玻璃体切除手术治疗复杂眼外伤

目的:探讨玻璃体切除术在治疗复杂眼外伤中的应用价值。方法:对75例77眼复杂眼外伤的玻璃体切除手术进行临床分析。结果:眼内非磁性异物18眼,摘出率100%。玻璃体积血26眼,复杂视网膜脱离23眼,复位率85%,化脓性眼内炎5眼,炎症均控制。继发性青光眼5眼,眼压均控制在正常范围内。77眼中术后视力提高者63眼(85%),视力不变或下降者14眼(15%)。结论:玻璃体切除手术是目前最理想的治疗复杂眼外伤的方法。     

玻璃体切割术治疗严重眼外伤

目的 探讨玻璃体切割治疗严重眼外伤的效果和预后。方法 玻璃体切割联合白内障人工晶状体植入术、眼内异物摘除术、视网膜脱离复位术等治疗严重眼外伤46例54眼。观察并发症及视力情况。结果 外伤性白内障32眼中9眼行人工晶状体植入术;28眼眼内异物摘除率为96％;术后视力提高41眼(76％),视力不变者7眼(13％),视力下降者6眼(11％);致盲率由术前的47/54(87％)降低到21/54(39％),其中视力>0.3者18眼(33％)。结论 正确掌握玻璃体手术技术,严格选择适应症及手术时机,可以挽救大多数伤眼,并能获得一定的视功能。     

玻璃体切除术治疗复杂眼外伤的临床研究

目的 探讨玻璃体切除术在复杂眼外伤中的治疗效果和应用价值.方法 对36例(36只眼)复杂眼外伤的玻璃体手术进行回顾性分析.结果 36只眼中术后视力提高者32只眼,其中2只眼最佳矫正视力分别为0.4和0.8,0.12～0.3者26只眼,0.05～0.1者4只眼,视力不变者4只眼.9只眼眼内异物(合并化脓性眼内炎4只眼),异物取出率100%,眼内炎控制好;玻璃体积血16只眼,视网膜平伏,无再次出血;复杂视网膜脱离1只眼,视网膜复位;晶状体脱位合并继发性青光眼10只眼,眼压均控制正常,其中3只眼行Ⅰ期人工晶状体植入,7只眼行Ⅱ期人工晶状体植入.结论 玻璃体切除手术是目前最理想的治疗复杂眼外伤的有效方法,能挽救受伤眼并恢复一定的有用视力.     

玻璃体积血合并视网膜裂孔或脱离的玻璃体切割手术疗效观察

目的:探讨玻璃体积血合并视网膜裂孔或脱离采用玻璃体切割手术治疗的疗效及必要性。 方法:对28例28眼玻璃体积血合并视网膜裂孔或脱离患者采用玻璃体切割手术治疗,观察治疗前后视力改变,并分析玻璃体积血与视网膜裂孔或脱离的关系。 结果:不同原因所导致的玻璃体积血28例中,7例术前B超未发现视网膜脱离,而在术中发现3例裂孔,4例伴裂孔周围浅脱;28例患者术后视力（包括术后随访最佳视力）均有不同程度的提高,数指/眼前以上者27例(96%),≥0.05者20例(71%),≥0.3者5例(18%),手术前后视力比较,具有统计学差异(P＜0.05)。 结论:玻璃体积血合并视网膜裂孔或脱离采用玻璃体切割手术治疗,安全有效,且能尽早发现视网膜裂孔及浅脱离,阻止视网膜脱离进一步扩大。     

复杂眼外伤的玻璃体切除联合手术治疗

目的:探讨玻璃体切除联合手术治疗复杂眼外伤的疗效。方法:玻璃体切除联合白内障摘除、人工晶状体Ⅱ期植入、眼内异物摘出、视网膜脱离复位治疗复杂眼外伤26例26眼。结果:术后视力较术前提高者19眼,视力不变者6眼,视力下降者1眼;眼内炎2眼感染控制,眼内异物9眼均一次成功摘出,视网膜脱离成功复位者5眼,眼球萎缩1眼。结论:选择恰当的手术时机,合理的手术方案,对挽救眼球和恢复视功能起着决定性作用。     

联合手术治疗合并白内障的玻璃体视网膜病变

目的:探讨玻璃体视网膜病变合并白内障患者的玻璃体手术中,同期行白内障超声乳化摘除术的临床效果。方法:回顾性分析合并有白内障的玻璃体视网膜病变患者37例(40眼),实施玻璃体切割联合晶状体超声乳化人工晶状体植入手术,观察术后视力改善程度及术中术后并发症。结果:术后随访3~24mo,其中29眼(72%)视力有不同程度的改善,不变8眼(20%),下降3眼(8%);术后视力低下者主要原因为黄斑病变。结论:玻璃体切割联合晶状体超声乳化术治疗合并不同程度白内障玻璃体视网膜病变是安全有效的,可使患者视力改善,避免玻璃体切除术后并发白内障再次手术。     

玻璃体切除治疗复发性出血性玻璃体视网膜疾病

目的探讨玻璃体切除术对复发性出血性玻璃体视网膜疾病的临床效果。方法对43例(44眼)玻璃体积血施行三通道经睫状体平坦部玻璃体切除术,联合膜剥离,水下透热,眼内光凝(或经巩膜冷凝),并根据病情选用眼内长效填充材料。结果视网膜静脉阻塞18眼,外伤性玻璃体积血9眼,视网膜裂孔致玻璃体积血6眼,静脉周围炎5眼,增生性糖尿病视网膜病变3眼,蛛网膜下腔出血合并玻璃体积血(综合症)2眼,老年性黄斑变性1眼。术后随访2～24月,44眼视力均有不同程度的提高,随访视力较术前相比差异有统计学意义(P<0.05),视力0.05以上者36眼(81.82%),0.2～0.8者27眼(61.36%)。结论复发性出血性玻璃体视网膜疾病经药物治疗无效,B超显示出现玻璃体后脱离或B超显示伴有牵引性视网膜脱离者,玻璃体切除术是消除玻璃体积血并使视网膜复位的有效方法。     

玻璃体切除治疗出血性玻璃体视网膜疾病

目的探讨玻璃体切除术对出血性玻璃体视网膜疾病的临床效果。方法对39例(40眼)玻璃体积血施行三通道经睫状体平坦部玻璃体切除术,联合膜剥离,水下透热,眼内光凝(或经巩膜冷凝),并根据病情选用眼内长效填充材料。结果视网膜静脉阻塞15眼,外伤性玻璃体积血9眼,视网膜孔源性玻璃体积血6眼,珠网膜下腔出血合并玻璃体积血(Terson综合症)4眼,静脉周围炎(Eales病)5眼,老年性黄斑变性1眼。术后随访2~40月,平均(12±3.4)月,40眼视力均有不同程度的提高,0.05以上者33眼(82.50%),与术前相比差异有统计学意义(P<0.05),视力0.2~0.8者26眼占65.00%。结论出血性玻璃体视网膜疾病经药物治疗无效,B超探示出现玻璃体后脱离或B超显示伴有牵引性视网膜脱离者,玻璃体切除术是消除玻璃体积血并使视网膜复位的有效方法。     

玻璃体积血的病因分析及手术治疗的疗效

目的：探讨玻璃体积血的病因及行玻璃体切割术治疗的临床疗效。

方法：对162例173眼玻璃体积血患者进行病因分析,采用玻璃体切割术治疗。

结果：术后诊断：173眼中增殖期糖尿病视网膜病变83眼(48.0%),视网膜分支静脉阻塞24眼(13.9%),Eales病13眼(7.5%),视网膜中央静脉阻塞10眼(5.8%),外伤性玻璃体积血9眼(5.2%),视网膜裂孔8眼(4.6%),视网膜脱离9眼(5.2%),增生性玻璃体视网膜病变7眼(4.0%),单纯玻璃体积血4眼(2.3%),视网膜大动脉瘤2眼(1.2%),息肉样脉络膜血管病变2眼(1.2%),脉络膜视网膜炎1眼(0.6%),年龄相关性黄斑病变1眼(0.6%)。不同年龄病因分布不同,术后随访3～15mo,术前与术后视力相比,41眼(23.7%)视力不变,115眼(66.5%)视力提高,17眼(9.8%)视力下降。术后视力与术前相比差异具有统计学意义( P<0.05)。

结论：增殖期糖尿病视网膜病变、视网膜分支静脉阻塞、Eales 病是导致玻璃体积血的主要原因。玻璃体切割联合术手术并发症少,能在一定程度上提高患者视力,是治疗玻璃体积血安全有效的方法。     

进展型增生性糖尿病视网膜病变玻璃体 切割手术的价值与意义

目的了解有不同并发症的进展型增生性糖尿病视网膜病变眼进行玻璃体手术的结果。方法将患有Ⅰ、Ⅱ型糖尿病进展型增生性糖尿病视网膜病变的314只眼分为玻璃体积血合并局限牵拉性视网膜脱离组;广泛纤维血管膜合并牵拉性视网膜脱离组;牵拉孔源混合性视网膜脱离组;玻璃体积血视网膜脱离合并老年性白内障行玻璃体手术联合白内障摘除及人工晶状体植入组,分别进行回顾性分析。结果玻璃体积血合并局限牵拉性视网膜脱离组中Ⅰ、Ⅱ型糖尿病患 者手术后获得0.1以上视力的分别占39.4%和66.7%,广泛纤维血管膜合并牵拉性视网膜脱离组中Ⅰ、Ⅱ型糖尿病患者手术后获得0.1以上视力的分别占31.6%和51.6%,牵拉孔源混合性视网膜脱离组手术后获得0.1以上视力者占31.6%,玻璃体积血视网膜脱离合并老年性白内障行玻璃体手术联合白内障摘除及人工晶状体植入组手术后获得0.1以上视力者占62.5%。首要的术中 并发症是医源性视网膜裂孔,术后视力丧失的主要原因包括新生血管性青光眼、视网膜脱离和视网膜中央动脉阻塞。结论玻璃体切割手术联合全视网膜光凝术,能有效地改善进展性糖尿病视网膜病变患者的视力。(中华眼底病杂志,2001,17:171-174)     

Pars plana vitrectomy: comparison of three techniques for the treatment of diabetic vitreous hemorrhage.

BACKGROUND AND OBJECTIVE: To compare the outcome of three vitrectomy techniques in the treatment of diabetic vitreous hemorrhage. PATIENTS AND METHODS: The study group included 38 patients (38 eyes) with diabetic vitreous hemorrhage. Three-port pars plana vitrectomy was used in 20 eyes, unimanual vitrectomy with indirect ophthalmoscopy in 10 eyes, and sutureless 25-gauge vitrectomy in 8 eyes. Main outcome measures were operative time, preoperative and postoperative visual acuity and intraocular pressure, and postoperative complications. RESULTS: Mean operative time was 66 minutes for three-port vitrectomy, 35 minutes for indirect vitrectomy, and 40 minutes for 25-gauge vitrectomy. Mean duration of follow-up was 26 months (range = 5 to 43 months). All three techniques successfully treated the vitreous hemorrhage, with similar best-corrected visual acuity outcome and similar complication rates. A greater tendency for hypotony on the first postoperative day was observed in the 25-gauge vitrectomy group. CONCLUSIONS: The three major techniques for treating vitreous hemorrhage are similarly effective and yield similar outcomes. The specific technique used should be selected on the basis of the clinical status of the patient and the skills of the surgeon.     

23G玻切术治疗PDR术后早期出血的危险因素分析

目的：分析23G玻璃体切割术治疗增生型糖尿病视网膜病变(PDR)术后早期发生出血的危险因素。

方法：回顾性分析2016-06/2018-01于我院行23G玻璃体切割术治疗的PDR患者100例100眼的临床资料,根据术后早期(1mo内)是否发生玻璃体出血分为早期玻璃体出血组(27例)和无玻璃体出血组(73例),分析术后早期发生玻璃体出血的危险因素。

结果：两组患者年龄、术前抗VEGF治疗、术前存在纤维血管膜增殖、术中视盘新生血管出血、术中注入气体情况有明显差异(P<0.01),其中术前存在纤维血管膜增殖、术中存在视盘新生血管出血是导致术后早期出血的独立危险因素。

结论：23G玻璃体切割术治疗PDR术后早期玻璃体出血主要发生于眼底病变严重者,术前存在纤维血管膜增殖及术中视盘新生血管出血会增加其发生风险。     

Planned two-step vitrectomy for extremely large and thick subretinal hematoma

PURPOSE: To describe a new surgical strategy, planned two-step vitrectomy, for a large and thick subretinal hematoma involving 3 or more quadrants of the fundus. SURGICAL METHODS: In a first-step vitrectomy, a retinotomy was made in the posterior pole, after any vitreous hemorrhage had been removed. Following fluid-gas exchange with no laser photocoagulation around the retinotomy, patients took a face-down position for a few days to a week to facilitate subretinal hemorrhage movement to the vitreous cavity and anterior chamber. In a second-step surgery, the hemorrhage in the vitreous cavity and anterior chamber was washed out. The remaining subretinal hemorrhage was aspirated, and the retina was reattached with fluid-gas exchange and laser photocoagulation around the retinotomy. RESULTS: The planned two-step vitrectomy was performed in 4 consecutive patients with large and thick subretinal hematomas involving 3 or more quadrants seen during a 3-year period. By a face-down position after the first-step vitrectomy, subretinal hemorrhage moved to the vitreous cavity and anterior chamber. The remaining subretinal hemorrhage in a smaller quantity could be easily removed, leading to retinal reattachment in the second-step surgery. CONCLUSIONS: The planned two-step vitrectomy is a safer and more effective procedure for removing a large quantity of subretinal hemorrhage in a shorter period of surgical time, compared with hemorrhage removal in a single vitrectomy.     

Pars plana vitrectomy in eyes containing a treated posterior uveal melanoma

PURPOSE: To determine the safety of pars plana vitrectomy in eyes containing a treated posterior uveal melanoma. DESIGN: Interventional case series. METHODS: Retrospective case series of patients with posterior uveal melanoma who underwent pars plana vitrectomy. Complications, vitreous cytology, local tumor control, and metastasis were assessed. RESULTS: Nine patients met study criteria. Tumors were treated with (125)I plaque radiotherapy (seven patients) or transpupillary thermotherapy (two patients). Vitrectomy was performed for vitreous hemorrhage (five patients), macular pucker (two patients), macular hole (one patient), and rhegmatogenous retinal detachment (one patient). Vitrectomy was performed at a mean of 24.7 months (range, 7-47 months) after melanoma treatment. Dispersion of tumor cells at vitrectomy was not observed in any patients. Melanoma cells were detected in the vitreous aspirate in one of seven cases examined cytologically. This patient had intratumoral and vitreous hemorrhage before plaque radiotherapy, underwent combined vitrectomy/cataract extraction, and developed intraocular tumor dissemination 56 months after vitrectomy. No other patients developed intraocular tumor dissemination. At mean follow-up of 24 months (range, 3-63 months) after vitrectomy, none of the nine patients developed systemic metastasis. CONCLUSIONS: Pars plana vitrectomy rarely may lead to intraocular tumor dissemination, although the risk of this complication is probably low if the tumor has been treated and has responded to therapy before vitrectomy. Vitrectomy should be approached with caution if a vitreous hemorrhage is present, especially if the hemorrhage occurred before tumor treatment, as this may seed tumor cells into the vitreous cavity.     

Ⅱ型增殖性糖尿病视网膜病变患者行玻璃体切除地机与术后视力 …

探讨Ⅱ型增殖性糖尿病视网膜病变合并严重玻璃本出血或合并血管纤维增殖引起的视网膜牵拉性视网膜脱离情况下,进行玻璃全切除术的手术时机。     

玻璃体切割术治疗视网膜静脉周围炎伴玻璃体出血

目的：评价玻璃体切割术治疗视网膜静脉周围炎伴玻璃体出血的疗效。方法：回顾性分析我院自1999年3月至2002年9月经玻璃体切割术治疗的视网膜静脉周围炎伴玻璃体出血患者13例18只眼的临床资料。结果：随访期为7个月～4年，平均23个月。18只眼视网膜均在位，16只眼(88.9％)视力较术前有不同程度的提高，其中视力≥0.3者11只眼(71％)，最好视力为1.0。术后玻璃体再出血2例，经药物治疗后出血吸收。无新生血管性青光眼发生。结论：玻璃体切割术是治疗视网膜静脉周围炎伴玻璃体出血的有效方法，可明显改善患者视力；结合术中及术后激光光凝治疗，可有效预防玻璃体再出血及新生血管性青光眼等并发症的发生。     

Hemostatic effects of SF6 after diabetic vitrectomy for vitreous hemorrhage

PURPOSE: To investigate the hemostatic effects of SF6 gas in preventing postoperative vitreous hemorrhage in diabetic vitrectomy. METHODS: A prospective, randomized study of 33 diabetic eyes with vitreous hemorrhage, treated by vitrectomy. In 17 of our cases SF6 20% was injected into the eye at the end of the operation, while in 16 cases BSS remained in the vitreous cavity. RESULTS: The incidence of vitreous hemorrhage recurrence was 17.6% for the SF6 group and 12.5% for the BSS group (statistically not significant). Progression of lens opacities was observed in 23.5% of the SF6 group, and in 18.8% of the BSS group (statistically not significant, with a higher incidence in the SF6 group). CONCLUSIONS: SF6 gas did not show hemostatic effects in the cases studied. Furthermore, it may have contributed to cataract progression. Therefore we suggest that the use of SF6 is not recommended as a treatment modality in preventing new vitreous hemorrhage after diabetic vitrectomy.     

增殖性糖尿病视网膜病变玻璃体视网膜手术后玻璃体出血的临床观察

目的：探讨增殖性糖尿病视网膜病变（proliferative diabetic retinopathy,PDR)玻璃体视网膜手术严重玻璃体出血的原因，并发症及处理方法。方法：对我院1997年1月至2001年3月住院行玻璃体视网膜手术治疗PDR的182例（198只眼）患者中术后发生严重玻璃体出血的16例（17只眼）患者进行回顾性分析。结果：术后玻璃体出血中52.9%出现于术后第一天，出血原因包括纤维血管膜残端出血，视网膜新生血管膜渗血，视网膜切开，视网膜裂孔，前玻璃体纤维血管增殖等；出血并发症包括继发性青光眼，增殖膜形成等。结论：PDR玻璃体切割术后玻璃体出血为术后常见的并发症；对于出血量大、难于吸收及出现并发症的病例，积极治疗可改善视力预力预后。     

视网膜大动脉瘤合并玻璃体积血的手术疗效

目的：分析评价视网膜大动脉瘤合并玻璃体积血行玻璃体切割术联合眼内视网膜光凝治疗的临床疗效。 方法：回顾分析2009-01/2011-02在我院住院治疗的11例11眼视网膜大动脉瘤合并玻璃体积血的患者,给予玻璃体切割术联合眼内激光治疗;并对其手术疗效、视力和并发症进行观察分析。 结果：术后随访6～24mo,11例患者玻璃体腔均无再次出血,视网膜大动脉瘤周边血管闭塞,瘤体萎缩、瘢痕化;术后视力0.05～0.4,均有不同程度提高;其中2例2眼术后眼压一过性升高,局部给予降眼压药物治疗后恢复正常。 结论：玻璃体切割术联合眼内视网膜光凝治疗,对视网膜大动脉瘤合并玻璃体积血患者是一种疗效确切的治疗方法。     

Incidence of rhegmatogenous retinal detachment after vitrectomy in eyes of diabetic patients

PURPOSE: To assess the incidence of rhegmatogenous retinal detachment (RRD) after pars plana vitrectomy (PPV) among diabetic patients with complications of proliferative diabetic retinopathy. METHODS: Ninety-three eyes of diabetic patients-who underwent PPV with or without intraocular gas tamponade for complications of proliferative diabetic retinopathy-were reviewed retrospectively. Indication for vitrectomy was vitreous hemorrhage in 80 patients (86.1%), tractional retinal detachment in 3 (3.2%), and vitreous hemorrhage associated with tractional retinal detachment in 10 (10.7%). RESULTS: Four (4.3%) of 93 eyes developed an RRD after vitrectomy. The primary reason for vitrectomy was recurrent or nonresolving vitreous hemorrhage. The retina was attached with one additional surgical procedure in two of these eyes; the other two had to undergo a third operation before attachment was achieved. CONCLUSION: RRD occurs in a small percentage of patients after PPV with or without gas tamponade for vitreous hemorrhage or tractional retinal detachment caused by proliferative diabetic retinopathy. Thorough postoperative follow-up is important to make early diagnosis and intervention possible.