OCT在急性中心性浆液性脉络膜视网膜病变诊治中的应用

目的:应用OCT动态观察急性中心性浆液性脉络膜视网膜病变(acute central serous chorioretinopathy,ACSC)细微结构的变化,比较其激光治疗、药物治疗与二者联合治疗的疗效。方法:经FFA及OCT确诊的96例98眼ACSC患者,应用OCT比较单纯药物治疗、激光治疗以及激光联合药物治疗对视网膜下液的吸收,并比较各组间的视力差异。随访时间为治疗后2,4,8wk。结果:各组之间在治疗前视网膜脱离范围均没有统计学意义。在治疗后2,4,8wk比较,激光治疗组与药物治疗组间视网膜脱离范围和治愈率均没有统计学意义;联合治疗组与前两组比较,其视网膜脱离范围更小,治愈率更高,其差异均有统计学意义。结论:药物联合激光治疗急性中心性浆液性脉络膜视网膜病变能缩短病程,提高治愈率;OCT无创、简便、直观,能对CSC的愈后过程进行灵敏的追踪。     

巩膜扣带术联合氩激光治疗硅油眼视网膜再脱离

目的探讨巩膜扣带术联合氩激光光凝对硅油眼视网膜再脱离的治疗作用。方法对硅油眼视网膜再脱离患者行巩膜扣带术联合氩激光治疗的45例（45眼）进行回顾性分析。结果术后39眼视网膜复位,成功率86．67％,23眼（51．11％）视力提高。结论矾膜扣带术联合氩激光光凝是治疗硅油眼视网膜再脱离的有效手术方法之一,此手术方法经济、省时。     

A case of choroidal hemangioma with bullous exudative retinal detachment treated successfully by transpupillary thermotherapy]

BACKGROUND: Choroidal hemangioma associated with bullous retinal detachment may be difficult to treat, due to varying results with conventional laser photocoagulation, radiotherapy, or surgical drainage. Here we report on a case of extensive bullous retinal detachment secondary to circumscribed choroidal hemangioma that was resolved after combined treatment with vitrectomy, silicone oil tamponade, and transpupillary thermotherapy. CASE: A 29-year-old woman presented with a large choroidal hemangioma in her right eye associated with serous retinal detachment. The tumor measured 8 disc diameters in size and was located in the inferotemporal macula, abutting the fovea. RESULTS: Laser photocoagulation of the tumor was unsuccessful in inducing absorption of subretinal fluid. Because of progressive bullous retinal detachment, surgery was performed consisting of external drainage of subretinal fluid, vitrectomy, endolaser photocoagulation of the tumor, and silicone oil tamponade. The silicone oil was removed four weeks postoperatively at which time almost complete resolution of the retinal detachment was observed. However, retinal detachment recurred eight weeks later, and transpupillary thermotherapy was then applied to the tumor. By four weeks after transpupillary thermotherapy, total reabsorption of subretinal fluid, visual acuity improvement, and decreased height of the choroidal hemangioma were noted. CONCLUSION: Transpupillary thermotherapy is an effective treatment for serous retinal detachment associated with choroidal hemangioma.     

脉络膜脱离孔源性视网膜脱离术中不放液观察

目的 观察视网膜裂孔冷凝，巩膜环扎外加压手术不放液治疗脉络膜脱离型孔源性视网膜脱离的疗效。方法 对28眼脉络膜脱离型孔源性视网膜脱离进行裂孔冷凝，巩膜环扎，外加压，术中不引流视网膜下液，对其治疗结果进行分析。结果 28眼中一次成功25眼，视网膜下液在1～2天吸收为13眼，3天～1周内吸收为12眼，术后均有不同程度的视力提高。结论 在成功封闭裂孔后，脉脱型孔源性视网膜脱离视网膜下液可自行吸收，手术成功率高，可有效减少放液所带来的并发症。     

环扎加压放液与不放液治疗视网膜脱离的体会

目的评价环扎加压放液与不放液治疗视网膜脱离的临床疗效。方法随机分为A组（不放液）与B组（放液）进行手术。结果A组30例手术成功28例（93.3％）;B组30例成功27例（90％）。复位的55眼视力均有提高。两组疗效无显著性差异（P＞0．05）。结论环扎加压不放液治疗视网膜脱离与放液比较具有手术难度小、时间短、并发症少等优点,且疗效可靠,但对周边超过90°的巨大裂孔、黄斑后极部裂孔不适应该术式。     

巩膜扣带术不放液治疗陈旧性原发视网膜脱离

目的:观察分析巩膜扣带术不放液治疗陈旧性视网膜脱离的临床效果。方法:回顾分析我科46例(46眼)陈旧性视网膜脱离患者经巩膜扣带术不放液进行治疗。病例资料,男39例,女7例。年龄9~18岁15例,18~35岁20例,35岁以上11例。提供病史2mo~2a。视网膜下方2个象限浅脱离35眼占76%,其视网膜小圆孔、多筛孔36眼占78%,所有患者脱离的视网膜下均伴有黄色机化条索,46眼均行外路手术不放视网膜下液,采用单纯巩膜外加压16眼(35%),环扎联合加压30眼(65%)。结果:随访1~12mo,46眼中有44眼1次手术达到视网膜解剖复位(96%),术后矫正视力0.1以上36眼。结论:巩膜扣带术不放液治疗好发于青少年陈旧性视网膜脱离,简单有效。     

Anatomic and visual acuity outcomes following thermal laser photocoagulation or photodynamic therapy for symptomatic circumscribed choroidal hemangioma with associated serous retinal detachment.

BACKGROUND AND OBJECTIVE: This study reports and compares the anatomic and visual acuity outcomes of patients treated with either thermal laser photocoagulation or photodynamic therapy for circumscribed choroidal hemangioma with associated serous retinal detachment. PATIENTS AND METHODS: Retrospective, consecutive, interventional case series of patients treated for symptomatic circumscribed choroidal hemangioma. RESULTS: Thirteen of 23 patients (57%) treated with thermal laser photocoagulation exhibited complete resolution of subretinal fluid, 6 (26%) had partial resolution of subretinal fluid, and 4 (17%) had persistent subretinal fluid despite therapy. At 3 months posttreatment, visual acuity was improved in 6 (26%), stable in 13 (57%), and worsened in 4 (17%) of 23 patients. All 5 patients who underwent photodynamic therapy had complete resolution of subretinal fluid. At 3 months posttreatment, visual acuity improved in 4 (80%), remained stable in 1 (20%), and worsened in 0 (0%) patients. CONCLUSIONS: Photodynamic therapy shows similar if not better anatomic and visual acuity results than thermal laser photocoagulation when treating symptomatic circumscribed choroidal hemangioma.     

Choroidal (subretinal) neovascularization secondary to choroidal nevus and successful treatment with argon laser photocoagulation. Case reports and review of literature

Retinal detachment secondary to choroidal nevus may be caused by subretinal fluid accumulation or neovascularization. Foveal subretinal fluid or leakage of choroidal neovascularization may impair visual acuity. 10 cases of nevus with serous sensory retinal detachment successfully treated with laser photocoagulation are reviewed. 2 additional cases of successful laser therapy for retinal detachment secondary to choroidal neovascularization with nevus of the choroid are presented.     

激光脉络膜切开视网膜下放液的临床观察

目的 探讨激光脉络膜切开与冷针穿刺脉络膜视网膜下放液的安全性及效果。 方法 孔源性视网膜脱离需行巩膜扣带术的病例70例74只眼，随机分为两组，A组34例36只眼采用冷针穿刺脉络膜放液，B组36例38只眼采用半导体激光眼内激光探头光凝脉络膜放液，比较两种方法的效果及并发症发生情况。 结果 两种放液方法均获成功，冷针穿刺脉络膜放液发生视网膜下出血3例、1例视网膜嵌塞、视网膜穿孔，而激光脉络膜切开放液组未发生明显的并发症。 结论 半导体激光脉络膜切开视网膜下放液可以降低并发症发生率，适用于任何需视网膜下放液的病例，尤其在视网膜下液不多的病例。 (中华眼底病杂志,1998,14:202-203)     

Remodeling of choroidal venous drainage after vortex vein occlusion following scleral buckling for retinal detachment

PURPOSE: To evaluate the choroidal drainage route after scleral buckling for retinal detachment. METHODS: We performed wide-angle indocyanine green angiography with a scanning laser ophthalmoscope in 22 eyes of 22 patients with rhegmatogenous retinal detachment that had been treated with scleral buckling and cryopexy. The 22 eyes had at least one retinal break located posterior to the equator where vortex veins were present. The period between angiography and retinal detachment surgery was less than 3 months in 10 eyes, 3 to 12 months in five eyes, and more than 1 year in seven eyes. RESULTS: At the site of the silicone exoplant and cryopexy for retinal breaks, one vortex vein was occluded in seven eyes and two in five eyes. Choroidal veins were congested in the quadrant of the occluded vortex vein in two of 12 eyes that had angiography less than 3 months after retinal detachment surgery. In 10 of 12 eyes that had angiography 3 months or more after retinal detachment surgery, new drainage routes developed that connected the sector of the occluded vortex veins to that of the intact vortex veins with venovenous anastomoses. No venous congestion was found in the areas of the occluded vortex veins in the 10 eyes. Venous collaterals formed between the superior and inferior vortex in all 10 eyes and between the temporal and nasal vortex in two eyes. CONCLUSIONS: New venous drainage routes, which were connected to the intact vortex veins, formed in eyes with occluded vortex veins resulting from scleral buckling surgery and compensated for choroidal venous congestion. The choroidal veins have a great deal of plasticity that enables remodeling of the drainage routes, depending on the pressure gradient.     

巩膜扣带术治疗陈旧性视网膜脱离

目的:观察巩膜扣带术治疗陈旧性视网膜脱离的效果。方法:选取38例38眼陈旧性视网膜脱离患者,术中直视下定位、冷凝视网膜裂孔。针对不同病例36眼于裂孔处缝合硅海绵(其中19眼加缝硅胶环扎带),另2眼单纯行环扎术。26眼进行了视网膜下液引流术,7眼在手术前、后联合了激光光凝术。结果:其中33眼单次手术视网膜解剖复位,首次手术复位率87%,2眼再次手术后复位,手术最终解剖复位率92%。术中及术后无严重并发症发生。结论:通过个体化设计手术方案,巩膜扣带术治疗伴有视网膜下增生的陈旧性视网膜脱离可获得较高的手术治愈率。     

Iodine-125 plaque radiotherapy of choroidal hemangioma.

BACKGROUND: Circumscribed choroidal hemangioma (CCH) is a benign vascular tumor that is not associated with systemic abnormalities and its pathogenesis is unknown. Most choroidal hemangiomas remain stable in size, and treatment is periodic observation unless complicated by an overlying serous retinal detachment. CASE REPORT: A 43-year-old white man came to our clinic reporting decreased vision in the left eye for 1 year. On funduscopic evaluation, a large elevated nonpigmented red-orange lesion, just temporal to the fovea of the left eye, was observed with surrounding areas of subretinal fluid. On the basis of findings obtained through ophthalmoscopy, fluorescein angiography, and ultrasonography, the patient was diagnosed with a circumscribed choroidal hemangioma. Treatment of the CCH was with iodine-125 plaque radiotherapy, which significantly reduced the tumor size and improved vision. CONCLUSION: CCH is a benign vascular tumor that is characteristically nonprogressive, but in cases of vision loss caused by serous detachment of the fovea, argon laser photocoagulation or radiotherapy is the treatment of choice. Recent studies indicate that iodine-125 plaque radiotherapy is indicated for large choroidal hemangiomas involving the macula or with associated retinal detachment. The main goal of treating CCH is to preserve vision and to prevent the progression of vision loss.