92例双眼裂孔源性视网膜脱离临床分析

分析双眼裂孔源性视网膜脱离的临床特点。方法 :对 92例双眼裂孔源性视网膜脱离发病率 ,玻璃体病变 ,屈光状态 ,视网膜裂孔形态、数目、分布 ,膜分级 ,手术方法及治疗结果进行分析。结果 :双眼裂孔源性视网膜脱离发病率为 12 5 4% ,双眼视网膜脱离患者中 6 9 5 7%为 30岁以内青少年 ,92例双眼视网膜脱离中 81例为近视眼 ,双眼视网膜脱离之裂孔形态以圆孔为主 ,在数量、分布上双眼高度对称 ,手术成功率与膜分级关系密切。结论 :提示近视是双眼裂孔源性视网膜脱离发生的重要因素 ,强调对青少年视网膜脱离双眼检查及定期随访的必要性。     

92例双眼裂孔源性网视膜脱离临床分析

目的：分析双眼裂孔源性视网膜脱离的临床特点。方法：对92例双眼裂孔源性视网膜脱离发病率，玻璃体病变，屈光状态，视网膜裂孔形态、数目、分布，膜分级，手术方法及治疗结果进行分析。结果：双眼裂孔源性视网膜脱离发病率为12.54%，双眼视网膜脱离患者中69.57%和30岁以内青少年，92例双眼视网膜脱离中81例为近视眼，双眼视网膜脱离之裂孔形态以圆孔为主，在数量、分布上双眼高度对称，手术成功率与膜分级关系密切。结论：提示近视是双眼裂孔源性视网膜脱离发生的重要因素，强调对青少年视网膜脱离双眼检查及定期随访的必要性。     

孔源性视网膜脱离术后黄斑裂孔形成的原因分析

目的 探讨孔源性视网膜脱离术后黄斑裂孔形成的原因.方法 回顾性分析2017年10月至2019年12月武汉大学人民医院东院眼科所有孔源性视网膜脱离手术患者的临床资料,筛选术后发生黄斑裂孔的患者,结合光学相干断层扫描(OCT)检查结果分析黄斑裂孔形成的原因.结果 本研究共纳入孔源性视网膜脱离手术患者409例(423眼),其...     

氩激光治疗视网膜裂孔的疗效分析

目的 评估氩激光治疗视网膜裂孔的疗效及影响因素。方法 视网膜干性裂孔292例,局限性视网膜脱离伴裂孔113例,对接受氩激光治疗的患者进行性别、年龄、近视屈光度及裂孔类型比较,以分析不同类型视网膜裂孔患者的氩激光疗效。结果 氩激光视网膜干性裂孔疗效显著;对局限性视网膜脱离伴裂孔的疗效取决于视网膜脱离的范围、程度以及裂孔的部位大小形状及近视屈光度;性别不影响光凝疗效。结论 视网膜干性裂孔应尽早光凝治疗,大于2PD的孔源性视网膜脱离不宜激光治疗。     

激光联合双眼包扎或戴小孔镜治疗孔源性视网膜脱离临床观察

自1920年Gonin开始,封闭视网膜裂孔一直是孔源性视网膜脱离的治疗原则。目前,除复杂性视网膜脱离外,孔源性视网膜脱离的主要治疗方法是巩膜扣带术。我科2000～2001年利用810-激光联合双眼包扎或戴小孔镜及合适的体位治疗15例孔源性视网膜脱离患者,效果满意,现报     

视网膜脱离患者对侧眼的特征

“苏格兰视网膜脱离研究”组近期在Br J Ophthalmol杂志上发表了一篇关于1 130例孔源性视网膜脱离患者对侧眼特征的研究报道。孔源性视网膜脱离（rhegmatogenous retinal detachment, RRD）是严重威胁视力的疾病,常有双眼视网膜病理性改变。以往研究证明,因多存在视网膜变性、裂孔等危险因素,视网膜脱离患者对侧眼发生RRD的风险明显增加。然而,目前关于原发性RRD对侧眼病理改变特征的大样本流行病学研究较少。作者的此项研究旨在观察RRD患眼对侧眼的疾病倾向和临床特征。“苏格兰视网膜脱离研究”是为期2年的人群为基础的前瞻性流行病学研究,以所有苏格兰人群原发性RRD患者为研究对象。原发性RRD由一位玻璃体视网膜专家通过双目间接检眼镜检查后得出诊断,所有RRD患眼视网膜下液范围 >2个视盘直径（PD）,术前或术中确认存在视网膜全层裂孔。记录所有患眼及对侧眼是否存在玻璃体后脱离（PVD）、眼部或头部外伤史、视网膜裂孔及变性等信息。该研究共收集原发性RRD患者1 202例,随访超过2年且对侧眼临床资料齐全者占94%（1 130例）。所有患者按是否存在PVD以及视网膜裂孔类型进行分组。存在PVD的990例（876%）患者中,985%（975例）发现单发或多发马蹄孔,其中15% 存在巨大裂孔。而未发生PVD的140例（124%）患者中,40%存在圆孔,478%存在视网膜筛状孔,121%可见视网膜劈裂。研究发现,84%（95 /1 130例）的患者对侧眼存在全层视网膜裂孔。在患眼已发生PVD的990眼的对侧眼中,85%存在着视网膜裂孔,其中894%为与PVD相关的视网膜裂孔,而另106%为圆孔,无PVD。而RRD患眼未发生PVD的140例患者中,发现10例（71%）对侧眼全层视网膜裂孔,其中7例为圆孔。所有1 130例患者中,RRD患眼、对侧眼视网膜格子样变性者分别占187%、 145%。而在RRD患眼存在视网膜格子样变性的211例患者中,616%的对侧眼同样可见格子样变性。视网膜格子样变性最常见于因圆孔而导致视网膜脱离患者的对侧眼中（329%）。13%（148/1 130例）的患者对侧眼最佳矫正视力≤6/18,后者常伴有陈旧性视网膜脱离。73%（88/1 202例）的患者存在双眼RRD,仅15%患者（18/1 130）双眼RRD同时被发现,其余多先后发生,两眼间RRD发病的中位数间隔时间为38年（18~64年）。双眼RRD患者与单眼RRD患者相比,年龄、性别及眼部症状之间无统计学差异,但双眼RRD患者较少主诉中心视力降低,究其原因,约60%的双眼视网膜脱离患者黄斑区未脱离,而单眼RRD患者黄斑区未脱离者仅442%（P<00001）。综上所述,视网膜脱离患者对侧眼孔源性病理改变发生的危险性较大,约84%的患者对侧眼存在全层视网膜裂孔,73%的患者双眼RRD,严重威胁视力及生存质量。13%的患者对侧眼最佳矫正视力≤6/18,其中约20%为RRD所致。     

孔源性视网膜脱离对侧眼的观察及治疗

目的 探讨孔源性视网膜脱离患者对侧眼检查的重要性及其激光治疗效果.方法 回顾性分析本院2004年1月至2006年11月170例孔源性视网膜脱离惠者的病例资料及治疗情况.结果 170例患者中对侧眼具有格子样变性者103例,双眼变性区基本对称88例,其中对侧有裂孔者34例,伴局限性视网膜浅脱离者9例;97例行激光视网膜凝固,6例行巩膜外垫压冷凝术,随访3-6个月,有12例补充激光凝固,无再发视网膜脱离情况.结论 孔源性视网膜脱离患者对侧眼检查极其重要,多数具有对称性病变,给予早期预防性治疗,能有效的预防孔源性视网膜脱离的发生.     

老年人孔源性视网膜脱离手术临床分析

目的 探讨老年孔源性视网膜脱离的临床特点。方法 对62例（62眼）60岁以上老年人孔源性视网膜脱离手术临床资料进行了回顾性分析。结果 近视占72.58%，其中高度近视54.84%。裂孔形态以马蹄形居多，占60.22%，玻璃体后脱离占70.96%。61例1次手术成功占82.26%。7例2次手术成功占11.29%。结论 老年视网膜脱离的裂孔以马蹄形居多，高度近视及玻璃体后脱离与老年孔源性视网膜脱离关系密切，手术成功率与患者年龄，全身情况关系不大，严重的PVR是未愈的主要原因。     

简单孔源性视网膜脱离外路手术后视网膜再脱离原因分析

目的:分析简单孔源性视网膜脱离外路显微手术后视网膜再脱离的主要原因,根据这些原因采取有效的预防措施,提高手术的成功率。方法:对15例15眼简单孔源性视网膜脱离外路显微手术后视网膜再脱离的患者进行分析,查找视网膜再脱离的主要原因。所有视网膜再脱离患者增生性玻璃体视网膜病变(PVR)≤B级。结果:术后随访1a,简单孔源性视网膜脱离外路显微手术后视网膜再脱离15例15眼患者中,出现新裂孔7眼(46.7%);原裂孔未能封闭4眼(26.7%);遗漏裂孔2眼(13.3%);脉络膜脱落1眼(6.7%);PVR1眼(6.7%)。结论:简单孔源性视网膜脱离外路显微手术后视网膜再脱离的主要原因为:出现新裂孔、原裂孔未能封闭、遗漏裂孔。     

脉络膜脱离型视网膜脱离的临床研究

目的分析脉络膜脱离型视网膜脱离的临床特点。方法连续选择具有典型临床症状的脉络膜脱离型视网膜脱离患者61例61眼，与同期行玻璃体切割手术的非脉络膜脱离型孔源性视网膜脱离患者52例53眼进行对比研究，观察二者眼部体征及手术复位率等情况，并分析脉络膜脱离型视网膜脱离的好发因素。结果脉络膜脱离型视网膜脱离患者的眼前节反应重，眼压低（平均4mmHg），与一般孔源性视网膜脱离患者相比差异有统计学意义（P〈0．01）；采用玻璃体切割手术，前者的一次性手术复位率为65．51％，后者为88．68％，二者差异有统计学意义；脉络膜脱离型视网膜脱离组中年龄50岁以上及屈光度-6D以上的患者占总例数的50％以上，27．87％的患者合并有黄斑裂孔。结论脉络膜脱离伴视网膜脱离具有严重的葡萄膜炎和低眼压症状，老年人和高度近视者好发，多合并有黄斑裂孔，其手术复位率显著低于一般孔源性视网膜脱离者。     

Simultaneous bilateral rhegmatogenous retinal detachment. 7 case studies

PURPOSE: Simultaneous bilateral rhegmatogenous retinal detachments are rare. The purpose of our study was to examine the incidence, predictive factors, surgical results and prognosis of these retinal detachments. PATIENTS AND METHODS: A retrospective analysis of the medical records of 468 consecutive patients, 7-89 years of age (mean, 45.7 years), undergoing surgery for rhegmatogenous retinal detachment between 1993 and 2000. RESULTS: During this period, a total of 497 operations for rhegmatogenous retinal detachment were done. Thirty-two patients had bilateral rhegmatogenous retinal detachment. Simultaneous detachments were observed in seven patients (1.5%). In four cases, the diagnosis of retinal detachment was fortuitous. In fact, most patients presented with unilateral symptoms. The mean age (35 years) of patients suffering from simultaneous bilateral rhegmatogenous retinal detachment was younger than that of patients with unilateral or consecutive bilateral retinal detachments. Five patients were myopic. Multiple round retinal holes were the most frequent lesions responsible for retinal detachment. A preoperative proliferative vitreoretinopathy was found in 57% of cases. The retina was reattached in nine cases (81%). CONCLUSION: Simultaneous bilateral rhegmatogenous retinal detachment is usually found in relatively young myopic patients with atrophic retinal holes. They are rare but severe because of their frequent association with preoperative proliferative vitreoretinopathy.     

Simultaneous, bilateral rhegmatogenous retinal detachment

PURPOSE: To examine the incidence, the preoperative findings and the surgical outcome of patients presenting with simultaneous, bilateral retinal detachment. METHODS: A retrospective analysis of the medical records of patients undergoing surgery for rhegmatogenous retinal detachment between 1990 and 1998. RESULTS: During this period a total of 827 operations for rhegmatogenous retinal detachment were done in 791 consecutive patients. Eighteen patients (2.3%) had simultaneous, bilateral retinal detachment, giving an annual incidence of 0.35 patients per 100,000 population. They all presented with unilateral symptoms. Compared with the group of unilateral or consecutive, bilateral retinal detachments, patients suffering from simultaneous, bilateral retinal detachments were significantly younger, with a mean age of 40.3 years. Thirteen patients had multiple, round retinal holes associated with lattice degeneration. Sixteen patients were myopic, ranging from -3 to -9.25 diopters. The retina was reattached in 35 (97%) of the 36 eyes operated on during the study period. CONCLUSION: Simultaneous, bilateral retinal detachment is usually found in relatively young, myopic patients with round, atrophic retinal holes, presenting with unilateral visual symptoms.     

北京市城区及近郊区孔源性视网膜脱离发病情况调查

目的：调查北京市城区及近郊区孔源性视网膜脱离（retinal detachment,RD）发病情况及分布特点。方法：由35所北京市有条件诊断和治疗孔源性RD的各级医院及北京大学保健流行病学研究室组成的协作组,采用前瞻性设计的新发患者登记方法收集病例资料,对北京市城区和近郊区1999年10月至2000年9月间在其医院初诊的孔源性RD患者（包括门诊和住院患者）进行调查。以1999年12月国家统计局分布的人口资料数据为基数,对孔源性RD的年发病率、年龄、性别、季节分布特征及屈光状态等进行分析。结果：北京市城区和近郊区1999年10月至2000年9月孔源性RD年发病率为7．98／10万[95％可信区间（confidence interval,CI)：7．3－8．7]。其中外伤眼孔源性RD年发病率为0．93／10万（95％CI：0．7－1．2）,无晶状体或人工晶状体眼孔源性RD患者年发病率为0．80／10万（95％CI：0．6－1．0）,无外伤史有晶状体眼孔源性RD患者发病率为6．25／10万（95％CI：5．7－6．9）。外伤眼孔源性RD年发病率,男性为1．55／10万（95％CI：1．1－2．0）,女性为0．30／10万（95％CI：0．1－0．5）,男性高于女性。各年龄段孔源性RD患者发病率不同,其发病率高峰分别为20－29岁和60－69岁。无季节性差异（0．8＜P＜0．9）。无眼别差异（P＞0．05）。约5．82％为双眼孔源性RD,其中高度近视所占比例高于单眼孔源性RD（χ^2=5.73,0.01＜P＜0．02）。结论：北京市城区和近郊区1999年10月至2000年9月孔源性RD年发病率为7．98／10万（95％CI:7．3－8．7％）。     

首选玻璃体手术治疗脉络膜脱离型视网膜脱离的疗效分析

目的评估首选玻璃体手术治疗无明显PVR的脉络膜脱离型视网膜脱离的疗效。方法选取32例(32只眼)脉络膜脱离型视网膜脱离,PVR低于C1,常规应用糖皮质激素同时尽快采用玻璃体手术,放脉络膜上腔积液,硅油填充或膨胀性气体填充,并酌情联合巩膜扣带术。所有病例术后随访3个月以上。结果黄斑裂孔者17例,27例无PVD,一次手术复位率为87．5％(28/32),有2例2或3次手术成功,余下2例失败。结论对无明显PVR的脉络膜脱离型视网膜脱离首选玻璃体手术,有利于减少PVR的发生和提高手术复位率。     

Asymptomatic rhegmatogenous retinal detachment

The vast majority of patients with rhegmatogenous retinal detachments present with either acute or chronic symptoms. In these cases repair of the retinal detachment is almost always recommended to either improve vision or prevent further visual loss. In a small subgroup, rhegmatogenous retinal detachments were detected as incidental findings in asymptomatic patients. Such asymptomatic detachments are often caused by atrophic holes in lattice degeneration and are more commonly located in the inferior quadrants. Demarcation lines are often present. Asymptomatic retinal detachments also occur in a younger age group of patients when compared with symptomatic rhegmatogenous retinal detachments. The management of eyes with an asymptomatic retinal detachment is controversial. The risk of complications during surgical repair must be weighed against the chance that the retinal detachment will progress. Recently published clinical data suggest that the risk of progression of asymptomatic rhegmatogenous retinal detachments is small. Consequently, observation can be considered as a reasonable management option in reliable patients until progression is documented or symptoms occur. Patient education geared toward instruction on self-monitoring of the visual field and a review of the risks and benefits of retinal detachment repair versus observation are important in patients with asymptomatic retinal detachment.     

Clinical features and surgical management of retinal detachment secondary to round retinal holes

AIMS: The majority of rhegmatogenous retinal detachments result from pathological posterior vitreous detachment (PVD) and secondary horseshoe or giant retinal tears. Retinal detachment without PVD is usually associated with either retinal dialysis or round retinal holes. This study characterises the features, surgical outcome, and incidence of bilateral involvement of detachment associated with round retinal holes. METHODS: In all, 110 retinal detachments from 96 consecutive patients with retinal detachment secondary to round retinal holes were studied. Analysis of patient age, sex, refraction, preoperative visual acuity, presented symptoms, position and extent of detachment, number and distribution of holes present, posterior hyaloid membrane status, surgical management, outcome of surgery, and postoperative visual acuity were studied. RESULTS: The mean age for patients was 34 years with a marked female preponderance (64%) and myopia (83%). The posterior hyaloid membrane remained attached in 95 eyes (86%). In all, 45% patients had bilateral pathology, of which 33% had 'mirror image' distribution. Detachments were predominantly shallow (93%) and slow in progression (17%). A total of 100 detachments were repaired with cryotherapy and scleral buckling, eight with cryotherapy alone, and one with laser retinopexy. In all, 99% detachments were successfully reattached with a single procedure. The mean follow-up period was 2 years. There were no instances of redetachment. CONCLUSIONS: Round hole detachments are slowly evolving detachments with attached vitreous gel in young, predominantly female myopes. Examination of the fellow eye should be mandatory as there is a high incidence of bilateral pathology. Scleral buckling procedures remained highly effective in this selected group of patients.     

Bilateral Rhegmatogenous Retinal Detachment during External Beam Radiotherapy

Herein, we report a case of nontraumatic bilateral rhegmatogenous retinal detachment (RRD) during external beam radiotherapy for nonocular tumor, presented as an observational case study in conjunction with a review of the relevant literature. A 65-year-old male was referred to our hospital due to bilateral RRD. He underwent a biopsy for a tumor of the left frontal lobe 4 months prior to presentation, and the tumor had been diagnosed as primary central nerve system B-cell type lymphoma. He received chemotherapy and external beam radiotherapy for 1 month. There were no traumatic episodes. Bilateral retinal detachment occurred during a series of radiotherapies. Simultaneous nontraumatic bilateral retinal detachment is rare. The effects of radiotherapy on ocular functionality, particularly in cases involving retinal adhesion and vitreous contraction, may include RRD. Thus, it is necessary to closely monitor the eyes of patients undergoing radiotherapy, particularly those undergoing surgery for retinal detachment and those with a history of photocoagulation for retinal tears, a relevant family history, or risk factors known to be associated with RRD.     

脉络膜脱离型视网膜脱离的手术疗效分析

目的　探讨脉络膜脱离型视网膜脱离的手术疗效。方法　回顾 2 0 0 0年 10月～ 2 0 0 1年 10月间 ,本院收治的 12例 (12只眼 )脉络膜脱离型视网膜脱离的临床资料 ,分析手术方式、术前激素的治疗、PVR等因素与手术疗效的关系。结果　 15 9例 (92 % )本组 12只眼随访 3～ 6个月 ,10只眼治愈 ,2只眼复发。治愈率为 83.3% ,低于一般孔源性视网膜脱离的治愈率。结论　脉络膜脱离型视网膜脱离是一种复杂性视网膜脱离 ,PVR发展快 ,术前应及时给予激素治疗 ,PVRA、B级及部分 C1 级可行巩膜扣带术 ,术中尽量不放视网膜下液 ,PVR部分 C1～ 3、D级应行玻璃体切除术     

Lattice degeneration of the retina and the pigment dispersion syndrome.

Retinal detachment occurs more frequently in patients with pigment dispersion syndrome. We evaluated the incidence of peripheral retinal abnormalities known to predispose to rhegmatogenous retinal detachment in a consecutive series of 60 patients with pigment dispersion syndrome with or without glaucoma. Lattice degeneration was present in at least one eye of 12 patients (20%). Seven patients had bilateral lesions. Full-thickness retinal breaks were found in seven patients (11.7%) and two patients (3.3%) had asymptomatic rhegmatogenous retinal detachments that required scleral buckle procedures. The incidence of lattice degeneration and full-thickness retinal breaks appears to be increased in this group of patients, and may be responsible for the increased risk of rhegmatogenous detachment.