硅油填充术在化脓性眼内炎伴视网膜脱离中的应用

目的：观察硅油填充术在化脓性眼内炎伴视网膜脱离应用后视功能及感染变化的情况。方法：应用经睫状体扁平部玻璃体晶体切除术、气液交换术及硅油填充术联合巩膜外环扎术治疗6例眼球穿通伤并化脓性眼内炎视网膜脱离的患者,术后通过静脉、结膜下及眼药水途径给予抗感治疗,真菌感染者用非甾体类消炎药抗炎,细菌感染者用皮质类固醇。术后追踪观察1至9个月。结果：6例患者视网膜得到解剖复位,化脓性感染得到控制,矫正视力0．02－0．4,5例眼压正常,1例低眼压,3例硅油入前房。结论：化脓性眼内炎伴视网膜脱离应用硅油填充术能有效地使视网膜得到复位。通过静脉、结膜下及眼药水联合途径给予抗感染治疗,可控制眼内感染。     

玻璃体切割联合硅油填充术治疗眼内炎

目的：观察玻璃体切割联合硅油填充术治疗化脓性眼内炎的疗效。方法：应用经睫状体平坦部玻璃体切割术,以联合硅油填充术治疗21例21眼化脓性眼内炎患者,术后予以静脉、结膜下及点眼等途径给予抗感染、抗炎治疗。结果：玻璃体切割术后追踪随访3～12mo,21眼细菌性感染全部控制,术后视力较术前视力有显著性提高。结论：玻璃体切割联合硅油填充术能有效控制炎症,稳定视网膜功能,对治疗一些视网膜情况不佳或炎症难以控制的化脓性眼内炎患者疗效确切可靠,值得推广。     

硅油填充治疗外伤感染性眼内炎伴视网膜脱离

目的 探讨硅油填充治疗外伤性感染性眼内炎伴视网膜脱离的效果和影响因素。方法 回顾性分析1995年1月至2002年12月，我院眼科行硅油填充治疗外伤性感染性眼内炎伴视网膜脱离的16例16眼临床资料。结果 感染性眼内炎均得到控制。视网膜完全复位11眼(68．8％)，限局性视网膜脱离3眼(18．8％)，完全脱离2眼(12．5％)。术后视力光感-0．04者11眼，≥0．05者5眼。结论 应用硅油填充术能够有效地治疗外伤性感染性眼内炎伴视网膜脱离，术后并发症主要是视网膜脱离复发和增生性玻璃体视网膜病变(PVR)。     

硅油填充在外伤感染性眼内炎手术中的应用

目的探讨玻璃体切除联合硅油填充术治疗外伤感染性眼内炎的效果。方法回顾性分析23例（23眼）因眼球穿孔伤和（或）异物伤所致感染性眼内炎病例。应用标准三通道玻璃体切除术,并填充硅油,术中于灌注液中加入低浓度的万古霉素,未进行玻璃体腔内注药。结果全部病例术后均有效控制炎症,硅油填充下无视网膜脱离发生。15例（65．22％）硅油取出,其中11例（9例Ⅰ期）硅油取出后植入IOL,视力不同程度提高。结论外伤感染性眼内炎玻璃体切除术后的硅油填充是有效的治疗手段,利于视网膜复位和炎症控制,有效保护视功能。     

玻璃体切除硅油填充治疗无网脱外伤性眼内炎

目的探讨玻璃体切除联合硅油填充手术治疗无视网膜脱离的外伤性眼内炎的疗效,并分析相关因素。方法18例(18眼)因外伤性眼内炎接受玻璃体切除联合硅油填充手术,其中10眼于术后6月将硅油取出,并且6眼同时植入人工晶状体。术前视力光感至0.1。眼压平均为9 mmHg(5~23 mmHg),(1 mmHg=0.133kPa)。平均随访18月(3~43月)。结果术后视力手动至0.8,视力提高15眼(83.33%),不变3眼(16.67%)。眼压平均为17 mmHg(10~20 mmHg),显著高于术前眼压(P<0.05)。无视网膜脱离或眼球萎缩。并发症主要包括前房炎性渗出(16眼),术后短暂高眼压(3眼)。结论玻璃体切除联合硅油填充手术是治疗无视网膜脱离的外伤性眼内炎安全有效的方法。     

玻璃体切除联合硅油填充手术治疗急性感染性眼内炎

目的：研究玻璃体切除联合硅油填充手术治疗急性感染性眼内炎的临床效果。

方法：回顾性分析2008-01/2013-02我院收治的急性感染性眼内炎患者23例23眼临床资料,排除伴有球内异物的病例。所有患者均采用常规闭合三通道玻璃体切除联合硅油填充手术,其中6眼(并发外伤性白内障)联合Ⅰ期晶状体摘除+Ⅰ期人工晶状体植入术,3眼(并发外伤性白内障)联合Ⅰ期晶状体切除+Ⅱ期人工晶状体植入术, 4眼(硅油填充期间并发白内障)联合Ⅱ期晶状体摘除+Ⅱ期人工晶状体植入术,5眼(4眼外伤性眼内炎及1眼青光眼滤过泡漏致眼内炎)保留晶状体,1眼(白内障术后眼内炎)联合Ⅰ期人工晶状体取出+Ⅱ期人工晶状体植入,4眼(白内障术后眼内炎)保留人工晶状体。

结果：随访6～24mo,行玻璃体切除联合硅油填充手术的患者23例23眼眼内炎均得到有效控制,21眼(91%)患者视力不同程度提高。有2眼玻璃体切除术后眼压≥30mmHg,1眼行硅油取出术后眼压恢复正常,另1眼取硅油术后眼压仍高,需应用降眼压药物控制。

结论：急性感染性眼内炎患者及时行玻璃体切除联合硅油填充手术治疗,能有效控制眼内炎,提高患者视力。     

玻璃体切除硅油填充治疗眼内异物伴视网膜脱离

目的评价玻璃体切除术联合硅油填充对限内异物伴视网膜脱离的治疗价值。方法玻切联合硅油填充治疗17例（18眼）眼内异物搞出前后网脱的病例。结果出院时视网膜完全复位者13眼（72．2％）；视力数指以上者10眼（55．6％），其中3眼＞0．05。结论该方法对于一般玻璃体切除联合环扎术难以治愈的病例是一种有效方法。     

玻璃体切除联合硅油填充治疗白内障术后感染性眼内炎

目的 探讨白内障摘除术后感染性眼内炎的手术治疗方法并评价其疗效.方法 对2006年9月至2007年8月间从外院转来的行白内障摘除、人工晶状体植入术后并发感染性眼内炎的6例7只眼.其中5例6只眼为经巩膜隧道的小切口白内障囊外摘除术,1例1只眼为超声乳化手术.采取显微玻璃体切除、眼内激光光凝及眼内硅油填充.结果 随访1～6月.随访时6只眼眼前节无异常,视网膜平伏,视力提高;1只眼因细菌毒力过强,眼内组织损伤严重而无光感,但眼球得以保留.结论 白内障术后感染性眼内炎是一种严重的手术并发症,治疗不及时,视功能将受到不可逆的损害.应用玻璃体切除联合硅油填充,可使眼内炎得到有效控制,最大限度的保存视力和保留眼球.     

玻璃体切除联合硅油填充治疗急性感染性眼内炎二例

急性感染性眼内炎是一种严重的眼病,治疗不及时多导致失明或眼球萎缩,我院采用玻璃体切除联合硅油填充治疗急性感染性眼内炎2例,取得了较好效果,现报告如下:例1男17岁左眼被铁钉刺伤1天,眼痛伴视力急剧下降5小时,于2005年9月15日入院,患者1天前工作中不慎被铁钉刺入左眼,当时于工厂附近诊所洗眼加眼膏包眼处理,第2天晨起时觉眼痛、流泪,自行打开眼罩后发觉视物不见。眼部检查:左眼视力光感不确,眼压54mmHg,眼睑红肿,4点处角巩膜缘处有2mm闭合创口,角膜水肿,后弹力层皱褶,KP( ),房水混浊,前房积脓3mm,虹膜肿胀,纹理消失,瞳孔痉挛缩小2mm×…     

玻璃体切除术治疗较复杂型孔源性视网膜脱离的临床研究

目的 探讨玻璃体切除术治疗较复杂型孔源性视网膜脱离的临床疗效.方法 对2006年8月至2007年6月期间PVR B-C2,视网膜裂孔在大小、形态、数目及分布上特殊的较复杂型视网膜脱离病例40例(40只眼)随机分为两组,分别采用经睫状体扁平部玻璃体切除术(PPV)和巩膜扣带术(SB)进行治疗.术前、术后1月、3月行常规检查,随访6～14月,采用SPSS13.0统计学软件进行分析,比较两组病例的一次性及最终视网膜复位率;术前术后最佳矫正视力变化情况;术后术眼的眼轴长度、角膜散光度、眼屈光度的变化情况及术后各种并发症的发生情况.结果 (1)一次性及最终视网膜复位(率)PPV组与SB组差别无统计学意义(P<0.05).(2)PPV组最佳矫正视力提高率和提高程度均高于SB组(P<0.05).(3)①PPV术式对术眼术后眼轴长度、角膜散光度、眼屈光度改变的影响不大,术后1月、3月与术前相比差异均无统计学意义(P>0.05);②SB术式术眼术后1月、3月眼轴长度较术前增长,但是改变无统计学意义(P=0.1818,P>0.05);而角膜散光度较术前明显增加,且术后1月、3月与术前相比差别均有统计学意义(P<0.05);眼屈光度术后1月、3月与术前相比,均向近视方向增加,但是仅术后1月与术前比较,差异有统计学意义(P<0.05),术后3月与术前比较差别无统计学意义(P>0.05),说明SB术式术后早期对术眼影响较大,但随着术后时间的延长,影响会逐渐减小.(4)两组术后可引起不同的并发症,但总体上PPV术式引起的并发症比SB术式少.结论 采用玻璃体切割术治疗较复杂型孔源性视网膜脱离是一种安全、有效、可行的方法.在技术条件允许时,首选玻璃体手术治疗较复杂型孔源性视网膜脱离,更有利于提高患者视功能恢复的程度及速度,并减少并发症的发生.     

Pars Plana Vitrectomy for Diabetic Traction Retinal Detachment

One hundred twenty-five consecutive cases of traction macular detachment secondary to diabetic retinopathy are analyzed. Visual results show 72% to have improvement. Long-term follow-up (average 39 months) of the initial 75 cases revealed that 62% of the initially improved cases remained improved. Neovascular glaucoma rate continues to be higher in aphakic eyes as compared to phakic eyes.     

Outcomes of Recurrent Retinal Detachment Surgery following Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment

Aim: To study the anatomical and functional outcomes of recurrent retinal detachment (RD) surgery following pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment. Methods: Retrospective analysis of 133 consecutive cases of recurrent RD. Inclusion criteria: age ≥18 years, recurrent RD following PPV ± encircling band for rhegmatogenous RD. Exclusion criteria: age <18 years, post-endophthalmitis/tractional/exudative/combined RD, post-scleral buckle, primary surgery done at another institute. The final anatomical and functional outcomes, and their association with clinico-surgical factors, were analyzed. Results: Proliferative vitreoretinopathy (PVR) ≥ Grade C in re-detached retina (OR, 2.49; 95% CI, 1.02–6.09; P = 0.045) and need for multiple resurgeries (OR, 6.48; 95% CI, 2.51–16.69; P < 0.0001) were significant risk factors for the final anatomical failure. Eyes with PVR ≥ Grade C (OR, 0.31, 95% CI, 0.12–0.80; P = 0.013) in primary RD, and with multiple breaks (OR, 0.24; 95% CI, 0.06–0.96; P = 0.044) at the time of recurrent RD, were less likely to have final BCVA ≥20/200. The visual acuity at the time of recurrent RD had a moderately positive correlation (r = 0.454, P < 0.001), and the delay in recurrence of RD had a weakly positive correlation (r = 0.214, P = 0.046) with the final BCVA. Conclusions: PVR ≥ Grade C and multiple resurgeries are associated with higher incidence of anatomical failure in recurrent RD surgery. Multiple breaks are associated with a poorer visual outcome, whereas a better baseline visual acuity and delayed recurrence of RD after primary repair are associated with a better visual outcome.     

Diagnostic Ultrasound and Pars Plana Vitrectomy in Endophthalmitis

Purulentendophthalmitisistheinfectiousinflammationofeye.Whensevereendophtha鄄lmitisoccurs,vitreousbodyisofteninvolved,whichshowsopaqueandabscessformation.Whentheuveaandretinaareinvolved,theyshowswelling,ischemiaandexudates.Whenthelensisinvolved,itshowedopaqueanddegener鄄ated.Inclinical,mediaopacitiessuchastheex鄄udatesinanteriorchamber,cataractorcornealinfiltrationprecludetheophthalmoscopicevalua鄄tionofvitreousbody,whichmayaffectthedeci鄄sionofsurgery.B鄄scanultrasonographycanpro鄄videmuchin…     

Outcomes of the Perplexed Surgical Management of Retinal Detachment in Eyes with Coloboma

PurposeTo determine the anatomical and visual outcomes of retinal detachment in eyes with chorioretinal coloboma managed by pars plana vitrectomy, endolaser photocoagulation and silicone oil (SO) tamponade.MethodsRetrospective review of 29 eyes of 29 patients with retinal detachment associated with chorioretinal coloboma. All the cases were managed by vitrectomy procedures concluding with SO tamponade. Encircling band was placed based on pre-operative evaluation and/or surgeon’s discretion. Endolaser photocoagulation was applied around the peripheral retina, all around the peripheral breaks and around the colobomatous area. The outcome measures were evaluated with regard to functional and anatomical success.ResultsThe average age at the time of surgery was 21.76 ± 9.58 years (range, 10–50 years). The mean follow-up duration was 12.28 ± 4.8 months (range, 6–24 months). Primary attached retina was obtained in 21 / 29 (72.4%) eyes after single surgery. Re-detachment in 8 / 29 (27.6%) eyes which required revision surgery was the most frequent postoperative complication followed by raised intraocular pressure in 4 / 29 (13.8%) with SO in situ. Out of 29 eyes, 23 were followed up after the removal of SO. The mean duration of SO removal was 7.91 ± 3.9 months (range, 4–18 months). Implantation of encircling band, lens removal and cryotherapy provided no added advantage. At the final examination, improvement in vision was observed in 21 (72.4%) eyes and the anatomical attachment of the retina was attained in 27 (93.1%) eyes.ConclusionsComplete pars plana vitrectomy, endolaser photocoagulation along with SO tamponade is effective for retinal detachment associated with chorioretinal coloboma. This technique improves the anatomical outcome and helps in regaining significant visual acuity.     

视网膜切开在复杂性视网膜脱离手术中的应用

目的评价视网膜切开在复杂性视网膜脱离手术中的应用价值。方法回顾性总结了1994年7月至1995年12月在我科做视网膜切开手术的连续病例45例46只眼，其中裂孔性视网膜脱离伴增殖性玻璃体视网膜病变（proliferativevitreoretinopathy．PVR）35例35只眼、外伤性PVRS例8只眼、牵引性视网膜脱离2例3只眼。结果平均追踪7个月，内排液组40只眼一次手术成功24只眼占60％，有12只眼再发视网膜脱离做了第二次同样手术，其中同时取视网膜下膜2眼；取视网膜下膜5只眼和视网膜切开减张3只眼中，有6只眼视网膜复位，失败2只眼。视力改善37只眼占80％。结论在复杂性视网膜脱离中，合理选用视网膜切开、眼内排出视网膜下液、取除视网膜下膜和松解缩短、僵硬的视网膜，可提高手术疗效。     

脉络膜脱离型视网膜脱离术后黄斑中心凹下脉络膜厚度的变化

目的观察脉络膜脱离型视网膜脱离（RRDCD）患者接受玻璃体切割（PPV）复位视网膜后硅油填充状态下黄斑中心凹下脉络膜厚度（SCT）的变化。方法回顾性病例对照研究。2016年1月至2017年10月在武汉大学人民医院眼科中心就诊的35例首次接受PPV成功复位视网膜的RRDCD患者纳入研究（作为RRDCD组）。记录患者术后1d、1周、1个月、3个月的最佳矫正视力（BCVA）（LogMAR）、眼压,采用光学相干断层扫描（OCT）测量SCT。36例首次接受PPV成功复位视网膜的单纯孔源性视网膜脱离（RRD）患者作为RRD组及40例医院的体检者作为正常组。数据采用秩和检验（H检验）、重复测量方差分析、独立样本t检验、卡方检验等进行分析。结果术后1d、1周,RRDCD组、RRD组SCT均较正常组厚（术后1d：t=9.220,P<0.001;t=6.826,P<0.001。术后1周：t=4.341,P=0.011;t=2.849,P=0.034）,而这2个时间点RRDCD组和RRD组间的SCT差异无统计学意义。术后3个月,RRD组SCT与正常组比较差异无统计学意义（t=1.597,P=0.646）,而RRDCD组SCT相对正常组及RRD组都要薄,差异有统计学意义（t=-3.144,P=0.028;t=-6.207,P=0.010）。术后RRDCD组和RRD组SCT均呈持续降低趋势。相关性分析显示术后3个月,RRDCD组SCT与BCVA呈正相关（r=0.399,P=0.017）,RRD组SCT与BCVA无相关性（r=0.109,P=0.529）。结论RRDCD术后黄斑SCT变薄,且SCT与BCVA相关。SCT可以作为评估RRDCD术后视力的临床指标。     

Outcome and Significance of Silicone Oil Tamponade in Patients with Chronic Serous Retinal Detachment

Purpose

To evaluate the effectiveness of silicone oil tamponade in patients with chronic serous retinal detachment (SRD) persisting for three months after the resolution of ocular inflammation.

Methods

A total of 17 eyes of 17 patients diagnosed with chronic SRD persisting for three months after the resolution of ocular inflammation and with high risk of phthisis bulbi by secondary ocular hypotony and macular detachment by subretinal fibrous membrane formation were subjected to surgical intervention. Subjects underwent silicone oil tamponade after surgical drainage of subretinal fluid. Retrospective analyses on anatomical and functional success rates were then performed.

Results

Anatomical success with retinal reattachment was observed in ten of the 17 eyes (58.82%), while functional success measured as difference in the best-corrected visual acuity before and after the surgery were logarithm of the minimum angle of resolution (logMAR) 1.95 ± 0.66 and logMAR 1.51 ± 0.66, respectively (p < 0.05).

Conclusions

This study suggests that, in patients with chronic SRD despite prolonged medical treatment and resolution of inflammation, surgical drainage of subretinal fluid with silicone oil tamponade can achieve anatomical and functional success.