应用超声乳化自动注吸系统行硅油取出的临床观察和研究

目的 探讨应用超声乳化自动抽吸系统进行硅油取出手术的临床效果和安全性.方法 回顾性分析122例(125眼)应用超声乳化自动抽吸系统行硅油取出术患者的临床资料,对手术时间、术中及术后并发症如眼压、脉络膜上腔出血、视网膜脱离复发、角膜病变等进行观察并记录.结果 所有研究对象均一次完成硅油取出,平均用时18 min.术前12眼继发青光眼者硅油取出术后眼压恢复正常.11眼术后早期眼压低于10 mmHg(1 kPa=7.5 mmHg),低眼压发生率为8.8%,给予相应药物治疗后眼压恢复正常.硅油取出术后早期和随访期间,125眼中共有10眼发生视网膜脱离(术后2-7 d 6眼,术后0.5-3个月3眼.5个月1眼).5眼硅油致带状角膜病变者术后角膜混浊情况均不同程度改善.结论 应用超声乳化自动注吸系统行硅油取出是一种安全、有效的方法,具有临床可行性,值得推广.     

83例硅油取出时机及并发症的临床分析

目的 分析硅油充填的时间与视网膜复位的关系及硅油在眼内存留时间和硅油并发症产生的关系。方法 回顾分析83例(83只眼)行硅油取出术患者的临床资料及随访记录。结果 行硅油取出的时间为3～13个月，平均8个月。在无发生硅油相关的并发症的条件下，78例在取出硅油之后，视力无明显改变或稍有提高。角膜变性的病例，在硅油取出之后，其混浊情况无明显改变。11例青光眼在硅油取出之后眼压恢复正常者8例，5例在硅油取出之发生了复发性视网膜脱离。结论 硅油取出的最佳时机是3～6个月。硅油取出可以缓解硅油并发症的发展。硅油取出术的并发症主要为复发性视网膜脱离、脉络膜出血、脉络膜脱离、视网膜出血及低眼压。     

改良硅油取出联合巩膜扣带术治疗硅油填充术后视网膜脱离

目的：探讨改良硅油取出联合巩膜扣带术治疗硅油填充状态下视网膜脱离的效果。

方法：回顾性研究。选取2021-01/2023-02于我院治疗的硅油填充状态下视网膜脱离的患者14例14眼,采用改良硅油取出联合巩膜扣带术进行治疗。硅油取出方法采用自制的23 G抽吸器,即将一次性输血器的针管取出,靠近乳头端剪至2.5-3.0 mm,另一端连接已去除推注手柄的10 mL注射器,注射器另一端连接玻璃体切割器的负压系统,进行硅油取出; 巩膜扣带术中外加压块采用外加压复合体; 术后未重新注入硅油。随访6 mo,观察术后视网膜复位、最佳矫正视力(BCVA)、眼压和并发症等情况。

结果：术后6 mo,视网膜完全复位13眼,视网膜复位率达93%,BCVA(LogMAR)较术前改善(0.95±0.18 vs 1.15±0.21,P=0.002)。术后1 d出现一过性高眼压6眼,药物控制后恢复正常。术中未见视网膜出血、嵌顿、医源性裂孔等并发症,术后未出现眼内炎、脉络膜脱离等并发症。

结论：改良硅油取出联合巩膜扣带术可以有效治疗硅油填充状态下视网膜脱离,促使视网膜再复位。     

重硅油在外伤性视网膜脱离复位手术中的应用

目的 观察重硅油作为眼内填充物在外伤性视网膜脱离复位手术中的临床效果、并发症及安全性.方法 对15例(16眼)伴有全身外伤的外伤性视网膜脱离进行玻璃体切除术,术后应用重硅油填充,随诊2～5个月取出重硅油,取油后随访3～6个月,观察手术前后视力、眼压、晶状体情况,视网膜复位情况及硅油乳化情况.结果 硅油取出后13例(14眼,87.50％)视网膜平复,11例(12眼,75.00％)矫正视力较术前不同程度提高;1例(1眼,6.25％)因前增生性玻璃体视网膜病变而视网膜未复位,再次手术行标准硅油填充,视网膜复位好,另1例(1眼,6.25％)因合并严重的外伤性脉络膜脱离而视网膜无法复位,行眼内容摘除术.患眼重硅油填充术后主要的眼部并发症为硅油乳化,为术后2周至2月,平均乳化时间为(1.28±0.12)月,未引起明显的眼压升高或角膜内皮细胞损伤.结论 外伤性视网膜脱离行玻璃体切除手术后用重硅油填充效果良好,无明显并发症,明显提高了患者舒适度,但乳化较快.     

重硅油填充治疗极重度增生性玻璃体视网膜病变

目的:研究玻璃体切割联合重硅油填充治疗极重度增生性玻璃体视网膜病变(proliferative vitreous retinopathy,PVR)的临床疗效. 方法:回顾性筛选2012-06/2015-12我科收治的极重度PVR患者13例13眼,分析对其行玻璃体切割联合重硅油填充术及后期重硅油取出联合C3F8填充术的临床疗效.13眼于重硅油填充术后10~17wk行重硅油取出联合C3F8填充术.13眼观察随访时间为玻璃体切割联合重硅油填充术后第1~7d、出院后1、2、4~17wk,重硅油取出术后第 1~7d、出院后1、2、4、8、12、24wk复查,取油术后随诊时间不少于24wk.观察指标包括视网膜复位、最佳矫正视力、眼压、人工晶状体及并发症等.结果:患者13眼于重硅油填充术后随诊期间,下方裂孔均封闭、视网膜均平复;13眼分别于重硅油填充术后10~17wk行重硅油取出联合C3F8填充术,其中第5例患者于取油术后4wk因黄斑裂孔再次视网膜脱离,第8例患者于取油术后8wk因颞上方新的裂孔再次视网膜脱离,余11眼于取油术后随诊24wk,下方视网膜裂孔均封闭、视网膜平复.患者13眼于重硅油填充术前最佳矫正视力为光感~手动,于重硅油取出术后24wk随诊时最佳矫正视力为手动~20/250,其中重硅油取出术后再出现视网膜脱离的第5例及第8例患者于末次随诊时视力为指数和手动.4眼于重硅油填充术后1wk内出现高眼压,经抗炎和降眼压药物治疗后,眼压降至10~21mmHg,后期因重硅油乳化5眼出现药物难以控制的高眼压,对其及时行重硅油取出术,取油术后3眼曾出现一过性高眼压,经降眼压药物治疗后控制在10~21mmHg,后期3眼停用降眼压药物未再出现眼压升高情况.13眼于治疗期间未出现严重前房炎症反应、眼内炎等并发症.结论:对极重度PVR行玻璃体切割联合重硅油填充及后期重硅油取出联合C3F8填充术,可获得满意的视网膜复位率,并最大限度地提高患者的预后视力.     

合并脉络膜脱离的视网膜脱离的临床观察

目的:探讨合并脉络膜脱离的视网膜脱离手术治疗方法和手术时机的选择并观察疗效。方法:总结、分析2010-01/2012-01因视网膜脱离合并脉络膜脱离在我院住院的患者45例45眼,其中原发性裂孔源性视网膜脱离合并脉络膜脱离38例,复发性视网膜脱离合并脉络膜脱离7例。手术方法包括巩膜环扎、经巩膜穿刺口脉络膜上腔引流、玻璃体视网膜手术、眼内光凝、C3F8填充术或硅油填充术。结果:患眼45眼均行巩膜环扎术,均于手术中成功引流脉络膜上腔液体,6眼行C3F8填充,39眼行硅油填充术,45眼视网膜脉络膜全部复位,视网膜裂孔封闭。其中23眼术后视力≥0.1。结论:合并脉络膜脱离的视网膜脱离,采用巩膜环扎和玻璃体视网膜手术联合经巩膜穿刺口脉络膜上腔积液引流的联合手术方式有效。     

25G微创玻璃体切除联合内界膜剥除治疗PVR-C级视网膜脱离

目的:观察25G微创玻璃体切除联合内界膜剥除治疗增殖性玻璃体视网膜病变(PVR)-C级视网膜脱离的效果。方法:收集2015-08/2018-07在我院就诊的PVR-C级视网膜脱离患者37例37眼,对所有患者行25G微创玻璃体切除联合硅油填充术治疗,术中吲哚菁绿染色后剥除血管弓大小范围内界膜。3~6mo根据视网膜复位情况行硅油取出,术后随访12mo,观察视力、眼压、视网膜复位、黄斑前膜情况并进行回顾性分析。结果:术后视力均有不同程度提高;术后2wk内眼压增高者6眼,经过治疗,眼压均恢复正常;所有患者到随访末期均未出现黄斑前膜;2眼因下方视网膜周边部出现PVR致再次视网膜脱离,余35眼均成功取出硅油。结论:25G微创玻璃体切除联合内界膜剥除治疗PVR-C级视网膜脱离安全有效,并有效防止了黄斑前膜的出现。     

硅油填充眼复发性视网膜脱离堤坝式光凝术后取出硅油的效果

目的:探讨视网膜脱离术后硅油填充眼复发性视网膜脱离行堤坝式光凝术后取出硅油的临床效果。方法:回顾性分析郑州大学第一附属医院2018年9月至2020年6月行玻璃体切除硅油填充术后出现下方复发性视网膜脱离者41例(41只眼)的临床资料。所有患者在硅油取出术前于视网膜下积液区域后缘行堤坝式激光光凝术1～3次,末次光凝术后1周...     

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。     

玻璃体切除术联合巩膜外环扎治疗脉络膜脱离型视网膜脱离

目的：探讨玻璃体切除联术合巩膜外环扎治疗脉络膜脱离型视网膜脱离的临床疗效。

方法：回顾性分析2014-01/2018-02在我院行玻璃体切除术联合巩膜外环扎治疗的脉络膜脱离型视网膜脱离患者19例19眼,术后3～12mo行玻璃体腔硅油取出术。观察患者术后视网膜复位率、眼压、视力恢复及并发症情况。

结果：本组患者术后视网膜均复位,术后3mo患眼玻璃体腔硅油填充状态下眼压(16.09±3.58mmHg)、硅油取出术后6mo眼压(14.69±3.10mmHg)均高于术前(6.78±1.90mmHg)(均P<0.05)。硅油取出术后6mo,15眼患者视力较术前提高。术后无低眼压及眼球萎缩等并发症发生。

结论：玻璃体切除术联合巩膜外环扎治疗脉络膜脱离型视网膜脱离是相对安全有效的,视网膜复位率高,术后并发症少,再次手术率低。     

Outcome after silicone oil removal

BACKGROUND: Combined with vitreoretinal surgery, silicone oil injection has become a standard technique and improves the prognosis of complex retinal detachment. As silicone oil leads to long term complications, removal of silicone oil from the eye is recommended. To evaluate the outcome after silicone oil removal, retinal redetachment, visual acuity, and complications were analysed. METHODS: The authors analysed 115 consecutive cases of silicone oil removal (115 eyes), all operated by one surgeon. The series consisted of retinal detachments associated with proliferative vitreoretinopathy (103 eyes), proliferative diabetic retinopathy (six eyes), or ocular trauma (six eyes). The mean duration of intraocular silicone oil tamponade was 13.3 months, with a mean postoperative follow up of 1.8 years. RESULTS: Anatomic success after silicone oil removal, defined as a complete retinal attachment, was achieved in 95 of 115 eyes (82.6%). Redetachment occurred in 20 eyes (17.4%), mostly within the first 6 months after silicone oil removal. Including the successfully reoperated eyes, the authors present a final anatomic success rate of 108 eyes (93.9%). Visual acuity improved or remained unchanged in 93 eyes (80.9%). CONCLUSION: While reattachment and complication rates were quite similar to other studies, a better visual outcome was achieved in these cases. The duration of the silicone oil tamponade had no significant effect on the reattachment rate. The authors recommend not to apply standard criteria for the timing of silicone oil removal, but to decide individually, considering the underlying disease, as well as the previous operations.     

Retinal detachment after silicone oil removal

PURPOSE: To evaluate the causes of retinal detachment after silicone oil removal, to define possible risk factors and the anatomical and functional prognosis of this complication. METHODS: 112 eyes that underwent silicone oil removal were included. The group of eyes with retinal detachment after oil removal (18/112 eyes, 16.1%) was compared with the group with no postoperative retinal detachment. RESULTS: The most common cause for retinal detachment after oil removal was anterior PVR (77.8%). Initial PVR detachment, advanced PVR stages, anterior PVR, more preceding operations, aphakia/pseudophakia, myopia and shorter duration of the oil tamponade were significantly more represented in the group of eyes with retinal detachment after oil removal. The prognosis of retinal detachment after oil removal is poor. CONCLUSION: Some criteria could be regarded as risk factors for retinal detachment after silicone oil removal. Improvement of the results should be possible by considering these factors and by control of reproliferations.     

硅油取出术后临床观察

目的：探讨硅油取出术的安全性和有效性,分析硅油乳化的危险因素。

方法：选取2012-11/2013-04在我院行硅油取出术的患者63例63眼,观察硅油取出手术前1d,手术后1,2,3d; 1mo眼压; 术前1d和术后1mo视力; 分析硅油取出术患者临床资料,探讨硅油乳化的危险因素。

结果：行硅油取出术63眼术后视网膜解剖复位57眼(90%); 硅油取出手术前与术后各时间点眼压的差异具有统计学意义(P<0.05),且手术后眼压较手术前降低; 术后1mo最佳矫正视力较术前提高37眼(59%)(P=0.002),不变18眼(29%),下降8眼(13%); 硅油乳化23眼(37%),与硅油乳化相关的危险因素为低密度脂蛋白升高(P<0.05)。

结论：硅油取出术后视网膜解剖复位率满意,术后眼压、视力改善明显,控制血脂水平可能减缓硅油乳化的发生。     

Re-emergence of hidden residual intraocular silicone oil bubble after previous silicone oil removal

BACKGROUND: We describe the re-emergence of a hidden residual intraocular silicone oil bubble after previous silicone oil removal. HISTORY AND SIGNS: A 57-year-old patient underwent vitrectomy with silicone oil for a complicated retinal detachment. Six weeks later silicone oil was removed via the pars plana and phakoemulsification with lens implantation was performed. Subsequent clinical follow-up showed an attached retina without residual silicone oil bubbles. However, more than 2 years later the patient suffered sudden visual loss. Clinical examination showed a bubble of silicone oil wedged between a remaining layer of anterior vitreous and the capsular bag, reducing central visual acuity. THERAPY AND OUTCOME: Complete extraction of the silicone oil bubble was performed via the pars plana. CONCLUSIONS: Residual silicone oil bubbles may wedge themselves into vitreous pockets in the ophthalmoscopically invisible regions of the pars plana. Over time these bubbles may migrate into the retrolental space with obstruction of the visual axis.     

Effect of fluid-air exchange on reducing residual silicone oil after silicone oil removal

Graefe's Archive for Clinical and Experimental Ophthalmology - Our purpose was to determine the effect of fluid-air exchange on the amount of silicone oil (SO) droplets remaining in the...