重硅油填充治疗增生性糖尿病视网膜病变的临床研究

目的 观察重硅油作为眼内填充剂治疗增生性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)的有效性和安全性.方法 采用标准玻璃体切割联合重硅油Oxane HD填充术治疗PDR患者29例(29眼),观察重硅油填充期术眼的最佳矫正视力、视网膜复位情况、术后并发症等.结果 重硅油填充期平均为109 d,19例患者最佳矫正视力较术前提高,其余患者视力无提高,无术后视力下降患者.1例患者出现重硅油填充后视网膜脱离,其余患者视网膜均平伏,2例患者术后玻璃体再出血.术后主要并发症包括高眼压、葡萄膜炎、晶状体混浊、硅油乳化、黄斑前膜形成等.结论 重硅油Oxane HD作为眼内填充物可以有效安全地治疗PDR.     

重硅油应用眼内短期填充15例临床分析

目的 探讨重硅油(Densiron-68)用于眼内填充治疗复杂性视网膜脱离的临床效果、并发症及安全性.方法 采用玻璃体切割联合重硅油眼内填充治疗视网膜脱离患者15只眼,分别为糖尿病视网膜病变、急性视网膜坏死、黄斑裂孔性视网膜脱离、巨大裂孔性视网膜脱离、伴有严重PVR的复发性孔源视网膜脱离,填充时间最少为40d,最长为12个月.观察重硅油填充期间及取出后视网膜复位情况及并发症等.结果 12只眼取出重硅油后在随访期间(2～4月)观察到视网膜保持复位,复位率80%(12/15);3只眼视网膜脱离复发,其中2只眼再次手术并普通硅油填充,1只眼拒绝取出重硅油,14只眼矫正视力较术前提高,1只眼视力无改善.主要并发症有白内障、后发白内障、硅油乳化、瞳孔粘连、乳化滴粘附于人工晶状体、术后PVR、硅油充满前房、硅油进入视网膜下等.结论 重硅油眼内填充治疗复杂性视网膜脱离疗效肯定,并提高患者舒适度,但并发症发生率高,只适宜短期填充,且需要密切随访.     

中间型葡萄膜炎并发复杂性视网膜脱离的玻璃体手术治疗

目的:探讨中间型葡萄膜炎并发复杂性视网膜脱离的临床特征及玻璃体切除联合眼内填充术的治疗效果。方法:回顾性分析我院2000-01/2005-06收治的11例(共11眼)中间型葡萄膜炎并发复杂性视网膜脱离病例术前及术后详细的临床资料。所有患者均接受巩膜外环扎,玻璃体切除联合眼内填充术治疗,术中9眼行硅油充填,2眼填充长效惰性气体。术后随访12～66mo。结果:术后11眼均获视网膜良好复位及视力增进。随访期中有7眼于6～12mo取出硅油,硅油取出后2眼因周边部PVR或葡萄膜炎复发导致视网膜脱离复发,未取硅油的4眼(包括2只再手术眼)视网膜平伏。结论:中间型葡萄膜炎并发的复杂性视网膜脱离,尤其存在周边部纤维及血管膜的牵引时,玻璃体切除联合眼内填充术效果确切,周边部PVR和葡萄膜炎复发是术后限制视网膜复位的主要原因。     

硅油充填眼视网膜脱离原因分析及手术治疗

目的：探讨玻璃体切割联合硅油填充术后复发性视网膜脱离的原因及治疗方法，以便提高手术成功率。方法：回顾性分析我院3年来收治的31只硅油填充眼发生复发性视网膜脱离的原因，31只硅油填充眼进行二次手术，对不同情况分别采取硅油下剥膜、巩膜外垫压、视网膜前膜剥离、视网膜切开、眼内激光光凝等手术，再次眼内填充惰性气体3只眼。硅油21只眼，观察治疗效果。结果：31只硅油填充眼二次手术，视网膜解剖复位28眼，复位率为90％，部分复位3眼；术后视力提高者13眼41．9％，不变16眼。占51．6％，下降3眼，占9．7％。视网膜复位后硅油取出21眼，视网膜复位16眼，未复位5眼。结论：硅油填充眼的复发性视网膜脱离多以下方为主。术后增殖膜形成牵拉是造成硅油填充期间发生复发性视网膜脱离的主要原因。视网膜前膜剥离。视网膜切开，眼内激光光凝，再次眼内填充手术是治疗硅油填充眼复发性视网膜脱离的有效方法。     

标准三通道下硅油抽吸术的临床应用

目的 探讨在标准三通道下行硅油抽吸术的安全性及有效性.方法 48例48眼采用标准三通道下硅油抽吸术,观察术前硅油乳化情况、术中裂孔检出率、术后视网膜复位情况及术后最佳矫正视力.结果 术前硅油乳化18眼.术中检查出新裂孔8眼.末次随访时最佳矫正视力0.02～ ＜1.00者38眼.术中一次性顺利取出硅油43眼.末次随访时43眼硅油取出眼中,39眼视网膜复位良好,4眼于硅油取出术后3周～2个月视网膜脱离复发.结论 标准三通道下硅油抽吸术能详细检查眼底情况,及时处理硅油眼内视网膜病变,降低视网膜脱离的复发率,是安全有效的方法.     

重硅油眼内填充治疗复杂性视网膜脱离的近期效果

目的 观察重硅油作为眼内填充物治疗复杂性视网膜脱离的疗效和安全性.设计回顾性病例系列.研究对象复杂性视网膜脱离患者16例16眼.方法 采用玻璃体切割联合重硅油填充术治疗.术中依病情联合剥膜、视网膜切开、重水应用、眼内激光、超声乳化白内障吸出人工晶状体植入等.主要指标视网膜复位情况,视力、眼压等.结果 平均随访(15.1±8.48)周(3～28周).15例(93.8%)患者视网膜全部复位,裂孔封闭.13例患者于术后1～3个月行重硅油取出,3例在最后随访时重硅油仍未取出.1例在取硅油时发现上方裂孑L前缘稍浮,视网膜限局脱离,而行惰性气体填充术.所有患者术后均出现不同程度的晶状体混浊,主要表现为后囊膜混浊.4例出现暂时性高眼压.结论 重硅油眼内填充对治疗裂孔位于2～10点钟位之下方或两个以上裂孔位于视网膜同一侧的复杂性视网膜脱离疗效较好,并发性白内障是其主要副作用.(眼科,2008,17:254-257)     

玻璃体切除硅油充填联合眼内光凝治疗晚期Coats病

目的：探讨玻璃体切除硅油充填联合眼内光凝治疗伴有广泛渗出性视网膜脱离的晚期Coats病的临床治疗效果。方法：伴有广泛渗出性视网膜脱离的晚期Coats病患13例(13眼)进行玻璃体切除硅油充填联合眼内光凝治疗,其中并发性白内障同时行晶状体切除3眼。术后随访时间0．5～2a。观察术后视力、眼压、视网膜复位情况、视网膜血管改变及术后并发症。结果：术后3mo,13例患视网膜均复位,经FFA检查见异常扩张的血管逐渐闭塞和退缩;其中9眼最佳矫正视力均有不同程度提高,≥0．31眼,0．1～0．33眼,≤0．15眼;另有4眼术后视力没有明显变化。术后6和14mo时各有1例因血管渗漏致下方局限性渗出性视网膜脱离,经补行激光治疗后视网膜下液吸收,视网膜复位。结论：玻璃体切除硅油充填联合眼内光凝是治疗伴有广泛渗出性视网膜脱离的晚期Coats病的最为安全有效的方法。     

玻璃体视网膜手术治疗复发性视网膜脱离

目的：探讨玻璃体视网膜手术治疗复杂性视网膜脱离的效果。方法：应用玻璃体切割联合剥膜、视网膜切开、重水注入、眼内激光光凝、气液交换眼内气体C3F8或硅油充填术治疗42例各种复杂性视网膜脱离进行回顾性分析。结果：随访2-28月，解剖性复位33只眼（78.6%），视力≥0.02的功能性成功31只眼（73.8%），术中并发症眼内出血2只眼，医源性裂孔5只眼，重水进入视网膜下1只眼，术后并发高眼压3只眼，角膜变性混浊1只眼。结论：玻璃体视网膜手术是治疗复杂性视网膜脱离的理想的有效方法。彻底地剥膜，正确并有技巧的应用重水，选择合适的玻璃体腔填充物及避免并发症发生是手术成功的关键。     

三切口眼内硅油取出术的临床分析

目的 观察眼内硅油取出的有效方法,探讨三切口硅油取出手术效果.方法 对48例（48只眼）施行三切口眼内硅油取出、剥膜、惰性气体填充术等手术方法.结果 48只眼有23只眼伴有视网膜增生改变（47.9%）,术后视网膜保持复位46只眼（95.8%）,2只眼部分复位 2只眼继发青光眼眼压正常.术后视力：0.02者以上26只眼,其中0.1以上者10只眼.结论 三切口眼内硅油取出术安全,可防止硅油取出后视网膜脱离等并发症的发生.     

重硅油在玻璃体视网膜疾病手术中的应用

目的:评价Densiron 68硅油作为眼内充填物的有效性及安全性.方法:回顾性分析2015-01/2016-01我院眼科因复杂视网膜脱离接受重硅油充填术的患者30例30眼.观察分析术前及术后的最佳矫正视力(BCVA)、眼压、视网膜复位情况及术后并发症等. 结果:术前与硅油充填术后BCVA的差异,术前与取硅油术后3mo BCVA的差异均有统计学意义(z=-2.198,P=0.028;z=-2.682,P=0.007).平均术前眼压为16.067±4.025mmHg,硅油充填术后为20.233±8.007mmHg,差异有统计学意义(t=-2.913,P=0.005);而硅油取出术后眼压14.933±3.423mmHg,与术前眼压比较差异无统计学意义(t=2.635,P=0.430).重硅油取出术后视网膜复位率90%,常见并发症为硅油乳化、并发性白内障.结论:重硅油Densiron 68作为眼内充填物治疗复杂性玻璃体视网膜疾病有效及安全,但由于重硅油乳化率较高、术后易并发白内障,因此临床使用时应严格掌握适应证.     

Long-term outcomes of heavy silicone oil tamponade for complicated retinal detachment

PURPOSE: To assess the long-term success rates and complications of heavy silicone oil tamponade (Oxane HD) in the management of complicated retinal detachment with proliferative vitreoretinopathy (PVR). METHODS: Twenty-one eyes of 21 patients with complicated retinal detachment and PVR were included in this study. Vitreoretinal surgery with heavy silicone oil (Oxane HD) tamponade was performed in all patients. Heavy silicone oil was injected by perfluorocarbon liquid-air-silicone oil exchange, and was removed after 3 months. The main outcomes of the surgery including the success and complication rates were evaluated during the mean follow-up period of 11.4+/-0.88 months. Wilcoxon signed ranks test was used for statistical analysis of visual acuity changes. The outcomes of our study were compared with those of the previous studies. RESULTS: All eyes had complicated retinal detachment with PVR Grade C3 or worse. Retinal detachment was rhegmatogenous in 6 eyes, secondary to previous detachment surgery in 11 eyes, secondary to proliferative diabetic retinopathy in 3 eyes, and secondary to perforating eye injury in 1 eye. The overall anatomic success rate was 80.9% at the end of the follow-up period. The overall visual success rate was 42.8%, with no statistically significant difference from baseline (p>0.05). Postoperative complications included severe reproliferation (4 eyes), intraocular pressure rise (3 eyes), anterior dislocation of silicone oil (2 eyes), posterior subcapsular cataract formation (4 eyes), vitreous hemorrhage (1 eye), rubeosis iridis (3 eyes), optic atrophy (1 eye), and ocular pain and photophobia (21 eyes). CONCLUSIONS: According to the results of this study, vitreoretinal surgery with temporary heavy silicone oil tamponade appears to increase the anatomic success rates with minimal complication rate in cases with complicated retinal detachment and PVR.     

重硅油OxaneHD在外伤性视网膜脱离手术中的应用

目的分析重硅油OxaneHD在外伤性视网膜脱离中的疗效及并发症。方法外伤性视网膜脱离25例（25眼）经过标准玻璃体切除手术，应用OxaneHD填充，随访3～18个月，分析视网膜复位率和眼部并发症的发生情况。结果一次填充OxaneHD后视网膜复位率为72．0％，术复位者5例（20．0％）接受二次手术填充硅油或惰性气体后视网膜达到解剖复位，2例（8．0％）成为硅油依赖跟。观察到的主要并发症有白内障、高眼压、重硅油乳化。结论重硅油OxaneHD填充治疗外伤性视网膜脱离的疗效良好，可明显提高患眼舒适度。     

Silicone oil-RMN3 mixture ("heavy silicone oil") as internal tamponade for complicated retinal detachment

PURPOSE: To evaluate the efficacy and safety of a silicone oil-RMN3 mixture ("heavy silicone oil") as heavier as water internal retinal tamponade after vitrectomy for complicated retinal detachment. The relative density of the heavier-than-water silicone oil was 1.03 g/cm3, and the viscosity was 3,800 cSt. Heavy silicone oil is designed to tamponade the inferior retina in complicated retinal detachment. METHODS: Patients with a complicated retinal detachment involving the inferior part of the retina requiring internal tamponade with silicone oil were recruited for this prospective study. Inclusion criteria were retinal detachment secondary to proliferative vitreoretinopathy (stage > or = C2), inferior or posterior tears, or penetrating trauma. The heavy silicone oil was injected at the end of surgery after peeling of retinal membranes or retinotomy. Follow-up examinations were scheduled at 1, 3, 6 months, and 1 year after the initial surgery. RESULTS: A total of 33 eyes of 33 patients aged from 20 to 84 years (mean, 56 +/- 18 years) were treated with heavy silicone oil. Follow-up ranged from 12 to 16 months. Rhegmatogenous retinal detachment with significant proliferative vitreoretinopathy accounted for 17 cases, inferior holes for three, and trauma with retinal detachment for three. Initial visual acuity ranged from 20/50 to hand motions. Initial retinal reattachment was achieved in all cases. Complications included increased intraocular pressure in six eyes (18%), intraocular inflammation and synechia formation in one eye (3%), a central retinal artery occlusion after heavy oil removal in one eye, and scattered retinal hemorrhages during follow-up in two eyes (6%). Significant emulsification was not observed during intraocular tamponade with heavy silicone oil. At the last follow-up, all eyes had macular attachment, and 24 eyes had a visual acuity better than or equal to 20/400. CONCLUSIONS: The results of this prospective study show the good intraocular tolerance of heavy silicone oil as tamponade in complicated retinal detachment. Its specific gravity allows for sufficient tamponade of inferior retinal tears for at least 3 months without significant side effects.     

Anatomical and functional results of endotamponade with heavy silicone oil - Densiron 68 - in complicated retinal detachment

BACKGROUND: High-density silicone oils are newly developed long-term tamponade agents for the treatment of complicated retinal detachment in the inferior retina. Previous studies describe satisfying anatomical and functional results. In this study we examined the largest cohort so far for a 9-month follow-up and performed a comparison to conventional silicone oil. METHODS: Our study documents results and adverse effects after vitreoretinal surgery and endotamponade with Densiron 68 in 99 cases of complicated retinal detachment. A 9-month follow-up was performed. Data of 21 patients with intraocular conventional silicone oil tamponade in complicated retinal detachment were retrospectively analyzed and served as control. RESULTS: Anatomical success was achieved in 78 of 89 eyes (87.6%) with completed follow-up; visual acuity did not change significantly (from mean preoperative logMAR 1.88 to postoperative logMAR 1.96 (p = 0.9). Compared to control a higher anatomical success but a similar number of adverse effects were observed with heavy silicone oil in vitreous. Nevertheless, patients who received Densiron 68 twice due to redetachment showed a significantly higher rate of intraocular inflammation with the tamponade agent in situ. CONCLUSION: Our results support the hypothesis of Densiron 68 as potent tamponade agent for complicated retinal detachment in the inferior retinal segments especially in eyes where a previous operation failed.     

玻璃体切除联合重硅油治疗下方视网膜脱离的临床研究

目的观察2种不同密度的硅油Densiron68与Oxane5700治疗下方视网膜脱离的临床效果。方法非随机前瞻性临床研究。玻璃体切除术联合硅油填充治疗视网膜脱离45例（46眼）。分析其临床疗效。结果随访至硅油取出术后6个月。Densiron68组和Oxane5700组在首次手术后视网膜复位率分别为78．3％和73．9％（P〉0．05）;进一步治疗后分别为91．3％和87．0％（P〉0．05）;随访结束时分别为91．3％和82．6％（P〉0．05）。但在曾行玻璃体手术或巩膜扣带术者的首次手术后复位率分别为71．4％和33,3％。术后炎症反应、硅油乳化、并发性或后发性白内障的发生率Densiron68组高于Oxane5700组（P〈0．05）。结论Densiron68和Oxane5700治疗复杂视网膜脱离的疗效无明显差异。术后炎症反应、硅油乳化、并发性或后发性白内障的发生率Densiron68组高于Oxane5700组。对曾使用普通硅油失败或无法坚持俯卧位者,Densiron68是一种较好的选择。     

Intraocular inflammation following endotamponade with high-density silicone oil

Background The use of a mixture of silicone oil and partially fluorinated alkanes (high-density silicone oil) has recently been suggested as intraocular tamponade in complicated retinal detachment of the inferior quadrants. We describe a series of patients who developed a clinical picture resembling anterior granulomatous uveitis following endotamponade with high-density silicone oil.Methods We evaluated 19 eyes of 18 patients who underwent pars plana vitrectomy and intraocular tamponade with high-density silicone oil (Oxane HD^®). The indication for this type of intraocular tamponade was limited to cases with complicated retinal detachment of the inferior quadrants. Oxane HD^® was removed after a mean period of 3 months.Results One to eight weeks following vitrectomy with high-density silicone oil, an intraocular inflammation was observed in 7 of 19 eyes (37%). These eyes presented with keratic precipitates (KP), pigmented clumps in the inferior part of the anterior chamber and increased anterior chamber cellular reaction. This inflammatory response did not react to topical steroids. In addition to KP a considerable amount of cellular precipitation was noted on the surface of the oil bubble. Strikingly, the intraocular inflammatory signs completely resolved following removal of the high-density silicone oil.Conclusions An inflammatory response, resembling granulomatous uveitis, occurs in a significant number of patients after high-density silicone oil endotamponade. It is likely that this vitreous substitute is an immunogenic agent, given the complete resolution of the inflammation after removal of the high-density silicone oil. The routine use of this newly developed silicone oil should therefore await the outcome of additional controlled clinical trials.The authors have no commercial, proprietary or financial interest in any research or devices presented in this study     

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。     

Different endotamponade agents and their clinical indications

The use of polydimethylsiloxane (PDMS) as silicone oil endotamponade has become a gold standard in retinal surgery. In cases of complicated retinal detachment with inferior and posterior retinal detachment this tamponade may be insufficient, and heavy silicone oils may be superior in such cases. Monocentric studies about use of the heavy silicone oil Densiron 68, a mixture of PDMS with perfluorohexyloctane (F6 H8), are reviewed. Meanwhile, F 6 H8 is approved as sole endotamponade, but complications such as emulsification and inflammation associated with the use of only F 6 H8 as endotamponade are reported and will also be reviewed. An advantage of heavy silicone oils is the relatively short residence time of the endotamponade. An uncomfortable "head down" position of the patients after surgery is not necessary. Current research focuses on developing new heavy silicone oils with a lower tendency to emulsify.     

重硅油填充治疗下方裂孔源性视网膜脱离的临床研究

目的评价用重硅油填充治疗下方裂孔源性视网膜脱离伴严重增生性玻璃体视网膜病变（PVR）的手术效果及并发症。方法对下方视网膜裂孔和严重PVR的复杂性视网膜脱离12例（12只眼）行玻璃体切割联合玻璃体腔重硅油填充术。术后对视力、角膜、眼底及眼压等情况进行随访。结果术后随访2.5～27个月,平均7.7个月,83.3%的病例视网膜裂孔封闭、视网膜完全复位;术后视力6只眼（50%）提高,4只眼（33.3%）不变;2只眼（16.7%）下降;4只眼（33.3%）术后眼压异常,其中2只眼（16.7%）为一过性低眼压,2只眼（16.7%）为一过性高眼压;2只眼（16.7%）并发性白内障;2只眼（16.7%）重硅油乳化;1只眼（8.3%）重硅油进入前房;1只眼（8.3%）严重的前房炎症反应。结论对下方裂孔源性视网膜脱离伴严重PVR,行玻璃体切割联合玻璃体腔重硅油填充术,可获得满意的视网膜复位率,而且并发症的发生率低。     

A pilot study on the use of silicone oil–RMN3 as heavier-than-water endotamponade agent

Aims This work was conducted to report an interventional non-comparative pilot study using Oxane HD, a mixture of ultra-purified silicone oil and RMN3, a partially fluorinated olefin, as heavier-than-water internal tamponade. Methods Twenty-eight consecutive patients were recruited for this study. Indications included recurrent retinal detachment (RD) with proliferative vitreoretinopathy (PVR) (stage ≥C2) arising from inferior or posterior tears, recurrences after vitreoretinal surgery, penetrating trauma and combined rhegmatogenous and choroidal detachment. The patients underwent a pars plana vitrectomy, membrane peeling, and Oxane HD was used as long-term internal tamponade. Results Oxane was removed after 88 days (range 45–96 days) and exchanged with BSS in five eyes, long-acting gas in 14 eyes and with silicone oil in nine eyes. Retinal reattachment was achieved in 15 eyes. The overall anatomical success rate obtained using Oxane HD was 53.5%. In 15 patients with previous marked scleral buckling, the success rate was 26%: in nine patients recurrent RD occurred in the inferior sector, in five patients new tears were detected in the lower sectors; membrane formation was observed in 15 eyes. In 13 patients without marked scleral indent, the success rate was 84.6%. There was no evidence of dispersion and excessive inflammation. Conclusion Oxane HD may be a useful tool in complicated RD with large inferior breaks, inferior PVR or combined rhegmatogenous, and choroidal detachment without marked scleral buckling, which put the eye profile out of shape, led to a higher failure rate and reduced the tamponading effectiveness of Oxane HD.