重硅油玻璃体替代物及其临床应用

玻璃体替代物的产生和发展扩大了玻璃体视网膜手术的适应证并提高了手术疗效，目前临床常用的玻璃体替代物如空气、长效气体（SF6、C2F6、C3F8）和硅油比重都小于水，对于下方视网膜顶压效果都不理想，术后要保持一定的体位。重硅油比重大于水，可以对下方视网膜产生有效顶压。本文对重硅油的理化性质、实验室研究，临床应用等方面进行综述。     

新一代重硅油Oxane HD、Densiron 68和HWS 46-3000的比较

相对于传统硅油,比水重的硅油在理论上具有许多优势,尤其是在伴有增生性玻璃体视网膜病变的下方视网膜脱离的治疗中.近年,三种新一代的重硅油,Oxane HD,Densiron 68和HWS46-3000开始应用于临床,已显示出较好的眼内耐受性,提高了手术成功率,为临床治疗难治性视网膜脱离增添了有用的工具.本文对这三种重硅油的物理性质、临床疗效和术后并发症等进行比较,逐一论述.     

重硅油眼内填充治疗复杂视网膜脱离的临床观察

目的探讨重硅油玻璃体腔填充治疗复杂性视网膜脱离的术后效果。方法对4例视网膜下方裂孔或/和发生严重增殖性玻璃体视网膜病变的复杂性视网膜脱离患者进行了玻璃体腔填充重硅油视网膜复位术,术后对眼压及眼底情况随访观察。结果3例术后眼压长时间增高,药物控制效果差,2例视网膜复位,2例再手术时取出重硅油填充标准硅油。结论重硅油玻璃体腔填充后引起高眼压,眼内耐受性较差。     

重硅油填充在下方裂孔的视网膜脱离术中应用

目的 评价重硅油眼内填充治疗下方裂孔的视网膜脱离手术疗效及并发症.方法 对下方视网膜裂孔和严重增生性玻璃体视网膜病变(PVR)的复杂性视网膜脱离15例(15眼)行玻璃体切除联合玻璃体腔重硅油填充术.并同时选取15眼患相似类型的视网膜脱离者,在玻璃体切除术后给予眼内普通轻硅油填充作为对照.硅油取出的时间:重硅油组为手术后21～99d,轻硅油组为32～108d.两组时间比较,P＞0.05.术后对视力、眼压及并发症等情况进行随访.结果 随访8～13个月,重硅油组视网膜一次完全复位者13眼(86.67％),轻硅油组一次视网膜完全复位者9眼(60.00％)(P＜0.05),重硅油组并发症有:并发性白内障7眼,重硅油乳化4眼,高眼压3眼,严重的前房炎症反应1眼.结论对下方裂孔的视网膜脱离行玻璃体切除联合玻璃体腔重硅油填充术,可获得良好的视网膜复位率,可提高因为年龄或全身因素无法俯卧患者的舒适性.并发症主要为并发性白内障,高眼压,硅油乳化,前房炎症反应,经过适当处理均可解决.     

玻璃体切除联合重硅油填充治疗下方PVR视网膜脱离

目的探讨玻璃体切除联合重硅油眼内填充治疗下方严重PVR视网膜脱离的效果。方法对26例（26眼）诊断为合并下方PVR视网膜脱离者行玻璃体切除联合眼内重硅油填充,并同时随机抽取26眼患相似类型的视网膜脱离者,在玻璃体切除术后给予眼内硅油填充作为对照治疗。术后随访7～12月,观察其视网膜复位、视力、眼压及硅油乳化等情况。结果重硅油组视网膜一次性完全复位者24眼,占92．30％,硅油组一次性视网膜完全复位者18眼,占69．23％,（P〈0．05）。视网膜完全复位者绝大部分视力有不同程度提高。所有患者均未见明显炎症反应。结论玻璃体切除联合重硅油眼内填充是治疗下方PVR视网膜脱离的有效方法,可以降低术后视网膜脱离的复发率。     

新一代重硅油Oxane HD、Densiron 68和HWS46—3000的比较

相对于传统硅油，比水重的硅油在理论上具有许多优势，尤其是在伴有增生性玻璃体视网膜病变的下方视网膜脱离的治疗中。近年，三种新一代的重硅油，Oxane HD，Densiron68和HWS46-3000开始应用于临床，已显示出较好的眼内耐受性，提高了手术成功率，为临床治疗难治性视网膜脱离增添了有用的工具。本文对这三种重硅油的物理性质、临床疗效和术后并发症等进行比较，逐一论述。     

重硅油在严重眼外伤玻璃体手术中的应用

目的探讨重硅油作为眼内填充物治疗严重眼外伤的临床应用。方法对严重眼外伤12例（12眼）进行了玻璃体切除联合重硅油填允。一类是因为眼内异物伤异物位于（损伤）下方视网膜或后极部者共8例。另一类是眼外伤引起下方视网膜脱离增生者共4例。均经闭合式玻璃体切除手术,术中根据病情需要进行异物摘出、剥膜、重水、激光、气-液交换等,最后,行重硅油填充。结果均于术后3个月行硅油取出。所有患眼视网膜全部平复,裂孔封闭、瘢痕稳定。结论重硅油对治疗下方复杂性异物伤和外伤性视网膜脱离有明显疗效。     

硅油充填眼下方视网膜脱离的巩膜外手术治疗

0 引言 玻璃体切割手术后充填硅油使很多复杂视网膜脱离得到治疗,硅油充填期间大部分患者能够获得有用视力,但仍有一定比例的患者术后再次视网膜脱离,尤其以下方视网膜脱离多见,我们对2007-06/2009- 02 10例这类视网膜脱离患者行巩膜外垫压治疗,待视网膜复位后再行硅油取出,效果良好,报道如下.     

硅油充填术后复发性视网膜脱离的临床研究

目的分析硅油填充术后带油情况下视网膜再脱离常见原因和再次手术的方法.方法54例54眼合并严重增殖性玻璃体视网膜病变(proliferative vitreoretinopathy,PVR)的视网膜脱离行硅油填充术后带油视网膜再脱离的病例进行临床回顾研究.结果54眼后段检查:下方视网膜脱离37眼(68.5%),明确视网膜裂孔35眼中22眼见下方裂孔(62.9%),形成视网膜前增殖41眼中22眼位下方(53.7%).51眼再次手术治疗,其中38眼行硅油取出联合玻璃体术式,视网膜复位率92.1%(35/38).7眼行巩膜手术,视网膜复位5眼.结论带油眼视网膜的病理生理改变主要位于下方,大部分病例可通过再次手术获得成功.     

玻璃体切割联合眼内硅油填充术治疗脉络膜脱离型视网膜脱离临床疗效观察

目的 评价玻璃体切割联合眼内硅油填充术治疗脉络膜脱离型视网膜脱离的手术效果.方法 对17例行玻璃体切割联合眼内硅油填充术的脉络膜脱离型视网膜脱离患者进行回顾性分析.分析术前与术后最佳矫正视力、眼压,术后最终视网膜复位率,复发性视网膜脱离发生率等情况.结果患者玻璃体切割联合眼内硅油填充术初次手术复位率为47.0％,复发性视网膜脱离发生率为53.0％,最终视网膜复位率为82.4％.患者术前平均LogMAR视力2.54,术后平均视力1.90,手术前后视力有明显提高.患者术前平均眼压8.41 mm Hg,术后平均眼压13.88 mm Hg,手术前后有明显改善.除白内障及一过性眼压升高外无其他并发症.结论 玻璃体切割联合眼内硅油填充术治疗脉络膜脱离型视网膜脱离是安全有效的手术方法.     

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.     

Risk factors for anatomical success and visual outcome in patients undergoing silicone oil removal

PURPOSE: To define risk factors for anatomical success and visual outcome in patients undergoing removal of silicone oil. METHODS: This retrospective study included patients who had silicone oil removed at this hospital between 1996 and 2000. All were followed for at least six months. Patients with recurrent retinal detachment after silicone oil removal were compared with patients without this complication. We also compared patients whose vision improved or stabilized with patients whose vision deteriorated. Risk factors for anatomical success and visual outcome were identified. RESULTS: We analysed 94 eyes of 92 patients with silicone oil removal. Nineteen eyes (20%) had recurrent retinal detachment, and in 30 eyes (32%), the vision deteriorated after removal of the oil. Initial vision less than ambulatory vision, initial pathology of giant retinal tears and recurrent retinal detachment, postoperative hypotony and postoperative epiretinal membrane occurred more frequently in eyes with than without recurrent retinal detachment. Pre- and postoperative hypotony, postoperative epiretinal membranes and postoperative recurrent retinal detachment were also more frequent in eyes with deteriorated vision. CONCLUSIONS: When treating giant retinal tears or recurrent retinal detachments with silicone oil tamponade, surgeons and their patients need to be aware of the higher possibility of unfavorable results, particularly when the initial vision is less than ambulatory vision. The presence of risk factors before and after silicone oil removal should remind surgeons of the higher risk profile of this particular surgery.     

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。     

Use of silicone oil for temporary tamponade in the treatment of retinal detachment with vitreoretinal retraction. 1. Short- and long-term anatomic and functional results in 110 cases

Vitreoretinal retraction treated by silicone oil injections to provide internal tamponade after vitrectomy showed total reapplication in 28.2%, persistent residual detachment with a flat posterior pole in 18.2%, and a measurable visual acuity in 40%, including 10% of patients in show it was superior to 2/10. When immediate postoperative visual acuity could be measured this good result remained stable. When relapse occurred in spite of the presence of the silicone, it involved patients with the lowest postoperative visual acuity due to progressive major retinal fibrosis. These findings suggest that silicone oil injection is a valid procedure for treatment of retinal detachment requiring internal tamponade, and that perhaps its earlier use is indicated. Part 2 discusses its tolerance of this material.     

Airbag hit as a cause of retinal detachment--case report

PURPOSE: The aim of this paper is presentation of a patient with retinal detachment due to airbag hit in a car accident. MATERIAL AND METHODS: 50 years old woman with posttraumatic retinal detachment underwent cerclage and pars plana vitrectomy and silicone oil injection. Phacoemulsification and intraocular lens implantation followed. RESULTS: Final visual acuity of 0.5 was achieved. No postoperative complications were observed. CONCLUSIONS: Despite the complicated preoperative situation, good anatomic and functional results could be achieved. Airbag may be also cause of severe ocular trauma.     

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 vitreoretinal surgery. Part 2: Results and complications

The surgical results and postoperative complications associated with silicone oil injection in the treatment of complicated retinal detachment were evaluated in a series of 164 eyes followed for a minimum of 6 months. The incidence of recurrent retinal detachment, corneal decompensation, cataract, glaucoma, and hypotony were noted to be high, and the final visual results were often disappointing. The avoidance and treatment of these complications are discussed, and removal of the silicone oil after sustained anatomic retinal reattachment has been attained is recommended.     

视网膜脱离患者玻璃体切除硅油填充术后3天高眼压发生率及危险因素

目的 探讨玻璃体切除及硅油填充术治疗视网膜脱离术后3天内眼压升高的发生比例及危险因素。设计 前瞻性病例系列。研究对象 2018年2-8月北京大学第三医院连续行玻璃体切除术联合硅油填充术治疗的视网膜脱离患者135例。方法  使用回弹式眼压计测量患者术后2、4、6~8小时、1、2、3天的眼压。任何时间眼压≥25 mmHg定义为眼压升高。生存期定义为从玻璃体切除术结束至第一次眼压≥25 mmHg发生时的时间间隔（小时）。采用Cox回归分析评估术后3天内发生高眼压的相关危险因素。采用Kaplan-Meier生存曲线可视化不同病因的视网膜脱离患者的生存概率。主要指标 高眼压发生率及危险因素。结果 135例患者中44例（32.6%）发生眼压升高,眼压升高在术后第1天发生率最高（20.2%）。Cox分析显示视网膜脱离的病因与眼压升高显著相关（P=0.006）,以原发性孔源性视网膜脱离作为对照,糖尿病性牵引性视网膜脱离和复发性视网膜脱离发生眼压升高的风险分别为3.5 倍（P=0.002,HR=3.41） 和3倍 （P=0.010,HR=2.91）。糖尿病牵引性视网膜脱离和复发性视网膜脱离的总生存率显著低于原发性视网膜脱离和外伤性视网膜脱离（P<0.05）。结论 视网膜脱离患者行玻璃体切除硅油填充术后3天内眼压升高比例约占1/3,主要发生在术后第1天。对于玻璃体切除硅油填充眼特别是糖尿病牵引性视网膜脱离及复发性视网膜脱离者,术后第1天复查仍有必要性。（眼科,2022,31：27-32）     

玻璃体切除联合眼内填充治疗复杂性视网膜脱离158例

目的:探讨一期玻璃体切除联合眼内填充术治疗复杂性眼视网膜脱离的临床疗效。方法:158例(158眼)复杂性视网膜脱离施行玻璃体切除联合眼内填充手术治疗。其中,35例行C3F8充填,123例行硅油充填,术后随访2～12mo。结果:视网膜完全复位128眼(81.0%),部分复位23眼(14.5%),未复位7眼(4.5%)。其中,硅油填充123例,103例解剖复位,复位率为83.7%。C3F8填充35例,25例解剖复位,复位率71.4%。术后视力均有不同程度的提高。结论:玻璃体切除术联合眼内填充治疗复杂性视网膜脱离有良好的疗效,解除视网膜牵引及合理选择充填物,及时处理并发症是手术成功的关键。     

眼球穿孔伤视网膜脱离的联合手术治疗

目的 回顾性研究玻璃体视网膜手术联合硅油填充术治疗眼球穿孔伤所致视网膜脱离的效果。方法 采用闭合式玻璃体切除、剥膜、水下电凝、视网膜切开、气/液交换、油/气交换、玻璃体腔硅油填充,部分患者联合巩膜环扎。结果 98眼中,出院时77眼（78.57%）视网膜复位。随访67眼,50眼（74.63%）保持视网膜平复。视力：数指以上者43眼（64.18%）;≥0.05者14眼（20.90%）;≥0.1者12眼（17.91%）。结论 联合手术对眼球穿孔伤视网膜脱离有较好的治疗效果。能治愈常规方法难以治愈的患者。