视网膜脱离复位后的振荡电位观察

目的：应用视觉电生理技术观察孔源性视网膜脱离复位术后的振荡电位变化，了解术后视网膜的微循环改善情况。方法：选用美国LKC公司UTAS－E2000型电生理仪，按照国际标准化建议对73例孔源性视网膜脱离患者在巩膜扣带术术前，术后记录振荡电位，术后随访个月。选择43例为对照组。结果：视网膜脱离后，振荡电位振幅明显下降，子波数减少，手术复位后1个月，子波数增加，但振荡电位的总振幅在随访期间无明显变化，仅在术后5个月有缓慢增长趋势。一些病例可在术后远期出现改变。结论：视网膜脱离复位后，其微循环在短期内有一定程度的恢复，与手术方法及视网膜的病理损害有关。     

Retinal function after scleral buckling for recent onset rhegmatogenous retinal detachment: assessment with electroretinography and optical coherence tomography

PURPOSE: To investigate central and peripheral retinal function after scleral buckling surgery for recent onset rhegmatogenous retinal detachment (RD). METHODS: Fifteen phakic patients with rhegmatogenous RD for <1 week underwent scleral buckling surgery. Clinical investigation, optical coherence tomography (OCT), full-field electroretinography (ERG), and multifocal ERG (mfERG) with fundus illumination were performed preoperatively and 6 months postoperatively. RESULTS: Anatomical success was achieved in 14 patients. mfERG amplitudes were reduced preoperatively in detached retina, with significant improvement at follow-up (P = 0.002). Foveal amplitudes improved significantly (P = 0.027). There was no significant difference in postoperative mfERG amplitudes between areas that had been preoperatively detached or attached (P = 0.739). In the subgroup of eight patients in whom the detachment engaged the fovea preoperatively, rod function improved significantly as assessed with full-field ERG (P = 0.008). In these patients, the extent of detachment ranged between 4 clock hours and 6 clock hours, as compared with 2 clock hours and 5 clock hours in the remaining patients. OCT showed subretinal foveal fluid in four patients at follow-up. CONCLUSIONS: In recent onset rhegmatogenous RD, total rod and localized central retinal dysfunction in detached retina can improve significantly after reattachment. mfERG and OCT are suitable tools for further studies of functional outcomes in RD.     

影响视网膜脱离患者视网膜功能的因素

目的:评价视网膜脱离患者年龄、病程、视网膜脱离面积、黄斑脱离情况等因素对视网膜功能的影响。方法:将孔源性视网膜脱离(retinal detachment,RD)188例189眼的患者年龄、病程、视网膜脱离面积、黄斑脱离情况、视力与视网膜脱离眼的fERG和mfERG各指标进行相关分析。结果:影响RD眼fERG和mfERG的主要因素是脱离面积、黄斑脱离和视力。以|γ|>0.4,且P≤0.05判定为有相关性。脱离面积与明视和暗适应最大反应ERG a、b波幅值,30Hz闪烁光幅值,OPs波数和幅值负相关;与mfERG象限野P1波幅值密度、幅值负相关。相关系数最高者为fERG暗适应最大反应b波幅值(γ=-0.704)。黄斑脱离与明视和暗适应最大反应ERG b波幅值,30Hz闪烁光ERG幅值负相关;与mfERG环形野环1的P1波幅值密度、幅值负相关,与mfERG象限野P1波幅值密度负相关,相关系数最高者为mfERG环形野环1的P1波幅值(γ=-0.584)。视力与明视和暗适应最大反应a、b波幅值,30Hz闪烁光幅值,OPs子波数和幅值正相关;与mfERG环形野环1的P1波幅值密度、幅值正相关,相关系数最高者为30Hz闪烁光ERG幅值(γ=0.597)。RD眼的fERG异常率最高者为暗适应最大反应ERG b波幅值,异常率为71.3%,视网膜脱离象限野mfERG异常率最高者为P1波幅值,异常率为85.3%。结论:影响RD患者视网膜功能的重要因素是脱离面积和黄斑脱离情况。RD眼对视网膜功能异常反应的mfERG对视网膜功能异常反应的敏感性高于fERG。     

巩膜扣带术治疗视网膜脱离118例临床分析

目的 对原发怍（孔源性）视网膜脱离行巩膜扣带术治疗并对其效果进行评价。方法 对118例118眼原发性视网膜脱离病人行巩膜扣带术治疗。术中直接检眼镜定位，放视网膜下液，巩膜外液氮冷凝，巩膜扣带或环扎术。结果 术后随访1周至半年，视网膜裂孔封闭、完全复位107眼（90．68％），视力提高90眼（76.27％）。结论 巩膜扣带术是治疗原发性视网膜脱离常用有效的方法。     

23G经结膜无缝线玻璃体切割手术治疗巩膜扣带手术失败的视网膜脱离

目的 探索利用23G经结膜无缝线玻璃体切割手术治疗巩膜扣带术失败的视网膜脱离患者的可行性及对眼表结构的保护作用.方法 8例患者8只眼接受手术,均使用Alcon公司的一步法穿刺套管.所使用的眼内手术器械是Alcon的23G专用器械,手术是在Zeiss 200P手术显微镜下使用Alcon Accuras 400高速玻璃体切割平台下进行.术毕均充填20%的C3F8.结果 8例患者术后切口闭全良好无渗漏,术后3d有3例患者出现了轻度低眼压,3d后恢复正常.视网膜Ⅰ期复位.除了结膜下的轻度的出血外,无其他并发症发生;眼表结构保持完整,无新的瘢痕形成.术后3个月内有2例患者诉轻度的眼内异物感,其他患者未诉不适.结论 23G经结膜无缝线玻璃体切割手术能有效治疗巩膜扣带手术失败后的视网膜脱离,且有利于维持眼表结构的完整性.

Abstract：

Objective To evaluate the feasibility of 23G transconjunctival sutureless vitrectomy (23G TSV) in treatment of rhegmatogenous retinal detachment after scleral buckling failed, and to explore whether the operation is helpful to protect the structure of ocular surface.Methods Eight patients with rhegmatogenous retinal detachment after scleral buckling failed were subject to operation, and the Alcon operation platform and the 23G TSV system were used.Results Retinal reattachment was achieved in all patients after surgery,and no serious complication occurred except for the mild subconjunctival hemorrhage.Furthermore, the structure integrity of ocular surface was maintained, and no new scar was formed.Conclusions 23G TSV is a useful technique for treating rhegmatogenous retinal detachment after scleral buckling failed, and it may be favorable to protect the structure of ocular surface.     

Ocular pulse amplitude measurement after retinal detachment surgery

BACKGROUND: The purpose of our study was to evaluate the influence of scleral buckling on the ocular pulse amplitude (OPA) following retinal detachment (RD) surgery. PATIENTS AND METHODS: The study included 48 patients with unilateral rhegmatogenous RD who underwent an uncomplicated RD operation using the conventional technique of scleral buckling without vitrectomy. Patients with ocular disease other than RD or systemic vascular disease, as well as those under local or systemic treatment potentially affecting the regulation of the ocular blood flow, were excluded. In addition to standard ocular examination, the OPA was measured using dynamic observing tonometry with SmartLens device before and after the operation. RESULTS: Mean preoperative OPA was 2.34 +/- 0.25 mm Hg, while mean postoperative OPA was 0.68 +/- 0.07 mm Hg for scleral buckling equal or greater than 3 quadrants (group C), 1.44 +/- 0.26 mm Hg for two quadrants buckling (group B), and 2.36 +/- 0.16 mm Hg for radial buckling (group A). Statistically significant differences were recorded between mean preoperative and postoperative OPA in the groups B and C, as well as between mean postoperative OPA and mean OPA of the fellow eyes in the same groups. CONCLUSIONS: Conventional surgery of rhegmatogenous RD using the scleral buckling technique leads to significant ocular circulatory alterations, which are indirectly represented and recorded in the clinical practice by the reduction of the OPA.     

巩膜扣带术与玻璃体切割术治疗累及黄斑的孔源性视网膜脱离后对黄斑结构改变及视力预后的影响

背景 视网膜脱离患者在成功完成视网膜复位手术后并不能很快恢复视力,其原因目前尚不十分清楚. 目的 比较累及黄斑的孔源性视网膜脱离患者巩膜扣带术和玻璃体切割术后黄斑椭圆体区完整性、黄斑区视网膜神经上皮层下积液的发生率及留存时间,探讨黄斑区视网膜神经上皮层下积液存留对视力预后的影响.方法 回顾性分析2010年1月至2013年1月于北京大学人民医院眼科确诊的孔源性视网膜脱离患者66例66眼的病例资料,按手术方式分为巩膜扣带术组和玻璃体切割术组,记录2个组患者病程、屈光状态、最佳矫正视力LogMAR、有无合并症等,观察黄斑区神经上皮下积液存留时间及黄斑椭圆体区完整性,计算2个组在术后1个月时黄斑区神经上皮下积液的发生率. 结果 术前巩膜扣带术组及玻璃体切割术组间年龄、性别、病程、屈光度及LogMAR视力差异均无统计学意义(均P＞0.05).巩膜扣带术组视网膜下积液平均存留(96±60)d,玻璃体切割术组为(21±6)d,差异有统计学意义(t=7.966,P=0.000).术后1个月时,巩膜扣带术组黄斑区神经上皮下积液发生率为78.6％,大于玻璃体切割术组的12.5％,差异有统计学意义(x2=26.891,P=0.000),巩膜扣带术组黄斑区神经上皮下积液完全吸收患者与未完全吸收患者LogMAR视力比较,差异有统计学意义(t=3.185,P=0.003);术后6个月时,巩膜扣带术组与玻璃体切割术组LogMAR视力比较,差异无统计学意义(t=1.876,P--0.065),巩膜扣带术组黄斑区神经上皮下积液完全吸收患者与未完全吸收患者LogMAR视力比较,差异无统计学意义(t=1.755,P=0.087).视网膜神经上皮下积液吸收后,2个组内黄斑椭圆体区连续患者与椭圆体区缺失患者LogMAR视力比较,差异均有统计学意义(巩膜扣带术组:t=2.555,P=0.015;玻璃体切割术组:t=4.005,P=0.001). 结论 椭圆体区受损程度与视网膜脱离时间有关,而椭圆体区的完整性明显影响患者的视力预后.对于累及黄斑的孔源性视网膜脱离患者,玻璃体切割术后视网膜神经上皮下积液吸收较巩膜扣带术快;视网膜神经上皮下积液的存留延缓视力的恢复,手术方式对最终的视力恢复影响不大.     

Laser in situ keratomileusis as treatment for anisometropia after scleral buckling surgery

Scleral buckling is an excellent procedure for retinal reattachment but can induce disabling refractive errors. Laser in situ keratomileusis (LASIK) has been proven effective for the reduction of refractive errors induced by ophthalmic surgery. We describe the case of a 53-year-old man who developed symptomatic anisometropia after placement of a scleral buckle for repair of a rhegmatogenous retinal detachment (RD). After the scleral buckling procedure, he retained excellent best corrected visual acuity but could not tolerate spectacle or contact lens correction. Thirty-four months after the scleral buckling procedure, LASIK was performed to correct myopic astigmatism with excellent refractive and functional results. This case demonstrates that LASIK may be safe and effective for the correction of refractive errors induced by RD repair.     

Local dry vitrectomy combined with segmental scleral buckling and viscoelastic tamponade for rhegmatogenous retinal detachment with vitreous traction

AIM: To demonstrate combined local dry vitrectomy and segmental scleral buckling for the treatment of partial rhegmatogenous retinal detachment (RRD) with local vitreous traction in patients at high-risk for proliferative vitreoretinopathy (PVR). METHODS: Seven eyes of 7 patients were retrospectively studied, including 3 retinal dialysis and 4 retinal detachment (RD) (3 eyes with peripheral retinal hole and 1 eye with giant tear). All patients exhibited partial RD and local vitreous traction. Combined local dry vitrectomy without conventional infusion and segmental scleral buckling was performed. Viscoelastic fluid was injected into the vitreous cavity if needed. Demographic information, preoperative and post-operative complications, and outcomes were recorded. RESULTS: The mean age of the patients at presentation was 22.43±14.28y. All seven patients obtained retinal reattachment after a single surgical intervention. Post-operative visual acuities were improved in all patients. None of them developed complications, except for temporary mildly increased intraocular pressure in 2 cases. CONCLUSION: Combined local dry vitrectomy and segmental scleral buckling and viscoelastic tamponade if needed are effective for patients of RRD with local vitreous traction. The technique avoids many complications associated with regular surgery and was minimally invasive to both the external and internal eye.     

An evidence-based analysis of surgical interventions for uncomplicated rhegmatogenous retinal detachment

PURPOSE: To evaluate the various surgical interventions available for uncomplicated rhegmatogenous retinal detachment. METHODS: Reports of controlled clinical trials of surgical interventions (pneumatic retinopexy, scleral buckling and vitrectomy) for uncomplicated rhegmatogenous retinal detachment indexed in MEDLINE from 1968 to January 2006 were included. The primary outcomes evaluated included single-operation reattachment rates, multiple reoperation reattachment rates and improvements in visual acuity (VA). RESULTS: We found five controlled trials (two randomized) comparing the efficacy of pneumatic retinopexy versus scleral buckling. The single-operation reattachment rates were higher for scleral buckling, but the final reattachment rates were similar. We found nine controlled trials (four randomized) evaluating vitrectomy. There were no statistically significant differences between retinal reattachment rates or final visual acuities, except in one randomized and one non-randomized controlled trial in which the VAs were significantly better in the vitrectomy than the scleral buckling group. CONCLUSIONS: Pneumatic retinopexy is a possible alternative to scleral buckling in the treatment of uncomplicated rhegmatogenous retinal detachment. The rates of missed or new retinal breaks after pneumatic retinopexy, however, are higher than following scleral buckling. The clinical outcomes of vitrectomy for rhegmatogenous retinal detachment compare favourably.     

影响巩膜扣带术后视功能恢复因素的临床观察

目的:探讨孔源性视网膜脱离行巩膜扣带术后,影响其视力恢复的相关因素。方法:回顾性分析孔源性视网膜脱离患者102例102眼,均行一次巩膜扣带术成功治疗视网膜脱离。术后随访3～6mo,观察术后最佳矫正视力,χ2检验用于分析影响视力恢复的相关因素。结果:黄斑是否脱离、术前最佳矫正视力、视网膜脱离范围及术中是否行视网膜下放液均与术后最佳矫正视力相关(P<0.01)。黄斑脱离在1wk内与1wk以上术后视力恢复差异有统计学意义(P<0.05)。结论:黄斑是否脱离及脱离时间、术前最佳矫正视力、视网膜脱离范围和术中放液是影响术后视力恢复的重要因素,术前应详细分析病情,术中尽可能避免行视网膜下放液。     

光凝与冷凝在孔源性视网膜脱离手术中的比较

目的　观察两种视网膜脱离手术的疗效并进行比较。方法　回顾分析 2 0 0 1年～ 2 0 0 2年因视网膜脱离行手术治疗的 30例病人。其中一组手术方式为巩膜扣带术联合术后激光治疗 ,另外一组为冷凝加巩膜扣带术 ,随访时间为 3个月至 1年。结果　两组视网膜复位率均为 88.6 7% ,差异无显著性 (P >0 .0 5 )。结论　巩膜扣带术联合术后激光治疗是治疗孔源性视网膜脱离的一种可行的方法 ,其疗效等同于传统的冷凝加巩膜扣带术。     

视网膜脱离复位术后屈光改变的临床研究

目的　了解视网膜脱离复位术后屈光状态的改变及恢复情况。方法　收集 39例 (39只眼 )手术复位成功的孔源性视网膜脱离患者 ,于术前及术后 1周、1、3、6月分别进行检影验光 ,A超测量眼轴长度 ,角膜曲率计检查 ,观察动态变化情况。结果　术前本组孔源性视网膜脱离中 ,近视眼占 82 .0 5 %。 >4 .0 D者占 6 9.2 3% ,眼轴长度>2 6 mm者占 6 9.2 3%。 3例环扎术后 ,全部眼轴加长 ,近视度加深。术后 1周及 1月时 ,散光值 >2 .0者为 12 .82 % ,术后 3个月逐渐减少。放射状加压术后散光值更大 ,差异有显著性 (P <0 .0 5 ) ,但 6个月内能恢复原状。结论　术前眼轴越长 ,近视度越高 ,发生孔源性视网膜脱离机会越多。环扎术后 ,眼轴变长 ,近视度加深 ,且半年内无明显改善。环形加压术或放射状加压术后早期 ,近视度数降低 ,向远视方向改变 ,从 +0 .5 D～ +5 .0 D不等 ,1月时最为明显。放射状加压术更易引起角膜曲率改变 ,散光值更大。但这种屈光改变是暂时性的 ,术后 6个月逐渐恢复原状 ,并趋于稳定。临床上适宜于视网膜脱离复位术后 6个月重新验光配镜。     

频域光相干断层扫描视网膜脱离术后黄斑改变

目的 分析累及黄斑区的孔源性视网膜脱离巩膜外垫压术后黄斑区形态改变。方法 累及黄斑的孔源性视网膜脱离43例,经间接检眼镜下巩膜扣带术和（或）联合环扎术后,视网膜解剖复位。分别于术后1周、1月、3月、6月复查视力、眼底检查和频域OCT检查并统计分析。结果 术后1周时,最佳矫正视力0．05～0．3,较术前提高（P=0．015）;OCT显示黄斑区视网膜下液完全吸收者占11．6％,好转者占44．2％,与术前相比差异有统计学意义（P：0．008）。术后3个月时,最佳矫正视力0．3～0．6,提高2行以上者占76．7％。术后12个月最佳矫正视力0．3—1．0,提高2行以上者占93．0％,与术后3个月时相比差异有统计学意义（P=0．025）,与术后6个月时相比差异无统计学意义（P=0．24）,黄斑区视网膜下液完全吸收者占90．7％,与术后6个月时相比差异有统计学意义（P=0．0018）。结论 频域OCT检查能够发现临床眼底检查不能发现的黄斑区神经上皮脱离的存在,黄斑区视网膜光感受器内外节连接结构连续性中断,进而为预测累及黄斑区的孔源性视网膜脱离术后视力恢复进程及病情解释提供依据。     

先天性白内障术后视网膜脱离的手术治疗

目的 探讨先天性白内障术后视网膜脱离的特点及手术方法。 方法 对42例先天性白内障患者44只白内障术后孔源性视网膜脱离眼的临床资料进行回顾分析,比较不同的视网膜脱离手术方法治疗后的效果。先天性白内障术后发生视网膜脱离平均间隔时间为14.8年。绝大多数白内障手术为吸出术并有后囊膜切开史 ;多数瞳孔不能散大并有后发性白内障形成。16只眼曾测眼轴,平均轴长(26.80±1.90) mm。视网膜脱离手术前裂孔发现率仅43.2%。 结果 巩膜手术成功率80.3%,玻璃体手术成功率85.7%。 结论 先天性白内障术后发生视网膜脱离间隔时间长;因瞳孔因素,周边眼底检查困难,巩膜手术成功率低,玻璃体手术是较理想的手术方式。 （中华眼底病杂志,2000,16：71-138）     

最小量巩膜外垫压术治疗孔源性视网膜脱离的疗效分析

目的比较分析最小量巩膜外垫压术与巩膜环扎垫压术治疗孔源性视网膜脱离的疗效。方法回顾性分析2008年3月至2009年3月收治的20例（20只眼）孔源性视网膜脱离患者行最小量巩膜外垫压术（A组）的临床资料,并在同期住院行巩膜环扎垫压术的孔源性视网膜脱离患者中随机选择40例（40只眼）作为对照组（B组）,术后随访比较两组的视网膜复位率、最佳矫正视力及并发症情况。结果术后视网膜首次复位率A组为90％,B组为95％;最佳矫正视力A组为0．48±0．33,B组为0．48±0．28;增生性玻璃体视网膜病变（PVR）进展者A组占5％,B组占10％,两组间均没有显著差异（P=0．4642、0．9662、0．5089）。术后A组出现复视1只眼,B组出现短期高眼压3只眼,黄斑水肿1只眼,复视1只眼;两组术后屈光度的变化有显著差异（P=0．0019）,前房深度、眼轴长度及散光度的变化均没有显著差异（P=0．5444、0．8732、0．0582）。结论外加压手术是一种有效复位脱离视网膜的手术方式,最小量巩膜外垫压术对孔源性视网膜脱离能获得很好的疗效,而对眼球创伤小、仅改变眼局部形态结构,能避免传统巩膜环扎垫压术的一些并发症,但远期疗效还有待进一步观察。     

10-year follow-up of visual functions in patients who underwent scleral buckling

PURPOSE: To study long-term visual functions in eyes that underwent scleral buckling for treatment of rhegmatogenous retinal detachment. METHODS: We retrospectively studied a nonconsecutive case series of 205 eyes with retinal detachment that underwent scleral buckling and were followed up for 10 years after surgery. Preoperatively, postoperatively, and 10 years after surgery, best-corrected visual acuities and visual fields were recorded. RESULTS: During the first postoperative year and during the next 9 years, there were significant increases in visual acuity (P<0.0001 and P<0.0001, respectively). Between the operation and 1 month postoperatively, there was a significant increase in the area size of visual field measured by Goldmann perimetry (V-4 isopter, P=0.0001; I-4 isopter, P=0.0001). Between 1 month and 10 years after surgery, there was no significant change of the area size of each isopter (V-4, P=0.786; I-4, P=0.211). CONCLUSION: Improvement in visual acuity after scleral buckling is possible over a long period. There may be a limit to long-term improvement of visual field after scleral buckling.     

巩膜扣带术联合氩激光光凝治疗视网膜脱离

目的 探讨将巩膜扣带术中冷凝改为术后氩激光光凝封闭裂孔,治疗视网膜脱离（retinal detachment,RD)的疗效及适应证范围。方法 回顾性分析1999年12月至2000年4月,在我院行巩膜扣带术接受氩激光光凝治疗的RD患者35例（38只眼）的临床资料。结果 术后随访3－6个月,38只眼中,视网膜完全复位36只眼（94．7％）。术后视力≥0。05者31只眼（86．1％）,最佳矫正视力为1．0。结论 将巩膜扣带术中冷凝改为术后氩激光光凝,可简化术中操作,减少视网膜和脉络膜血管的损伤及术后并发症的发生,是治疗RD的有效方法之一。     

Anatomic and visual results in asymptomatic clinical rhegmatogenous retinal detachment repaired by scleral buckling

PURPOSE: To report presenting characteristics as well as anatomic and visual results in asymptomatic clinical rhegmatogenous retinal detachment repaired by scleral buckling. METHODS: Review of 28 eyes of 27 patients with an asymptomatic clinical retinal detachment-defined as a rhegmatogenous retinal detachment with subretinal fluid extending more than 2 disk diameters posterior to the equator-which were repaired by scleral buckling from January 1989 through December 1996 with follow-up of 6 months or longer. RESULTS: With a single scleral buckling procedure, anatomic reattachment of the retina occurred in all eyes; one eye redetached 14 months after the initial surgery secondary to a new retinal break and was successfully reattached. All eyes had best-corrected presenting and final visual acuity of 20/50 or better. Final best-corrected Snellen visual acuity was within 1 line of best-corrected presenting visual acuity in 82% of eyes; three eyes improved more than 1 line of Snellen visual acuity and two eyes lost more than 1 line. CONCLUSION: Anatomic and visual results in asymptomatic clinical rhegmatogenous retinal detachment after scleral buckling surgery are excellent. Strong consideration should be given to repair of these detachments.     

视网膜脱离巩膜扣带术后后极部视网膜定量分析

目的:研究视网膜脱离(retinal detachment,RD)巩膜扣带术后后极部视网膜水肿情况。方法:应用视网膜厚度分析仪(RTA)对38例38眼孔源性RD巩膜扣带术后手术成功眼后极部视网膜厚度进行测量。结果:术后进行RTA测量随访的时间为72.61±57.27d,经RTA测量,RD术后黄斑中心凹平均厚度168.03±38.27μm,与对侧眼比较二者差异无显著性(P>0.05);RD眼术后后极部平均厚度175.50±33.85μm,与对侧眼比较二者差异无显著性(P>0.05),RD眼术后后极部最大厚度(310.18±158.40μm)与对侧眼比较,二者差异有显著性(P<0.01)。结论:通过RTA可精确测量并观察后极部视网膜水肿发生情况,视网膜脱离巩膜扣带术后2mo后极部视网膜局限性水肿仍存在,术后这个时间患者仍存在视物变形与此有关,仍需进行进一步的长期随访观察后极部视网膜水肿消退的时间。而且,在这段时间内考虑给予相应的干预治疗,以改善视功能。