28例取硅油病例的临床研究

２８例行硅油注入病例，由于硅油并发症的出现，行硅油取出术，平均取出时间为１１．８个月，其中有８只眼在硅油注入后视网膜再次脱离，有５只眼在取硅油时出现网脱，这些病例行再次视网膜复位术。另外１５只眼行单纯硅油取出术。本文对硅油注入后的并发症，硅油注入后复发视网膜脱离的原因以及硅油取出的时机和意义进行了讨论。     

28例取硅油病例的临床观察

２８例行硅油注入病例，由于硅油并发症的出发，行硅油取出术，平均取出时间为１１．８个月，其中有８只眼在硅油注入后视网再次脱离，有５只眼在取硅油出现网脱，这些病例行再次视网复位术。另外１５只眼行单纯硅取出术。本文地硅油注入后的并发症，硅油注入后复发视网膜脱离的以及硅油取出的时机和意义进行了讨论。     

视网膜脱离玻璃体切除及硅油注入术后并发症的临床观察

目的：探讨视网膜脱离玻璃体切除及硅油注入术后并发症的发生、发展，对术后视力恢复的影响及硅油取出后的转归。方法：对视网膜脱离玻璃体切除及硅油注入术后113例(116只眼)，94只眼行单纯硅油取出，其余的22只眼根据眼底情况分别处理后再取硅油。结果：经6～8个月(平均6．5个月)随访，109只眼视网膜复位良好，5只眼视网膜再脱离，2只眼失访。结论：视网膜脱离玻璃体切除硅油注入术后应及时随访复查，在视网膜复位最佳时间取出硅油可以减少术后并发症发生，及时准确处理好并发症，对保证术后视力的恢复有重要意义。     

急性视网膜坏死综合征的手术治疗

目的探讨双眼急性视网膜坏死综合征（ARNS）的手术时机、治疗方法及效果。方法回顾性分析9例双眼ARNS的诊治过程及预后。常规抗病毒联合糖皮质激素治疗,对病情未能控制者行玻璃体切除联合硅油充填术,后发眼早于首发眼手术干预。择期行硅油取出术。结果18眼中1眼药物治愈,1眼放弃治疗后全视网膜脱离,16眼行玻璃体切除联合硅油充填术。术后12眼视力较术前提高,双眼手术患者后发眼术后视力均好于首发眼;14眼视网膜平复,2眼周边部视网膜浅脱离。硅油充填术后3～12个月,16眼行硅油取出术,术中4眼出现局限性视网膜脱离,再次平复视网膜,术后视网膜复位良好。1眼在硅油取出后应用糖皮质激素导致病毒复发,给予抗病毒治疗后病情得到控制,随访期间未见复发。结论双眼ARNS后发眼应在早期进行手术干预,玻璃体切除术联合硅油充填可能是双眼ARNS手术治疗中最佳方案,治愈的ARNS应用糖皮质激素时应联合抗病毒治疗以防复发。     

硅油取出术42例临床分析

目的　观察视网膜脱离硅油取出术后效果及探讨硅油取出的最佳时机。方法　对 42例施行过玻璃体视钢膜手术及硅油填充眼 ,采用平坦部双切口等方法取出硅油。结果　术后视网膜保持复位 35只眼 (83% ) ,7只眼再脱离 ;术后视力 :0 .0 2以上 2 0只眼 (45 % ) ,其中 0 .1以上 6只眼。结论　硅油注入术后 ,如视网膜稳定复位 ,最佳取出硅油时机为 3～ 6个月 ,对可疑视网膜裂孔或发生新裂孔的病例 ,取出硅油前 1月左右行氩激光视网膜光凝。     

改进的23G硅油取出法治疗复杂性视网膜脱离硅油填充眼的临床观察

自1962年以来,硅油已被广泛应用于复杂性视网膜脱离的玻璃体切割手术[1].为了避免硅油长期填充引起的继发性青光眼、角膜变性等严重并发症,一般硅油注入术后3～6个月取出为佳[2],但对于复杂性视网膜脱离硅油取出的手术时机及安全性尚无明确的标准[3].本研究采用改进的23G硅油取出手术方法治疗复杂性视网膜脱离硅油填充眼,评价手术的安全性及有效性.     

硅油取出术31例

３１例（３２只眼）行硅油取出术，其取出时间平均为硅油注入术后１３．９个月。取出原因主要为白内障形成、青光眼、硅油乳化等，其中６只眼为视网膜复位稳定无并发症者。硅油取出后，２４只眼视膜在位；２４只眼视力≥０．０２；８只眼发生术后并发症，其中７只眼为复发性视网膜脱离，对硅油取出术的意义和时机进行了讨论。     

急性视网膜坏死综合征的玻璃体手术治疗

目的 研究急性视网膜坏死的玻璃体手术治疗的时机和疗效.方法 对13例(14只眼)伴有或将会发生视网膜脱离的ARN患者行玻璃体手术治疗.其中5只眼加行巩膜外加压或环扎术,3只眼行晶状体切除,4只眼行30～360度视网膜切开,10只眼注入硅油,2只眼注入C3F8.结果 随访3月至3年,术后有2只眼复发视网膜脱离,其中1只眼发生黄斑前膜、牵拉性视网膜脱离;另1只眼为取出硅油后出现视网膜裂孔、视网膜脱离.术后视网膜复位率为85.7%(12/14).术后6只眼(42.9%)视力有提高.结论 对于并发视网膜脱离或具有视网膜脱离危险因素的ARN患者行玻璃体手术疗效肯定,可保存和提高视功能.     

急性视网膜坏死综合征硅油填充术后硅油取出时机选择

目的观察急性视网膜坏死综合征(ARN)行玻璃体切除联合硅油填充术后硅油充填期间及硅油取出术后并发症,进而探讨硅油取出的适宜时机。方法对连续就诊的伴有视网膜脱离的48例(48只眼)ARN患者实施玻璃体切除视网膜复位联合硅油填充术,对于确认视网膜已经复位,没有活动性的增生病变及视网膜裂孔,并在视网膜变性区域补充激光光凝的所有患者经不同时长的硅油填充期后实施硅油取出术,回顾分析其硅油填充期间及硅油取出术后并发症如视网膜脱离、并发性白内障、继发性青光眼、角膜变性等的发生情况。结果硅油填充术后视力总体上较术前有明显提高;硅油填充时间为3~15个月,平均5.8个月。取出硅油之后,总体视力无明显改变;8例于取硅油术后随访期内发生视网膜再脱离;1例角膜变性的病例,在硅油取出之后无明显改变;5例并发性白内障取油时实施超声乳化联合人工晶状体植入术;6例发生脉络膜脱离经药物治疗后痊愈;24例在硅油取出之后晶状体混浊程度较硅油取出术前无明显改变;3例无晶状体眼患者取油术后裸眼视力下降,但最佳矫正视力同硅油取出术前。结论硅油填充及硅油取出术的并发症主要为视网膜再脱离、脉络膜脱离、并发性白内障、继发性青光眼、硅油乳化、角膜变性、低眼压等。对于ARN而言,硅油填充时限4~6月时取油术后视网膜再脱离的发生率较低,取油较为适宜。     

硅油取出术59例临床观察分析

目的:探讨硅油取出术临床应用对硅油填充及硅油取出的并发症、视网膜恢复情况及取油时机。方法:在显微镜下通过巩膜切口主动持续负压抽吸硅油。结果:患者59例62眼硅油填充眼取出硅油后,53眼视网膜复位,9眼视网膜未完全解剖复位,需进一步手术干预。结论:在视网膜复位3～6mo后,可行硅油取出术,可减轻硅油对眼的毒副作用及减少并发症,减少硅油取出术并发症,极少数为硅油依赖眼。     

硅油取出术中眼底检查的意义

目的 探讨硅油取出术中眼底检查的意义.方法 硅油取出术术中进行眼底检查者42例,观察术前、术后视力及视网膜复位情况.结果 手术前最佳矫正视力为光感～0.5,手术后最佳矫正视力为手动～1.0.34例(80.95％)由于术前合并增生性玻璃体视网膜病变(PVR)、瞳孔膜闭、并发性或后发性白内障、硅油乳化等情况,硅油取出术之前无法看清眼底,在硅油取出术术中进行眼底检查,并进行相应的处理.术后随访:32例(94.12％)视网膜复位良好,2例(5.88％)视网膜脱离复发;另外8例(19.05％,8/42)因视网膜复位不佳,术中行剥膜、激光、冷凝等处理,拟延期取硅油.本组硅油取出比例为80.95％.结论 术中对眼底进行全面的检查,可以得到明确的视网膜复位情况,有利于硅油填充眼视网膜的修复处理,降低再次玻璃体视网膜手术的比例.     

Silicone oil in the surgical treatment of retinal detachment--indications and clinical experience]

Silicone oil is being used with increased frequency for retinal tamponade during vitreous surgery for complicated retinal detachments. Though it is now possible to reattach most detached retinas, the visual outcome of the silicone oil procedure is often disappointing. This is due to the well known complications of silicone oil (i.e. cataract, glaucoma, corneal opacification), and the necessity to remove the silicone oil in a second surgical procedure with a certain risk of redetachment. Possible toxicity to retina and optic nerve has not yet get been completely evaluated. An alternative method is the use of expanding gases for internal retinal tamponade. Expanding gases are not as effective as silicone oil in advanced stages of proliferative vitreoretinopathy (PVR), but are afflicted with much less complications. We reviewed the charts of our patients, operated on for retinal detachment, to analyse the anatomical and functional results with silicone oil versus gas tamponade. Regarding the last 421 consecutive surgical procedures for retinal detachment (368 eyes), silicone oil has been used in 5%, expanding gases in 14%. The silicone oil procedure was restricted to the most advanced cases of PVR. The anatomic success rate with silicone was 72%, with gas tamponade 87%. Visual acuity of 0.05 and better achieved 19% of the eyes treated with silicone oil versus 61% of the eyes with gas tamponade. These results confirm the findings of other investigators: despite of the high anatomic success rate with silicone oil, the functional results are poor. Because many complicated cases of retinal detachment can also be treated successfully with gas tamponade, silicone oil should remain the last step in retinal detachment surgery.     

玻璃体视网膜手术治疗外伤性视网膜脱离合并增生性玻璃体视网膜病变的临床观察

目的：探讨玻璃体视网膜手术（ VRS）治疗合并增生性玻璃体视网膜病变（ PVR）的外伤性视网膜脱离（RD）患者的临床疗效。方法对2007年6月至2013年3月50例（51只眼）合并PVR的外伤性RD患者行VRS治疗,术后随访5～26个月,平均10．8个月。结果视网膜完全解剖复位47只眼,部分复位3只眼,未复位1只眼,总有效率98．4％。视力提高者41只眼（80．39％）;视力不变者7只眼（13．73％）,视力下降者4只眼（7.84％）。51只眼均行硅油填充术,继发性青光眼14只眼（27．45％）;8只眼因术后硅油进入前房行前房冲洗术（15．69％）;5只眼视网膜复位后Ⅱ期硅油取出术后低眼压或多次复发RD,长期硅油高粘度填充（9．80％）。结论通过VRS手术能有效解除外伤性PVR引起的视网膜牵拉,复位视网膜,提高视力。     

Prevention and control of proliferative vitreoretinopathy: primary retinal detachment surgery using silicone oil as a planned two-stage procedure in high-risk cases

AIMS: For rhegmatogenous retinal detachment, reattachment with a single procedure is associated with better visual outcomes. In the past, silicone oil has been used mostly as a last resort following failed primary surgery. This study evaluates a novel approach to patients at high risk of primary failure, using silicone tamponade as the primary stage of a planned two-stage procedure. METHODS: We report a series of 140 eyes that underwent primary surgery for rhegmatogenous retinal detachment. Patients at higher risk of surgical failure (eg giant retinal tear, inability to posture, poor view, uncertainty of location of primary break, primary proliferative vitreoretinopathy (PVR), multiple tears with rolled posterior edges, retinoschisis/detachment, staphyloma with macular hole) were managed by a planned staged procedure using primary silicone oil tamponade. This was followed by silicone removal at a later date. RESULTS: Fifty-four eyes underwent scleral buckling alone, with primary success in 52/54 (96%). Fifty-three eyes underwent vitrectomy and gas, achieving primary success in 50/53 (94%). Thirty-three eyes were classified high risk and managed with primary silicone. Silicone was safely removed in 22/25. In eight eyes, silicone was retained without attempt at removal. In total, primary retinal reattachment was achieved in 128 of 140 eyes (91.4%). Of these, 124 (97%) did not require long-term tamponade. Only four eyes (2.9%) developed PVR. DISCUSSION: A planned two-stage approach to highrisk cases of retinal detachment using primary silicone oil tamponade followed by silicone removal can achieve a high primary reattachment rate with less than 3% incidence of PVR.     

Retinal detachment after silicone oil removal

PURPOSE: To evaluate the causes of retinal detachment after silicone oil removal, to define possible risk factors and the anatomical and functional prognosis of this complication. METHODS: 112 eyes that underwent silicone oil removal were included. The group of eyes with retinal detachment after oil removal (18/112 eyes, 16.1%) was compared with the group with no postoperative retinal detachment. RESULTS: The most common cause for retinal detachment after oil removal was anterior PVR (77.8%). Initial PVR detachment, advanced PVR stages, anterior PVR, more preceding operations, aphakia/pseudophakia, myopia and shorter duration of the oil tamponade were significantly more represented in the group of eyes with retinal detachment after oil removal. The prognosis of retinal detachment after oil removal is poor. CONCLUSION: Some criteria could be regarded as risk factors for retinal detachment after silicone oil removal. Improvement of the results should be possible by considering these factors and by control of reproliferations.     

Silicone Oil Removal Strategies

Although it is widely accepted to use silicone oil in the treatment of very complex retinal detachments, there is no dafinite agreement on when and why silicone oil should be removed. Frequently found is a statement on the necessity of silicone oil removal after a certain period of time. However, the rate of retinal detachment after silicone oil removal varies widely and appears to correlate with the undedying disease process and its severity. The literature on strategies of silicone oil removal, the rate of complications, and, thus, the risk-benefit ratio is scant. Therefore, for the discussion of silicone oil removal we rely on personal experience and the rather rare studies on silicone oil removal. Regarding the data given in the literature, the rate of vitreoretinal complications after silicone oil removal, even in cases with a clinically stable-appearing retinal situation, is rather high in severe proliferative vitreoretinopathy (PVR) and lower in most advanced cases of severe proliferative diabetic retinopathy (PDR) requiring silicone oil tamponade. The benefits of silicone oil removal are better in cases of cytomegalovirus retinitis or other situations without a PVR component. Silicone oil removal has to be considered a procedure of ill-defined risks, especially if silicone oil is really used as a last therapeutic resort in most severe cases of complicated retinal detachment. Further, exact criteria for the timing and safe removal of silicone oil in these complex vitreoretinal disorders still needs to be defined. A strategy for the removal of silicone oil is discussed     

硅油依赖眼的临床特征

目的 探讨硅油依赖眼的成因和临床特征.方法 回顾性系列病例研究.收集2000年1月至2006年12月间312例(407只眼)行玻璃体切除术和硅油填充患者的临床资料.对其中24例(24只眼)玻璃体切除术后硅油依赖眼的成因、手术过程及预后等情况进行回顾性分析.结果 312例(407只眼)行玻璃体切除术和硅油填充患者中,发生硅油依赖眼24只眼(5.9%);其中17只眼硅油取出后,仍有玻璃体视网膜增生,或反复发生玻璃体出血和增生膜形成,进行C<,3F<,8填充后效果不佳,再行硅油填充;有3只眼因术中发现视网膜无法复位,而行硅油置换;另外4只眼行360°周边视网膜切除术,取出硅油后出现持续低眼压.随访结束时复查患者视力,眼前1尺数指至0.1有13只眼,眼前手动有9只眼,光感和无光感各1只眼.结论 硅油依赖眼发生率约为5.9%,多数发生在严重或反复出现玻璃体视网膜增生及360°周边视网膜切除的患者,其视力预后不佳.     

急性视网膜坏死综合征视网膜切开的疗效评价

目的　观察玻璃体切除视网膜切开术在急性视网膜坏死综合征 (acuteretinalnecrosissyndrome ,ARN)的临床疗效。方法　 12例急性视网膜坏死伴有增生性玻璃体视网膜病变 (proliferativevitreoretinopathy ,PVR)的视网膜脱离 ,使用常规的玻璃体切除术不能使视网膜得以复位 ,对坏死的视网膜及呈网状裂孔的视网膜进行 2 0°～ 3 60°切开并行全氟化碳液体填充、眼内激光光凝、硅油填充等治疗。结果　术毕 12例均取得视网膜解剖复位 ,其中 1例因继发性青光眼中途取出硅油而放弃治疗 ,10例 6～ 8月后取出硅油 ,随访 6月 8例视网膜完全复位 ,2例取硅油后视网膜脱离复发 ,1例因并发性白内障无法观察眼底情况。结论　视网膜切开术对急性视网膜坏死有一定的疗效。     

Preservation of anterior capsule during vitrectomy and lensectomy for retinal detachment with proliferative vitreoretinopathy

PURPOSE: To report a series of 15 eyes with rhegmatogenous retinal detachment and proliferative vitreoretinopathy (PVR) or at high risk for advanced PVR, which underwent pars plana vitrectomy (PPV) and lensectomy (PPL) with preservation of the anterior capsule. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Fifteen consecutive patients with retinal detachment and varying degrees of PVR in one eye. METHODS: All eyes had undergone PPV and PPL with preservation and polishing of the anterior capsule and had at least 6 months of follow-up. Of the 15 eyes, grade C PVR was present preoperatively in 11 and was anterior in 5. Seven of 15 eyes had gas and 8 of 15 had silicone oil tamponade. Eight of 15 eyes had subsequent posterior chamber intraocular lens (PCIOL) placement; 5 eyes had simultaneous silicone oil removal. One eye had a PCIOL placed at the time of the PPL. MAIN OUTCOME MEASURES: Visual acuity, retinal reattachment, complications of gas or silicone oil tamponade, and anterior capsular clarity. RESULTS: Fourteen eyes had complete retinal reattachment at the final visit (1 of 15 had macular redetachment only). Final visual acuity was better or equal to preoperative acuity in all eyes, improving by 4 +/- 4 lines overall. No eyes had corneal decompensation, pupillary block, or other vision-threatening anterior segment complication. The anterior capsule remained centrally clear in the 13 eyes that did not have a primary central capsulotomy. One eye with minimal preoperative PVR developed hypotony. CONCLUSIONS: Vitreoretinal surgeons can preserve the anterior capsule in eyes with retinal detachment and PVR to help prevent intraoperative and postoperative complications of gas or silicone oil, simplify future PCIOL placement, and maintain a normal iris appearance.