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。     

玻璃体切割术治疗增殖性糖尿病视网膜病变

目的：观察玻璃体切割术治疗增殖性糖尿病理视网病变的疗铲及手术并发症。方法：应用睫状体平坦部玻璃体切割术治疗增殖性糖尿病视网病变患者１７例１９只眼，其中ＰＤＲＶ期１０只眼；ＰＤＲⅥ期９只眼。结果：术后视力大于０．０５者１２只眼，占６３．１％。复发性玻璃体出血５只眼，占２６．３％。结论：增殖性糖尿性视网膜病变引起的广泛玻璃体出血可以观察３个月，若视力不改善，应尽早行玻璃体例体切割术。     

视网膜黄斑前膜的手术治疗

应用玻璃体切割术切除了１５只眼的视网膜黄斑前膜，其中特发性７只眼，继发性８只眼，术后随诊６～２７个月，１４只眼视力增进，占９３％，其中半数以上增进３行以上，视力的增进与手术时机的选择有关，术后除１只眼出现旁中心暗点外，无其它并发症。     

外伤性白内障切割并悬吊式人工晶体植入术

对３４例３４只眼穿孔性眼外伤所致白内障行晶体前玻璃体切割，并悬吊式人工晶体植入术。术后矫正视力达０．８及以上者７只眼（２０．６％）；０．３－０．７者１４只眼（４１．２％）；００５－０２者８只眼（２３．５％）；０．０５以下者５只眼（１４．７％）。未发现人工晶体倾斜。主要并发症有：术中后房少量出血６只眼，虹膜后粘与人工晶体前膜形成５只眼，悬吊线残端暴露１只眼，黄斑囊样水肿２只眼，视网膜脱离１只眼。     

眼球严重挫伤致视力损害的分析

目的 分析眼球挫作引为视力严重损害的情况。方法 对１３８例肯挫伤的损伤情况及治疗结果进行分析。结果 角膜２３例占１６．７％，前房积血７５例占５４．３％，外伤性葡萄膜炎３８例占２７．５％，继发性青光眼６３例占４５．７％，眼列中２３．９％，晶状体脱位２７例占１９．６％，外伤性白内障３９例占２８．３％，玻璃体积血２３例占１６．７％，视网膜脱离及视神经挫伤各５便占３．６％。结论眼球严重挫作是多部位的复合伤     

硅油,SF6填充治疗巨大裂孔视网膜脱离

３７例（３７眼）巨大裂孔视网膜脱离手术，其中３０例为玻璃体切割硅油填充，７例为六氟化硫（ＳＦ６）填充。术后完全复位３０例（８１．１％），部分复位４例（１０．８％），３例（８．１％）未复位。术后获０．０２以上视力３２例（８６．５％），影响术后视力的主要因素是裂孔位置与黄斑部的关系及其视网膜前膜、下膜的增殖情况。合理选择眼内填充物是视网膜复位的重要因素。     

玻璃体切除术治疗外伤性玻璃体病变

本文总结了９２例外伤性玻璃体病变应用玻璃体切除治疗的结果。其中玻璃体出血性混浊１６眼；外伤增殖性玻璃体病变９眼；增殖性玻璃体病变伴牵引性视网膜脱离５１眼；增殖性玻璃体病变伴眼内异物１３眼；外伤性眼内炎３眼。手术方法采用闭合式玻璃体切除、环扎、外加压、玻璃体条索剪断、冷凝、气液交换等。术后玻璃体清亮者８６眼，占９３．５％；视力增加者７１眼，占７７．２％；牵引性视网膜脱离术后复位３３眼，占６４．７％。     

儿童孔源性视网膜脱离

报告儿童视网膜脱离１２６例１５８眼，占同期视网膜脱离病人的７．４％。平均年龄１０．３岁（５～１４岁）男性占９０．５％。双眼发病３２例（２５．４％）。３３．５％有眼部钝挫伤史。４７．５％合并有先天发育异常，近视占３６．７％。从发病至确诊的间隔时间平均５．３月，３１％发病后半年才确诊。６２％全脱离，９１．８％黄斑部脱离，ＰＶＲＣ和Ｄ级占５１．３％，６２．７％合并有视网膜下线条。１３２眼手术，术后３个月解剖复位率为８７．１％，半年为７７．３％。     

玻璃体切割联合保留前囊膜的晶状体切除治疗糖尿病性视网膜病变

目的　对老年糖尿病性视网膜病变患者采取玻璃体切割联合保留前囊膜的晶状体切除治疗并进行随访观察,以探讨其临床疗效。方法　以我院２０１０年３月至２０１２年８月收治的增生型糖尿病性视网膜病变老年患者５７例（６０眼）为观察对象。所有患眼均采取玻璃体切割联合保留前囊膜的晶状体切除治疗,一期不进行人工晶状体植入而行硅油填充。观察患者术前术后视力变化及并发症发生情况。结果　术后随访１２～２３（１６．４±２．５）个月,患眼术后视力较术前提高者５５眼（９１．７％）,视网膜复位率为１００％。术后有１１眼眼压增高,２眼出现虹膜新生血管,４眼发生局部虹膜粘连及４眼前囊膜３级混浊。结论　玻璃体切割联合保留前囊膜的晶状体切除是处理老年增生型糖尿病性视网膜病变的较好方法。     

玻璃体切除和人工晶体植入联合与分期手术的探讨

对７１例累及前后段复杂眼外伤患者采取玻璃体切除、晶体切除或囊外摘出、眼内异物取出、视网膜裂孔封闭的联合手术，同期或分期植入人工晶体。其中同期植入４６只眼，分期植入２５只眼。术后视力１．０以上１３只眼（１８．３％），０．３以上４４只眼（６２％），０．０５～０．２者１４只眼（１９．７％）。对联合与分期手术的选择、手术方式、合并症的处理等进行了探讨。     

Vitrectomy for idiopathic and secondary preretinal macular membrane

PURPOSE: To evaluate the results of pars plana vitrectomy and membrane stripping for idiopathic and secondary preretinal macular membrane (PMM). MATERIAL AND METHODS: Twenty one consecutive subjects (21 eyes) ranging in age from 40 to 78 (mean 66.9) with PMM underwent vitrectomy and membrane peeling. 17 cases had membranes that were considered idiopathic, and 4 cases were associated with other disorders: 3 occurred after successful retinal reattachment surgery, 1--after laserotherapy in the course of diabetic retinopathy. Visual acuity (VA), Amsler grid, and postoperative complications were assessed. The follow-up was 1 to 22 months, mean 5.7. RESULTS: Visual acuity improved postoperatively in 15 eyes (71.4%), at least two lines on the Snellen chart in 8 eyes (38.1%), entirely in patients with idiopathic PMM. It remained unchanged in 3 eyes (14.3%) and deteriorated in 3 eyes (14.3%). Eyes with transparent membrane showed greater visual improvement than opaque ones. The preoperative Amsler test was positive in 15 patients (71.4%), postoperatively--in 4 cases (19%). 2 idiopathic cases with VA of 0.7 showed postoperatively VA of 1.0. Complications included retinal detachment in 2 eyes (1 in idiopathic and 1 in secondary PMM), and development of nuclear sclerotic cataract in 2 eyes. At 6 months of follow-up, a residual membrane formation in 1 cases appeared. Macular pseudohole was observed in 1 eye with no impact on visual results. CONCLUSIONS: 1. Vitrectomy with membrane peeling for preretinal macular membrane provides improvement in visual acuity and reduces metamorphopsia 2. Thin, cellophane-like appearance of the membrane gives a better prognosis of visual function improvement.     

Role of the vitreous in idiopathic preretinal macular fibrosis indicated by visual acuity in follow-up cases

The vitreous and visual acuity in 103 eyes with idiopathic preretinal macular fibrosis were examined. The vitreous was studied biomicroscopically and the follow-up course was 6 months or more. Twenty-two eyes had no posterior vitreous detachment (group 1), 4 eyes had partial posterior vitreous detachment without traction to the macula (group 2), 17 eyes had partial posterior vitreous detachment with traction to the macula (group 3), and 60 eyes had complete posterior vitreous detachment (group 4). There were significantly more eyes with a visual acuity of 0.4 or worse, decreased acuity, or macular fluorescein leakage in group 3 than in groups 1 or 4. Decreased visual acuity was found in 41% of eyes with macular fluorescein leakage, but in only 11% of eyes without macular fluorescein leakage. It is presumed that the vitreous traction to the macula and macular fluorescein leakage are closely related to the outcome of visual acuity in cases with idiopathic preretinal macular fibrosis.     

Prognostic factors in idiopathic preretinal macular fibrosis

We retrospectively studied 124 eyes with idiopathic preretinal macular fibrosis to assess the value of fluorescein angiography and vitreous examination for predicting the visual prognosis. During a mean follow-up period of 43 months (range, 12–14 months), the visual acuity of 33 eyes (27%) declined two or more lines from the initial value, although the appearance of the fibrosis remained unchanged in 114 cases (92%). At initial examination, 38 eyes (31%) showed fluorescein leakage into the macula; these eyes were more prone to further visual deterioration than were those without leakage (P< 0.05). Of 14 eyes with partial vitreous detachment and vitreous traction to the fibrosis, 6 (43%) had a final visual acuity of 20/200 or worse; this proportion was significantly higher than that found either in eyes with no detachment or in those with complete vitreous detachment (P< 0.05). The presence of fluorescein leakage and/or vitreous traction to the fibrosis may predict worse functional prognosis in eyes with idiopathic preretinal macular fibrosis.J. Akiba and A. Yoshida were on leave from the Department of Ophthalmology, Asahikawa Medical College, Japan     

黄斑裂孔第3、4期視網膜内界膜染色舆剥除的前瞻性研究

目的 爲了確定用吲哚青綠介導特發性黄斑裂孔第3、4期視網膜内界膜剥除手術的解剖和視覺效果.方法連績研究3～4期特發性黄斑裂孔病人28例28祗眼.所有眼都施行平部玻璃體次全切除術,必要時清除後部玻璃體及任何可見的視網膜前膜.將濃度爲每毫升0.25mg至1.25mg的ICG溶液緩慢地注入到黄斑,待浸漬時停止.内界膜被染色,距黄斑裂孔邊緣1～2個視盤直徑環行剥除内界膜.手術結束時使用12%Perfluoropropane(C3F8)氣體.術後病人需要保持面朝下2周.結果 隨訪時間爲6～14個月,平均9.5個月.14祗眼(50%)為黄斑裂孔第4期,另14祗眼(50%)爲黄斑裂孔第3期.11祗眼(39.3%)爲1年以上的慢性黄斑裂孔.最後隨訪時25祗眼(89.3%)解剖復位,黄斑裂孔閉合.其中21祗眼(75%)黄斑裂孔封閉,另4眼(14.3%)黄斑裂孔變平.18祗眼(64.3%)視力提高兩行或兩行以上.視力平均提高2.6行(範圍2～7行).非慢性裂孔和慢性裂孔分别提高3.4行和1.4行.經統計學處理,兩組間具有顯著性差异(P=0.031).結論 ICG介導視網膜内界膜剥除在封閉特發性黄斑裂孔第3～4期中是很有幫助的.     

Idiopathic preretinal macular fibrosis. Study of correlation between morphologic changes and visual acuity

Idiopathic preretinal macular fibrosis is an affection characterized by the development of preretinal membranes, macular distortion and, sometimes, macular edema. These changes as well as the consequent reduction of the visual acuity may vary very widely from one case to another. In this study, the degree of correlation among the various retinal morphological changes and among them and the visual acuity was investigated. This study shows that the importance of retinal distortion is strictly dependent on the appearance of the preretinal membranes that the appearance of the preretinal membrane and the importance of the retinal distortion are equally valid predictors of visual acuity, that the macular edema (defined as fluorescein leakage) depends mainly on the degree of contraction of the preretinal membrane and that such leakage does not represent the best parameter in order to predict the visual acuity.     

超声乳化晶状体摘除治疗合并特发性黄斑前膜的白内障

目的：探讨合并特发性黄斑前膜的白内障患者行超声乳化晶状体摘除+人工晶状体植入术的临床疗效。 方法：回顾分析2008-01/2011-10于我院行超声乳化晶状体摘除+人工晶状体植入术的合并特发性黄斑前膜的白内障患者112例118眼,根据临床表现和OCT检查结果按早期、增殖期、牵拉期予以分组,分别于术前、术后1wk;6mo检测患者裸眼视力、最佳矫正视力,OCT检测黄斑中心凹视网膜厚度及视网膜组织变化情况并予以比较。 结果：所有患者术后6mo裸眼视力及最佳矫正视力较术前均有不同程度提高。术后最佳矫正视力早期组≥0.5者100%,增殖期组≥0.5者73%,牵拉期组≥0.1者53%。术后6mo,OCT检测黄斑中心凹视网膜厚度较术前变化均无统计学意义,牵拉期组患者有2例最终行玻璃体切除+黄斑前膜剥离术。 结论：超声乳化晶状体摘除+人工晶状体植入术对于合并特发性黄斑前膜的白内障患者可以改善视觉质量,并不会加重原有眼底病变,是一种安全有效的治疗方法。但对于黄斑前膜已处于牵拉期的白内障患者,单纯白内障手术对术后视力改善有限,建议联合或再行眼底手术治疗。     

Clinical course and surgical treatment of macular epiretinal membranes in young subjects

OBJECTIVE: To examine the surgical and nonsurgical visual outcomes of young subjects with idiopathic macular epiretinal membranes (ERMs). DESIGN: Retrospective observational and noncomparative interventional case series. PARTICIPANTS: Nineteen consecutive subjects (20 eyes) aged 40 years or less with an idiopathic macular ERM. METHODS: Group 1: 10 consecutive eyes were initially seen with visual acuity of 20/50 or better; 7 eyes were observed, and 3 eyes with progressive visual loss to <20/50 underwent vitrectomy and membrane peeling. Group 2: 10 consecutive eyes with presenting visual acuity of 20/60 or worse underwent vitrectomy and membrane peeling. MAIN OUTCOME MEASURES: Visual acuity, cataract formation, ERM recurrence, operative complications. RESULTS: Group 1: With no surgery, visual acuity remained stable or improved in 5 of 10 eyes (50%), with a mean follow-up of 3.7 years. Three of 10 eyes (30%) had visual loss < or =20/60 develop and underwent vitrectomy. Postoperative visual acuity improved an average of 6 lines with a mean follow-up of 17.6 months. Group 2: After vitrectomy, visual acuity improved 2 or more lines in 7 of 10 eyes (70%), with a mean improvement of 4.4 lines and mean follow-up of 29.2 months. Groups 1 and 2: Three of 13 eyes (23%) that underwent vitrectomy had recurrent ERM formation. CONCLUSIONS: Young subjects with idiopathic macular ERMs and a presenting visual acuity of 20/50 or better had a favorable visual outcome with observation. Subjects with an initial vision of 20/60 or worse, or those who had a visual decrease to < or =20/60 had significantly improved visual acuity after vitrectomy. ERM recurrence is relatively high after surgery.     

视网膜内界膜剥除术治疗特发性黄斑裂孔疗效探讨

目的 通过分析玻璃体切割联合视网膜内界膜剥除治疗特发性黄斑裂孔的手术效果,针对"内界膜剥除治疗特发性黄斑裂孔的不同观点"进行探讨.方法 黄斑裂孔患者71例71只眼,均施行玻璃体切除联合内界膜剥除,玻璃体内注气.随访12个月以上,观察不同分期裂孔的闭合率、视力以及mfERG的变化情况.结果 67只眼(94.37%)黄斑裂孔闭合,Ⅱ期裂孔两周内全部闭和,Ⅳ期裂孔两周闭和率仅为31.3%;71只IMH眼手术后1年视力提高59只眼,占83.10%,视力不变7眼,占9.86%,视力减退5眼,占7.04%.手术前、后视力高于0.1者分别为35只眼(49.26%)、65只眼(91.55%),经x2检验差异有统计学意义;一年后,Ⅱ期、Ⅲ期、Ⅳ期裂孔视力0.5以上者分别为81.25%、15.38%、0.经统计学分析,差异有统计学意义(P＜0.05),Ⅱ期、Ⅲ期和Ⅳ期术后视力提高率分别为93.6%、84.6%和62.5%.并且,手术后1年mfERG一阶函数的1环和2环P1波反应密度不断增加,差异有统计学意义(P＜0.05);而3、4、5环P1波反应密度与手术前比较,差异无统计学意义(P＞0.05).结论 玻璃体切割联合视网膜内界膜剥除治疗特发性黄斑裂孔是非常有效的方法,但需要熟练掌握手术操作技术和技巧,把术后并发症控制在最低限度.

Abstract：

Objective To estimate the therapeutic effect of vitrectomy with internal limiting membrane peeling in the treatment of idiopathic macular hole,to approach the different viewpoint about the vitrectomy with internal limiting membrane(ILM)peeling in the treatment of idiopathic macular hole.Methods In 71 eyes of 71 cases underwent vitrectomy with ILM peeling for idiopathic macular hole were analyzed retrospectively,air-fluid exchanged and C3F8 tamponaded.The follow-up after the surgery was 12 months.The best corrected visual acuity,mfERG and the rate of concrescence were observed.Results Anatomic closure of the macular hole was achieved in 67(94.37%)patients,59(83.10%)patients achieved a better final visual acuity.Preoperatively,the best corrected visual acuity above 0.1 was 35(49.26%)patients.Postoperatively,the best corrected visual acuity above 0.1 was 65(91.55%)patients(P ＜0.05).After a year,the best corrected visual acuity above 0.5 for 2,3,4 stage of macular hole were 81.25%,15.38%,0,respectively.Amplitude of wave P1 of ring 1 and ring 2 by mfERG was significantly increased in postoperatively than that in preoperatively(P＜0.05).There was no significantly difference for P1 of ring 3,ring 4 and ring 5 between postoperatively and preoperatively(P ＞0.05).Conclusions Parsplana vitrectomy with ILM peeling is an effective method to treat macular hole.But the risks should be treated carefully.     

继发性与特发性黄斑前膜的手术疗效分析

目的 探讨玻璃体视网膜手术后继发性黄斑前膜的影响因素，比较继发性黄斑前膜与特发性黄斑前膜的手术效果。 方法 分析26例黄斑前膜患者的26只眼（其中玻璃体视网膜手术后继发性黄斑前膜18只眼，特发性黄斑前膜8只眼）行玻璃体切割、黄斑前膜剥离等治疗前后的视力、眼底彩色照相以及部分患者的光相干断层扫描（optical coherence tomography，OCT）检查和随访3~12个月的临床资料。 结果 8例继发性黄斑前膜患者中，与手术有关者9例，占50.0%。巩 膜外冷凝、眼内激光光凝封闭巨大视网膜裂孔手术后继发黄斑前膜差异有显著性的意义（χ2=12.24，P＜0.05）。与玻璃体积血有关的继发性黄斑前膜11例，占61.1%。手术后3个月内视物变形消失者8例，占30.8%；视物变形改善者18例，占69.2% ；两组患者手术后视力均有明显提高。其中，继发性黄斑前膜患者手术后视力平均提高1.33行，最好矫正视力为0.6；特发性黄斑前膜患者手术后视力平均提高3行，最好矫正视力达0.8。 结论 巩膜外冷凝封闭巨大视网膜裂孔、手术前后伴玻璃体积血是玻璃体视网膜手术后继发黄斑前膜的高危因素。特发性黄斑前膜的手术疗效明显好于继发性黄斑前膜。 （中华眼底病杂志，2003，19：90-92）     

Surgery of idiopathic epimacular membranes. Prognostic factors]

Seventy consecutive cases of idiopathic epimacular membrane removal were reviewed in order to evaluate the prognosis factors of this surgery. The characteristics analyzed where the duration of the symptoms, pre and postoperative visual acuity and the macular changes on fluorescein angiography. The mean follow-up after surgery was 9 months. Mean preoperative visual acuity was 0.17 and the mean best postoperative visual acuity 0.43. Visual acuity improved by 2 lines or more in 81% of the cases and the mean improvement was 3.5 lines. The complications of epimacular membrane surgery included nuclear cataract (10 eyes underwent cataract surgery), peripheral retinal breaks (3%), and retinal detachment (3%) successfully operated. Three of the main preoperative data were related to better postoperative visual outcome: preoperative visual acuity: eyes with visual acuity of 0.16 or more tended to have better postoperative vision than eyes with poorer preoperative vision (mean postoperative visual acuity 0.5 and 0.34 respectively; p < or = 0.05); duration of visual impairment before surgery: eyes with a visual impairment of less than 2 years had better postoperative vision than the others (mean postoperative visual acuity, 0.5 and 0.3 respectively; p < or = 0.05); the absence of preoperative angiographic macular edema: eyes without preoperative macular edema had better postoperative vision than the others (mean postoperative visual acuity: 0.5 and 0.4 respectively; p < or = 0.05). The normal postoperative pattern of macular vessels and foveolar shape was also a statistically significant factor of good vision recovery.