玻璃体切除治疗儿童外伤后化脓性眼内炎的疗效观察

目的总结分析儿童化脓性眼内炎玻璃体切除手术的临床效果。方法对３３例（３３眼）１２岁以下儿童化脓性眼内炎行玻璃体切除手术，配合全身及局部应用抗生素治疗。结果３３例患儿眼内感染全部控制，３眼术后玻璃体积血，２７眼视力不同程度提高，４眼眼球萎缩。结论玻璃体切除术联合抗生素应用对儿童外伤后化脓性眼内炎具有重要治疗价值     

玻璃体切割治疗后段眼内异物伤视力预后及相关因素分析

目的 评价经玻璃体切除手术治疗后段眼内异物伤的临床疗效,以及术后视力预后的主要影响因素. 方法 于2008年9月至2011年6月,经玻璃体切除治疗后段眼内异物伤患者64例64眼,对术前最佳矫正视力 (BCVA)、异物大小、异物位置、外伤严重程度、手术时间、视网膜脱离(RD)与术后BCVA的关系进行分析.结果 经玻璃体切除术后BCVA≥0.1者50只眼(78.13％),≥0.5者18只眼(28.13％).玻璃体切除联合眼内异物取出手术后影响BCVA的因素为伤口长度、术前BCVA、手术时机、RD、眼内炎、tPVR、异物损伤区域.结论 后段眼内异物伤宜首选玻璃体切割手术.合并 RD、眼内炎和tPVR者应尽早行玻璃体切割手术治疗,但术后视力预后差.     

玻璃体切除术治疗后段眼内异物及视网膜脱离

目的探讨玻璃体切除术治疗眼后段眼内异物及视网膜脱离的效果。方法常规平坦部三切口闭合式玻璃体切除术联合眼内异物摘出、视网膜复位、眼内光凝、眼内注入C3F8及硅油眼内填充等多联手术。结果26例（26眼）眼内异物全部一次摘出成功及视网膜脱离完全复位22眼，占84．62％，19眼视力均有不同程度的提高。其中，2眼视力0．5，1眼视力0.6。结论眼后段眼内异物合并视网膜脱离，选择玻璃体手术具有直观、准确、安全、组织损伤小、异物摘出率高及去除外伤性玻璃体视网膜增生等优点。     

玻璃体切除术治疗眼后段异物的临床报告

目的观察玻璃体切除术治疗眼后段异物的临床效果。方法对37例(37只眼)眼后段异物患者进行玻璃体切除术治疗。结果所有病例的眼后段异物均一次性取出,成功率为100%。出院时视力≥0.1者23只眼,继发性青光眼1只眼,继发性眼内出血1只眼,无角膜失代偿及其他并发症。结论玻璃体切除术治疗眼后段异物取出成功率高,并能同时处理其它合并症,是治疗眼后段异物的理想方法。     

玻璃体切除摘出眼后段异物

目的探讨玻璃体切除术摘出后段眼内异物的效果和意义。方法对玻璃体切除联合眼内异物摘出术治疗的54例（54眼）眼后段眼内异物进行回顾性研究。结果所有的病例均一次手术成功摘出眼内异物，术后视力明显提高。但巨大眼内异物或合并有眼内炎者预后较差。结论玻璃体切除联合眼内异物摘出术损伤小、准确、安全、疗效好。     

玻璃体切除术治疗儿童眼外伤影响术后视力的相关因素

目的 探讨玻璃体切除术手术治疗儿童后段眼外伤影响术后视力的相关因素.方法 62例行玻璃体切除术手术治疗眼后段眼外伤的儿童术后视力与相关因素进行统计学分析.结果 统计学分析P＜0.05的指标组有:是否有视网膜脱离;是否注入硅油;足否行视网膜切开术;手术次数;是否有多种跟外伤;术前视力.P＞0.05的指标有:外伤至手术的时问(其中1月以内与1月以上);有无眼内异物;有无眼内炎;伤口的级别;是否做品状体切除;患者年龄;术前有无玻璃体积血;是否注入膨胀性气体;眼挫伤或开放性伤.结论 伤眼视网膜脱离发生、术中注入硅油、术中行视网膜切开及视网膜造孔、多次手术、伤情复杂包括多种外伤及术前视力低下是儿童眼外伤后行玻璃体切除术手术影响术后视力的重要因素.     

玻璃体手术治疗复杂眼后段异物81例

目的:总结玻璃体手术治疗不同原因所致复杂眼后段异物的视力后果,分析受伤原因对视力的影响。方法:回顾性分析2001-01/2002-12经玻璃体手术治疗的复杂眼后段异物81例(87眼)的临床资料。按照受伤原因分为敲击伤36例(36眼)、爆炸伤37例(43眼)和其它外伤8例(8眼)引起的眼后段异物3组。结果:87眼均为复杂的眼后段异物。主要并发症包括外伤性白内障49眼,眼内炎9眼,视网膜脱离19眼,视网膜裂孔12眼,玻璃体积血43眼。玻璃体手术后:70眼(81%)视力提高,14眼(16%)视力不变,3眼(3%)视力下降;其中0.02以上40眼(46%),0.2以上34眼(39%)。术前无光感9眼中,4眼恢复光感以上视力。敲击伤和爆炸伤组术后的视力均好于术前的视力(P <0.05),敲击伤所致眼内异物的术后视力效果明显好于爆炸伤和其它原因所致眼内异物的视力(P <0.01)。结论:经过及时、恰当的玻璃体手术治疗,多数复杂的眼内异物的患者可得到相当的视力,其中敲击伤所致眼内异物效果较好。     

玻璃体切除术治疗复杂眼外伤的效果观察

目的观察玻璃体切除术治疗复杂性眼外伤的效果。方法回顾总结玻璃体切除术治疗复杂性眼外伤33例（33眼）的资料,分析手术的效果。结果33眼复杂眼外伤术后视力提高者30眼（90．9％）,术前视力为无光感的4眼术后视力均不同程度恢复。眼内异物摘出成功率100％,视网膜脱离复位率100％。结论现代玻璃体显微手术的发展使复杂眼外伤的治疗效果大为改善,使外伤后无光感的患眼获得了一定程度上复明的希望。     

严重眼外伤的玻璃体手术治疗

目的探讨玻璃体手术治疗严重眼外伤的效果。方法严重眼外伤35例(35眼),行玻璃体切除术和眼内异物摘出术,联合角巩膜缝合、晶状体切除、眼内激光光凝、巩膜外冷凝以及C3F8或硅油填充术,并根据年龄、眼部外伤情况及术前炎症反应,行人工晶状体Ⅰ期植入或Ⅱ期植入术。随访3～6月。结果术中16例眼内异物均成功摘出,视网膜脱离22眼,其中19眼复位。术后视力提高22眼,视力不变10眼,视力下降3眼。结论玻璃体切除术能有效治疗严重眼外伤,能最大限度挽救患者的视力和眼球。     

眼内后极部非磁性异物的玻璃体切除摘出术

目的 探讨以玻璃体切除术摘出眼内后极部非磁性异物的手术方法和效果。方法 回顾性分析了3l例(34眼)眼内后极部非磁性异物行玻璃体切除联合异物摘出术的临床资料。结果 应用玻璃体切除术联合眼内非磁性异物摘出术中的31例(34眼)中，32眼为一次手术成功摘出，成功率为94．12％。术后视力提高19眼(55．88％)，术后视力不变6眼(17．65％)，视力下降9眼(26．47％)。结论 玻璃体切除术治疗眼内后极部非磁性异物手术操作方便，准确，损伤小。     

Pars plana vitrectomy during cataract surgery for prevention of aqueous misdirection in high-risk fellow eyes

PURPOSE: To report the use of pars plana vitrectomy as a prophylactic measure during cataract surgery for prevention of aqueous misdirection in high-risk fellow eyes. METHODS: Chart review of two patients with severe aqueous misdirection in their first eye at the time of cataract surgery that only responded to pars plana vitrectomy. RESULTS: In both patients, cataract extraction with posterior chamber intraocular lens implantation was initially performed after pars plana vitrectomy, with the creation of hyaloido-capsulo-iridotomy to establish a communication between the vitreous cavity and the anterior chamber. CONCLUSION: Pars plana vitrectomy as a prophylactic measure during cataract surgery may have a beneficial role in fellow eyes at high risk for developing aqueous misdirection.     

A Case of Retinal Detachment in Colobomatous Macrophthalmos With Microcornea Syndrome

We report a rare case of retinal detachment in colobomatous macrophthalmos with microcornea syndrome. A 25-year-old female who had suffered from poor vision in her left eye since early childhood and high myopia in her right eye (-11 D) visited our clinic because of a sudden deterioration of vision. Examination of the anterior segment showed microcornea with coloboma of the inferior pupil margin in the left iris. Fundus examination of the left eye revealed an inferior choroidal coloboma extending from the optic disc and macula. The patient also had total bullous retinal detachment. Pars plana vitrectomy with silicone oil tamponade was performed, and the retina was reattached. In the very rare condition of colobomatous macropthalmos with microcornea, retinal detachment may develop. Pars plana vitrectomy with additional silicone oil tamponade may be performed to treat this condition.     

PARS PLANA VITRECTOMY IN TRAUMA CLINICAL EXPERIENCE*

Pars plana vitrectomy provides a technique for assessing and treating severely damaged eyes. It has proved particularly successful in the management of non-magnetic and low-magnetic intraocular foreign bodies. It is similarly successful in the treatment of patients with unresolved vitreous haemorrhage secondary to penetrating or non pentrating trauma. Results may be disappointing in patients with vitreous haemorrhage associated with traction bands in the vitreous, pre-retinal membranes, and traction retinal detachment. Vitrectomy done earlier may improve the success rate in this group. The treatment has been used successfully in the treatment of anterior segment complicatons of eye trauma.     

眼球穿孔伤伴外伤性白内障患者一期与二期前段玻璃体切除术的效果比较

目的探讨前段玻璃体切除在眼球穿孔伤所致的外伤性白内障手术中的应用价值。方法对于我院2008年1月-2009年2月收治的眼球穿孔伤伴后囊破裂型外伤性白内障58例（58眼）,其中32例行眼球清创缝合、一期白内障摘出联合前段玻璃体切除手术：26例行眼球清创缝合术,术后1周-1月行二期白内障摘出联合前段玻璃体切除手术。术后随访1-3月,观察两组的治疗效果。结果一期前段玻切组32眼,术后矫正视力0.1-0.8,其中1眼0.1,7眼0.2-0.3,24眼0.4-0.8。32眼中1眼术后眼压高,药物无法控制,行二期平坦部玻璃体切除术。二期前段玻切组26眼,术后矫正视力数指-0.8,其中3眼视力≤0.1,7眼0.2-0.3,16眼0.4-0.8,26眼中4眼因一期术后眼压高,1周内行二期手术,术后2眼眼压仍无法控制,行平坦部玻璃体切除术。一期前段玻切组的并发症较二期组少而且轻。结论对于眼球穿孔伤所致后囊破裂型外伤性白内障患者,于清创缝合时进行白内障摘出和一期前段玻璃体切除,可以减少并发症,并减少二期手术的难度及风险,获得较好的矫正视力。     

Indications for pars plana vitrectomy after perforating injuries (author's transl)

A preliminary report is given on 100 consecutive cases of pars plana vitrectomy after perforating injuries due to nonmagnetic IOFB (9 cases), magnetic IOFB (32 cases) and lacerating injuries (19 cases). Pars plana vitrectomy was performed to remove persistent vitreous membranes, to prevent proliferative transformation with following retinal detachment or to make the IOFB become visible for extraction. These eyes were practically amaurotic but in 43 cases out of 100 a positive results could be achieved (i.e. the retina being attached, posterior pole becoming visible). Indications, technique and complications of both pars plana vitrectomy and FB extraction are discussed. As a result pars plana vitrectomy should be performed within an interval of at least 2 weeks after the first intervention (i.e. wound closure of FB extraction).     

Management of surgically dislocated intravitreal lens fragments by pars plana vitrectomy.

We examined 26 eyes (19 of them following phacoemulsification) with surgically dislocated intravitreal lens fragments; 24 eyes were subsequently operated on using pars plana vitrectomy for removal of lens fragments. From this select group of patients we found moderate to severe uveitis, glaucoma, and vitreous opacification present in virtually all cases. Less common complications were retinal detachments (six cases) and bullous keratopathy; the latter problem was found most commonly in eyes subjected to anterior segment maneuvers such as the use of lens loops or vitreous irrigation for removal of the lens material. Pars plana vitrectomy proved an excellent method for removal of lens fragments. A simultaneous two-instrument technique using the Wilson foreign-body forceps and the vitrectomy machine facilitated removal of the denser sclerotic lens fragments. This procedure resulted in resolution of the uveitis and glaucoma with improvement in visual acuity in 20 of the 24 eyes. However, only 10 of the 24 patients operated on obtained 20/40 or better visual acuity. A relatively prompt pars plana vitrectomy in eyes subjected to a minimum of surgical trauma yielded the best visual results.     

Results of pars plana vitrectomy in penetrating ocular trauma

Thirty-four severely injured eyes were operated with pars plana vitrectomy. The nine cases with involvement exclusively of the anterior segment alone were operated with success in all cases. However, the injuries of the posterior segment still reflect significant problems in that only 50 percent obtained successful visual results. This reflects, in great part, the degree of severity of the initial damage.The theoretical rationale for pars plana vitrectomy in penetrating ocular trauma is discussed. Because of the many variables from patient to patient and injury to injury, conflicting clinical impressions as to appropriate management prevail. In the abscence of a definitive clinical trial or suitable experimental model, our guidelines for the role and proper timing of pars plana vitrectomy for penetrating ocular trauma are presented.This study was supported in part by the National Institutes of Health grant EY 02061-01.Dr. Ryan is recipient of the Louis B. Mayer Scholar Award from Research to Prevent Blindness, Inc., New York, New York.     

Delayed posttraumatic Propionibacterium acnes endophthalmitis in a child.

A 7-year-old boy presented with granulomatous anterior uveitis after an unrecognized penetrating injury in the same eye 2 months previously. The uveitis was unresponsive to topical corticosteroid therapy, lensectomy with anterior vitrectomy, and administration of intraocular and subconjunctival injections of vancomycin. Pars plana vitrectomy, capsulectomy, and injection of intravitreal vancomycin were eventually performed, leading to complete resolution of the intraocular inflammation. Culture and histopathologic examination of a capsular specimen confirmed sequestered Propionibacterium acnes infection. This case demonstrates that P. acnes may cause delayed endophthalmitis following penetrating trauma and may persist within capsular remnants in the aphakic eye.     

Vitrectomy without internal limiting membrane peeling for macular retinoschisis and foveal detachment in highly myopic eyes

Purpose: To report the surgical outcome of pars plana vitrectomy (PPV) without internal limiting membrane (ILM) peeling in three highly myopic patients with macular retinoschisis and associated posterior staphyloma. Methods: We report three highly myopic patients with macular retinoschisis and foveal detachment who underwent simple PPV without ILM peeling, with long‐acting gas tamponade. Main outcome evaluations included best corrected visual acuity, biomicroscopic appearance and optical coherence tomography findings. Results: Pars plana vitrectomy without ILM peeling resulted in anatomic and functional improvement in all three operated eyes for follow‐up periods of ≥ 12 months. Conclusions: Pars plana vitrectomy without ILM peeling is effective for treating macular retinoschisis and foveal detachment in highly myopic eyes with posterior staphyloma. Visual and anatomic outcomes are comparable with those in previous studies in which ILM removal was performed.     

Bilateral full-thickness macular hole

Bilateral full-thickness macular hole is a rare retinal disease. A 63-year-old man complained of metamorphopsy on his left eye. Pars plana vitrectomy was performed for stage 2 macular hole with anatomical and functional success. Postoperatively, the right eye showed the same symptoms, and stage 2 macular hole, detected by ocular coherency tomography, developed within 4 months, but closed after pars plana vitrectomy.