23G或25G玻璃体切割术联合过氟萘烷治疗巨大裂孔性视网膜脱离33例临床分析

目的:探讨23G或25G玻璃体切割术联合应用过氟萘烷治疗巨大裂孔性视网膜脱离的临床疗效,并讨论其临床意义。方法:回顾性分析2014年1月~2016年6月西安市第四医院眼科收治的巨大裂孔性视网膜脱离患者33例(33眼)。患者均行23G或25G玻璃体切割术,术中联合应用过氟萘烷、视网膜激光和注硅油等治疗以观察术后视网膜复位和视力,以及并发症等情况。结果:首次术后33例患者视网膜解剖上完全复位,未见严重并发症。其中2例术后1月因增生性玻璃体视网膜病变致视网膜再脱离再次手术治疗复位,1例取硅油术后2月因新的视网膜裂孔再次脱离行手术治疗后复位。术后平均随访15个月,未再发现视网膜脱离,视力也得到较好的恢复。结论:23G或25G玻璃体切割术联合应用过氟萘烷治疗巨大裂孔性视网膜脱离是一种手术成功率高、疗效良好的方法,值得临床推广应用。     

玻璃体切除联合白内障手术治疗增殖性糖尿病视网膜病变52眼分析

目的评价玻璃体切除联合白内障手术治疗增殖性糖尿病视网膜病变（proliferative diabetic retinopathy,PDR）的临床效果。方法回顾性分析了2005年7月至2009年12月在我院行玻璃体切除联合白内障手术的PDR患者48例（52眼）,术后随访7个月以上,统计分析手术方式、术前、术后最终矫正视力、手术并发症等临床资料。结果硅油填充率随着糖尿病眼底病变发展而增加,VI期硅油填充率分别与IV期、V期相比差异显著,P〈0.01;随访期间,71.15%（37/52）术后视力提高,随着糖尿病眼底病变发展,术后视力提高率下降,IV、V、VI期术后视力提高率分别是100%、92.31%和62.16%,但各组间无显著差异,P〉0.05,其中视力0.1以上的眼数由术前的5眼（11.36%）增加到术后的33眼（75%）,术后视力显著好于术前,P〈0.01;一次性视网膜复位成功率100%。1眼术后玻璃体再次出血,7眼发生后发性白内障,硅油填充组6眼术后早期发生高眼压,4眼在术后不同时期发生硅油乳化。结论玻璃体切除联合白内障手术治疗PDR是安全有效的,有利于早期恢复患者视力,避免再次白内障手术。     

糖尿病视网膜病变玻璃体视网膜术后高眼压发生率及相关因素

目的探讨糖尿病视网膜病变(DRP)行玻璃体视网膜术后高眼压的发生率及相关因素。方法选择行玻璃体视网膜术治疗的DRP患者986例(1 326眼)为研究对象。分析术后高眼压的发生率,并且对比分析不同类型、不同分级、术前是否合并黄斑脱离、行硅油/C3F8充填、术中行全/补充视网膜光凝、是否晶状体切除患者高眼压发生率的差异。结果 1 326眼术后发生高眼压共计368例(27.8%)。增生型DRP患者术后高眼压发生率(34.0%)显著高于非增生型(17.2%)(χ2=30.648,P=0.000);DRP D级高眼压发生率为34.1%,显著高于B级(20.8%)(χ2=16.348,P=0.001);术前合并黄斑脱离患者高眼压发生率(30.4%)显著高于无黄斑脱离患者(22.7%)(χ2=8.834,P=0.003);术中充填硅油患者(39.1%)显著高于填充C3F8患者(24.0%)(χ2=28.088,P=0.000);术中全视网膜光凝者(32.8%)显著高于补充光凝患者(16.8%)(χ2=21.159,P=0.000);术中行晶状体切除者(40.5%)显著高于无晶状体切除者(25.9%)(χ2=15.532,P=0.000 1)。结论 DRP患者玻璃体视网膜术后高眼压的发生率高,并且与DRP类型、分级、术前合并黄斑脱离、术中填充物、视网膜光凝、晶状体切除等相关。     

取出眼内硅油填充后的视网膜再脱离

目的　评价眼内填充的硅油去除以后视网膜再脱离的频度和危险因素。方法　这个研究包括 2 2 5例患者 ,由两名手术医师中的一名为他们做经睫状体平坦部的玻璃体切割术 ,在平均十个月以后连续接受眼内硅油取出术。平均随访时间为 17.37(SD14 .4 0 )个月 (范围 3.0 2 - 6 7.4 2月 )。结果　在 2 2 5例患者中取出硅油后视网膜再脱离的有5 7例 (2 5 .3% )。视网膜再脱离的危险因素如下 :以前视网膜脱离手术不成功的次数 (P=0 .0 0 0 8) ;手术者 (P=0 .0 0 7) ;硅油取出前的视力 (P=0 .0 0 9) ;玻璃体基底部切除不完全(P=0 .0 1) ;未行下方视网…     

玻璃体视网膜手术对开放性眼外伤的治疗研究

目的 探讨玻璃体视网膜手术在治疗开放性眼外伤中的疗效.方法 回顾性分析2004年9月至2008年10月行玻璃体切除术治疗开放性眼外伤53例(53眼).结果 33例眼内异物,摘出率100%,11例复杂视网膜脱离,复位率31.7%,3例继发性青光眼,眼压均控制在正常范围,6例眼内炎,5例得到控制.所有53例53只眼中,术后视力较术前提高者45只眼(84.9%),术后视力不变或下降8只眼(15.1%).结论 玻璃体视网膜手术对大部分开放性眼外伤患者的视力有所改善.     

玻璃体视网膜手术对开放性眼外伤的治疗研究

目的探讨玻璃体视网膜手术在治疗开放性眼外伤中的疗效。方法回顾性分析2004年9月至2008年10月行玻璃体切除术治疗开放性眼外伤53例（53眼）。结果 33例眼内异物,摘出率100%,11例复杂视网膜脱离,复位率31.7%,3例继发性青光眼,眼压均控制在正常范围,6例眼内炎,5例得到控制。所有53例53只眼中,术后视力较术前提高者45只眼（84.9%）,术后视力不变或下降8只眼（15.1%）。结论玻璃体视网膜手术对大部分开放性眼外伤患者的视力有所改善。     

冷凝联合光凝与单纯冷凝治疗孔源性视网膜脱离的比较观察

目的 比较观察冷凝联合激光光凝与单纯冷凝治疗孔源性视网膜脱离的疗效。方法 回顾性分析2001年6月-2005年6月因孔源性视网膜脱离进行手术治疗的患者108例109眼。其中一组66眼采用巩膜扣带术、冷凝联合激光光凝治疗，一组采用巩膜扣带术单纯冷凝治疗。结果 两组一次性手术复位率无显著性差异，术后复发率单纯冷凝组高于联合治疗组且有显著性差异（X^2=4．79，P〈0．05），术后联合治疗组视力改善高于单纯冷凝组有显著性差异（X^2=7，91，P〈0．05）。结论 对于孔源性视网膜脱离其增殖性病变在PVRC2级以下者，冷凝联合激光光凝治疗较单纯冷凝治疗效果好。     

532激光联合曲安奈德治疗糖尿病视网膜病变的临床观察

目的评价倍频532激光联合曲安奈德治疗伴有黄斑水肿的糖尿病视网膜病变的疗效。方法对52例87眼伴有弥漫性黄斑水肿的糖尿病视网膜病变患者采用532激光进行黄斑格栅样光凝联合全视网膜光凝，同时球后注射曲安奈德20mg，1～3次，间隔1周，分析患者视力、黄斑水肿及并发症情况。结果激光治疗后随访6～18个月，87眼中51（59％）眼视力稳定，视力提高者30（35％）眼，视力下降者6（7％）眼；眼底荧光血管造影检查，光凝后水肿完全消退者50（57％）眼，部分消退者32（37％）眼，不变者5（6％）眼，晶状体混浊加重者5眼，4只眼眼压升高。结论532倍频激光联合曲安奈德治疗糖尿病视网膜病变有助于黄斑水肿消退，提高视力。     

孔源性视网膜脱离外路显微手术的临床观察

目的观察孔源性视网膜脱离外路显微手术的临床效果。方法对32例孔源性视网膜脱离患者的32只眼，在手术显微镜直视下进行视网膜放液或不放液，视网膜裂孔及变性区冷凝，硅胶块填压和／或环扎，术后观察视力恢复及视网膜复位情况。结果手术显微镜下患眼视网膜冷凝呈灰白色均清晰可见，无严重手术并发症。1次手术后视网膜完全复位30只眼，占93．4％，再次外路手术复位2只眼。结论孔源性视网膜脱离行外路显微镜直视下手术，具有简单方便直观、效果良好、成功率高等优点。     

白内障合并增生性糖尿病视网膜病变的联合手术治疗

目的探讨超声乳化和晶体切除术联合玻璃体切除在白内障合并增生性糖尿病视网膜病变（PDR）治疗中的临床疗效。方法分析79例PDR,共105眼,随机分2组,术式1组56只眼,为白内障超声乳化术后,行闭合式三通道玻璃体切除,囊袋内植入后房型人工晶体;术式2组49只眼,为经扁平部玻璃体联合晶体切除术,保留前囊、人工晶体植入前囊上、睫状体沟内。结果术后随访2个月～3年,术式1组视力改善46只眼,占82．1％;术式2组视力改善31只眼,占63．2％,两组术后视力改善眼数比较差异显著（χ^2=4．762,P〈0．05）。术式1组术后发生虹膜新生血管（INV）1只眼,占1．8％;术式2组术后发生INV 7只眼,占14．3％,两组术后INV发生率比较差异显著（χ^2=5．835,P〈0．05）。结论在治疗白内障合并PDR患者中,术式1组优于术式2组,其术后并发症和INV的发生率也明显低,可使大多数患者的视力改善。     

Intraocular pressure values following vitrectomy with silicone oil tamponade

Secondary glaucoma is a relatively common complication after pars plana vitrectomy and silicone oil injection for repair of complex retinal detachment. The aim of this study was to evaluate the influence of silicone oil tamponade on intraocular pressure elevation and to identify the mechanism of this elevation. The study included 45 eyes of 45 patients who had undergone pars plana vitrectomy and silicone oil tamponade for repair of complex retinal detachment. Ophthalmic examination was performed before vitrectomy, and one and six months after vitrectomy. The increase in intraocular pressure was measured one month postoperatively in 37.77% of patients. The mechanism of intraocular pressure increase was silicone oil emulsification in 52.98%, closure of Ando's iridectomy in 23.54%, and idiopathic angle closure glaucoma in 23.54% of patients with elevated intraocular pressure. After silicone oil removal, elevated intraocular pressure persisted in 7 (15.55%) patients; in 5 patients it was controlled medically, while two patients underwent glaucoma surgery. Six months postoperatively 3 patients developed secondary neovascular glaucoma due to the prolipherative ischemic disease. Elevation of intraocular pressure following vitrectomy with silicone oil tamponade had a temporary effect, as it did not lead to permament intraocular pressure elevation but regressed after silicone oil removal from the eye.     

超声乳化与巩膜外冷凝联合手术治疗白内障合并视网膜脱离12例

目的：评价超声乳化与巩膜外冷凝联合手术治疗白内障合并视网膜脱离的疗效和可行性。方法：采用超声乳化白内障吸除联合间接眼底镜下巩膜外冷凝裂孔术，治疗白内障合并视网膜脱离12例（12只眼）。结果：术后所有病例白内障一次性摘除干净，10例视网膜复位，复位病例视力不同程度得到提高。结论：白内障超声乳化与巩膜外冷凝联合术是治疗白内障合并视网膜脱离行之有效的手术方法。     

Delayed recurrence of acute retinal necrosis (ARN): A case series

PurposeTo report five cases of acute retinal necrosis (ARN) that reactivated in the same eye or presented in the contralateral eye between two and nineteen years after the initial episode of acute retinal necrosis.CasesFive patients with a previous history of ARN developed recurrent ARN infection following a lengthy latency period. In all five patients who initially presented with unilateral disease, four developed infection in the contralateral eye and one developed recurrent infection in the ipsilateral eye. Latency periods ranged from two to nineteen years, and final visual acuity in the affected eyes ranged from 20/30 to no light perception. Each patient was treated with antiviral medication for both the initial infection and for subsequent reactivations, but was not on long-term prophylaxis at the time of recurrent disease.ConclusionAlthough rare, delayed onset reactivation of ARN can occur in either the same eye or contralateral eye despite adequate treatment. While contralateral spread of initial infection is fairly common, these reactivations rarely occur more than six weeks after initial infection. Currently there are no guidelines for use of prophylactic antiviral medication to prevent late recurrence of ARN.     

Visual field deficits in cats reared with cyclodeviations of the eyes

Summary Visual fields of ten cats which had one or both eyes rotated at 8 days of age were measured by two forms of perimetry and compared to visual fields of two normal cats and of four cats with monocular rotations at 16 days, 3 months or 6 months of age. All animals showed excellent localization of visual stimuli and responded to the actual location of stimuli in space rather than to the retinal locus normally associated with that location. In cats with monocular rotations, the field of the normal eye was always normal, extending from 90 ° ipsilateral to 30 ° contralateral. Cats with rotations of one eye at 3 or 6 months of age had essentially normal fields in the rotated eye as well, while cats with surgery at 8 or 16 days had restricted horizontal fields. They responded only to stimuli in the ipsilateral hemifield; they were blind in the contralateral hemifield. Their superior and inferior visual fields were normal. The field deficits related consistently to visual field coordinates and not to the angle or direction of rotation. In cats with binocular rotations the visual field of at least one eye extended across the midline. Thus, the extent of the field depended upon sensorimotor experiences of the cat both before and after surgery. It is argued that these monocular field deficits have a central origin, not a retinal one.When tested with both eyes open, seven of 14 experimental animals did not respond throughout the visual field seen by each eye alone. The total visual field with both eyes open was less than the sum of the two monocular fields; greatest losses were most pronounced in the extreme periphery of the field ipsilateral to the rotated eye. Since changes in eye position (e.g., convergence during bincocular viewing) were not observed, it is suggested that the binocular losses indicate suppression of the deviated eye which has a central origin.All animals were tested for visual following, visually-triggered extension (placing), and visually-guided reaching. Cats which had been routinely encouraged to use the rotated eye(s) by occlusion of the other eye showed skilful performance within a few weeks after surgery as previously reported by Peck and Crewther (1975), Mitchell et al. (1976) and others. In contrast, two cats reared with both eyes open after unilateral rotation in infancy were profoundly handicapped, as previously reported by Yinon (1975, 1976).This research was supported by Grant NS 14116 from the US Public Health Service     

Prognostication of the results of treatment of retinal detachment with silicone oil tamponade using pattern recognition methods

The aim of this work was to solve the problem of prognostification of anatomic and functional results of treatment of retinal detachment (RD) with silicone oil tamponade. Analysis of the treatment of 257 eyes was performed using pattern recognition methods. All the patients were characterized according to 32 signs related the preoperative status only. As a result, an informative sign system was developed; the present data proved to be not representative enough, which manifested mostly in the class of RD recurrence, where the rate of correct end result recognition was 75% (in the class of "normal condition" it was 95%). One of the most significant RD signs, PVR degree, in this study was placed in the second ten according to its informative value, probably due to the fact that PVR classification is not detailed enough.     

Acute retinal necrosis: insights into pathogenesis from the mouse model

Acute retinal necrosis (ARN) is a relatively rare syndrome that is caused by infection with one of several members of the human herpesvirus family. ARN usually occurs in otherwise healthy patients, although it has also been observed in immunocompromised individuals. It is characterized by retinal vasculitis and haemorrhaging, areas of retinal necrosis, vitreous and aqueous inflammation and optic neuritis. It may affect one or both eyes and frequently results in severely reduced vision or blindness in the affected eye. Results using the mouse model of ARN have provided insight into the pathogenesis of this disease. However, many unanswered questions remain, such as why does only a very small fraction of individuals infected with one or more herpesvirus develop ARN? Increased understanding of the interactions of herpesviruses with T cells and cytokines may enable the development of therapeutic strategies targeted specifically to control viral infection in the eye and/or brain.     

Silicone oil in the subarachnoidal space--a possible route to the brain?

Using this case report, we sought evidence that silicone oil may infiltrate the subarachnoidal space. Vitrectomy combined with silicone oil implantation was performed on the right eye of a 72-year-old woman. The silicone oil was removed 2 months later, because the patient had developed elevated intraocular pressure. The blind and painful eye was subsequently enucleated. By light microscopy, presumed silicone oil bubbles were identified in the optic nerve and the subarachnoidal space of the enucleated eye. These vacuoles were examined by energy-dispersive X-ray analysis (EDAX). In addition, in the vacuoles, immunohistochemistry was used to test for the presence of CD 68-positive macrophages. Silicone oil infiltration sites in the optic nerve, in the central retinal artery, and in the subarachnoidal space were located by light microscopy and confirmed by EDAX. CD 68-positive macrophages were found in the silicone-filled vacuoles. Silicone oil used for endotamponade may infiltrate the optic nerve and even the subarachnoidal space. This supports the assumption that silicone oil, under special circumstances, may even migrate into the brain.     

Biomaterials used in the posterior segment of the eye

The treatment of posterior segment eye disease and related conditions has improved greatly in recent years with the advent of new therapies, materials and devices. Vitreoretinal conditions, however, remain significant causes of blindness in the developed world. Biomaterials play a major role in the treatment of many of these disorders and the success rate of vitreoretinal surgery, especially in the repair of retinal detachment and related conditions, would increase with the introduction of new and improved materials. This review, which focuses on disorders that feature retinal detachment, briefly describes the anatomy of the eye and the nature and treatment of posterior segment eye disorders. The roles, required properties and suitability of the materials used in vitreoretinal surgery as scleral buckles, tamponade agents or drug delivery devices, are reviewed. Experimental approaches are discussed, along with the methods used for their evaluation, and future directions for biomaterial research in the posterior segment of the eye are considered.