纤维蛋白胶封闭视网膜裂孔的动物实验研究

目的观察纤维蛋白胶封闭青紫蓝兔视网膜裂孔的可靠性。方法将30只青紫蓝兔随机分为实验组(15只)和对照组(15只)。分别对2组动物行玻璃体切除、视网膜造孔和视网膜下注液,建立孔源性视网膜脱离模型。模型建立1周后2组动物均行玻璃体切除、气-液交换,至视网膜平复,实验组裂孔范围内应用纤维蛋白胶,灌注液填充玻璃体;对照组裂孔周围行激光光凝,灌注液填充玻璃体。术后行眼底照相、B超、OCT检查及病理切片光镜检查。结果2组在术后第1周全身麻醉下进行检查时各有1只动物死亡,其余实验组3例视网膜仍处于脱离状态,11例视网膜复位;对照组10例视网膜处于脱离状态,4例视网膜复位。结论纤维蛋白胶可能是封闭视网膜裂孔的可靠手段。     

眼内激光光凝术在玻璃体切除手术中的应用

目的 探讨眼内激光在玻璃体切除术中的用途及有效性。方法 将眼内激光应用于18例22眼玻璃体手术中。眼内光凝的方式：广泛视网膜光凝术14眼；环形激光视网膜拦截并封闭视网膜裂孔2眼；局限性光凝1眼；原发性或医源性裂孔光凝4眼；视网膜切开处光凝1眼。结果 术后随访1～24月(平均9月)，2眼术后再次视网膜出血，其余20眼均达到视网膜平伏、裂孔封闭、视力不同程度提高。结论 眼内激光是现代玻璃体手术中重要的辅助措施，它的应用明显提高手术成功率。     

气液交换术联合激光光凝治疗玻璃体切除术后视网膜脱离

目的探讨气液交换术联合眼外激光光凝治疗玻璃体切除术后视网膜脱离的疗效。方法在玻璃体切除术后早期发现视网膜脱离者立即行气液交换,眼内注入20%C3F82-3 mL并置换出等量玻璃体腔液体,然后行多波长氪离子激光光凝术封闭裂孔。结果本组24例24眼中经1-3次光凝有21眼视网膜复位,占87.50%,3眼因裂孔处有牵拉,裂孔不能闭合再次行玻璃体切除术并注20%C3F8而复位。随访10-18个月,21眼中无1眼发生视网膜脱离。结论玻璃体切除术后早期视网膜脱离立即行气液交换术联合激光光凝治疗,具有疗效确定、方法简单、费用低等优点。     

眼内C3F8气体填充状态下视网膜裂孔的激光治疗

目的观察眼内C3F8气体填充状态下视网膜裂孔激光治疗的疗效。方法30例（30眼）视网膜玻璃体手术C3F8填充眼，术后观察封闭不良的原裂孔及新裂孔进行裂隙灯显微镜下激光光凝，术后1周内进行光凝者9例，2～3周后进行光凝者21例。激光参数：氪黄／氪绿，光斑100～200μm，时间0．2～0．3s，功率200～400mW，光凝裂孔3～4排，达到灰白色光凝斑。光凝1次者20例，2次者6例，3次者4例，光凝后随访4～20周，观察光斑色素、裂孔封闭及视网膜复位情况。结果本组30例中有25例裂孔封闭且气体消退后视网膜复位，占83．33％。3例因裂孔处有牵拉裂孔不能闭合、2例因眼内增生性病变引起非裂孔处视网膜脱离，该5例再次玻切手术并注硅油，4例视网膜复位。并发症主要为光凝过度引起的网膜出血2例，均自行吸收。结论眼内C3F8气体填充状态下视网膜裂孔的早期激光治疗能取得良好效果。     

巨大裂孔视网膜脱离手术的探讨

目的探讨玻璃体视网膜手术治疗巨大裂孔视网膜脱离的手术方法和效果。方法巨大裂孔视网膜脱离11例（11眼）。其中10眼行闭合式三通道玻璃体切除联合巩膜扣带术和眼内视网膜光凝,另1眼未做巩膜扣带。6眼手术中采用全氟化碳液（重水）-硅油置换,硅油眼内填充;5眼为气体-液体交换,硅油填充。结果 11眼手术后视网膜均完全复位。随访观察中视网膜复位良好,2眼已取出硅油。但其中1眼取出油后又发生了视网膜脱离,并出现新裂孔,又做了硅油填充术。2眼发生继发性青光眼,2眼发生了并发性白内障,其中1眼已做了白内障手术。未发生全氟化碳液（重水）眼内残留或角膜变性等并发症。结论玻璃体切除术联合巩膜扣带、硅油眼内填充、视网膜激光光凝能有效治疗有巨大裂孔的视网膜脱离。     

下班体术后连续气体充填治疗视网膜巨大裂孔

目的 观察玻璃体切割联合术后眼内连续气-液交换术治疗巨大视网膜裂孔的临床效果。方法 采用玻璃体切割、巩膜宽环扎和眼内光凝或眼冷凝,治疗23例巨大视网膜裂孔,PVR-B-D1级。术后反复行徒手眼内气-液交换术,连续延长有效气体充填,19眼行晶状体切除。结果 气体完全消失3mo后,21眼视网膜复位,2眼失败。视功能在0.02以上18眼,主要并发症高眼压。结论 连续延长眼内气体充填可良好的封闭巨大视网膜裂孔,不影响术后激光治疗。优点：充填的时间和量更具有可控性,并发症少且易控制,无需再次手术取出。     

全氟癸烷液体在超过180°裂孔性视网膜脱离手术中应用

为评价全氟癸烷液体联合眼内氩激光光凝在超过１８０°巨大裂孔性视网膜脱离手术中的应用效果。采用环扎、玻璃体切除、膜剥离，部份病人联合视网膜切开或切除，术中注入全氟癸烷液体（Ｃ１０Ｆ１８），压平视网膜，展平视网膜瓣，同时应用眼内氩激光封闭视网膜裂孔，眼内充填硅油。共治疗了１０例１０眼巨大裂孔性视网膜脱离，其中裂孔超过１８０°者７眼，超过２７０°者３眼，经９～２３个月随访，９眼完全复位，１眼部份复位。术后最佳视力≥００５者５眼（５／１０）。全氟癸烷在玻璃体手术中的应用，治疗超过１８０°巨大裂孔性视网膜脱离，具有操作简便，并发症少，手术成功率高，平复视网膜后瓣，驱赶视网膜下液，便于进行增殖膜清除，以及直视下眼内氩激光封闭裂孔，不必于后极部做视网膜切开放液等优点。视网膜活动度恢复良好者，全氟癸烷注入量可超过裂孔缘，使其恢复原位。眼内注入全氟癸烷液体后宜采用硅油重水交换方式，充填硅油。     

玻璃体切割治疗复杂视网膜脱离45例临床分析

目的：分析玻璃体切割术治疗复杂性视网膜脱离的效果。方法：对45例45眼复杂性视网膜脱离眼行闭合式玻璃体切割术,术毕玻璃体腔行C3F8气体或硅油填充。结果：玻璃体切割联合玻璃体腔注气术15眼,1次手术视网膜复位13眼（87%）;玻璃体切割联合玻璃体腔内硅油填充术30眼,1次手术完全复位27眼（90%）。统计学检验两组1次手术视网膜复位率的差异无显著意义。术后视力：数指/眼前者2眼,0.02～0.05者3眼,0.06～0.1者10眼,0.12～0.25者19眼,≥0.3者11眼。术中常见的并发症有医源性视网膜裂孔,术后并发症最多见是继发性青光眼和白内障。结论：玻璃体切割联合眼内填充能有效地治疗复杂性视网膜脱离,术后大部分患者视力能得到改善。     

眼内激光在玻璃体手术中的应用

目的论证眼内激光在玻璃体切除术中的用途及有效性。方法将眼内激光应用于４０例（４５只眼）玻璃体手术中。玻璃体切除术的适应证：玻璃体积血３１只眼（增殖性糖尿病视网膜病变１３只眼，Ｅａｌｅｓ病１３只眼，视网膜静脉阻塞４只眼及巩膜穿孔伤、球内异物取出术后１只眼）；复杂性视网膜脱离１２只眼；眼内非磁性异物和球内异物取出术后各１只眼。眼内光凝的方式包括全视网膜光凝７只眼；局限性光凝２２只眼；原发性或医源性裂孔光凝１４只眼；视网膜切开处光凝２只眼及环扎带形成的环形嵴上光凝３只眼。结果仅６只眼在封闭视网膜裂孔时因气－液交换不彻底而致光凝点反应不明显。术后随访２～１８个月（平均９个月），５只眼术后发生视网膜脱离。结论眼内激光是现代玻璃体手术不可缺少的重要工具，它的应用明显减少了手术并发症。     

国产猪源纤维蛋白黏合剂玻璃体腔注射后对兔眼视网膜组织的生物安全性研究

背景 猪源纤维蛋白黏合剂已广泛应用于临床手术中,能够起到止血和闭合伤口的作用.目前眼科学者认为猪源纤维蛋白黏合剂在玻璃体切割术中可替代长效气体或硅油作为填充物,但国产猪源纤维蛋白黏合剂是否对视网膜有毒性作用仍在研究中. 目的 研究国产猪源纤维蛋白黏合剂在眼内应用后对视网膜组织的生物安全性. 方法 15只青紫兰兔任选一眼作为实验眼,对侧眼作为对照眼.兔眼行玻璃体切割术,实验眼术毕于玻璃体腔内注射猪源纤维蛋白胶0.5 ml,对照眼注射等量平衡盐溶液.术后1、3、7、15、30 d用裂隙灯及直接/间接检眼镜检查眼前后节的炎症反应,术后1、3、7d用Schi(o)tz眼压计测量眼压,分别于术前和术后30 d进行视网膜电图(ERG)检查,评估视网膜的功能变化,术后30 d行眼科B型超声检查.玻璃体腔内注射后第30天摘除眼球并制备视网膜切片,光学显微镜下检查视网膜的组织形态学变化,透射电子显微镜下观察视网膜的超微结构变化. 结果 实验组15只兔眼中出现并发症者7只眼,其中晶状体损伤后发生白内障者3只眼,术后增生性玻璃体病变和视网膜脱离者5只眼,眼内炎者1只眼.对照组15只兔眼晶状体损伤后发生白内障者2只眼,术中发生视网膜损伤者2只眼.眼内注射后30d实验组未出现并发症的8只眼及对照组的11只眼均未见明显的眼内炎症反应,术后眼压均正常,2个组间及手术前后各时间点间的眼压变化差异均无统计学意义(F分组=0.008,P=0.929;F时间=3.600,P=0.075).实验组及对照组间兔眼注药前后ERG a波、b波振幅的总体差异均无统计学意义(a波:F分组=0.728,P=0.405;b波:F分组=0.222,P=0.644);各组兔眼手术前后ERG a波、b波振幅的总体差异均无统计学意义(a波:F时间=0.516,P=0.482;b波:F时间=0.057,P=0.814).眼内注射后30 d,实验眼和对照眼视网膜组织层次清晰,无水肿及阳性细胞浸润,各层视网膜的细胞及视网膜光感受器、视网膜色素上皮的色素细胞形态均正常,亚细胞器结构清晰,细胞膜和核膜完整,线粒体嵴排列整齐. 结论 国产猪源纤维蛋白黏合剂玻璃体腔注射后对兔眼视网膜无毒性作用.     

羊膜匀浆治疗实验性孔源性视网膜脱离

目的 观察和探讨羊膜匀浆在封闭视网膜裂孔中的作用及其机制。方法 40只新西兰白兔随机分为A、B、 C、D 4组，其中A、C为治疗组，B、D为对照组，每组各10只兔。每只兔随机取1只眼进行实验。经扁平部玻璃体切割，视网膜造孔，人为造成视网膜脱离，气液交换。治疗组裂孔表面滴加0.1 ml羊膜匀浆，而对照组滴加0.1 ml磷酸盐缓冲液(PBS)；术毕视网膜复位，20% SF6眼内填充。A、B组于手术后14 d处死动物，C、D组于手术后28 d处死动物，进行光学显微镜、电子显微镜和免疫组织化学染色检查。结果 手术后14 d，A组视网膜复位6只眼，占60%，B组视网膜复位2只眼，占20%（P=0.021）。手术后28 d，C组视网膜复位8只眼，占80%， D组视网膜复位3只眼，占30%(P=0.046)。各组之间视网膜复位的比例比较，差异有统计学意义(P＜0.05)。治疗组手术后出现轻度前节炎症反应，经局部应用糖皮质激素后炎症于3～5 d消退。光学显微镜检查结果显示，治疗组应用羊膜后在视网膜裂孔边缘有多层成纤维细胞样细胞增生，与其下脉络膜和视网膜色素上皮细胞发生粘连。对照组视网膜裂孔边缘细胞增生明显减少，视网膜不能和脉络膜形成粘连。电子显微镜检查与光学显微镜检查结果一致。成纤维细胞样细胞免疫组织化学染色显示胶质纤维酸性蛋白 （GFAP）阳性，提示裂孔边缘增生细胞主要是视网膜胶质细胞。结论 羊膜匀浆有助于封闭视网膜裂孔，通过刺激裂孔边缘视网膜胶质细胞增生，促进视网膜脱离复位。     

Extended retinal tamponade in the treatment of retinal detachment with proliferative vitreoretinopathy.

We have used intraocular sulphur hexafluoride or liquid silicone as an adjunct to vitreous surgery in the treatment of a non-randomised sequential series of 19 eyes with retinal detachment complicated by proliferative vitreoretinopathy. We have studied the surgical results and complications of these two tamponades and drawn preliminary conclusions on their use in retinal reattachment surgery. After a seven-month minimum follow-up 13 (68%) of the eyes have reattached retinas. Six (60%) of 10 eyes treated only with silicone have reattached retinas, and four (67%) of six eyes treated only with sulphur hexafluoride gas tamponade have reattached retinas. An additional three eyes treated initially with silicone oil subsequently developed retinal detachments; all were successfully reattached with sulphur hexafluoride tamponade after silicone oil removal. Intraoperative pneumatic retinal reattachment to assess relief of retinal traction combined with the production of widespread chorioretinal adhesions to wall off persistent anterior traction and detachment, as well as extended postoperative gas tamponade of the retina, appears to enhance the surgical results in retinal detachment complicated by proliferative vitreoretinopathy. Silicone oil tamponade of the retina appears to be useful in cases where retinal traction cannot be entirely relieved and in patients who are unable to tolerate the head positioning required for effective gas tamponade of the retina. A controlled clinical study recently begun will be required to define further the precise role of these methods of retinal tamponade.     

玻璃体内空气填充治疗黄斑裂孔性视网膜脱离的远期疗效观察

目的评价玻璃体内空气填充治疗黄斑裂孔性视网膜脱离的远期疗效及适应症。方法单纯性黄斑裂孔者仅行玻璃体内空气注入；合并其他部位裂孔者，先采用常规凝固方法将这些裂孔封闭，再行玻璃体内空气注入。以单针法行气液交换，空气注入量不少于１．５毫升。结果出院时，９２．９％病例术后解剖学复位，７８眼随访６月～８年，８眼复发，复发率１０．３％。结论绝大部分黄斑裂孔性视网膜脱离病例（约９０％）行玻璃体内空气注入能获治愈。     

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。     

Intraocular Use of Hydrogel Tissue Adhesive in Rabbit Eyes

Purpose

To evaluate the safety and efficacy of newly developed hydrogel glue to treat rhegmatogenous retinal detachments in in vitro and in vivo studies.

Methods

In the in vitro study, the solid hydrogel glue was soaked in a balanced salt solution (BSS). The pH was measured periodically, and the dissolution time was recorded. In the in vivo study in six albino rabbits, 0.1?ml of hydrogel glue was injected into the right vitreous cavity, and 0.1?ml BSS was injected into the left vitreous, as the control. Clinical, electroretinography (ERG) and histological examinations were performed. Retinal detachment with a retinal hole was created in 12 albino rabbits after vitrectomy. After fluid–air exchange, the hydrogel glue was applied to the hole in nine rabbits; three other rabbits were used as controls. Clinical and histological examinations were performed.

Results

The pH ranged from 6.65 to 8.14. The glue remained solid in BSS for 7 weeks. The glue injection did not induce inflammation. There was no significant difference between the study and control eyes in the ERG amplitude or the implicit times of the a and b waves. No significant histological abnormality was detected. The retina was reattached with glue in three of nine eyes. The histological examination showed glue under the retina.

Conclusions

Hydrogel glue, which seemed to be minimally toxic to the eye, can be used to patch retinal breaks. However, methods to mix a small amount of each solution completely and a more effective intraocular delivery system for the glue are needed.?Jpn J Ophthalmol 2007;51:89–95 © Japanese Ophthalmological Society 2007

     

The management of subretinal gas following attempted pneumatic retinal reattachment

Pneumatic retinopexy is a recently described procedure for treating retinal detachments with cryotherapy and intraocular gas injection, rather than scleral buckling. Prospective studies are underway to assess its safety and efficacy. One potential complication of this technique is persistent detachment due to subretinal gas. We report seven cases of subretinal gas following attempted pneumatic retinal reattachment. In all cases, multiple fish-egg gas bubbles were present following injection; some of these bubbles gained access to the subretinal space during the early postoperative period. The subretinal gas gave the detached retina a pearly, dome-shaped, refractive sheen. Three cases were managed by positioning the patients' heads to allow the subretinal gas to pass through the retinal break back into the vitreous cavity. One case underwent successful scleral buckling that closed the retinal break despite the presence of a small subretinal gas bubble. Three cases required vitrectomy, air-fluid exchange, and cryotherapy or endolaser treatment. In five of the seven eyes the retina was eventually reattached successfully.     

Experimental Study of Effect of Perfluorohexyloctane to Retina

Objective:To investigate the effect of perfluorohexyloctane to the retina of rabbit eyes.Methods:Perfluoroh-exyloctane(experimental group)or BSS(control group)into vitreous cavities of fifteen vitrectomized New Zealand white rabbits.A slit-lamp biomicroscope and an indirect ophthalmoscope were used to examine all the eyes pre-and postoperation Histopathological examination was performed after the rabbits were sacrificed.Results:Perfluorohexyloctane was injected into the vitreous cavity foming a single large clear globe.No retinal detachment and cataract were foun.The edema of outer plexiform layer was significant.and then get thin,inner nuclear layer and ganglion cell bodies had a darker cytoplasm and nucleoplasm.Conclusions:Perfluorohexyloctane in vitreous cavity had significant side effects on retina As a silicone Solvent,it should be removed out completly after injection We don‘t recommend to use it as a new intraocular temponade.     

松弛性视网膜切开术治疗视网膜脱离合并严重前增殖性玻璃体视网膜病变

目的探讨松弛性周边视网膜切开术联合眼内激光治疗视网膜脱离合并严重前增殖性玻璃体视网膜病变的效果。方法对４４例视网膜脱离合并严重前增殖性玻璃体视网膜病变的患者行松弛性周边视网膜切开术，联合眼内激光和硅油填充治疗。观察术后视网膜解剖复位、视功能及术后眼压变化情况。其中２２例取出了硅油。结果４４例全部获得视网膜复位（其中８例合并皱褶），３８例获得不同程度的视力改善。２２例取出硅油后，有２１例视网膜保持复位。部分患者术后眼压偏低。１例患者黄斑移位。结论松弛性周边视网膜切开术是治疗严重前增殖性玻璃体视网膜病变的有效方法之一。视网膜下膜的清除有利于视网膜展平复位。部分患者出现术后眼压偏低和黄斑移位现象，因此应严格掌握手术适应证，术中尽可能避免黄斑移位，同时应在视网膜复位、眼压正常时再取出硅油。