姜黄素防治兔眼增生性玻璃体视网膜病变的实验研究

背景先前的系列研究表明,姜黄素可以诱导体外培养的兔视网膜色素上皮（RPE）细胞凋亡,抑制其RPE细胞的增生,且在玻璃体内应用后不良反应较小,具有防治增生性玻璃体视网膜病变（PVR）的潜在价值。目的探讨姜黄素玻璃体内注射对RPE细胞诱导的兔眼PVR模型的防治效果。方法新西兰白兔20只40只眼,所有兔眼玻璃体注射前先抽取0．2ml玻璃体液,然后在兔眼玻璃体内注射0．1ml（2×10^6）同种RPE细胞,每只兔随机选取1只眼立即注入1mg／L的姜黄素0．1ml作为姜黄素组（20只眼）,对侧眼注入等量的含质量分数0．5‰DMSO的生理盐水作为对照组（20只眼）。注药后1、3、7、14、21、28d裂隙灯显微镜下观察角膜、房水、晶状体的透明度及眼前节炎症反应情况;使用间接检眼镜、眼底彩色照相和B型超声检查玻璃体视网膜情况。以视网膜脱离发生眼数作为检测指标,评价姜黄素对PVR的防治效果。结果玻璃体注药后1d、3d所有兔眼发生眼前节炎症反应,玻璃体轻中度混浊,但未见增生条带及视网膜脱离。玻璃体注药后7d,所有兔眼前节炎症反应基本消退,对照组14只眼（75％）玻璃体出现增生条带,姜黄素组2只眼（10％）玻璃体内出现增生条带,差异有统计学意义（P〈0．01）,但2组均未见视网膜脱离。注药后14d,对照组11只眼（55％）出现视网膜脱离,姜黄素组2只眼（10％）出现视网膜脱离,差异有统计学意义（P〈0．01）;注药后21d,对照组16只眼（80％）出现视网膜脱离,姜黄素组3只眼（15％）出现视网膜脱离;注药后28d,对照组19只眼（95％）出现视网膜脱离,姜黄素组3只眼（15％）出现视网膜脱离,差异有统计学意义（P〈0．01）。结论姜黄素玻璃体腔内注射可以有效预防RPE细胞诱导的兔眼实验性PVR的发生发展。     

急性视网膜坏死的手术治疗

目的研究玻璃体手术治疗急性视网膜坏死（ａｃｕｔｅｒｅｔｉｎａｌｎｅｃｒｏｓｉｓ,ＡＲＮ）的疗效。方法对１７例（２０只眼）伴有或即将发生视网膜脱离的ＡＲＮ患者进行手术治疗。共有１８只眼行玻璃体手术,其中１５只眼加行巩膜外加压或环扎术;７只眼行晶体摘除术,７只眼行３０°～３６０°视网膜切开,１只眼球内注入Ｃ３Ｆ８,１２只眼注入硅油。９只眼在术后５～７个月取出硅油。２只眼行单纯巩膜外手术,均为３６０°冷凝、环扎、外加压。结果随访期５个月至５年,手术２０只眼中有２只眼因术中脉络膜上腔出血而致眼球萎缩,１只眼在取硅油后因复发视网膜脱离而致眼球萎缩,余均维持有用视力;其中８只眼视力优于００２,３只眼视力优于０２。结论视网膜脱离是急性视网膜坏死的严重并发症,通过适时的玻璃体视网膜手术可以显著改善其预后     

复杂性视网膜脱离术中应用过氟化碳的临床疗效分析

目的 分析过氟化碳液体在玻璃体切除术中的治疗效果,以提高复杂性视网膜脱离的治愈率。方法 分析复杂性视网膜脱离７６只眼在玻璃体切除术中应用过氟化碳液体的临床效果及并发症,对合并 严重增殖性玻璃体视网膜病变（ＰＶＲ）的视网膜脱离５４只眼及巨大裂孔视网膜脱离１１只眼的术后复位率及术后视力分别进行统计。结果 ７６只眼中,术后视网膜复位７０只眼（９２．１％）;术后视力〉０．０２者６９只眼（９０．８％）,其中     

眼内异物摘出术后视网膜脱离

目的 报告并分析眼内异物摘出术后视网膜脱离发生率及有关病因。方法 眼内异物２０例（２０眼）,用玻璃体切除术摘出眼内异物。结果 ２０眼中术后视网膜脱离４眼（２０％）。术后视力提高１４眼（７０％）,视力不变３眼（１５％）,视力下降３眼（１５％）。结论 眼内异物摘出术后视网膜脱离发生原因：⑴残留玻璃体形成牵拉;⑵激光封闭裂孔不确切;⑶术中未发现的小裂孔;⑷术前玻璃体积血浑浊未能及时激光治疗;⑸异物较大,     

外伤性玻璃体出血视网膜脱离术后并发症临床分析

目的：分析玻璃体切割与视网膜脱离术后并发症的发生原因和预防措施。方法：对33例（33只眼）外伤性玻璃体出血合并视网膜脱离进行了玻璃体切割与视网膜复位术。结果：术后暂时性眼压升高33只眼（100％），角膜内皮皱褶30只眼（90％），玻璃体出血3只眼（0．09％）；视力最低手动／20cm，最高0．4。结论：玻璃体切割与视网膜脱离复位术并发症的预防与处理是保证手术效果的关键。     

玻璃体切割术治疗黄斑裂孔视网膜脱离

用玻璃体切割术治疗黄斑裂孔视网膜脱离６４只眼，其中伴重度增殖性玻璃体视网膜病变者２０只眼，另有１８只眼查见玻璃体黄斑部牵引。视网膜复位５７只眼（８９．１％），复位眼中视力增进者４３只眼、未变者１３只眼、下降者１只眼。影响手术成功的主要因素是重度ＰＶＲ、高度近视、后巩膜葡萄肿、视网膜脱离的范围以及病程时间。     

简易兔视网膜脱离模型制作方法的改进及探讨

目的对简易兔视网膜脱离模型制作方法进行改进。方法对12只(24眼)中国大白兔,均施行兔的视网膜脱离形成手术,从麻醉、玻璃体的取出到手术操作方法进行改进,并观察其自然复位情况。结果经改进后,玻璃体可取出0.8～1.2mL。24只兔眼均发生完全性视网膜脱离,玻璃体出血1眼,视网膜下出血2眼;造模后7d,9眼后极部复位,但周边部仍然脱离,其他眼呈浅脱离状态;14d,所有兔眼后极部视网膜平伏,但周边部,尤其裂孔周围,仍见视网膜脱离。结论经过改进后,减少了晶状体混浊的发生。通过更多的去除玻璃体,能够更长时间的维持视网膜脱离状态。     

复杂性孔源性视网膜脱离的玻璃体视网膜手术失败原因初步探讨

目的探讨复杂性孔源性视网膜脱离的玻璃体视网膜手术失败原因。方法对４７７例（４７９只眼）复杂性孔源性视网膜脱离采用玻璃体视网膜手术（ｖｉｔｒｅｏｒｅｔｉｎａｌｓｕｒｇｅｒｙ,ＶＲ术）,即玻璃体切除、膜剥离、气液交换、惰性气体（ＳＦ６,Ｃ３Ｆ８）及硅油眼内填充。结果近期有效者３４７例（３４９只眼,７２．９％）,失败者１３０例（１３０只眼,２７．１％）。结论多因素逐步回归分析显示影响ＶＲ术近期效果的显著因素为眼内填充硅油、巨大裂孔、眼内填充ＳＦ６、医源性裂孔、前部增殖性玻璃体视网膜病变（ｐｒｏｌｉｆｅｒａｔｉｖｅｖｉｔｒｅｏｒｅｔｉｎｏｐａｔｈｙ,ＰＶＲ）、严重视网膜下增殖、ＰＶＲ、眼内填充Ｃ３Ｆ８、手术频次及脉络膜脱离     

急性玻璃体后脱离眼的激光扫描检眼镜检查

目的探讨对急性玻璃体后脱离眼进行详细眼底检查的必要性并评价欧堡全景200激光扫描检眼镜在其眼底病变检查中的应用价值。方法对我院329例（329只眼）玻璃体后脱离患者进行欧堡全景200激光扫描检眼镜与三面镜检查,统计眼底病变的发生率并对两种检查方法的结果进行比较。结果 329例（329只眼）受检患者中,三面镜检出有临床意义的眼底病变59只眼（17.9%）,其中视网膜裂孔34只眼（10.33%）,裂孔性视网膜脱离4只眼（1.22%）,视网膜格子样变性21只眼（7.9%）,视网膜出血18只眼（5.47%）。全景200激光扫描检眼镜对眼底病变的检查结果与三面镜检查结果无差异。结论急性玻璃体后脱离眼进行详细眼底检查是非常必要的,欧堡全景200激光扫描检眼镜为玻璃体后脱离患者眼底疾病的筛查提供了一条简便、高效的方法。     

玻璃体硅油置换术后对视网膜及ERG影响的实验研究

探讨玻璃体硅油置换术后对眼底和视网膜电流图（ＥＧＲ）的影响。将实验动物兔２０只４０眼随机分实验组和对照组，分别行玻璃硅油置换术和玻璃体林格氏液置换术。术前术后不同时期分别行眼底玻璃体观察和ＥＲＧ及视网膜组织学检查。结果：实验组玻璃体视网膜增殖及视网膜脱离的发生率明显低于对照组。对照组ＥＲＧａ、ｂ波幅值降低与临床观察表现一致，而实验组ＥＲＧａ、ｂ波幅值下降和临床表现呈背离关系。组织学检查硅油对视网膜未见毒性反应。结论：硅油可以替代玻璃体并可减少玻璃体增殖和视网膜脱离的发生率。硅油置换术后的ＥＲＧ不能客观反映视网膜功能。     

孔源性视网膜脱离后视网膜新生血管的实验研究

目的：观察孔源性视网膜脱离（RRD）后新生血管的形成及形态学改变。方法：采用玻璃体手术制备25只眼RRD模型，排除失败的5只眼后，将20只眼分为5组，每组4只兔（眼）。分别在RRD第1，4，7，14和28天，观察新生血管的形态学改变。结果：RRD1和4天，未见新生血管。7天可见视备用新生血管。14天眼底荧光造影可见新生血管末梢渗漏。但主干枝无渗漏。14-28天，以视盘为中心的新生血管范围逐渐扩大，部分新生血管已发育成熟。虹膜无新生血管形成。结论：随着RRD时间的延长，视网膜新生血管范围逐渐扩大，并逐渐发育成熟，新生血管是一种视网膜缺氧的代偿性反应。     

Incidence of rhegmatogenous retinal detachment after vitrectomy in eyes of diabetic patients

PURPOSE: To assess the incidence of rhegmatogenous retinal detachment (RRD) after pars plana vitrectomy (PPV) among diabetic patients with complications of proliferative diabetic retinopathy. METHODS: Ninety-three eyes of diabetic patients-who underwent PPV with or without intraocular gas tamponade for complications of proliferative diabetic retinopathy-were reviewed retrospectively. Indication for vitrectomy was vitreous hemorrhage in 80 patients (86.1%), tractional retinal detachment in 3 (3.2%), and vitreous hemorrhage associated with tractional retinal detachment in 10 (10.7%). RESULTS: Four (4.3%) of 93 eyes developed an RRD after vitrectomy. The primary reason for vitrectomy was recurrent or nonresolving vitreous hemorrhage. The retina was attached with one additional surgical procedure in two of these eyes; the other two had to undergo a third operation before attachment was achieved. CONCLUSION: RRD occurs in a small percentage of patients after PPV with or without gas tamponade for vitreous hemorrhage or tractional retinal detachment caused by proliferative diabetic retinopathy. Thorough postoperative follow-up is important to make early diagnosis and intervention possible.     

Late onset vitreoretinal complications of regressed retinopathy of prematurity

AIM: To report the clinical findings, management, and outcomes in eyes undergoing surgery for regressed retinopathy of prematurity (ROP) with vitreoretinal complications. METHOD: Retrospective review of 40 eyes of 32 patients with regressed ROP who presented between 1989 and 2001 at two UK referral centres. RESULTS: Of 29 eyes presenting with rhegmatogenous retinal detachment (RRD), 15 initially underwent a scleral buckling procedure and 14 initially underwent vitrectomy with or without additional buckling. Primary surgery was anatomically successful in 11/15 eyes that underwent a non-vitrectomy retinal detachment repair and 8/14 that required vitrectomy. The final reattachment rate after reoperation was 28/29 eyes. Median visual acuity improved from 6/60 to 6/36 following retinal detachment repair. A further 11 eyes of eight patients from this series underwent prophylactic surgery, laser, or cryotherapy for predisposing vitreoretinal pathology and/or retinal breaks, all of which were stabilised. CONCLUSIONS: In eyes with RRD and signs of regressed ROP successful reattachment of the retina can be achieved using either vitrectomy or external surgery with an associated overall improvement in visual acuity. A range of external and closed microsurgical approaches is required to effectively deal with the diverse manifestations of regressed ROP.     

Primary vitrectomy for combined rhegmatogenous retinal detachment and choroidal detachment with or without oral corticosteroids: a pilot study

PURPOSE: The occurrence of choroidal detachment (CD) in eyes with primary rhegmatogenous retinal detachment (RRD) is relatively uncommon (2%-4.5%). Recent reports suggest that primary vitrectomy yields better anatomic success than scleral buckling. However, for these inflamed eyes with low intraocular pressure, the influence of preoperative oral steroids on reattachment rates has not been elucidated yet. METHODS: Twenty eyes with combined RRD and CD that underwent primary vitrectomy were randomized to receive oral steroids (for 1 week) or no oral steroids before surgery. RESULTS: Preoperative clinical data such as mean age, lens status, Snellen visual acuity, duration of macular detachment, CD (size and extent), and retinal detachment characteristics (e.g., extent, number of retinal breaks, atrophic or tractional retinal break, size of retinal break, and location of retinal break) were similarly distributed in both groups. Single-operation anatomic success was 81.8% (9/11) among those patients who received preoperative oral steroids and was 66.7% (6/9) among those who did not receive preoperative oral steroids. After reoperation, anatomic success was 100% in both groups. The mean follow-up was 20.1 months. CONCLUSION: The results suggest that administration of oral steroids before primary vitrectomy in eyes with combined RRD and CD improves reattachment rates.     

Silicone oil tamponade in 23-gauge transconjunctival sutureless vitrectomy

PURPOSE: To describe 20 consecutive patients treated with 23-gauge transconjunctival sutureless vitrectomy and silicone oil tamponade for retinal detachments (RD) of different etiologies. METHODS: Prospective case series. Twenty patients with complex retinal detachment were submitted to a primary 23-gauge transconjunctival pars plana vitrectomy: rhegmatogenous retinal detachment with proliferative vitreoretinopathy (RRD + PVR) in 7 cases, diabetic tractional retinal detachment (DTRD) in 5 cases, giant retinal tear (GRT) in 2 cases, RRD with multiple tears in 2 cases, GRT + uveitis in 1 case, RRD + uveitis in 1 case, DTRD + RRD in 1 case, and RRD + PVR with intraocular foreign body (IOFB) in 1 case. Length of postoperative follow up ranged from 3 to 14 months. RESULTS: Final visual acuity ranged from 20/25 to hand motion. Postoperatively, none of the 20 eyes had hypotony or leakage of silicone oil through the sclerotomies. Seventeen out of 20 (85%) had improved vision. CONCLUSION: Silicone oil tamponade was demonstrated to be a feasible option in conjunction with 23-g transconjunctival sutureless vitrectomy to treat complex retinal detachment.     

玻璃体切除联合曲安奈德玻璃体腔注射治疗孔源性视网膜脱离

目的 探讨玻璃体切除联合曲安奈德(TA)玻璃体腔内注射治疗合并脉络膜脱离的孔源性视网膜脱离的临床疗效和安全性.方法 观察采用玻璃体切除联合曲安奈德玻璃体腔内注射治疗合并脉络膜脱离的孔源性视网膜脱离15例患者(15眼),术后不再全身应用糖皮质激素,仅给予激素眼液点眼.结果 术后随访时间6～30个月,平均(19±9.5)个月.一次手术视网膜复位率100%.术后3个月硅油取出后,2例视网膜脱离复发,1例再次剥膜充填硅油后视网膜复位;另1例放弃治疗.视网膜总复位率为93.3%(14/15).术后并发症包括:4例术后眼压升高,均局部用药控制,5例出现晶状体后囊下皮质局限性混浊.结论 玻璃体切除联合(TA)玻璃体腔内注射治疗合并脉络膜脱离的孔源性视网膜脱离,可以明显减轻术后葡萄膜炎症反应,从而减少PVR的发生,显著提高手术的成功率.     

Increased glutamate levels in the vitreous of patients with retinal detachment

Experimental models have implicated glutamate in the irreversible damage to retinal cells following retinal detachment. In this retrospective study we investigated a possible role for glutamate and other amino acid neurotransmitters during clinical rhegmatogenous retinal detachment (RRD). Undiluted vitreous samples were obtained from 176 patients undergoing pars plana vitrectomy. The study group consisted of 114 patients (114 eyes) with a rhegmatogenous retinal detachment. Controls included 52 eyes with an idiopathic macular hole or idiopathic epiretinal membrane and 10 eyes with a traction retinal detachment due to proliferative diabetic retinopathy. Vitreous concentrations of glutamate, gamma-aminobutyric acid (GABA), taurine, glycine, and aspartate were determined by high-pressure liquid chromatography (HPLC). Multivariate analysis was used to examine a possible association between amino acid neurotransmitter levels and several clinical variables including visual acuity. The mean vitreous concentration of glutamate in eyes with a rhegmatogenous retinal detachment (16.6 +/- 5.6 microM) was significantly higher as compared to the controls (13.1 +/- 5.2 microM) (P = 0.001). Taurine levels were also increased in RRD, whereas no significant difference could be observed in glycine, aspartate and GABA levels when comparing RRD with controls. A correlation was found between increased vitreous glutamate and a lower pre-operative visual acuity. No association was, however, observed between post-operative visual acuity and the level of any of the five amino acid neurotransmitters. RRD was associated with a significantly increased vitreous glutamate concentration. Using visual acuity as a functional parameter in this study, we could not demonstrate a correlation between vitreous glutamate, or any of the other tested amino acid neurotransmitters and visual outcome.     

高度近视黄斑裂孔性视网膜脱离合并脉络膜脱离的相关因素分析

目的 探讨高度近视黄斑裂孔性视网膜脱离合并脉络膜脱离的相关危险因素,总结其临床特点及治疗方法.方法 连续收集合并脉络膜脱离的高度近视黄斑裂孔性视网膜脱离的病例10例(A组),并以同一时期不伴脉络膜脱离的高度近视黄斑裂孔性视网膜脱离病例12例为对照(B组),对比两组发病年龄、病程、术前屈光度、眼轴、眼压、视网膜脱离范围以及术后视网膜复位、视功能恢复等情况.结果 A组发病年龄大、近视度数高、眼压低、视网膜脱离范围大,与B组相比差异有统计学意义(P<0.05),其中眼压差异显著(P<0.01);两组的一次玻璃体切割手术视网膜复位率相近,A组为80%,B组为83%,但A组术后视力≥0.02的比例低(P=0.048).结论 高度近视黄斑裂孑L性视网膜脱离一旦合并脉络膜脱离常伴有年龄大、病程长、近视度数高、视网膜脱离广泛和显著低眼压等特点.适时采用玻璃体切割合并硅油填充术可达到与不合并脉络膜脱离组相近的视网膜复位率,但视力预后仍较差.     

Primary vitrectomy for rhegmatogenous retinal detachment associated with choroidal detachment

Objective

This study aimed to report the success rate of primary vitrectomy, scleral buckling, and oral steroids in eyes with combined rhegmatogenous retinal detachment (RRD) and choroidal detachment (CD) and to compare these results with those reported in the literature for similar cases managed by scleral buckling alone.

Design

Consecutive case series.

Participants

Twenty-one eyes of 21 consecutive patients with primary RRD associated with CD were examined.

Intervention

All patients were treated with systemic corticosteroids before surgery. Pars plana vitrectomy with scleral buckling or encircling or both were performed.

Main outcome measures

Retinal reattachment rate and resolution of choroidal detachment were measured.

Results

At mean follow-up of 11.4 months, retinal reattachment was attained in 19 eyes (90.5%) compared to less than 53% reported in the literature for scleral buckling alone. With preoperative oral steroids, choroidal detachment regressed completely in 13 eyes (61.9%). In the remaining eyes with persistent choroidal detachment, suprachoroidal fluid was drained during vitrectomy.

Conclusion

Aggressive treatment with oral steroids followed by pars plana vitrectomy and scleral buckling or encircling is recommended instead of scleral buckling alone in the management of combined primary rhegmatogenous retinal detachment and choroidal detachment.     

巩膜环扎术是否必须?——玻璃体视网膜手术方法的探讨

目的探讨巩膜环扎带对玻璃体手术治疗孔源性视网膜脱离(RRD)治愈率及视力预后的影响。方法回顾分析有随访纪录的以玻璃体手术治疗的孔源性视网膜脱离140例(140眼)(除去黄斑孔),按是否做巩膜环扎术分为环扎组和非环扎组。比较环扎组与非环扎组在不同增生型玻璃体视网膜病变(PVR)分级及裂孔不同位置的复位率以及两组术后视力的改善情况。结果环扎组79眼,视网膜完全复位67眼,复位率84.81%。非环扎组61眼视网膜完全复位52眼,复位率85.25%。非环扎组视网膜解剖复位率略高于环扎组,但差异无统计学意义(P>0.05)。两组在不同PVR级别以及裂孔不同位置的视网膜复位率相比差异无统计学意义(P>0.05)。术后视力改善者,环扎组63眼占79.75%;非环扎组49眼占80.33%,两组间差别无统计学意义(P>0.05)。结论有玻璃体手术指征的RRD提高玻璃体视网膜手术成功率的关键是彻底松解视网膜固定皱襞及裂孔周围的牵引,彻底地封闭所有视网膜裂孔及有效的眼内填充,巩膜环扎术并非必须。