改进后巩膜加固术治疗黄斑裂孔性视网膜脱离

改进后巩膜加固术治疗黄斑裂孔性视网膜脱离空军郑州医院眼科刘德成，王惠珍黄斑裂孔性视网膜脱离的手术方法较多，但由于黄斑位置及功能上的特点致手术操作不便，其效果亦不一。我们于１９９２年５月至１９９４年４月对９例９只眼黄斑裂孔性视网膜脱离改用后巩膜加固术治...     

高度近视黄斑裂孔视网膜脱离的玻璃体手术和激光光凝治疗

目的探讨高度近视黄斑裂孔视网膜脱离患者玻璃体手术联合激光光凝治疗的成功率及并发症。方法高度近视黄斑裂孔视网膜脱离患者３５例３８只眼，１１例１２只眼单行经睫状体平部的玻璃体手术及惰性气体眼内填充，未作激光光凝治疗；２４例２６只眼在玻璃体手术术中及术后作黄斑裂孔缘激光光凝。术后均作６个月以上的随访（平均随访时间２１．７个月）。结果非光凝组５只眼黄斑裂孔性视网膜脱离复发，占４１．７％，术后０．１以上视力６只眼，占５０．０％；光凝组２只眼黄斑裂孔复发，占７．７％，１只眼因周边新裂孔形成而复发视网膜脱离，术后有１３只眼视力在０．１以上，占５０．０％。统计学检验两组黄斑裂孔复发率概率Ｐ＝０．０２４，视网膜脱离复发率概率Ｐ＝０．０４８７。两组患者术后视力无显著差异。结论玻璃体手术联合黄斑区激光光凝治疗可提高高度近视黄斑裂孔视网膜脱离的手术成功率。     

复发性黄斑裂孔性视网膜脱离的内境界膜剥离术

目的 探讨高度近视眼后巩膜葡萄肿患者复发性黄斑裂孔性视网膜脱离，采用吲哚青绿染色的内境界膜剥离术手术结果。方法 2000年2月～2003年4月间，一次性手术后复发的伴有高度近视后巩膜葡萄肿的黄斑裂孔性视网膜脱离患者26例(26只眼)，经玻璃体切除、吲哚青绿染色后施行裂孔周围全周内境界膜剥离术。结果 平均随访观察6．7个月，22只眼视网膜解剖复位，4只眼再次手术注入硅油复位。黄斑裂孔19只眼术后消失，视力提高者16只眼，不变者7只眼，下降者3只眼。结论 吲哚青绿染色下的内境界膜剥离术对于复发性黄斑裂孔性视网膜脱离是有效的治疗手段。     

黄斑裂孔性视网膜脱离手术效果分析

目的：探讨黄斑裂孔性视网膜脱离手术的效果。方法：于29例（30只眼）黄斑裂孔性视网膜脱离病人治疗中,采用冷凝联合巩膜外垫压或环扎、玻璃体腔注气,部分病例采用玻璃体切除联合硅油填充。结果：经随访观察4-12个月,手术后视网膜复位28只眼（93.3%),未复位2只眼（6.7%)。结论：对黄斑裂孔性视网膜脱离,根据具体病情,采用不同的手术方法进行治疗,可获得成功。     

高度近视黄斑裂孔性视网膜脱离玻璃体手术治疗分析

目的探讨玻璃体视网膜手术治疗高度近视黄斑裂孔性视网膜脱离的效果。方法对27例(27只眼)高度近视黄斑裂孔性视网膜脱离患者采用玻璃体切除联合惰性气体或硅油填充术,术后随访时间3个月~24个月,平均10个月。结果27只眼中惰性气体填充22只眼,硅油填充5只眼,初次手术视网膜复位成功24只眼(24/27),成功率88.9%。3只眼视网膜脱离复发,2只眼再次手术。所有视网膜复位成功患者的视力均有不同程度提高。术后主要并发症有晶状体后囊混浊及继发性青光眼。结论玻璃体视网膜手术是治疗高度近视黄斑裂孔性视网膜脱离安全有效的手术方法。     

巩膜环扎术联合玻璃体腔注气治疗黄斑裂孔性视网膜脱离疗效观察

目的：评价巩膜环扎术联合玻璃体腔注气在黄斑裂孔性视网膜脱离治疗中的价值。方法：对黄斑裂孔性视网膜脱离患者21例（22只眼）施行巩膜环扎术联合玻璃体腔内注气。全部病例随访3～12月。结果：18只眼一次或二次手术成功复位，占82％；4只眼分别在术后2～4个月后复发，其中2只眼再次手术后视网膜复位。2只眼未再手术。术后视力均较术前提高，无严重并发症。结论：巩膜环扎术联合玻璃体腔注气治疗黄斑裂孔性视网膜脱离安全、方便、有效。     

高度近视黄斑裂孔性视网膜脱离硅油填充和激光治疗随访

目的：探讨高度近视黄斑裂孔性视网膜脱离玻璃体手术硅油填充联合激光治疗的解剖复位及功能恢复,方法：高度近视黄斑裂孔性视网膜脱离患者23例25只眼,行玻璃体手术硅油填充联合激光治疗随访。硅油取出时间平均7个月。术后均作1年以上随访（平均18个月）。结果：硅油取出后视网膜复位23只眼（92％）,术后视力在0．1以上16只眼（66％）。结论：玻璃体手术硅油填充联合激光治疗高度近视黄斑裂孔性视网脱离,有利于脱离的视网膜解剖复位及功能恢复。     

玻璃体视网膜显微手术中医源性视网膜裂孔

目的：探讨玻璃体视网膜显徽手术中发生医源性视网膜裂孔的原因和处理措施． 方法：回顾性分析本院1994年7月至1996年3月玻璃体视网膜显微手术中发生的医源性视网膜裂孔24眼(40个裂孔)的原因，位置和术中术后的处理情况。 结果：24只眼中增殖性玻璃体视网膜病变(proliferative vitreoretinopathy，PVR)16只眼，外伤性PVR 5只眼，牵拉性视网膜脱离3只眼。对新裂孔的处理采用巩膜冷凝、硅胶填压、眼内电凝、眼内填充和术后激光光凝．下方和手术嵴后医源性视网膜裂孔分别占70%和92%．平均随访5个月，视网膜完全复位和黄斑复位17只眼，视力改善19只眼，均在0.02以上．结论：医源性视网膜裂孔是一种严重的并发症，应在术中、术后采取措施促使其封闭． （中华眼底病杂志，1997，13：19-21）     

黄斑裂孔性视网膜脱离的手术治疗

目的 探讨黄斑裂孔性视网膜脱离的术式选择及与疗效的关系。方法 经单纯注气术，巩膜环扎注气术、冷凝环扎注气术治疗１５例黄斑裂孔视网膜脱离。结果 经不同术式手术治疗，１５例１５眼均获得了较满意的近期疗效。结论 对黄斑裂孔性视网膜脱离的手术治疗，应根据病情选择术式，最大可能避免黄斑部进一步损伤，从而提高有限的中心视力。     

47例黄斑裂孔性视网膜脱离手术治疗临床分析

为探讨黄斑裂孔性视网膜脱离手术治疗及其效果。对４７例（４８眼）黄斑裂孔性视网膜脱离采用单纯气液交换术、环扎放液注气术、双环扎注气术、玻璃体切割环扎注气术及气油交换术等方式，术后进行３—９个月（平均６．５月）随访。结果：４３眼治愈，治愈率达８９．５％，其中９０％患眼视力提高。结论：黄斑裂孔性视网膜脱离对黄斑裂孔的处理要选择既能使裂孔愈合，又能保存视力的手术方式，并重点分析了环扎术在手术中的作用、运应及并发症的处理     

Posterior scleral reinforcement in the treatment of macular retinoschisis in highly myopic patients

The objective of this study was to evaluate the clinical curative effect of posterior scleral reinforcement for macular retinoschisis in highly myopic patients. Twenty-four highly myopic eyes with macular retinoschisis were treated with posterior scleral reinforcement surgery from September 2005 to March 2007 in our hospital. Visual field, best corrected vision acuity (BCVA), refractive error, optical coherence tomography and A/B Scan ultrasound graphy results were retrospectively analysed. The central visual field in 18 eyes was improved after surgery; optical coherence tomography showed complete resolution of the myopic foveoschisis in 20 (83.33%) of the 24 eyes after surgery. The postoperative BCVA was improved by 0.1 or more in 18 eyes (75%), and remained within 0.1 of the preoperative BCVA in five eyes (20.83%) at the end of follow-up. Compared with the preoperative data of 23 eyes, the final magnitude of myopia after surgery was significantly decreased ( t  = 3.527, P  = 0.002). In conclusion, this procedure can effectively treat highly myopic patients with macular retinoschisis without macular hole or retinal detachment, and might be better for maintaining central vision and preventing the occurrence of complications.     

Amniotic membrane for covering high myopic macular hole associated with retinal detachment following failed primary surgery

AIM: To evaluate the therapeutic effect of amniotic membrane (AM) for covering high myopic macular hole associated with retinal detachment following failed primary surgery. METHODS: Seventeen eyes of 17 patients whose axial length was more than 29 mm suffered from macular hole (MH) or MH associated with retinal detachment (RD), and had previously surgery of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and silicone oil (SO) tamponade. Half a year after the surgery, optical coherence tomography (OCT) showed that MH did not heal in all 17 eyes and RD was still maintained in 13 eyes of these 17 eyes. We performed SO removal combined with AM covering on macular area and C3F8 tamponade, and phacoemulsification combined with intraocular lens implantation simultaneously cataract eyes. We followed up these patients for one year. RESULTS: In all 17 eyes, SO was removed successfully, MHs were healed and RDs were reattached. One eye (5.89%, 1/17) had AM shifted half a month after surgery and underwent a second surgery to adjust the position of the AM and supplement C3F8. After surgery, the visual acuity (VA) improved in 15 eyes (88.24%, 15/17), no change in two eyes (11.76%, 2/17). No serious complications occurred in all eyes. CONCLUSION: AM covering is helpful to rescue the previous failure surgery of high myopic MH.     

高度近视黄斑孔性视网膜脱离手术探讨

目的 评价黄斑加固联合内界膜剥离、注气治疗早期高度近视黄斑孔性视网膜脱离的效果.方法 10例10只眼早期高度近视黄斑孔性视网膜脱离进行了黄斑加固、玻璃体切除、内界膜剥离、玻璃体腔注气治疗.均有黄斑部视网膜脱离,眼轴长度均超过27.0 mm,均有黄斑全层破孔.视网膜已僵硬者排除在外.术后随访6～18个月.结果 10只眼初次手术后,视网膜全部复位.但1只眼1月后视网膜再次脱离,再次行玻璃体腔注气术后视网膜复位,黄斑孔未闭合.10只眼中有5只眼黄斑孔闭合;5只眼黄斑孔部分区域闭合,部分组织缺损（1个月后黄斑孔周围行激光封闭）.术中未见医源性裂孔形成,术后1只眼玻璃体积血,2周后自行吸收.余术后无眼内出血或眼内炎等严重并发症发生.结论 黄斑加固联合内界膜剥离注气术是治疗早期高度近视黄斑孔性视网膜脱离安全有效的手术方法.能提高视网膜解剖复位率、黄斑孔闭合率.     

玻璃体切割联合硅油填充与C3F8填充治疗高度近视黄斑裂孔视网膜脱离临床效果比较

背景 高度近视黄斑裂孔视网膜脱离(MHRD)可造成严重的视力下降,经睫状体平坦部的玻璃体切割术联合眼内填充术已应用于该病的临床治疗,目前常用的眼内填充物包括硅油及可膨胀性气体C3F8,两种填充物的效果比较仍缺少相关研究证据. 目的 评价玻璃体切割联合硅油填充与C3F8填充治疗高度近视黄斑裂孔视网膜脱离的手术效果.方法 采用回顾性病例对照设计.对采用玻璃体切割联合眼内填充术治疗的51例高度近视MHRD患者,根据术中眼内填充物的不同将患者分为硅油填充组和C3F8填充组,两组患者基线资料一致.对两组术眼术后的最佳矫正视力(BCVA)、视网膜复位率、黄斑裂孔闭合情况及视网膜脱离复发率进行分析和比较. 结果 两组患者术前视力差异无统计学意义(U=266.000,P=0.286),基线视力一致,术中不同眼内填充物治疗后视力差异亦无统计学意义(U=205.000,P=0.029);应用硅油填充及C3F8填充患者BCVA术后与术前相比均有显著提高,差异均有统计学意义(Z=-2.729,P=0.006;Z=-3.273,P=0.001),两组患者术后视网膜脱离发生率及黄斑裂孔解剖闭合率差异均无统计学意义(P=0.894、1.000).患者除白内障外无其他并发症发生. 结论 应用C3F8填充治疗高度近视MHRD与硅油填充治疗效果相同,且均安全、有效.     

Macular hole surgery in high myopia

PURPOSE: To evaluate the anatomic and functional outcomes of macular hole surgery in high myopia and to determine whether surgery is beneficial in myopic eyes with macular holes. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Twenty eyes of 18 highly myopic subjects who underwent pars plana vitrectomy for macular holes. METHODS: We analyzed demographics, preoperative, and postoperative characteristics in 20 eyes with macular holes with a mean of 10.4 months duration and myopia of 6 diopters or greater. MAIN OUTCOME MEASURES: Macular hole closure rate and mean visual acuity preoperatively and postoperatively. RESULTS: Mean subject age was 56.4 years and preoperative visual acuity was 20/100+2. The macular hole was closed with one surgery in 60.0% of eyes and in 85.0% of eyes with one or more surgeries. The mean final acuity in all eyes was 20/63, and 40.0% improved greater than three Snellen lines at the final visit. The use of adjunctive agents seemed to have no effect on macular hole closure or visual acuity. A subgroup of three myopic eyes with retinal detachments surrounding the macular hole had successful closure with visual acuity improvement in two of three eyes. CONCLUSIONS: Macular hole surgery can give substantial visual improvement in myopic eyes with macular holes, but the anatomic closure rates are lower than in eyes with idiopathic macular holes, and thus a higher reoperation rate is required.     

病理性近视黄斑裂孔患者黄斑区视网膜前膜的组织学观察

目的 观察病理性近视内界膜表面结构的组织学变化与黄斑裂孔发生发展的关系.方法 同顾分析行玻璃体切割手术的病理性近视黄斑裂孔患者34例34只眼的临床资料.患眼屈光度均超过-6.00 D,眼轴26.00～33.12 mm,平均眼轴长度27.74 mm.5只眼为黄斑裂孔无视网膜脱离(黄斑裂孔组),29只眼为黄斑裂孔合并后极部视网膜浅脱离(视网膜脱离组).对入选患眼行睫状体平坦部三切口的玻璃体切割手术,手术中观察Weiss环以判断玻璃体后脱离程度,获取34只眼的视网膜前膜及19只眼的内界膜组织标本,行苏木精-伊红(HE)及醋酸铀-枸橼酸铅双染色,采用光学及透射电子显微镜观察.结果 玻璃体切割手术中,5只眼出现Weiss环,24只眼的视网膜表面有多层玻璃体组织残留.光学显微镜观察发现,内界膜表面的视网膜前膜主要由玻璃体胶原纤维.星形胶质细胞及细胞外基质组成.透射电子显微镜观察发现,19只眼的内界膜标本中,5只眼可她内界膜一玻璃体胶原纤维-细胞的"三明治"样结构,1只眼可见内界膜损伤、表面组织牵引和星形胶质细胞移行.结论病理性近视玻璃体后界面劈裂、内界膜表面组织结构的变化是黄斑裂孔发生发展直至视网膜脱离的重要原因.     

高度近视眼黄斑孔玻璃体视网膜界面的超微结构研究

目的 探讨高度近视眼并发的黄斑孔源性视网膜脱离患者的玻璃体视网膜界面特征。方法 12例高度近视眼黄斑孔视网膜脱离患者，玻璃体切割术中剥离黄斑区内界膜及黏附的玻璃体组织。其中8例标本应用透射电镜观察，4例采用免疫胶体金技术进行层粘连蛋白、纤维连接蛋白标记。2例正常尸体眼作对照。结果 透射电镜显示除l例玻璃体皮质和内界膜部分脱离外，7例标本均发现有成片的玻璃体后皮质粘附于内界膜表面。6例标本发现有上皮样细胞，其胞浆中含色素颗粒，表面有较多足突。免疫电镜显示其界面的层粘连蛋白、纤维连接蛋白数量明显多于正常人（P〈0．001）。结论 高度近视眼并发的黄斑孔源性视网膜脱离患者，黄斑区形成玻璃体劈裂。其视网膜表面膜组织中，以上皮样细胞为主介导胶原纤维的收缩。纤维连接蛋白和层粘连蛋白参与了膜收缩。     

Vitreoretinal surgery for macular hole after laser assisted in situ keratomileusis for the correction of myopia

AMS: To describe the characteristics and surgical outcomes of full thickness macular hole surgery after laser assisted in situ keratomileusis (LASIK) for the correction of myopia. METHODS: 13 patients (14 eyes) who developed a macular hole after bilateral LASIK for the correction of myopia participated in the study. RESULTS: Macular hole formed 1-83 months after LASIK (mean 13 months). 11 out of 13 (84.6%) patients were female. Mean age was 45.5 years old (25-65). All eyes were myopic (range -0.50 to -19.75 dioptres (D); mean -8.4 D). Posterior vitreous detachment (PVD) was not present before and was documented after LASIK on 42.8% of eyes. Most macular hole were unilateral, stage 4 macular hole, had no yellow deposits on the retinal pigment epithelium, had no associated epiretinal membrane, were centric, and had subretinal fluid. The mean diameter of the hole was 385.3 microm (range 200--750 microm). A vitrectomy closed the macular hole on all eyes with an improvement on final best corrected visual acuity (VA) on 13 out of 14 (92.8%) patients. CONCLUSIONS: This study shows that vitreoretinal surgery can be successful in restoring vision for most myopic eyes with a macular hole after LASIK.     

Retinal detachment associated with macular hole surgery: characteristics, mechanism, and outcomes.

OBJECTIVE: To study the frequency, features, and outcomes of retinal detachment (RD) occurring after macular hole surgery. METHODS: Retrospective review of all cases of macular hole surgery. Cases with postoperative RD were identified for study. Outcome measures included baseline demographic and ocular characteristics, RD features, surgical procedure, macular hole status, and final visual and anatomic outcomes. RESULTS: Retinal detachment occurred in 8 (1.8%) of 438 eyes undergoing macular hole surgery. The rate of RD was 3.5% early in the course of the surgeon's experience (first 200 cases) and 0.4% later in the surgeon's experience (after 200 cases) (P = 0.026). Two of the eight eyes with RD had undergone previous macular hole surgery. All six primary cases occurred after repair of stage 3 macular holes, which had involved peeling of the posterior cortical face. The RD involved the inferior quadrants in seven eyes and the macula in two eyes. The pathogenic retinal break was in the equatorial region in four eyes, was anterior to the equator in two eyes, and remained undetermined in two eyes. The retina was attached and the macular hole was closed in all cases at the final follow-up examination (mean 30 months). The macular hole reopened 2 years following successful reattachment of the RD in one eye. Final visual acuity was > or =20/60 in four eyes and <20/200 in one eye. CONCLUSION: Retinal detachment after macular hole surgery is uncommon, and may be related to posterior cortical vitreous stripping. Early detection of RD minimizes adverse visual and anatomic outcomes.     

病理性近视黄斑裂孔患者黄斑区视网膜前膜的组织学观察

目的 观察病理性近视内界膜表面结构的组织学变化与黄斑裂孔发生发展的关系.方法 同顾分析行玻璃体切割手术的病理性近视黄斑裂孔患者34例34只眼的临床资料.患眼屈光度均超过-6.00 D,眼轴26.00～33.12 mm,平均眼轴长度27.74 mm.5只眼为黄斑裂孔无视网膜脱离(黄斑裂孔组),29只眼为黄斑裂孔合并后极部视网膜浅脱离(视网膜脱离组).对入选患眼行睫状体平坦部三切口的玻璃体切割手术,手术中观察Weiss环以判断玻璃体后脱离程度,获取34只眼的视网膜前膜及19只眼的内界膜组织标本,行苏木精-伊红(HE)及醋酸铀-枸橼酸铅双染色,采用光学及透射电子显微镜观察.结果 玻璃体切割手术中,5只眼出现Weiss环,24只眼的视网膜表面有多层玻璃体组织残留.光学显微镜观察发现,内界膜表面的视网膜前膜主要由玻璃体胶原纤维.星形胶质细胞及细胞外基质组成.透射电子显微镜观察发现,19只眼的内界膜标本中,5只眼可她内界膜一玻璃体胶原纤维-细胞的"三明治"样结构,1只眼可见内界膜损伤、表面组织牵引和星形胶质细胞移行.结论病理性近视玻璃体后界面劈裂、内界膜表面组织结构的变化是黄斑裂孔发生发展直至视网膜脱离的重要原因.