晶状体玻璃体切割联合巩膜环扎术治疗严重眼外伤

目的评价晶状体玻璃体切割术联合巩膜环扎术治疗严重眼外伤的效果。方法总结这类病人的临床资料8例,对术后临床效果进行分析、评价。结果8例病人中严重眼球穿通伤6眼,爆炸伤2眼。球内异物3例,并发视网膜脱离4例。2次手术前视力光感4眼,手动3眼,0．08者1眼,2次手术后,手动1眼。数指1眼,0．04～0．08者4眼,0．1～0．3者2眼。眼压均有不同程度的回升。所有患者均避免了眼球摘除之苦,无回例发生交感性眼炎。结论晶状体玻璃体切割联合巩膜环扎术是治疗严重眼外伤有效措施之一。     

晶状体玻璃体切割术后透明角膜切口的二期人工晶状体植入术

目的 探讨晶状体玻璃体切割术后经颞侧透明角膜隧道切口的二期折叠式人工晶状体植入术的手术方法和疗效.方法 通过颞侧透明角膜隧道切口对晶状体玻璃体切割术后6～12个月的29例（29眼）二期植入折叠式人工晶状体,用聚丙烯缝线将人工晶状体襻固定于睫状沟中.术后随访6～18个月,观察术后视力、人工晶状体位置及术中术后并发症.结果 术后3个月裸眼视力＞0.5者16眼,0.3～0.5者12眼,0.2～0.3者1眼.术后视力与术前最佳校正视力相比较,差异无统计学意义（P＞0.05）.手术并发症主要为眼内出血（1眼）、人工晶状体倾斜（2眼）.结论 经颞侧透明角膜隧道切口及睫状沟缝合固定襻的折叠式人工晶状体植入术,手术效果可靠,并发症少,是晶状体玻璃体切割术后无晶状体眼屈光矫正的理想手术方式.     

巩膜外硅压联合玻璃体切割术治疗人工晶状体或无晶状体眼视网膜脱离

目的:探讨在治疗人工晶状体或无晶状体眼视网膜脱离中巩膜硅压联合玻璃体切割术比单纯巩膜硅压手术的优越性。方法:回顾性分析30例我院联合手术治疗的人工晶状体或无晶状体眼视网膜脱离患者的临床资料。各位患者均采用巩膜外硅压联合玻璃体切割手术修复脱离的视网膜,术后随诊3～14mo,对手术后的解剖复位、视力提高情况以及并发症进行考察。结果:所有患者(30眼)均1次手术复位成功并有不同程度的视力提高,没有发现任何玻璃体切割手术的并发症。结论:在治疗人工晶状体或无晶状体眼视网膜脱离中,巩膜外硅压联合玻璃体切割术比单纯巩膜硅压手术有明显的优越性,其成功率的提高与玻璃体切割术提高周边视网膜的可见度,以及减少PVR的发生相关。     

玻璃体切割联合人工晶状体悬吊术治疗晶状体全脱位

目的 探讨玻璃体切割联合人工晶状体悬吊术治疗晶状体全脱位的临床疗效.方法 晶状体全脱位患者12例(12只眼),其中继发青光眼7例(7只眼),实施玻璃体切割联合人工晶状体悬吊术.术后随诊3～11个月,平均7.6个月,记录术前术后视力、眼压.结果 术后视力0.1～0.3者2只眼,0.3～0.5者6只眼,0.5以上者4只眼,经x2检验,P<0.01有显著性意义.眼压3个月后均在正常范围内.结论 玻璃体切割联合人工晶状体悬吊术治疗晶状体全脱位是一种安全有效的治疗方法.     

眼外伤玻璃体切割术后带虹膜隔人工晶状体植入术

目的 探讨眼外伤后无虹膜无晶状体眼的治疗方法。方法 对2例(2只眼)眼外伤玻璃体切割术后无虹膜无晶状体眼患者施行带虹膜隔人工晶状体植入术。结果 术后所有患者畏光症状消失,视力明显提高,无任何严重并发症发生。结论 带量膜隔人工晶状体植入术是目前矫正无晶状体眼伴无虹膜的安全有效方法。     

玻璃体切割术后人工晶状体植入术

玻璃体切割术后的白内障或联合晶状体摘出术后的无晶状体眼实施人工晶状体植入术 ,较为复杂。近年来我们治疗 32例 32眼结果报告如下。1　资料与方法1.1　临床资料　 32例 32眼 ,男 2 6例 ,女 6例 ;年龄 8～6 2 a;病程距玻璃体切割术 3～ 12 mo,注入硅油者均已取出 ;术前视力 :手动 8例 ,眼前数指 6例 ,0 .0 2～ 0 .1者 13例 ,0 .2～ 0 .5者 5例 ;其中白内障 17例 ,无晶状体眼 15例 ;随访时间 6 mo～ 2 a。原发病为单纯性玻璃体出血者 2 0例 ,严重增殖性玻璃体视网膜病变 (PVR)、复杂性眼外伤和视网膜脱离者12例。1.2　手术方法　常规麻醉…     

玻璃体切割联合超声乳化及人工晶状体悬吊术治疗晶状体脱位

目的探讨玻璃体切割联合超声乳化及人工晶状体悬吊术治疗晶状体脱位的临床疗效。方法选取晶状体脱入玻璃体内的患者30例(30眼),其中眼球钝挫伤引起的晶状体全脱位25眼,针拨白内障术后晶状体全脱位2眼,白内障摘出术中晶状体核脱入玻璃体内3眼。根据脱入玻璃体内的晶状体核硬度不同采用不同的手术方法,行玻璃体切割联合晶状体切除及人工晶状体悬吊植入术,必要时行硅油填充。术后随访0.5～1a,观察视力、眼压及并发症等情况。结果本组患者行玻璃体切割联合晶状体切除及人工晶状体悬吊植入术19例(19眼);玻璃体切割联合超声乳化及人工晶状体悬吊植入术10例(10眼);玻璃体切割联合超声乳化及硅油充填术1例(1眼)。术后视力:0.1～0.3者16眼,0.3～0.5者9眼,0.5以上者5眼;术后继发青光眼3眼,经降眼压治疗后恢复正常范围。术后随访期间未发现视网膜脱离、玻璃体积血、人工晶状体偏位等并发症。结论玻璃体切割联合超声乳化及人工晶状体悬吊植入术治疗晶状体脱位是一种安全、有效的方法。     

人工晶状体巩膜缝线固定术矫正儿童玻璃体切割术后无晶状体眼疗效分析

目的 评价二期人工晶状体现膜缝线固定术矫正儿童玻璃体切割术后无晶状体眼的疗效.方法 对16例16眼儿童玻璃体切割术后(其中8例因化脓性眼内炎、8例因外伤性视网膜脱离行手术)的无晶状体眼行四襻折叠人工晶状体经巩膜缝线固定术;术中全程均使用前房维持器.患者平均年龄为(7.62±2.02)岁(5～11岁),术前最佳矫正视力平均为0.25±0.24,患儿平均眼压为(13.14±0.33)mmHg(1 kPa=7.5 mmHg),其中10眼有角膜瘢痕.术后随访6～22个月,平均(12.56±5.73)个月.结果 术后早期原发病为眼内炎者有5眼出现低眼压,平均为(6.02±1.34)mmHg,一般在术后7 d恢复正常眼压.末次随访时,尚未出现缝线暴露、人工晶状体脱位与偏斜和视网膜脱离等严重并发症;患眼最佳矫正视力平均为0.29±0.21,其中最佳矫正视力<0.05者2眼,0.05～0.3者5眼,≥0.3者9眼.结论 儿童玻璃体切割术后二期人工晶状体行经巩膜缝线固定术,是矫正儿童单侧无晶状体眼的较好方法,但如何预防和处理患者术后早期低眼压以及对其远期疗效和并发症的评价仍需长期随访观察.     

玻璃体切割术治疗人工晶状体眼视网膜脱离

人工晶状体眼的视网膜脱离 ,由于晶状体皮质残留 ,囊膜增殖及人工晶状体像差等因素的影响 ,眼底特别是周边部视网膜检查困难 ,不易发现视网膜裂孔。常规的巩膜扣带手术成功率低。现将我们近年来 ,采用玻璃体切割术治疗的 60例 60眼人工晶状体眼的视网膜脱离的结果报告如下 :对象及方法1 一般情况 :本组病例 60例 60眼 ,男性 37例 ,女性 2 3例 ;年龄 4 5～ 78岁 ;视网膜脱离距人工晶状体植入术的时间为 2 0天～ 5年 ;所有病例在植入人工晶状体前 ,均无视网膜病史 ,其中前房型人工晶状体 5例 ,后房型人工晶状体 5 5例。后囊完整的5 0例 ,人工…     

玻璃体切割术治疗严重眼外伤的疗效观察

目的:观察玻璃体切割术治疗严重眼外伤的疗效。方法:分析我院自2005年以来收治的严重眼外伤患者38例38眼,其中钝挫伤5眼,眼球破裂伤27眼,眼内异物6眼,全部患者均经睫状体平坦部行闭合式巩膜三通道玻璃体切割术,其中全部联合行视网膜光凝术38眼,联合硅油填充术30眼,行C3F8注气术8眼,联合巩膜外环扎术15眼。结果:术后随访6mo～2a,38例患者眼球萎缩仅2例,视力无提高5例,其余31例术后视力均较术前提高,其中1例术前无光感,术后出现光感。结论:玻璃体切割术治疗严重眼外伤效果明显。     

Scleral buckling combined with internal cyclopexy for severe traumatic cyclodialysis cleft in open globe injuries

This study aimed to evaluate the effect of scleral buckling combined with internal cyclopexy on the treatment of severe traumatic cyclodialysis cleft in open globe injuries (OGIS). This retrospective study recruited 10 patients of 10 eyes. With our surgical intervention, all the 10 eyes achieved retinal and ciliary body anatomic re-attachment. The choroidal ruptures in nine eyes were closed with complete choroidal reattachment. Postoperative best-corrected visual acuity of nine eyes had various improvements. The mean intraocular pressure was increased from 8.9±2.6 mm Hg to 13.4±4.4 mm Hg. Eventually, six eyes underwent silicone oil (SO) removal without complications, two eyes still had SO tamponade and two eyes became SO-dependent eyes. The result shows that internal direct cyclopexy combined with scleral buckling is an effective treatment for severe traumatic cyclodialysis cleft in OGIS.     

人工晶状体眼伴有PVR C1以下孔源性视网膜脱离的手术方式选择

目的 观察比较巩膜扣带术（SB）和经睫状体平部玻璃体切除术（PPV）对伴有增生性玻璃体视网膜病变（PVR）C1级以下的孔源性视网膜脱离的人工晶状体眼的术后效果,并对该类患者的手术方式选择进行分析。设计 回顾性病例系列。研究对象 北京同仁医院南区就诊伴有PVR C1以下孔源性视网膜脱离的人工晶状体眼患者156例（156眼）。方法 回顾患者病历资料,按手术方式分为SB组（44眼）和PPV组（112眼）,记录两组患者的一般资料、眼别、视网膜脱离时间、视网膜裂孔数量及形态、PVR分期等,观察并比较两组术后6个月时视网膜解剖复位情况（首次手术复位率及最终复位率）、最佳矫正视力（BCVA）及二次手术的情况,并分析二次手术的原因。主要指标 视网膜脱离复位率、BCVA及二次手术情况。结果 术前SB组和PPV组在性别、眼别、视网膜脱离时间、视网膜裂孔数量及形态、PVR分期均无统计学差异（P均>0.05）。SB组和PPV组首次术后视网膜复位率分别为77.3%（34/44眼）和92.9%（104/112眼）（χ2=7.52,P=0.006）。视网膜未成功复位的患者均行二次玻璃体切除术,最终两组所有患眼视网膜全部复位（100%）。在SB组首次手术视网膜未复位的病例中,除1例为新发视网膜裂孔,其余患者视网膜裂孔均位于环扎嵴上,视网膜未复位的原因均与PVR进展相关。在PPV组,首次术后视网膜未复位的原因也与术后PVR相关。SB组手术前后的BCVA分别为1.1（0.70,1.80）和0.75（0.50,1.00）（P=0.003）;PPV组手术前后BCVA分别为1.9（1.53,1.90）和0.7（0.50,1.00）（P<0.001）。两组术后BCVA无统计学差异（P=0.35）。结论 对于人工晶状体眼PVR C1以下孔源性视网膜脱离,术后PVR是影响手术成功率的重要相关因素。尽管SB术可以取得较好的手术效果,但PPV术在视网膜复位率上优于SB术。（眼科,2023, 32： 192-196）     

Keratometric alterations following the 25‐gauge transconjunctival sutureless pars plana vitrectomy versus the conventional pars plana vitrectomy

Purpose: To assess the alterations in keratometric astigmatism following the 25‐gauge transconjunctival sutureless pars plana vitrectomy versus the conventional pars plana vitrectomy. Methods: Sixteen consecutive patients were enrolled into the study. Conventional vitrectomy was applied to eight of the cases and 25‐gauge transconjunctival sutureless vitrectomy was performed in eight patients. Keratometry was performed before and after the surgery. Results: In the 25‐gauge transconjunctival sutureless pars plana vitrectomy group, statistically significant changes were not observed in the corneal curvature in any post‐operative follow‐up measurement (p > 0.05); whereas in the conventional pars plana vitrectomy group, statistically significant changes were observed in the first postoperative day (p = 0.01) and first postoperative month (p = 0.03). We noted that these changes returned to baseline in three months (p = 0.26). Conclusion: Both 25‐gauge transconjunctival sutureless and conventional pars plana vitrectomy are effective surgical modalities for selected diseases of the posterior segment. Surgical procedures are critical for the visual rehabilitation of the patients. The post‐operative corneal astigmatism of the vitrectomised eyes can be accurately determined at least two months post‐operatively     

Late-onset Lens Particle Glaucoma as a Consequence of Posterior Capsule Rupture after Pars Plana Vitrectomy

 Purpose: To report the treatment of late-onset lens particle glaucoma associated with posterior capsule rupture during pars plana vitrectomy. Methods: Case report. Results: A 33-year-old man had severe pain and impaired vision in the left eye after vitrectomy, associated with white fleck-like particles circulating in the anterior chamber. The intraocular pressure (IOP) was 38 mmHg. The anterior lens capsule was intact, however, lens particle glaucoma was diagnosed by the slit-lamp examination, B-mode ultrasonography and ultrasound biomicroscopy (UBM). The lens material was removed by irrigation-aspiration after the patient remained face down for two hours to facilitate precipitation of the lens material from the vitreous into the anterior chamber. IOP after the procedure was 21 mmHg. Conclusion: Posterior lens capsule may be disrupted during vitrectomy. Although the anterior lens capsule is intact, lens particle glaucoma should be considered when IOP increases with particulate matter circulating in the anterior chamber. Surgical removal of this material may be sufficient to control IOP without the need for additional glaucoma surgery.     

Pars plana vitrectomy with posterior iris claw implantation for posteriorly dislocated nucleus and intraocular lens

We evaluated the safety and efficacy of pars plana vitrectomy (PPV) with primary posterior iris claw intraocular lens (IOL) implantation in cases of posterior dislocation of nucleus and IOL without capsular support. This was a retrospective interventional case series. Fifteen eyes underwent PPV with primary posterior iris claw IOL implantation performed by a single vitreoretinal surgeon. The main outcome measures were changes in best corrected visual acuity and anterior and posterior segment complications. A total of 15 eyes were included in this study. Eight had nucleus drop, three had IOL drop during cataract surgery and four had traumatic posterior dislocation of lens. The final postoperative best corrected visual acuity was 20/60 or better in 11 patients. This procedure is a viable option in achieving good functional visual acuity in eyes without capsular support.     

Pars plana vitrectomy with pars plana tube implantation in eyes with intractable glaucoma

AIMS—Intractable glaucoma is glaucoma resistant to medical therapy and conventional surgical procedures. In this study, a planned surgical technique is discussed for controlling the increased intraocular pressure in selected cases with intractable glaucoma.
METHODS—Total pars plana vitrectomy with pars plana tube implantation was performed in 17 eyes of 17 cases with intractable glaucoma. Patients with neovascular glaucoma were not included in this study. The mean age of these patients (seven men, 10 women) was 44.6 (SD 22.1) years and mean follow up period was 30.3 (15.5) months (range 4-71). Drainage implants with a disc were used in 16 cases, whereas, a tube with scleral buckle (Schocket surgery) was preferred in one case. An intraocular pressure below or equal to 20 mm Hg without any adjunctive medication or with only one type of antiglaucomatous drop was considered as an adequate operative outcome.
RESULTS—16 out of 17 eyes maintained adequate pressure control. Only three out of these 16 eyes required prophylactic antiglaucomatous medications. One patient underwent reoperation for pressure control. The most severe complications observed postoperatively were intravitreal haemorrhage (one case), choroidal detachment (one case), implant failure (one case), total retinal detachment (two cases), and corneal endothelial decompensation (five cases).
CONCLUSION—Pars plana placement of drainage tube following pars plana vitrectomy should be considered as an alternative method for controlling increased intraocular pressures in selected patients with intractable glaucoma.

Keywords: glaucoma; pars plana vitrectomy; pars plana tube implantation     

Clinical Features of Endophthalmitis after Vitreoretinal Surgery

Purpose: To investigate the rate, clinical features, treatment outcomes and prognosis ofpostvitrectomy endophthalmitis.Methods: Patients undergoing pars plana vitrectomy for vitreous opacity or complicatedretinal detachment during 1988 to 2000 were collected. Vitrectomies for recentpenetrating trauma or endophthalmitis were excluded. Patients suffered from clinical orculture-proven postvitrectomy endophthalmitis were selected.Results: Postvitrectomy endophthalmitis happened to 3 of 7 000 patients, resulting in anoverall frequency of 0. 04%. Enhanced systemic and local antibiotics were used assoon as diagnosis was made. Endophthamitis were controlled within 6 days, 8 days and10 days, respectively. Final visual acuities were light perception in 2 patients and0. 02 in 1 patient.Conclusion: Postvitrectomy endophthalmitis was rare, but it deteriorate the visualacuity. Both ophthalmologist and patients should pay high attention to it. Eye Science2003; 19: 39 - 43.     

Cataract Extraction after Vitrectomy

Cataract extractions were performed in 25 patients who had previously undergone pars plana vitrectomy. Posterior chamber IOLs were implanted in 20 of 26 eyes. Modification of the usual surgical technique was often necessary because the zonules and/or posterior capsule were unusually mobile. Lens opacities were nuclear sclerotic in 17 eyes (65%) and posterior subcapsular in nine eyes (35%). Visual acuity improved an average of five lines, and final visual acuity was 20/50 or better in 13 eyes (50%). Visual acuity after cataract extraction closely paralleled the best visual acuity after vitreous surgery in all patients. Complications were tears in the posterior capsule in two eyes and postoperative vitreous hemorrhage in one eye. These complications did not limit final vision.     

借助显微镜照明直视下单通道经睫状体平坦部玻璃体切割术治疗人工晶状体脱位

目的：描述一种显微镜照明直视下、经单通道睫状体平坦部行玻璃体切割术治疗人工晶状体全脱位至玻璃体腔的手术技术。

方法：收集2013年至今经超声乳化白内障摘除术后自发性人工晶状体(IOL)囊外脱位或IOL复合体脱位至玻璃体腔的病例。术后随访至6mo。本文详细描述了该手术技术,并回顾性总结了8例典型病例。

结果：共40例患者接受了该手术方法。与IOL全脱位至玻璃体腔相关的危险因素包括：玻璃体切除手术史、超声乳化术中后囊膜破裂或悬韧带断裂、既往眼部外伤史、长眼轴、Ⅱ期IOL植入、陈旧性葡萄膜炎、视网膜色素变性、或抗青光眼手术史。术中所有患者的IOL均顺利取出。随访期内未发生与手术步骤相关的术中或术后并发症。术前患者的最佳矫正视力(CDVA)位于20/133至20/25间,末次随访时(术后6mo)基本持平。眼压值均位于正常范围。

结论：显微镜照明直视下单通道玻璃体切割术是一种处理IOL脱位的相对简单、安全有效的手术方法,其能缩短手术时间,并大大减少手术相关并发症的发生。