玻璃体切割术治疗球内异物

目的 :探讨玻璃体切割术治疗球内异物的手术方法、时机 ,以便更好地指导临床实践。方法 :对在 1999～ 2 0 0 1年间在我院行经平坦部三切口玻璃体切割术取出眼内异物的 41例 (4 1只眼 )进行回顾性研究 ,并对术前、术后视力等进行统计学分析。结果 :术后视力较术前视力明显提高 ,差异显著 (P <0 0 1)。术后感染控制良好 ,无严重术后并发症发生。结论 :玻璃体切割术在治疗球内异物上具有明显的优势。通过外路手术行球内磁性异物取出术应选择合适的病例。     

玻璃体切割联合眼球内后段异物取出术

目的：评价玻璃体切割联合眼球内后段异物取出术的效果。方法：对眼球后段异物行玻璃体切割联合球内异物取出的11例患者临床资料进行回顾分析。结果：11例11眼均1次手术成功取出异物。伴有视网膜脱离者,视网膜均完全复位,伴有眼内炎者均得到治愈。8眼视力较术前有提高,3眼视力术后无变化,无继发性出血,角膜内皮失代偿及其他并发症发生。结论：玻璃体切割联合异物取出手术损伤小、准确、安全、疗效好,是治疗眼球后段异物的有效措施。     

后入路玻璃体切割术治疗眼球贯通伤伴球内异物

目的:探索早期后入路玻璃体切割术治疗眼球贯通伤伴球内异物的有效性.方法:近2a来我院急诊收治的10例10眼眼球贯通伤伴球内异物患者,急诊行玻璃体切割+眼内异物取出+硅油填充术,术后给予积极预防感染、消炎处理,根据伤道周围视网膜生长情况补充视网膜光凝.结果:患者1眼因化脓性眼内炎、术中视网膜脉络膜损毁严重视网膜未能复位,最终眼球萎缩,患者9眼成功施行玻璃体切割手术,取出异物,随诊时间3~18mo,其中2例患者因复发性视网膜脱离行二次玻切硅油置换手术,其余患者视网膜复位良好,无再出血,眼压维持8~21mmHg;最后一次随访时患者3眼最佳矫正视力>0.1,2眼矫正视力0.01~0.1,患者4眼因后极部脉络膜视网膜损伤严重矫正视力光感~指数/50cm,眼球萎缩患者视力无光感.结论:早期后入路玻璃体切割、异物取出联合硅油填充术为一种有效地治疗眼球贯通伤伴球内异物的手术治疗方法.     

玻璃体切割联合硅油填充治疗球内异物的随访观察

目的 评价玻璃体切割联合硅油填充术对严重球内异物伤眼的治疗效果.方法 回顾性研究18例严重球内异物伤眼的临床资料.所有患眼均行玻璃体切割术取出异物,硅油填充,术后平均随访27.8个月.随访项目包括最佳矫正视力、PVR发生情况、青光眼、角膜变性、白内障、低眼压及眼球萎缩等.结果 术后3、6、12及24个月功能成功(VA≥0.02)率分别为88.9%、100%、100%及100%,与术前27.8%相比明显升高(P<0.05);脱盲(VA≥0.05)率分别为44.4%、72.2%、77.8%及77.8%与术前0相比明显升高(P<0.05);脱离低视力(VA≥0.3)率分别为11.1%、27.7%、33.3%及33.3%与术前0相比明显升高,除术后3个月外,均有统计学意义(P<0.05).术后12个月时,硅油眼PVR的发生率为28.6%,明显低于无硅油眼的90.9%(P<0.05).术后24个月时,硅油填充≥12个月眼的PVR的发生率为42.9%.明显低于硅油填充<12个月眼的90.9%(P<0.05).61.1%眼发生暂时性眼压升高,16.7%眼发生角膜变性,11.1%眼发生低眼压,未发生白内障和眼球萎缩.结论 玻璃体切割联合硅油填充术是治疗严重球内异物伤眼的有效手段,在无严重硅油填充并发症的情况下,适当延长硅油填充时间可以明显降低PVR发生的风险.     

玻璃体切割联合小直径球内异物取出术临床疗效

目的:探讨玻璃体切割联合球内异物取出术治疗眼球内异物伤(异物直径≤3mm)的临床疗效。方法:选择2006-01/2010-01来我院治疗的眼内异物伤患者25例25眼,采用玻璃体切割联合球内异物取出术,13例13眼术中部分或全部保留晶状体前囊膜。随访6mo,18例18眼二期植入人工晶状体或缝合固定,随访处理并发症。分析手术适应证,手术并发症,术后疗效。结果:患者25例25眼均一期成功取出球内异物。睫状体脱离1例药物治疗痊愈。视网膜脱离患者行玻璃体切割注硅油术后视网膜复位。随访6mo时视力提高者23眼,无变化2眼。结论:玻璃体切割联合球内异物取出术治疗眼球内异物伤(异物直径≤3mm)是有效的临床治疗方法。     

电磁铁吸引联合玻璃体切割术取出球内异物的临床观察

目的:观察电磁铁吸引联合玻璃体切割手术取出不规则磁性球内异物的临床效果,分析其在治疗球内异物取出术中的优势.方法:回顾性分析我院2012-01/2013-12行玻璃体切割联合电磁铁吸引手术治疗不规则球内磁性异物患者30例30眼与我院2010-01/2011-12行单纯玻璃体切割治疗球内异物患者30例30眼的临床疗效.对两组患者术中异物取出情况、术中及术后并发症进行比较.结果:玻璃体切割联合电磁铁吸引取出异物的患者中有28眼(93％)异物均一次取出,单纯应用玻璃体切割取出异物的患者中有20眼(67％)异物一次性取出,两者比较差异有统计学意义(x2=5.333,P=0.021),玻璃体切割联合电磁铁吸引取出异物的患者在术中、术后的并发症均少于单纯应用玻璃体切割取出异物的患者.结论:不规则球内金属异物玻璃体切割异物取出术中联合应用电磁铁具有一定优势,可以在临床工作中加以推广.     

25G微创玻璃体切割术治疗球内异物的临床观察

目的　探讨25G微创玻璃体切割术治疗眼后段球内异物的临床疗效。方法　回顾性分析眼后段球内异物并接受25G微创玻璃体切割术联合球内异物取出术的21例21眼患者临床资料,其中17例17眼为磁性异物,4例4眼为非磁性异物。20例（20眼）并发白内障,3例3眼伴眼内炎,12例12眼伴视网膜脱离。根据不同的病情分别联合了白内障摘出、视网膜复位、硅油填充等操作,术后随访6个月,对其并发症和手术效果进行分析。结果　所有患眼均于完善术前检查后尽快行25G微创玻璃体切割手术联合球内异物取出术,Ⅰ期球内异物取出率为100%,眼内炎3眼炎症均得到控制,术中摘出混浊的晶状体,20例20眼球内异物由角膜切口取出,1例由巩膜切口取出。共19眼术后矫正视力较术前视力有所提高,14眼进行了II期人工晶状体植入,2眼硅油存留。术后未见与微创手术相关的并发症。结论　25G微创玻璃体切割术在眼后段球内异物取出术中显示出良好的临床效果,手术创伤小,视功能恢复快,并发症少,但要注意其适应证的选择。     

玻璃体切割治疗眼球穿通伤球内异物的临床观察

目的 探讨玻璃体切割术治疗眼球穿通伤伴球内异物的效果.方法 对璃玻体切割术联合球内异物取出术45例(47只眼)的患者进行回顾性分析.结果 46只眼成功取出异物,成功率为97.8%,术后视力提高36只眼(76.9%);无变化8只眼(17.0%);视力下降4只眼(8.5%).术后随访6～8个月.结论 通过封闭式玻璃体切除术可有效地取出眼内异物,提高术后视力.

Abstract：

Objective To observe the therapeutic effect of intraocular foreign bodies(IOFBs)with vitrectomy. Methods Forty-five patients(47 eyes)undergone extraction of intraocular foreign bodies with vitrectomy were reviewed. Results The IOFBs of 46 eyes were extracted successfully(97.8%). Visual acuity improved in 36 eyes(76.9%), no changed in 8 eyes(17.0%)and decreased in 4 eyes(8.5%). The follow-up was 6～8 months. Conclusions Vitrectomy is favorable for the extraction of IOFBs. The vision increases postoperatively.     

玻璃体切割治疗眼球穿通伤球内异物的临床观察

Objective To observe the therapeutic effect of intraocular foreign bodies(IOFBs)with vitrectomy. Methods Forty-five patients(47 eyes)undergone extraction of intraocular foreign bodies with vitrectomy were reviewed. Results The IOFBs of 46 eyes were extracted successfully(97.8%). Visual acuity improved in 36 eyes(76.9%), no changed in 8 eyes(17.0%)and decreased in 4 eyes(8.5%). The follow-up was 6～8 months. Conclusions Vitrectomy is favorable for the extraction of IOFBs. The vision increases postoperatively.     

玻璃体切割术在眼内异物手术中的应用

在直视显微镜下自睫状体扁平部行玻璃体手术，提高了球内异物取出率。２４眼均一次取出异物。术后视力提高１４眼，不变６眼，下降４眼。玻璃体切割术取球内异物应选在伤后１０—１４天。但手术复杂，且对眼内组织干扰大，应慎重选择。     

眼内异物伤玻璃体切除术视力预后影响因素的研究

目的探讨眼内异物伤玻璃体切除术视力预后的主要影响因素。方法参与预后分析的影响因素包括：术前视力、手术时间、伤口位置、伤口长度、异物大小、是否伤及晶状体、玻璃体积血、视网膜损伤区域、视网膜脱离共9项。对各影响因素与较好术后视力（视力≥0.5）和较差术后视力（视力〈0.1）分别进行卡方检验,然后应用多变量逻辑回归分析寻找影响预后的主要因素。结果本组眼内异物伤玻璃体切除术后69.4%术后视力≥0.1;术前较好视力和无视网膜脱离是取得术后较好视力（视力≥0.5）的重要因素;而术前视力差和出现视网膜脱离是术后视力较差（视力〈0.1）的重要因素。结论术前视力和视网膜脱离是影响眼内异物伤玻璃体切除术后视力预后最重要的因素。     

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.     

糖尿病黄斑水肿玻璃体手术后视网膜厚度与视力关系

目的　探讨糖尿病黄斑水肿 (diabeticmacularedema ,DME)玻璃体手术后 ,黄斑区视网膜厚度变化与视力改善相互关系。方法　对 2 1眼糖尿病黄斑水肿病例实施玻璃体手术的结果进行回顾性分析。手术前、后应用光学相干断层扫描 (Opticalcoherencetomography ,OCT)观察黄斑部视网膜厚度与视力改善相互关系。结果　手术后 2个月内视网膜厚度平均幅度下降 <2 0 0 μm ,视力提高不明显 ,与术前比较无显著差异 (P =0 0 3 6) ,术后 4个月视网膜厚度平均幅度下降 3 0 0 μm ,视力明显提高 ,与术前比较有显著差异 (P <0 0 0 1)。手术后 4个月黄斑区视网膜厚度 <2 0 0 μm ,平均视力 0 3 ,2 0 0～ 3 0 0 μm ,视力平均 0 12 ,>3 0 0 μm平均视力 0 0 6。术后并发症 ,黄斑板层裂孔 ,黄斑前膜。结论　糖尿病玻璃体黄斑牵引黄斑水肿 ,应及早实施玻璃体切除手术 ,解除玻璃体对黄斑的牵引 ,使视网膜解剖复位。术后黄斑中心凹视网膜厚度与视力存在一定的关系。但手术有较严重的并发症 ,应仔细选择手术适应症     

Relationship between compliance with ophthalmic examinations preoperatively and visual outcome after vitrectomy for proliferative diabetic retinopathy

Purpose  

To evaluate the relationship between compliance with ophthalmic examinations before vitrectomy for proliferative diabetic retinopathy (PDR) and postoperative vision.     

Long-term outcome after vitrectomy for diabetic macular edema

BACKGROUND: To determine the benefit of vitrectomy on eyes with diabetic macular edema. METHODS: A retrospective institutional case series was used including 66 patients (69 eyes) who had undergone pars plana vitrectomy for diabetic macular edema between 1992 and 2000. Prior to surgery, the patients had been treated with laser coagulation as recommended by the Early Treatment Diabetic Retinopathy Study. In the case of persistent macular edema, vitrectomy with removal of the posterior hyaloid in all cases and the inner limiting mem brane in 51 (74%) of all cases was performed. RESULTS: The mean preoperative best-corrected visual acuity improved from 20/320 to 20/80 at the time of best postoperative best-corrected visual acuity (p < 0.0001). The mean increase in Snellen lines was 2.7 +/- 7.9. In 90% of eyes, the macular edema improved. A persistence of the edema was observed in 10%. All eyes had at least 12 months of follow-up with a mean of 55 months and a maximum of 120 months. CONCLUSIONS: Our findings confirm that vitrectomy might represent a therapeutic alternative in the case of persisting diabetic macular edema after laser photocoagulation.     

弥漫性糖尿病黄斑水肿光凝后黄斑区视野和视网膜厚度变化

目的　探讨Ⅳ期糖尿病视网膜病变 (DR)合并弥漫性糖尿病性黄斑水肿 (DME)患者行全视网膜联合黄斑格栅状光凝后黄斑结构和功能的变化。方法　对 12例Ⅳ期DR合并DME患者15眼全视网膜联合黄斑格栅状光凝术前、术后 3天、 7天、 3 0天、 90天OCT、视力、黄斑光敏感度检查结果进行对比分析。结果　术后 2 8天、 90天视力较术前均明显提高 (WilcoxonranksumtestP <0 0 5、P <0 0 1) ;术后 3天黄斑中心厚度比术前有显著增加 (P <0 0 5 ) ,术后 7天与术前无差别 (P>0 0 5 ) ,术后 3 0天和术后 90天比术前均显著降低 (P <0 0 1) ;术后 3天黄斑中心 10°光敏感度较术前显著降低 (P <0 0 1) ,术后 7天与术前相比无明显变化 (P >0 0 5 ) ,术后 3 0天与术后 7天相比明显提高 (P <0 0 5 ) ,术后 90天与术前和术后 3 0天相比无明显变化 (P >0 0 5 )。结论　Ⅳ期DR合并弥漫性DME患眼行黄斑格栅样光凝联合全视网膜光凝术后 3月视力保持稳定或提高 ;术后早期原有黄斑水肿加重或引起黄斑水肿 ,随后逐渐减轻 ,至术后 1月、 3月黄斑视网膜厚度较术前显著下降 ;黄斑中心 10°光敏感度早期下降 ,后逐渐恢复提高     

Correlation between foveal structure and visual outcome following macular hole surgery: a spectral optical coherence tomography study

PURPOSE: The aim of this paper is to evaluate the retinal structure after macular hole surgery and to study the correlation of structural findings with final functional outcomes, using high-speed, high-resolution spectral optical coherence tomography (SOCT). METHODS: Sixty-eight eyes of 60 patients with full-thickness macular holes were included in the study. All patients underwent pars plana vitrectomy with trypan blue staining and internal limiting membrane (ILM) peeling. Patients were evaluated by SOCT, with 6 mum axial and 12-18 mum transverse resolution and three-dimensional images of the retina. RESULTS: There were four different types of macular hole closure: U-shape, V-shape, irregular and flat/open. The following retinal abnormalities were observed in postoperative scans: photoreceptor irregularities, lack of photoreceptors (photoreceptor defect), cysts in outer retinal layers, nerve fiber layer defects, lesion of all retinal layers, and RPE defects. It was possible to evaluate photoreceptor defects on a three-dimensional image. Retinal thickness in the fovea was also measured. CONCLUSIONS: Because of excellent resolution, SOCT is capable of visualization of retinal defects after macular hole surgery. Three-dimensional examination is adequate for evaluation of photoreceptor defects. Good postoperative visual acuity is correlated with U-shape closure, normal foveal thickness and absence of photoreceptor layer defects.     

硅油填充术后OCT检测黄斑中心凹厚度与视力相关分析

目的 分析硅油填充术后OCT榆测黄斑中心凹厚度与术后视力的相关性.方法 对35例(35只眼)行玻璃体切割联合硅油注入术者,分别于术后2周、1、2月行黄斑区OCT检查,观察图像特点,分析黄斑中心凹厚度与最佳矫正视力之间相关性.结果 黄斑中心凹厚度和最佳矫正视力的负对数之间为正相关,即黄斑中心凹厚度与术后最佳矫正视力呈现负相关.结论 随着黄斑中心凹厚度的减少,视力呈现上升的趋势.OCT能评估玻璃体视网膜手术后黄斑区的恢复情况,为临床治疗和预后提供了依据.

Abstract：

Objective To assess the relationships between the macular thickness measured by OCT and postoperative best-corrected visual acuity after vitrectomy with silicone oil eamponade.Methods Thirty-five consecutive cases underwent vitrectomy with silicone oil tamponade were collected.Cross-sectional images of macular with OCT at 2 weeks, 1 month, 2 months after the operation were observed and the relationships between macular foveal thickness and best-corrected visual acuity were analyzed.Results The direct correlation was showed between the macular foveal thickness and the negative logarithm of best-corrected visual acuity.The negative correlation was showed between the macular feveal thickness and postoperative best-corrected visual acuity.Conclusions Along with the increasing of macular foveal thickness, the best-corrected visual acuity is decreasing.We can assess the function of the macular post operative and find the basis of clinic therapy and prognosis.     

Association between foveal photoreceptor status and visual acuity after resolution of diabetic macular edema by pars plana vitrectomy

Summary

We retrospectively investigated the relationship between the appearance of IS/OS line on OCT images and visual acuity after resolution of DME by vitrectomy. Postoperative visual acuity of eyes with complete IS/OS after resolution of DME was significantly better than that without complete IS/OS, though macular edema was completely resolved in both groups.

Purpose

To evaluate the correlation between photoreceptor layer status following resolution of diabetic macular edema (DME) by pars plana vitrectomy (PPV) and final visual acuity (VA).

Methods

We retrospectively studied a series of 69 eyes from 58 patients with DME who were treated with PPV. Of the 69 eyes, 37 that were examined by optical coherence tomography (OCT) for at least 6 months and that showed a final macular thickness of less than 250 µm were included in this study. We assessed the integrity of the photoreceptor inner and outer segments (IS/OS) line in the fovea, using OCT in relation to their VA and other characteristics.

Results

There were no differences in initial VA or in foveal thickness between eyes with or without complete IS/OS at final observation. However, final VA without complete IS/OS was significantly poorer (P?=?0.004). VA had improved by more than 2 lines in eight of ten eyes with complete IS/OS and in ten of 27 eyes without complete IS/OS; the groups differed significantly with regard to this percentage (P?=?0.03).

Conclusions

The postoperative photoreceptor status of the fovea is closely related to the final VA after resolution of DME by PPV.     

External limiting membrane and visual outcome in macular hole repair: spectral domain OCT analysis

Purpose

To investigate the relationship between postoperative visual acuity and integrity of the external limiting membrane (ELM) and inner segment–outer segment (IS–OS) junction layers, using spectral domain optical coherence tomography (SD-OCT), in eyes with macular holes (MHs) following surgical repair.

Methods

Medical charts of MH-operated cases were retrospectively identified and reviewed. The primary outcome measures were best-corrected visual acuity (BCVA) and the status of the ELM and IS–OS lines, using SD-OCT, at 6 weeks and 6 months postoperatively.

Results

Sixty-two eyes of 62 patients were included. At 6 weeks following surgery, out of 56 (90.3%) eyes with successful MH closure: 0 eyes showed the combination of disrupted ELM and continuous IS–OS layers; 7 eyes (12.5%) demonstrated continuity of both ELM and IS–OS (ELM^c/IS–OS^c group); 29 eyes (51.8%) had continuous ELM with discontinuous IS–OS layers (ELM^c/IS–OS^d group); and 20 eyes (35.7%) had discontinuities in both the layers (ELM^d/IS–OS^d group). The ELM^d/IS–OS^d group had the lowest visual gain at 6 months (P=0.03). At 6 months, a restoration of the integrity of IS–OS layer was observed in 51.7% eyes in the ELM^c/IS–OS^d group and in 5% in the ELM^d/IS–OS^d group (P=0.001).

Conclusions

When both ELM and IS–OS layers showed disruptions 6 weeks postoperatively, a significantly worse BCVA was measured at 6 months, compared with the eyes with only IS–OS disruptions, detected 6 weeks following surgery. The integrity of the ELM layer appears to be a critical factor for the restoration of the photoreceptor layer and for predicting a successful visual outcome following MH repair.