玻璃体切除术治疗复杂性视网膜脱离

目的：分析玻璃体切除术治疗复杂性视网膜脱离的效果。方法：对80例84眼复杂性视网膜脱离，其中合并严重增殖性玻璃体视网膜病变（PVR）的视网膜脱离62眼巨大裂孔视网膜脱离22眼，行三切口闭合式后段玻璃体切除术C3F8注入或硅油注入，术后进行统计分析，结果：84眼中，术后的视网膜复位79眼，前部PVR的12眼，角膜变性的2眼，白内障的16眼，结论：后段玻璃体切除术治疗复杂性视网膜脱离是一种之行有效的方法。     

玻璃体切除术治疗增生性玻璃体视网膜病变的临床分析

目的 分析增生性玻璃体视网膜病变(PVR)的原因及治疗方法.方法 通过对眼外伤后行玻璃体切除术的PVR 33例临床观察,总结临床资料,对发生原因和治疗方法进行分析总结.结果 手术治疗的33例(33眼)手术中见视网膜周边裂孔5眼;黄斑孔3眼;外伤及异物致视网膜直接损伤25眼(其中视网膜下异物1眼、玻璃体内异物4眼、异物由眼球二次穿孔至眶内1眼).33眼均存在程度不同的增生样改变,发生牵引性视网膜脱离19眼.根据1983年美国视网膜协会PVR分级法,33例中A级(轻度)PVR 12眼,B级(中度)PVR 2眼,C级(重度)PVR AlP,14眼,PVR A2P2 4眼,D级(超重度)PVR D1 1眼(外伤3个月后手术的患者).结论 眼外伤后发生PVR有多种原因,与致伤时间有关,亦与眼外伤后一期处理及治疗有关.玻璃体切除术是解决这一问题的有效方法.     

复发性视网膜脱离的玻璃体手术治疗

目的：探讨玻璃体手术治疗伴明显增殖性玻璃体视网膜病变（PVR）的复发性视网膜脱离。 方法：复习1987年9月至1994年11月我院采用玻璃体切除术治疗的伴明显PVR复发性视网膜脱离患者47例。 结果：出院时痊愈30例（63.8%），好转9例（19.1%），失败8例（17.1%）. 结论：手术操作除类似常规玻璃体切除外，还应注意患眼因曾手术引起的组织学病变。 （中华眼底病杂志，1996，12：-10-12）     

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。     

玻璃体切除116例临床分析

我院眼科开展玻璃体切除（简称玻切）手术,治疗各种原因所致的玻璃体出血、视网膜脱离（RD）及增殖性玻璃体视网膜病变（PVR）116例124眼,现报告如下。临床资料：116例124眼（8例为双眼）,男75例,女41例,年龄5岁-81岁,平均42．6岁。孔源性RD54例54眼,其中黄斑裂孔4眼,巨大裂孔6眼。血管世视网膜病变29例35眼：Eales病10眼;视网膜中央静脉阻塞（RVO）17眼;增殖性糖尿病性视网膜病变（PDR）8眼。外伤性玻璃体视网膜病变28例28眼。其它5例7眼：综合征及Marchesani综合征各1例4眼,全葡萄膜炎2眼,眼内炎1眼。按美国视网膜学会…     

视网膜切开暴露区色素上皮层光凝对玻璃体切割术后低眼压等并发症的影响

目的探讨视网膜切开切除后暴露区视网膜色素上皮层激光凝固术对玻璃体切割术后低眼压,增殖性玻璃体视网膜病变（PVR）发生的影响。方法33例33眼玻璃体切割手术中需对视网膜做广泛切开切除,其中严重PVR所致视网膜脱离22眼,包括视网膜再脱离6眼,巨大裂孔8眼;外伤性视网膜脱离8眼;糖尿病视网膜病变Ⅵ期3眼.所有病例均在手术中对视网膜缺损,色素上皮暴露区作广泛密集激光光凝。33眼中硅油填充25眼,C3F8填充8眼。术后定期复查眼底,追踪观察术眼眼压和PVR发展情况,平均追踪期21m。结果硅油填充25眼中21眼手术后3m～26m取出硅油。33眼中视网膜解剖复位30眼。3眼视网膜再脱离,其中PVR再增殖2眼,糖尿病性视网膜病变1眼。视网膜复位30眼中26眼压（9.2-22）mmHg,平均16.4mmHg,4眼眼压〉28mmHg,给予抗青光眼药处理,无一例发生术后低眼压。结论对视网膜切开切除后暴露区视网膜色素上皮激光凝固术有防止玻璃体切割术后低眼压发生及一定程度上减少PVR发展的疗效。     

玻璃体切割术治疗玻璃体积血的疗效观察

目的观察玻璃体切割术治疗玻璃体积血的疗效。方法分析我院自2004年以来收治的玻璃体积血患者25例（25眼），其中视网膜静脉阻塞（RVO）10例（10眼），糖尿病视网膜病变（DR）8例（8眼），眼外伤5例（5眼），孔源性视网膜脱离（RD）2例（2眼），全部患者均经睫状体平坦部行闭合式巩膜三通道玻璃体切割术，其中20眼联合行视网膜光凝术，3眼联合硅油填充术，5眼行C3F8注气术，5眼联合巩膜外环扎术。结果术后随访6个月以上，25例患者仅1例视力无提高，其余24例术后视力均较术前提高，其中1例DR患者术后发生孔源性视网膜脱离二次玻切术网膜复位。2例DR患者发生视网膜再次出血，予药物治疗，出血渐吸收。结论玻璃体切割术治疗玻璃体积血疗效明显。     

PPV术后玻璃体后界膜残留与PVR

目的：描述玻璃体切割术后玻璃体后界膜残留的一些临床特征,探讨其在复发性PVR的作用。方法：玻璃体切割术后复发性PVR和视网膜脱离接受再次玻璃体切割36眼,术中发现玻璃体后界膜残留28眼：有硅油充填21眼,充填时间2～26mo;无充填7眼。首次病变：RRD合并CD、巨大裂孔、黄斑裂孔11眼、早期外伤玻璃体积血10眼、视网膜血管病变玻璃体积血7眼、特发性玻璃体病变2眼。追踪观察6～34mo。结果：B超发现玻璃体内有一层较为完整的膜状结构6眼。玻璃体后界膜残留所致的复发性PVR和视网膜脱离,多发生在术后4～12wk。PPV术中发现较为完整膜结构23眼,部分膜结构5眼,组织学和免疫组化证实为后界膜。再次手术后7眼PVR再生,5眼再次手术,2眼经历3次手术,最终21眼(75％)视网膜获得功能复位,2眼获解剖复位,2眼拒绝再手术,3眼眼球萎缩。结论：玻璃体后界膜残留是PPV手术常见并发症,易发生于PDR、无明显PVR的RRD和早期外伤性玻璃体积血患;玻璃体后界膜残留是PPV术后产生PVR和视网膜脱离的重要原因之一。     

孔源性视网膜脱离合并脉络脱离的玻璃体视网膜手术

目的：评价孔源性视网膜脱离合并脉络膜脱离的玻璃体视网膜手术（vitreoretinal surgery,VR手术）效果及失败原因。 方法：回顾性地分析61例（61眼）VR手术，全部眼有脉络膜脱离和增殖性玻璃体视网膜病变（prolirerative vitreoretinopathy PVR）。采用玻璃体切割及视网膜前膜剥除，气液交换、眼内惰性气体或硅油填充。 结果：近期（出院时）有效40眼（65.57%），用惰性气体的35眼中有效26眼（74.3%）.14例患者追踪3个月以上，平均追踪9.5个月， 有效10眼。影响手术的主要因素为脉络膜脱离范围、手术次数、气体填充及皮质激素使用时间，手术失败的主要原因可能与严重的PVR、前部PVR及巨大裂孔有关。 结论：采用VR手术可提高孔源性视网膜脱离合并脉络膜脱离的手术成功率。 （中华眼底病杂志，1996，12：16-19)     

增生性玻璃体视网膜病变玻璃体切割液内的细胞凋亡

目的检测增生性玻璃体视网膜病变(proliferative vitreoretinopathy,PVR)玻璃体切割液标本内是否存在细胞凋亡,观察Fas抗原(Fas)和Fas配体(Fas ligand,FasL)与细胞凋亡的关系。方法11例PVR新鲜玻璃体 切割液标本细胞离心涂片,末端标记(terminal deoxynucleotidyl transferase-mediated deoxyuridine 5-triphosphate nick-end labelling,TUNEL)染色检测凋亡细胞,以及Fas、FasL和细胞类型特异抗原细胞角蛋白(cytokeratin,CK)免疫组织化学检测, 并与2例角膜移植后的供体眼正常对照标本的上述检查结果相对比。　结果正常人视网膜Fas和FasL弱表达。Fas、FasL、CK和凋亡见于所有PVR玻璃体切割液标本。TUNEL阳性细胞占总细胞数的20.53%。70.35%、51.58%和82.97%的细胞分别高表达Fas、FasL和CK。Fas和凋亡的直线相关系数为0.99(P<0.001)。结论PVR眼玻璃体切割液标本可见Fas、FasL的表达和细胞凋亡。Fas和FasL的高表达可能与PVR中增生的视网膜色素上皮细胞凋亡有关。(中华眼底病杂志,1999,15:78-80)     

The development of severe proliferative vitreoretinopathy after retinal detachment surgery

A prospective clinical study was conducted to determine wether preoperative proliferative vitreoretinopathy (PVR), grade B, was a significant risk factor in the development of severe PVR after surgery for retinal detachment repair. Two series of consecutive retinal detachments associated with horseshoe retinal tears were compared. The first series included 40 eyes of 40 patients with preoperative PVR, grade O - A. The second series included 30 eyes of 27 patients with preoperative PVR, grade B. All eyes were operated on with conventional microsurgical techniques. At the first operation, no vitrectomies were carried out in any eyes. The incidence of postoperative PVR, grades C and D, was 20% (6/30 eyes) after a single operation in the series of eyes with preoperative PVR, grade B as compared to 0% in the series of eyes with preoperative PVR, grade O - A. The difference between the two groups was statistically significant (P = 0.01). It was also found that the incidence of postoperative proliferative PVR was significantly higher in eyes with preoperative vitreous hemorrhage (30.7%) as compared to eyes with no preoperative vitreous hemorrhage (0%;P = 0.02). Incomplete posterior vitreous detachment without collapse of the vitreous gel occurred significantly more frequently in eyes with preoperative proliferative vitreoretinopathy, grade B (68.4%, than in eyes with preoperative proliferative vitreoretinopathy, grade O - A(27.5%;P = 0.02).     

人玻璃体蛋白质组双向凝胶电泳技术的建立及优化

目的优化并确立一套适合人眼玻璃体的双向电泳实验方法。方法收集14只健康捐献眼的玻璃体,提取玻璃体总蛋白,改进条件以确立玻璃体蛋白质的双向电泳（2-DE）技术流程。结果以IPG胶条（pH4～7,线性,L）进行一向等电聚焦,以12％SDS均匀胶进行二向垂直电泳,获得人玻璃体分布均匀的双向凝胶电泳图谱并分离出400多个蛋白点,凝胶图谱的重复性较好。结论该优化的技术流程能有效提取及分离玻璃体蛋白质,为进一步的差异蛋白质组研究奠定基础。     

Severe proliferative vitreoretinopathy and retinal detachment. I. Initial clinical findings

We studied 716 eyes of 697 patients with retinal detachment associated with the more advanced stages of proliferative vitreoretinopathy (PVR). The factors that influenced the severity of PVR and our criteria for surgical treatment were analyzed using statistical methods. The more severe cases of PVR showed a higher prevalence of cases with (1) retinal detachment exceeding 12 months' duration, (2) no retinal breaks observed, (3) the largest retinal break of a size equal to or exceeding one clock hour, and (4) poor initial visual acuity. Compared with the unoperated group, the eyes on which we subsequently operated were characterized by a greater prevalence of (1) patients with bilateral retinal detachment complicated by PVR, (2) cases with relatively recent onset of retinal detachment, (3) phakic eyes, (4) eyes without vitreous hemorrhage, (5) eyes with one or more visible retinal breaks and with smaller breaks, (6) relatively better initial visual acuity, and (7) less severe degrees of PVR.     

补体C4b及甲状腺素转运蛋白在增生性玻璃体视网膜病变中的表达变化及意义

目的 探讨补体C4b及甲状腺素转运蛋白(TTR)在增生性玻璃体视网膜病变(PVR)中的表达变化及意义.方法 对照实验研究.提取5例PVR患者玻璃体标本,以10例眼球捐献者的玻璃体标本作为正常对照组,进行双向电泳分析.应用Image master软件分析凝胶图谱获得的差异性蛋白质点,再经质谱分析技术鉴定出差异性蛋白质.兔眼玻璃体腔内注射视网膜色素上皮细胞,制造兔PVR模型,采用酶联免疫吸附测定(ELISA)法检测玻璃体中差异性蛋白质的浓度,以进一步验证PVR患者的蛋白质组学结果.PVR患者组与正常对照组玻璃体中差异性蛋白质浓度比较采用配对样本t检验.结果 双向电泳凝胶图谱显示PVR患者组与正常对照组玻璃体中有79个差异表达蛋白质点,对其中9个表达上调的差异性蛋白质点进行质谱鉴定,分别为补体C4b、TTR及7个血清蛋白.经ELISA法检测,正常对照组玻璃体中补体C4b和TTR浓度分别为(20.18±1.97)mg/L和(88.58±8.84)mg/L,PVR患者组玻璃体中补体和TTR浓度分别为(38.1±5.79)mg/L和(112.57±6.89)mg/L;PVR患者组玻璃体中的补体C4b和TTR浓度明显高于正常对照组,差异有统计学意义(C4b:t=11.54,TTR:t=9.24;P＜0.05).结论 PVR患者组与正常对照组玻璃体中补体C4b和TTR表达存在差异.补体C4b和TTR的表达上调可能与PVR的发病机制有关.

Abstract：

Objective To investigate the differential expression of complement C4b and transthyretin in proliferative vitreoretinopathy (PVR). Methods It was a controlled experimental study.Human vitreous samples of 5 patients with PVR were analyzed by using two-dimensional gel electrophoresis and mass spectrometry,and the results were compared with those from normal control vitreous obtained from donor eyes. An in vivo model of PVR was created by intravitreous injection of cultured rabbit retinal pigment epithelial (RPE) cells. The vitreous of PVR models were analyzed by enzyme linked immunosorbent assay (ELISA) to confirm the proteomic results from the PVR patients. Results Seventy nine various proteins were expressed differently between PVR and normal vitreous,among which nine up-regulated proteins including complement C4b,transthyretin (TTR),and 7 albumins were identified by mass spectrometry. The up-regulation of complement C4b and TTR in PVR patients was also confirmed by ELISA. The concentration of complement C4b and TTR in normal vitreous were(20. 18 ± 1.97)mg/L and (88.58 ± 8.84)mg/L respectively,in PVR patients were ( 38.1 ± 5.79) mg/L and ( 112.57 ± 6.. 89 ) mg/L repectively,difference significantly between these two groups ( C4b: t = 11. 54,TTR: t = 9. 24;P ＜ 0. 05 ). Conclusions Differences of complement C4b and TTR expression were observed between PVR and normal vitreous. These results have lead to the assumption that there is a connection between elevated concentrations of both complement C4b and TTR and the pathogenesis of PVR and further studies on the functions of these proteins are required.     

Basic fibroblast growth factor,glutamine synthetase,and interleukin-6 in vitreous fluid from eyes with retinal detachment complicated by proliferative vitreoretinopathy

PURPOSE: To investigate the presence of basic fibroblast growth factor (bFGF), glutamine synthetase (GS), and interleukin-6 (IL-6) in vitreous fluid from eyes with retinal detachment complicated by proliferative vitreoretinopathy (PVR). DESIGN: Comparative case series; experimental study. METHODS: In a prospective study, we measured bFGF, GS, IL-6, and total protein in vitreous fluid samples from 53 eyes from 53 consecutive patients with PVR operated on in our hospital. As controls, vitreous fluid samples from eyes with a macular hole (n = 9) or pucker (n = 11) were used. MAIN OUTCOME MEASURES: Laboratory data of the patient group were compared with the control group and correlated with various clinical data, especially with visual recovery and redetachment. RESULTS: For IL-6, bFGF, and total protein we found significantly higher levels in PVR patients' eyes than in control eyes (P =.03, P =.046, and P <.0001, respectively). Within the PVR group, no significant correlation was found for IL-6, bFGF, GS, or total protein with the various tested clinical variables. CONCLUSIONS: We found increased levels of IL-6, bFGF, and total protein in vitreous fluid from patients' eyes with PVR. Whether the increased levels of IL-6, bFGF, and total protein are the result of an injury-induced upregulation of these proteins as part of a self-protective mechanism of the retina to minimize photoreceptor damage after the mechanical injury induced by retinal detachment is, at present, not known.     

Surgical management of retinal detachment secondary to acute retinal necrosis: clinical features,surgical techniques,and long-term results

PURPOSE: To describe the clinical features of complicated retinal detachment secondary to acute retinal necrosis (ARN) and to present the long-term results of vitreous surgery in these cases. METHODS: A retrospective study was conducted on 16 immunocompetent patients (18 eyes). The average follow-up period was 60 months. RESULTS: Proliferative vitreoretinopathy (PVR) grade C, with the predominance of anterior PVR, and characteristic changes in the vitreous base area were present in all cases before surgery. All eyes underwent vitrectomy, membrane peeling, endolaser photocoagulation, and intraocular tamponade without scleral buckling. Additional procedures were performed in 13 eyes. Retinal reattachment was achieved in the 18 eyes (100%) in the short term. Variable degrees of reproliferation occurred in all cases after surgery. Other delayed complications included ocular hypotony, macular pucker, peripheral retinal neovascularization, and severe preretinal fibrosis. Improvement of visual acuity occurred in 13 eyes (72.2%). Eleven eyes (61.1%) achieved final ambulatory visual acuity of 5/200 or better. CONCLUSIONS: Rhegmatogenous retinal detachment secondary to ARN has characteristic clinical features. Severe proliferative vitreoretinopathy with the predominance of anterior PVR develops rapidly. Reproliferation is the most important late postvitrectomy complication necessitating multiple surgical procedures in these cases. The visual results remain unfavorable due to the destructive nature of ARN.     

复杂性视网膜脱离术中应用过氟化碳的临床疗效分析

目的 分析过氟化碳液体在玻璃体切除术中的治疗效果,以提高复杂性视网膜脱离的治愈率。方法 分析复杂性视网膜脱离７６只眼在玻璃体切除术中应用过氟化碳液体的临床效果及并发症,对合并 严重增殖性玻璃体视网膜病变（ＰＶＲ）的视网膜脱离５４只眼及巨大裂孔视网膜脱离１１只眼的术后复位率及术后视力分别进行统计。结果 ７６只眼中,术后视网膜复位７０只眼（９２．１％）;术后视力〉０．０２者６９只眼（９０．８％）,其中     

视网膜脱离巩膜扣带术后严重增生性玻璃体视网膜病变发生的危险因素

目的 探讨孔源性视网膜脱离巩膜扣带术后严重增生性玻璃体视网膜病变（proliferative vitreoretinopathy, PVR）发生的临床危险因素。 方法 采用病例对照研究方法，回顾性分析4031例（4031只眼）PVR低于C1级、行视网膜脱离巩膜扣带术患者的临床资料。记录患眼眼压值、晶状体和玻璃体状态、视网膜脱离特征、是否伴发脉络膜脱离 等22个临床特征。4031例患者中，有2660例手术后随访时间3个月以上，其中72例 （72只眼）因为巩膜扣带术后［12~210 d ,平均时间（60.3±41.0）d］发生严重PVR导致视网膜再脱离，回到我科行第2次玻璃体切割术，纳入PVR组；从剩下的2588例患者资料中随机调取72例（72只眼）视网膜复位3个月以上患者的临床资料纳入对照组。应用SPSS（10.0）软件将2组分析结果进行单元和多元Logistic回归分析。 结果 视网膜脱离巩膜扣带术后严重PVR发生的相关因素为：巩膜扣带术前呈现不完全性玻璃体后脱离 （P<0.001），眼压低于7 mm Hg（1 mm Hg=0.133 kPa)(P＜0.002），以及单一视网膜裂孔大小大于2个视盘直径(disc diameter,DD)（P＜0.005）。 结论 孔源性视网膜脱离患者巩膜扣带术前有不完全性玻璃体后脱离、低眼压及单一视网膜裂孔大小大于2 DD可能是PVR发生的主要危险因素。 （中华眼底病杂志，2003，19：141-143）     

视网膜脱离手术后增殖性玻璃体视网膜病变的危险因素

本文复习了160例(160眼)视网膜脱离手术失败的病例,其中有增殖性玻璃体视网膜病变(proliferative vitreoretinopathy,PVR)改变的62例(称PVR组),没有PVR改变的98例(称无PVR组),通过这些病例的各种临床特点的比较对照,探讨术后PVR发生的临床危险因素.结果表明,视网膜脱离伴发葡萄膜炎反应或有低眼压存在,术前后玻璃体出血,多次手术是术后发生严重PVR的非常危险因素.这些因素同时存在PVR发生率更高、文中还提出减少和预防PVR发生的方法.     

Soluble TNF receptors in vitreoretinal proliferative disease

PURPOSE: To measure vitreous levels of soluble TNF-receptors (sTNF-Rs) types I and II in eyes with rhegmatogenous retinal detachment (RRD), uncomplicated or complicated with proliferative vitreoretinopathy (PVR), and in eyes with proliferative diabetic retinopathy (PDR). To examine whether there is any relationship between vitreous levels of sTNF-Rs and clinical features of these conditions and between vitreous sTNF-Rs and TNFalpha levels and serum levels of sTNF-RS: METHODS: Vitreous levels of sTNF-Rs and TNFalpha were measured by enzyme-linked immunosorbent assay in 30 eyes with PVR, 30 eyes with uncomplicated RRD, and 29 eyes with PDR. Vitreous from eyes of 10 deceased donors and 9 eyes with macular holes served as control specimens. Serum levels of sTNF-Rs were measured in 17 patients with PDR and 21 patients with PVR. RESULTS: Vitreous levels of sTNF-Rs I and II were increased in eyes with PVR, RRD, and PDR when compared with control eyes (P < 0.002). However, vitreous levels of sTNF-Rs I and II were higher in eyes with PVR than in eyes with RRD (P < 0.01) or PDR (P < 0.03). This contrasted with the findings that serum sTNF-Rs were higher in PDR than in PVR (P < 0.016) and that vitreous levels of TNFalpha were higher in eyes with PDR than in eyes with PVR (P < 0.0005). In PVR, vitreous sTNF-Rs levels were associated with the duration of retinal detachment, number of previous external operations, and grade of severity, whereas in PDR these levels were not related to the type or duration of diabetes or its complication with traction retinal detachment. CONCLUSIONS: These observations suggest the existence of TNF inhibitory mechanisms within the eye during retinal processes of inflammation and angiogenesis. That high vitreous levels of sTNF-Rs relate to severity of retinopathy suggests that these molecules may constitute reactive products of inflammation. Effective control of TNFalpha activity by sTNF-Rs within the retinal microenvironment may determine the outcome and severity of retinal proliferative conditions.