玻璃体切割联合下方巩膜外垫压治疗特殊视网膜脱离

目的：评估玻璃体切割联合下方巩膜外垫压治疗一类特殊视网膜脱离的效果。

方法：对具有以下特点：(1)病程大于6mo;(2)裂孔位于5：00～7：00的视网膜周边部或者在多发视网膜裂孔中有开放裂孔位于5：00～7：00的视网膜周边部;(3)视网膜脱离范围超过270度、并且伴有脱离区视网膜条索样增殖的19眼特殊类型视网膜脱离,采取玻璃体切割联合下方巩膜外垫压治疗,观察视网膜解剖复位和视功能恢复情况。

结果：视网膜解剖复位19眼; 最佳矫正视力均有不同程度提高,其中0.01～0.1有5眼; 0.12～0.3有9眼; ≥0.4有5眼。

结论：玻璃体切割联合下方巩膜外垫压是治疗病程大于6mo、视网膜裂孔位于5：00～7：00的视网膜周边部或者在多发视网膜裂孔中有开放裂孔位于5：00～7：00的视网膜周边部、视网膜脱离范围超过270度、并且伴有脱离区视网膜条索样增殖这类特殊视网膜脱离的有效方法。     

巩膜外加压术治疗玻璃体切除术后视网膜脱离

目的探讨巩膜外加压术治疗玻璃体切除术后视网膜脱离的适应证范围及临床疗效。方法对于玻璃体切除术后发生视网膜脱离的患者47例(47只眼),采用巩膜外加压或联合环扎术进行治疗,38例(38只眼)术中眼内注入消毒空气,观察术后视网膜脱离恢复情况。结果所有患者中,巩膜外加压或或联合环扎术治疗后视网膜完全复位40例(40只眼),其余7例(7只眼)视网膜未复位,再次行玻璃体切除联合气体/硅油填充术复位视网膜。结论对于玻璃体切除术后视网膜脱离的部分患者,采用巩膜外加压术进行治疗,能达到较好的治疗效果,既缩短了患者的病程,又减轻了患者的经济负担。     

巩膜外垫压联合玻璃体内注气术治疗玻璃体手术后无硅油填充眼视网膜脱离的临床效果

目的 探讨巩膜外垫压联合玻璃体内注气术治疗玻璃体手术后无硅油填充眼视网膜脱离的临床效果.方法 回顾性系列病例研究.收集2001年1月至2004年5月间在西京医院眼科行巩膜外垫压(或联合环扎)联合玻璃体内注气术治疗的52例(52只眼)玻璃体手术后在无硅油填充状态下发生视网膜脱离患者的临床资料,分析视网膜复位的效果、视力改善情况以及手术并发症等.结果 手术后随访6个月至2年,视网膜复位36只眼(69.2%);4只眼术后早期视网膜复位不良即接受了玻璃体切除联合硅油注入术;12只眼于再次手术后2个月后视网膜脱离复发,需行玻璃体切除术.视力提高32只眼(61.5%),不变3只眼(23.1%),下降8只眼(15.4%).术后发生黄斑前膜和气体性白内障各有1例(1只眼),余未见发生严重并发症者.结论 巩膜外垫压联合玻璃体内注气术对部分玻璃体手术后无硅油填充眼的视网膜脱离具有一定疗效,可减少再次行玻璃体切除术的机会.     

单纯巩膜外垫压术治疗黄斑裂孔性视网膜脱离

采用单纯巩膜外垫压术，治疗黄斑裂孔性视网膜脱离２８例，全部治愈。介绍了手术要点，讨论了本术式的构思，可行性和优点，术中不作热凝或冷凝，不放液，球内不注气，无需观察眼底，不仅缩短了手术时间，减轻了病人痛苦，重要的是避免了各种并发症的发生，有效地保护和提高视功能。     

巩膜外垫压术治疗直肌下裂孔视网膜脱离的临床观察

目的观察巩膜外垫压术治疗直肌下裂孔引发的视网膜脱离的疗效,探讨其临床特点。设计回顾性病例系列。研究对象西京医院47例（47眼）裂孔位于直肌下的视网膜脱离患者。方法所有患者均行巩膜外垫压术治疗,术中采用硅胶海绵或硅胶轮胎在相应位垫压（或联合环扎）,使裂孔位于垫压嵴上;部分病例联合消毒空气玻璃体内注入术。主要指标治疗前后视力变化、视网膜复位状况。结果手术后随访6个月-1年（平均7．3个月）,一次手术后视网膜完全复位率为89．4％（42／47眼）,好转率93．6％（44／47眼）;视力提高率为80．9％（38／47眼）。未见复视及眼球运动障碍等相关并发症。结论裂孔位于直肌下的视网膜脱离行巩膜外垫压（或联合环扎）术时有其特殊性,选择适当垫压材料、注重手术技巧以及精心操作,可获得较高的手术成功率,并可避免相关并发症的发生。     

巩膜外垫压术治疗孔源性视网膜脱离215例的临床观察

目的:观察巩膜外垫压术对孔源性视网膜脱离(rhegmatogenous retinal detachment,RRD)的疗效.方法:选取2008-05/2014-05在我院接受巩膜外垫压术治疗RRD的215例215眼患者的临床资料进行回顾性研究和分析.所有纳入研究的患眼必须达到确诊RRD的标准且增生性玻璃体视网膜病变(proliferative vitreoretinopathy,PVR)评级均在B级及以下.所有患眼术中均在双目检眼镜直视下行裂孔定位及巩膜外冷凝.随访至少2mo,术后观察视网膜的解剖复位、术后视力、术后并发症.结果:术中行视网膜下液(subretinal fluid,SRF)引流者107眼(49.8%),82眼(38.1%)在手术结束时向其玻璃体腔注入无菌空气.接受单次巩膜外垫压术达到视网膜解剖复位并随访2 mo以上无复发者196眼(91.2%),视网膜未能Ⅰ期复位者19眼(8.8%).与术前相比较,术后视力提高192眼(89.3%),视力不变14眼(6.5%),视力下降9眼(4.2%).没有因SRF引流和玻璃体腔注入无菌空气而产生相关并发症.发生手术相关并发症的患眼共有11眼(5.1%).结论:巩膜外垫压术治疗RRD安全有效,准确的裂孔定位及裂孔与垫压嵴的关系是手术成功最重要的因素.     

最小量巩膜外垫压术治疗孔源性视网膜脱离的疗效分析

目的比较分析最小量巩膜外垫压术与巩膜环扎垫压术治疗孔源性视网膜脱离的疗效。方法回顾性分析2008年3月至2009年3月收治的20例（20只眼）孔源性视网膜脱离患者行最小量巩膜外垫压术（A组）的临床资料,并在同期住院行巩膜环扎垫压术的孔源性视网膜脱离患者中随机选择40例（40只眼）作为对照组（B组）,术后随访比较两组的视网膜复位率、最佳矫正视力及并发症情况。结果术后视网膜首次复位率A组为90％,B组为95％;最佳矫正视力A组为0．48±0．33,B组为0．48±0．28;增生性玻璃体视网膜病变（PVR）进展者A组占5％,B组占10％,两组间均没有显著差异（P=0．4642、0．9662、0．5089）。术后A组出现复视1只眼,B组出现短期高眼压3只眼,黄斑水肿1只眼,复视1只眼;两组术后屈光度的变化有显著差异（P=0．0019）,前房深度、眼轴长度及散光度的变化均没有显著差异（P=0．5444、0．8732、0．0582）。结论外加压手术是一种有效复位脱离视网膜的手术方式,最小量巩膜外垫压术对孔源性视网膜脱离能获得很好的疗效,而对眼球创伤小、仅改变眼局部形态结构,能避免传统巩膜环扎垫压术的一些并发症,但远期疗效还有待进一步观察。     

23G玻璃体切割术联合巩膜外垫压治疗下方裂孔伴增殖型孔源性视网膜脱离的疗效和安全性

目的　对比分析23G玻璃体切割术（pars plana vitrectomy,PPV）和23G PPV联合巩膜外垫压（scleral buckling,SB）（SB-PPV）治疗下方裂孔伴增殖型孔源性视网膜脱离的手术疗效和安全性。方法　回顾性分析2013年1月至2016年12月我院收治的下方裂孔伴增殖型孔源性视网膜脱离患者70例（70眼）,其中39眼行SB-PPV为SB-PPV组,31眼行PPV为PPV组。观察两组患眼一次手术视网膜复位率,术中晶状体损伤和视网膜切除比例,术后最佳矫正视力和眼压等的差异。结果　SB-PPV组有36眼（92.3%）一次手术视网膜复位,PPV组为23眼（74.2%）,两组术后一次视网膜复位率相比差异有统计学意义（P=0.035）。SB-PPV组术中晶状体损伤1眼（2.6%）,PPV组术中晶状体损伤6眼（19.4%）,两组术中晶状体损伤率相比差异有统计学意义（P=0.021）。SB-PPV组视网膜切除2眼（5.1%）,PPV组视网膜切除10眼（32.3%）,两组视网膜切除眼数比例相比差异有统计学意义（P=0.008）。术后高眼压眼数比例以及术后1个月最佳矫正视力两组相比差异均无统计学意义（均为P>0.05）。结论　SB-PPV可提高下方裂孔伴增殖型孔源性视网膜脱离的一次手术视网膜复位率,且降低了术中晶状体损伤和视网膜切除的比例。     

放射状巩膜外垫压治疗视网膜脱离

放射状巩膜外垫压治疗视网膜脱离江苏省盐城市第一人民医院眼科熊士琳，吴德九，吴华新在视网膜脱离手术中，局部巩膜外垫压法因有操作简单，疗效确切，并发症少等优点而越来越受到重视。垫压物放置的方向与封闭裂孔的效果有极其重要的关系。我院自８６年以来对收治的部分...     

玻璃体腔内注气在失败外垫压视网膜脱离手术后的单独应用

目的:探讨玻璃体腔内注射膨胀气体在失败外垫压视网膜脱离手术后的单独应用价值以及手术干预的时机和前提。方法:回顾分析3例3眼接受巩膜外冷凝外垫压失败患者的临床资料,均因原裂孔没有完全封闭致使视网膜不能完全复位,术后72h均实施了单纯的经睫状体平坦部注射膨胀气体手术。结果:单纯玻璃体腔内注气后原视网膜裂孔闭合,视网膜复位,无任何短期和长期并发症的发生。结论:膨胀气体可单独应用在失败的巩膜外垫压术后,该手术较其他任何拟采取的补救措施具有手术时间短、创伤小、费用低、患者易接受等优点。     

巩膜扣带术治疗原发性非增生性视网膜脱离

目的观察巩膜扣带术治疗原发性(孔源性)非增生性视网膜脱离的疗效。方法36例(36眼)行巩膜扣带术。均按我们提出的视网膜脱离手术的3项要求(准确的裂孔定位,适度的冷凝和恰当的放置外垫压物)进行手术。术后随访,观察视网膜复位情况,视力、眼压及并发症。结果视网膜复位30眼(83.33%),失败6眼(16.67%),失败原因:1眼发生鱼嘴现象,3眼裂孔封闭不良,2眼垫压偏位。术后视力提高33眼,不变2眼,下降1眼。眼压升高3眼,服药后恢复正常。垫压物松动,环扎带移位及冷凝过度各1眼。结论巩膜扣带术治疗非增生性原发性视网膜脱离简单可靠。应用间接检眼镜直视下手术可大大提高手术成功率。     

Scleral buckle for progressive symptomatic retinal detachment complicating retinoschisis versus primary rhegmatogenous retinal detachment

Objective: To compare the functional and anatomic outcomes of encircling scleral buckle placement for the repair of progressive symptomatic retinal detachment complicating retinoschisis (PSRDCR) with outer-layer breaks (OLBs) posterior to the equator versus primary rhegmatogenous retinal detachment (RRD).Design: Retrospective comparative case series.Participants: Thirty-seven patients with PSRDCR with OLBs posterior to the equator (group A) and 703 patients with primary RRD (group B).Methods: All eyes were treated with an encircling scleral silicone band (style 240). External drainage of subretinal and retinoschisis cavity fluid and cryopexy or laser photocoagulation around the tears and the OLBs were performed in all eyes. Best-corrected visual acuity at 6 months postoperatively and final retinal reattachment rate were analyzed.Results: There was no statistically significant difference between the 2 groups in terms of patient age, gender, percentage of retinal detachments that were macula-off (p = 0.241), and preoperative best-corrected Snellen visual acuity (p = 0.927). Best-corrected Snellen visual acuity at 6 months postoperatively was ≤ 20/100 in 35% of eyes, 20/100-20/50 in 14% of eyes, and ≥ 20/40 in 51% of eyes in group A versus ≤ 20/100 in 37% of eyes, 20/100-20/50 in 33% of eyes, and ≥20/40 in 30% of eyes in group B (p = 0.12); the final retinal reattachment rate was 97% in group A versus 98% in group B (p = 0.77).Conclusions: Placement of an encircling scleral buckle may be an effective method to manage both PSRDCR with OLBs posterior to the equator and primary RRDs. The procedure is associated with comparable visual acuity and anatomic outcomes for both types of retinal detachment.     

曲安奈德玻璃体内注射联合23G微创玻璃体切割术治疗脉络膜脱离型视网膜脱离的疗效分析

目的　探讨曲安奈德玻璃体内注射联合２３Ｇ微创玻璃体切割术治疗脉络膜脱离型视网膜脱离的疗效。方法　２０１２年１月至２０１３年１月在我院就诊的２８例脉络膜脱离型视网膜脱离患者,经过术前短期糖皮质激素治疗后,行２３Ｇ微创玻璃体切割术治疗,术中联合玻璃体内注射曲安奈德４ｍｇ,术后随访６～１２个月,观察术后视力恢复、视网膜复位和并发症发生情况。结果　一次手术视网膜解剖复位率为８９．３％,再次术后视网膜解剖复位率１００．０％。术前ＬｏｇＭＡＲ视力为１．９８±０．５０,术后ＬｏｇＭＡＲ视力为１．１７±０．４０,差异有统计学意义（ｔ＝８．３７１,Ｐ＜０. ０５）。末次随访眼压（１６．２±３．７）ｍｍＨｇ（１ｋＰａ＝７．５ｍｍＨｇ）,与术前眼压（６．４±２．３）ｍｍＨｇ相比,差异有统计学意义（ｔ＝１７. ６１３,Ｐ＜０．０５）。术后有１５例出现一过性高眼压,３例白内障加重,１例发生后发性白内障,５例术后少量结膜下出血。结论　２３Ｇ微创玻璃体切割术联合术中曲安奈德玻璃体内注射治疗脉络膜脱离型视网膜脱离是安全有效的。     

脉络膜脱离型视网膜脱离术前玻璃体腔注射曲安奈德的临床疗效

目的:探讨术前玻璃体腔注射曲安奈德对微创玻璃体切割术治疗脉络膜脱离型视网膜脱离的临床疗效.方法:选择我院2015-01/2016-06临床确诊的脉络膜脱离型视网膜脱离患者23例23眼,入院后先行玻璃体腔内注射曲安奈德4~5 d后行23 G玻璃体切割和硅油填充术.观察手术前后视力、眼压情况,以及术后视网膜复位率和并发症情况.随诊6~9 mo.结果:曲安奈德注射后前房反应均减轻,眼压升高,由入院眼压4.02±1.47mmHg升高到术前13.69±4.68mmHg,术后升高到17.72±5.88mmHg,入院时眼压与术前和术后比较,差异均有统计学意义(P<0.05).患者术后末次随访视力较术前均有所改善,视力术后≥0.3者9眼(39%),术后≥0.05者18眼(78%).术后1wk,1、3mo和末次随访矫正视力与术前比较,差异均有统计学意义(P<0.05).视网膜复位情况:手术后2 wk有23眼(100%)全视网膜在位,一次视网膜解剖复位率87%,二次视网膜解剖复位率100%.术后1 mo时3眼出现下方视网膜局限性脱离,经二次手术巩膜外垫压后视网膜复位.无眼内出血、医源性视网膜裂孔、眼内感染、晶状体损伤等并发症.术后一过性高眼压7眼,均出现在术后12~14d,减少局部激素滴眼液使用和点用降眼压滴眼液后,眼压控制在正常范围.结论:术前玻璃体腔注射曲安奈德进行预手术处理,能够提高微创玻璃体切割术治疗脉络膜脱离型视网膜脱离的疗效,降低手术难度,提高视力,避免了全身使用激素的副作用.     

Foveal reattachment after macula-off retinal detachment occurs faster after vitrectomy than after buckle surgery

PURPOSE: To investigate the time course of foveal reattachment after successful surgery for macula-off retinal detachments. DESIGN: Prospective comparative nonrandomized interventional trial. PARTICIPANTS: Thirty-three patients (16 female and 17 male, 65+/-3 years old) with a spontaneous rhegmatogenous retinal detachment with peripheral breaks and a shallow elevation of the fovea. INTERVENTION: Nine patients were treated with episcleral buckle, cryotherapy, and, in selected cases, external drainage of subretinal fluid. Twenty-four patients were treated with vitrectomy, cryotherapy, and either complete (n = 8), or partial (n = 16) fluid-gas exchange. Patients with complete fluid-gas exchange were kept first in a prone position for 6 hours to help evacuation of subretinal fluid and, afterwards, on their side. Patients with partial fluid-gas exchange were kept in a supine position with the head elevated for 12 hours, allowing spontaneous absorption of submacular fluid. Patients were examined at 1, 6, and 10 to 12 months after surgery with a complete ophthalmic examination as well as optical coherence tomography (OCT). Mean follow-up was 10.0+/-0.5 months. MAIN OUTCOME MEASURE: Foveal attachment was determined clinically and by OCT. RESULTS: Postoperative OCT examination 1 month after buckle surgery (n = 9) showed a small subclinical area of subfoveal fluid in 67% of patients (n = 6). Fluid was still present in 45% of cases (n = 4) at 6 months and in 11% of cases (n = 1) even at 12 months. Optical coherence tomography examination 1 month after vitrectomy showed a completely attached fovea with no subfoveal fluid in all cases (n = 24). CONCLUSIONS: Complete foveal reattachment after macula-off retinal detachment occurs without delay after vitrectomy, whereas subfoveal fluid may persist subclinically for several months in patients operated with a buckle.     

巩膜扣带术治疗术前未发现裂孔的视网膜脱离

目的 观察巩膜扣带术治疗术前未发现裂孔的视网膜脱离的效果.方法 回顾性分析从2010年3月至2011年3月在南京医科大学第一附属医院眼科治疗的术前未发现裂孔的视网膜脱离患者36例(36眼),在显微镜下行巩膜扣带术.其中30例术中找到裂孔,其中10例行巩膜表面节段性外加压联合环扎术;20例单纯行环扎术.其余6例术中仍未找到明显裂孔,单纯行环扎术.32例进行了视网膜下液引流;4例在手术结束时行玻璃体腔气体充填.结果 36例术前未发现裂孔的视网膜脱离中有2例视网膜未能复位,余均复位良好.术后随访最短3个月,最长12个月,最终复位率94.4％.结论 巩膜扣带术治疗术前未发现裂孔的视网膜脱离安全有效.     

Scleral infolding combined with vitrectomy and gas tamponade for retinal detachment with macular holes in highly myopic eyes

PURPOSE: To describe the effectiveness of a surgical procedure, scleral infolding combined with vitrectomy and gas tamponade, for retinal detachment caused by macular holes in highly myopic eyes. METHODS: In a pilot study, scleral infolding was performed in 5 patients with macular holes, who were selected from 10 consecutive highly myopic patients with retinal detachment caused by macular holes (8 patients) or extramacular posterior-pole holes (2 patients), treated during 1 year at Okayama University Hospital. The patients were all women, 48-77 years of age (mean = 63.4 years), who had been followed-up for 1-2 years. Selection criteria for scleral infolding were either second surgeries for reopening of macular holes (2 patients) or residual retinal detachment around macular holes after complete fluid-air exchange with drainage of subretinal fluid at the initial surgery (3 patients). Following vitrectomy and complete epiretinal membrane removal in the posterior pole, the sclera was shortened by infolding on the temporal side. Three mattress sutures with 5-0 Dacron in each quadrant, 6 sutures in total, were placed at a 7-mm anteroposterior interval with posterior sutures located as deep as possible, near vortex veins. Fluid-gas exchange was then done, with or without endophotocoagulation applied around macular holes. RESULTS: After scleral infolding, macular holes were closed, and the retina was totally attached in all 5 patients. The final visual acuity ranged from 20/2000 to 20/70. CONCLUSION: Scleral infolding is a simple and effective procedure for treating retinal detachment with macular holes in highly myopic eyes and could be used as an optional procedure of reoperation for a failed initial vitrectomy.     

Prophylactic scleral buckle for prevention of retinal detachment following vitrectomy for macular hole

AIM: To review the rate of retinal detachment after macular hole surgery in patients who received vitrectomy and scleral buckle versus those who had vitrectomy alone. METHODS: All patient charts and hospital records were examined for patients who underwent vitrectomy surgery for macular hole between September 1993 and June 1997. A total of 326 patients were identified and all were followed for a minimum of 6 months. Clinical records were examined for details of the surgical procedure, visual acuity, hole closure status, adjuvant therapies used, and postoperative retinal attachment status. Relative risks (the ratio of the incidence rate in the exposed to that in the unexposed) with 95% confidence intervals and chi(2) tests were calculated to determine which variables were associated with retinal detachment. The primary outcome measure in this review was retinal attachment status. RESULTS: Of 326 eyes which underwent surgery for macular hole during the study period, scleral buckles were utilised in 152 (46.6%) patients. Analysis revealed a detachment rate of 13.2% in patients who did not receive a scleral buckle compared with 5.9% detachment rate in those who did. Analysis of these results indicated a 2.42 times greater risk of developing a retinal detachment in patients without a scleral buckle. Complications related to the use of scleral buckles occurred in two of 152 cases (1.3%) CONCLUSIONS: A reduction in the rate of retinal detachment was noted in patients receiving prophylactic scleral buckles. Those finding suggest a possible beneficial effect of this adjunctive procedure in preventing postoperative retinal detachments. The authors are currently preparing a multicentred, prospective, clinical trial to further study this hypothesis