从手术嵴上裂孔排除视网膜下液术

目的探讨从手术嵴上视网膜裂孔排除视网膜下液的效果。方法４３例４３只眼无后极部视网膜裂孔连续患者,在按常规玻璃体视网膜手术中,行气／液交换或油／液交换,利用手术嵴上原已存在的视网膜孔或电凝视网膜切开裂孔排出视网膜下液。内排液部位最多的是９～１２点。结果２４眼手术中视网膜全复位,１９眼术毕后极部视网膜下残留少量液体１～３天完全吸收１６眼。并发症主要是排液孔处术中出血和术后增殖膜形成。结论从手术嵴上视网膜裂孔排出视风膜下液是一种安全、简单和可靠的手术方式。     

脉络膜脱离孔源性视网膜脱离术中不放液观察

目的 观察视网膜裂孔冷凝，巩膜环扎外加压手术不放液治疗脉络膜脱离型孔源性视网膜脱离的疗效。方法 对28眼脉络膜脱离型孔源性视网膜脱离进行裂孔冷凝，巩膜环扎，外加压，术中不引流视网膜下液，对其治疗结果进行分析。结果 28眼中一次成功25眼，视网膜下液在1～2天吸收为13眼，3天～1周内吸收为12眼，术后均有不同程度的视力提高。结论 在成功封闭裂孔后，脉脱型孔源性视网膜脱离视网膜下液可自行吸收，手术成功率高，可有效减少放液所带来的并发症。     

环扎加压放液与不放液治疗视网膜脱离的体会

目的评价环扎加压放液与不放液治疗视网膜脱离的临床疗效。方法随机分为A组（不放液）与B组（放液）进行手术。结果A组30例手术成功28例（93.3％）;B组30例成功27例（90％）。复位的55眼视力均有提高。两组疗效无显著性差异（P＞0．05）。结论环扎加压不放液治疗视网膜脱离与放液比较具有手术难度小、时间短、并发症少等优点,且疗效可靠,但对周边超过90°的巨大裂孔、黄斑后极部裂孔不适应该术式。     

Pneumatic retinopexy with drainage of subretinal fluid

Thirty bullous retinal detachments were treated with pneumatic retinopexy and drainage of subretinal fluid. Patient selection criteria were similar to pneumatic retinopexy. All the eyes were reattached after the first operation. In three (10%) eyes new breaks with retinal detachment developed within two months after the initial operation and were treated with scleral buckling. One of these three eyes developed proliferative vitreoretinopathy grade D3 two months after scleral buckling. Twenty-nine (96.7%) out of thirty eyes were eventually reattached. The follow-up period was at least nine months. Visual acuity was maintained or improved in 29 (96.7%) eyes. Complications developing due to subretinal fluid like extension of detachment, persistence of subretinal fluid, subretinal gas, reopened retinal breaks were not encountered. By applying cryotherapy to a reattached retina after drainage of subretinal fluid, retinal pigment epithelial dispersion is decreased and the so-called steamroller technique is avoided. Drainage of subretinal fluid did not prevent a good success rate and did not result in additional complications.     

下直肌牵引巩膜外垫压不放液手术治疗上方孔源性视网膜脱离

目的观察下直肌牵引及单纯巩膜外垫压不放液手术治疗上方孔源性视网膜脱离的临床效果。方法对上方孔源性视网膜脱离56例（56眼）术前进行下直肌缝线牵引制动，采用视网膜裂孔冷凝、巩膜环扎、外垫压及术中不放液的手术方法，对治疗结果进行分析。结果56例（56眼）经下直肌牵引制动3～5天后，52眼（92．86％）的视网膜脱离特别是上方球形脱离有明显消退，视网膜下液均有消散，其中28眼（50．00％）完全复位。53眼（94．64％）均行不放液术达到准确封闭孔源的目的。出院前治愈率为96．43％，未愈3．57％。结论下直肌缝线牵引制动可促进视网膜下液消退、平复，有利于术中裂孔准确定位、扣压位置适当，从而有效封闭裂孔。扩大了不放液手术适应范围，提高不放液手术成功率。     

Modified external needle drainage procedure for rhegmatogenous retinal detachment

PURPOSE: To describe the results of a modified external needle subretinal fluid drainage technique to treat eyes with a rhegmatogenous retinal detachment. METHODS: One hundred eighty-seven consecutive patients with a rhegmatogenous retinal detachment who underwent scleral buckle and modified external needle drainage at Duke Eye Center or Vistar Eye Associates were included in this study. Subretinal fluid was drained by a technique whereby the intraocular pressure was raised to a supranormal level by tightening an encircling scleral buckle and then the subretinal space was entered by a needle introduced externally while the retina was directly viewed with an indirect ophthalmoscope. Subretinal fluid drainage success rate, one-operation reattachment rate, final retinal reattachment rate, intraoperative and postoperative complication rates, and final visual acuity were the main outcome measures. RESULTS: Subretinal fluid was successfully drained in all eyes. The one-operation reattachment rate was 91%, and the final reattachment rate was 98%. Intraoperatively, 15% of eyes required corneal debridement to obtain an adequate view for safe subretinal fluid drainage. Subretinal hemorrhage of no more than one clock hour occurred in 4.2% of eyes. A total of 2.6% of eyes developed an epiretinal membrane postoperatively that required a vitrectomy to improve the visual acuity. The postoperative visual acuity, 0.54 by logMAR (20/69 by Snellen), was significantly better than the preoperative visual acuity, 1.1 logMAR (20/250 by Snellen) (P < 0.0001). CONCLUSIONS: The modified external needle drainage technique is a flexible, effective method to drain subretinal fluid in eyes with a rhegmatogenous retinal detachment. The retinal reattachment rate and complication rate compare favorably to alternative subretinal fluid drainage techniques.     

Factors influencing absorption of subretinal fluid.

In 200 cases of retinal detachment successfully treated without drainage of subretinal fluid complete reattachment of the retina was achieved in the first postoperative week in 76 per cent of cases. Delay in subretinal fluid absorption in the remaining 24 per cent of cases was directly related to the duration of the retinal detachment but was not influenced by the patient's age, refractive error, or the characteristics of the detachment.     

Factors Influencing Absorption of Subretinal Fluid

In 200 cases of retinal detachment successfully treated without drainage of subretinal fluid, complete reattachment of the retina was achieved in the first post-operative week in 76% of cases. Delay in subretinal fluid absorption in the remaining 24% of cases was directly related to the duration of the retinal detachment, but was not influenced by the patients age, refractive error or the characteristics of the detachment.     

改良穿刺放液在外路法视网膜脱离复位术中的应用

目的 探讨外路法视网膜脱离复位手术中改良穿刺放视网膜下液的临床有效性及安全性.设计回顾性病例系列.研究对象2006年1月至2009年9月收住南京医科大学第一附属医院眼科的329例孔源性视网膜脱离的患者.方法 手术显微镜下予巩膜环扎和（或）巩膜外加压术,术中均联合改良穿刺法放出视网膜下液,即穿刺点选在角巩膜缘后11 mm的直肌两侧,避开涡状静脉和视网膜裂孔,采用25 G 5/8-in针头（1ml BD针头,新加坡Becton Dickinson Medical（S）Pte Ltd.）垂直巩膜穿刺放出视网膜下液,穿刺深度不超过针头斜面.收集术前、术后及手术数据并进行分析.主要指标改良穿刺放液的成功率及并发症的发生率.结果 329例外路法视网膜脱离复位手术,327例（99.4%）引流出视网膜下液,2例未引流出视网膜下液.改良穿刺放液的并发症有视网膜下出血2例（0.6%）,出血范围小于2PD,穿刺点正对视网膜裂孔处1例（0.3%）,导致玻璃体自巩膜穿刺口脱出.结论 改良穿刺放液法是外路法视网膜脱离复位术中引流视网膜下液的一种安全、有效的方法.     

A new instrument for drainage or injection of fluid within subretinal space

PURPOSE: To describe a new instrument, the subretinal aspiration and injection device (SR-AID), designed to facilitate the controlled external drainage or injection of fluid in the subretinal space. METHODS: The SR-AID is formed by an assembly of a probe, handle body, and a driving unit. The curved conduit within the probe segment forms a curved tunnel and acts as a guide along which a needle moves back and forth. The feasibility of fluid injection beneath the attached retina was tested in animal eyes. The efficacy of subretinal fluid drainage with the SR-AID were assessed in six cases of clinical retinal detachment. RESULTS: External approach to the subretinal space under ophthalmoscopic monitoring can be achieved by oblique angle penetration of the scleral wall with a needle from the SR-AID. Fluid was injected successfully into the subretinal space in three of six rabbit eyes and in two of two pig eyes. The mean duration required for the drainage of subretinal fluid with the SR-AID was 127 seconds. There was no incidence of significant subretinal hemorrhage or retinal perforation in the animal experiments and in human cases. CONCLUSION: Our case series suggests that the SR-AID provides an efficient and safe means of access to the subretinal space.     

不放液巩膜外加压术治疗陈旧性视网膜脱离

目的:探讨不放液巩膜外加压术治疗陈旧性视网膜脱离的临床疗效。方法:回顾性分析不放液单纯巩膜外加压术治疗32例32眼陈旧性视网膜脱离的临床病例资料,观察术后最佳矫正视力、手术并发症和视网膜复位情况。结果:术后随访6～12(平均9.2)mo,最佳矫正视力>0.1者17例17眼,2例2眼术后短期内眼压升高,首次手术解剖复位30例30眼,成功率94%。2例2眼术后视网膜下增殖继续发展,行玻璃体切除术后视网膜复位。结论:不放液巩膜外加压术对视网膜下增殖不严重的陈旧性视网膜脱离简单有效。     

缝针巩膜穿刺放液法在视网膜脱离手术中的应用

目的:探讨缝针巩膜穿刺放液法在视网膜脱离术中应用的有效性和安全性。方法:选取64例孔源性视网膜脱离患者,均采用外路视网膜脱离手术。分为A,B两组,A组采用巩膜切开放液法,B组采用缝针巩膜放液法。比较手术的成功率和并发症。结果:两组手术均获成功,成功率和并发症无显著性差异(P>0.05)。结论:缝针巩膜放液法是一种有效、安全的放液方法。     

视网膜下液引流联合玻璃体内注射抗血管内皮生长因子药物治疗重度渗出性视网膜脱离Coats病的临床疗效

目的 研究视网膜下液引流联合玻璃体内注射抗血管内皮生长因子药物雷珠单抗治疗重度渗出性视网膜脱离Coats病的效果.方法 选取2013年4月至2017年1月在北京同仁医院眼科中心确诊为3B期Coats病的患者13例13眼纳入研究.13例患者中,视力为无光感1例,光感～数指7例,0.01 ～0.1者2例,因年幼无法配合检查3例.巩膜外放液选取位置在视网膜脱离较高的位置,在显微镜观察下缓慢放出视网膜下液,所有患眼放液后于角膜缘后3.5 mm睫状体平坦部行玻璃体内注射抗血管内皮生长因子药物雷珠单抗0.5 mg(0.05 mL).随访期观察患者的视力、眼压、裂隙灯、间接检眼镜及彩色眼底像.分析异常血管变化,视网膜下液及渗出的吸收情况,视网膜复位及并发症发生情况.结果 13例患者中3例进行了2次的视网膜下液引流,10例进行了1次的视网膜下液引流;联合两次玻璃体内注射雷珠单抗的有6例,联合三次注射的4例,三次以上3例.所有患者的视网膜下液吸收或者大部分吸收后,进行了视网膜冷冻或激光治疗,单纯激光治疗的有5例,单纯视网膜冷冻治疗的3例,激光联合冷冻治疗的5例.13例患者中,视力提高的2例,无变化的8例,因年幼无法配合检查3例.在随访中,8例视网膜完全复位,未观察到与视网膜下液引流和眼内注药手术操作相关的并发症,如眼内炎、视网膜裂孔、玻璃体积血等.结论 视网膜下液引流联合玻璃体内注射雷珠单抗是一种有效治疗重度3B期Coats病的方法.     

Modified needle drainage. A safe and efficient technique of subretinal fluid drainage in scleral buckling procedure

PURPOSE: To compare modified needle drainage (MND) with conventional drainage (CD) of subretinal fluid (SRF) as described by Schepens in surgery for primary rhegmatogenous retinal detachment. METHODS: Prospective randomised clinical trial of 80 patients undergoing scleral buckling with subretinal fluid drainage for primary rhegmatogenous retinal detachment. In 40 patients modified needle drainage of subretinal fluid (SRF) was done using a perpendicular trans-scleral entry with a 26-gauge needle and the appearance of SRF in the hub of needle as end point. In 40 patients conventional drainage was done as described by Schepens using a diathermy needle. Adequacy of SRF drainage, intraoperative complications, anatomical and functional outcome were noted. RESULTS: 100% adequate drainage was achieved in all cases. The complication rate was 32.5% (n=13) in the CD group and 15% (n=6) in the MND group. In the CD group, 17.5% (n=7) patients had subretinal haemorrhage and in 2 eyes it was clinically significant. In the MND group 15% (n=6) of cases had subretinal haemorrhage and in one patient it was clinically significant. In the CD group, more serious SRF drainage complications were observed; these were absent in the MND group. CONCLUSION: Modified needle drainage is a safe and effective procedure for SRF drainage. In comparison with CD, MND is technically easy, less cumbersome and requires no special equipment.     

玻璃体手术联合视网膜下液体眼内引流治疗复杂视网膜脱离

为讨论玻璃体手术中经眼内引流视网膜下液体及与视网膜脱离复位的关系。对玻璃体手术中视网膜下液体眼内引流２５８例，随访１～４０个月。结果：视力增进２１０例，视网膜脱离完全复位２２８例（８８．４％）。结论：视网膜下液体眼内引流，排液充分、安全、为视网膜脱离复位奠定了基础。     

Prospective, randomised, controlled trial comparing suture needle drainage and argon laser drainage of subretinal fluid.

AIMS--This study was designed to compare suture needle drainage (SND) with argon laser drainage (ALD) of subretinal fluid. METHODS--A prospective, randomised, controlled, clinical trial was carried out on 93 patients undergoing external drainage of subretinal fluid during scleral buckling surgery for rhegmatogenous retinal detachment. The incidence of successful drainage, incidence of subretinal haemorrhage, incidence of retinal incarceration, and incidence of retinal perforation were determined. RESULTS--The success rate was 97.9% in the ALD group and 84.8% in the SND group (difference-13.1%, 95% CI-26.4% to 2.0%). The incidence of clinically significant subretinal haemorrhage was 4.3% in the ALD group compared with 28.3% in the SND group (difference 24.0%, 95% CI 7.6% to 40.4%). The incidence of incarceration was comparable in each group. There were no cases of retinal perforation. CONCLUSIONS--The use of ALD was associated with a higher rate of successful SRF drainage, and a lower incidence of clinically significant subretinal haemorrhage than SND. ALD is preferred when an endolaser is available.     

Endoscopy-guided subretinal fluid drainage in vitrectomy for retinal detachment

PURPOSE: To study the usefulness of endoscopy-guided subretinal fluid drainage in pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD). PARTICIPANTS/METHODS: A prospective non-comparative study of a small number of RRD cases. The study involved examining 10 eyes of 10 patients with RRD that received PPV. Two eyes had hazy corneas, which hindered the observation by surgical microscopy. Fluid-gas exchange was performed and then subretinal fluid was drained through a primary retinal break guided by an endoscope. No drainage retinotomy was made. Each clinical feature was studied and the surgical outcome and complications were evaluated. RESULTS: All eyes had retinal reattachment by a single operation. No serious complication related to surgery was experienced. CONCLUSIONS: Endoscopy-guided subretinal fluid drainage is the safe and effective procedure in PPV for RRD.     

激光脉络膜切开视网膜下放液的临床观察

目的 探讨激光脉络膜切开与冷针穿刺脉络膜视网膜下放液的安全性及效果。 方法 孔源性视网膜脱离需行巩膜扣带术的病例70例74只眼，随机分为两组，A组34例36只眼采用冷针穿刺脉络膜放液，B组36例38只眼采用半导体激光眼内激光探头光凝脉络膜放液，比较两种方法的效果及并发症发生情况。 结果 两种放液方法均获成功，冷针穿刺脉络膜放液发生视网膜下出血3例、1例视网膜嵌塞、视网膜穿孔，而激光脉络膜切开放液组未发生明显的并发症。 结论 半导体激光脉络膜切开视网膜下放液可以降低并发症发生率，适用于任何需视网膜下放液的病例，尤其在视网膜下液不多的病例。 (中华眼底病杂志,1998,14:202-203)     

Surgical management of bilateral exudative retinal detachment associated with central serous chorioretinopathy

PURPOSE: To report a case of bilateral bullous exudative retinal detachment in central serous chorioretinopathy (CSC) which was attached by vitrectomy and internal drainage of the subretinal fluid. METHODS: A 47-year-old man affected by bilateral atypical CSC with a bullous retinal detachment with subretinal exudate. A fluorescein angiogram (FAG) showed multiple points of leakage and staining of subretinal fibrosis. A tentative diagnosis of Vogt-Koyanagi-Harada (VKH) syndrome was made and the patient was treated with systemic corticosteroids and immunosuppressive agents. However, the subretinal fluid was not absorbed. He was then treated with vitrectomy and internal drainage of subretinal fluid. RESULTS: The retina was attached successfully in both eyes. Visual acuity improved to 20/50 in his left eye but did not improve in the right eye due to subretinal fibrotic scarring and atropic changes on the macula. CONCLUSIONS: Our case suggests that the surgical management of bullous exudative retinal detachment is safe and necessary.     

球形视网膜脱离环扎加压术放液与否的疗效分析

目的 对照分析球形视网膜脱离环扎加压不放液组和环扎加压放液组的手术治疗。方法 用统计学方法分析同时期球形视网膜脱离环扎加压术不放液组（２０３眼）与放液组（１５９眼）的一次手术复位率、ＰＶＲ发展的发生率及总手术成功率。结果 放液组一次手术复位率９５．６０％,显著高于不放液组８７．６８％（Ｐ〈０．０１）,ＰＶＲ发展发生率不放液组４．９３％,显著高于放液组０．６３％（Ｐ〈０．０５）。最终总手术成功率放液