康网灵对视网膜脱离复位术后残留视网膜下液的影响

目的:观察中药康网灵汤剂对波及黄斑部视网膜脱离复位术后黄斑部残留视网膜下液的影响。方法:将2004-11/2006-09脱离波及黄斑部的孔源性视网膜脱离,行视网膜成功复位术后经光学相干断层扫描(optical coherence tomography,OCT)证实黄斑部残留视网膜下液的患者60例60眼,随机分为两组,对照组常规处理,中药组在此基础上加服中药康网灵汤剂,3次/d,30d为1疗程,治疗6个疗程。治疗前后行OCT,多焦视网膜电图(multi-focal electroretinography,mERG)及视力检查。观察指标:治疗前和治疗后1,3,6mo黄斑部OCT,mERG的P1波振幅密度值(nV/deg2)及视力。数据结果均应用SPSS13.0软件进行统计学处理。结果:治疗前两组在年龄、病程、视力、黄斑部残留视网膜下液量及P1波振幅密度值上均无明显差异(P>0.05);治疗后中药组视力提高的眼数、黄斑部视网膜厚度及残留视网膜下液量减少,明显好于对照组;黄斑部mERG1,2环P1波振幅密度值在1,3mo均明显高于对照组,两组间有统计学意义(P<0.05)。3,4,5环在3,6mo与对照组无差异(P>0.05)。结论:中药康网灵汤剂能促进残留视网膜下液吸收,改善视功能。     

术前双眼遮盖及体位控制对孔源性视网膜脱离患者视网膜下积液吸收的作用

目的　探讨孔源性视网膜脱离患者术前双眼遮盖对减少视网膜下积液和手术效果的影响。方法　收集2017年4月至12月在安徽医科大学附属省立医院确诊为孔源性视网膜脱离并手术患者197例197眼,随机分为试验组100例100眼、对照组97例97眼,试验组术前给予患者约12 h双眼遮盖并使裂孔保持最低位,对照组未做特殊处理,记录患者年龄、性别、病程、裂孔情况、增生性玻璃体视网膜病变（proliferative vitreoretinopathy,PVR）分级、视网膜脱离等。综合直接眼底镜、间接眼底镜以及B超定量方法综合判断视网膜下积液情况。根据手术适应证,手术方式分为巩膜扣带术和玻璃体切割术,记录每例患者手术方式、时间和术中情况,并随访术后视网膜复位时间及术后视力恢复情况。结果　对照组有4例4眼视网膜下积液减少,试验组有38例38眼视网膜下积液减少,两组比较差异有统计学意义（P<0.05）。试验组行巩膜扣带术患者中视网膜下积液减少（27例27眼）与视网膜下积液未减少（31例31眼）者在术中操作、手术时间、术后视力方面差异均有统计学意义（均为P<0.05）;试验组行玻璃体切割术患者中视网膜下积液减少者（11例11眼）与视网膜下积液未减少者（31例31眼）在手术时间及术后视力等方面差异均无统计学意义（均为P>0.05）。试验组视网膜下积液减少与未减少者之间在PVR分级和年龄方面差异均有统计学意义（均为P<0.05）,Logistic回归分析显示年龄较小和PVC分级较轻是促进视网膜下积液吸收的独立因素（均为P<0.05）。结论　术前双眼遮盖及保持体位控制能够有效减少视网膜下积液,对于PVR较轻的年轻患者更为有效。对于行巩膜扣带术患者能够使手术时间缩短,减少术中操作,患者术后视力恢复也较佳。     

环扎加压放液与不放液治疗视网膜脱离的体会

目的评价环扎加压放液与不放液治疗视网膜脱离的临床疗效。方法随机分为A组（不放液）与B组（放液）进行手术。结果A组30例手术成功28例（93.3％）;B组30例成功27例（90％）。复位的55眼视力均有提高。两组疗效无显著性差异（P＞0．05）。结论环扎加压不放液治疗视网膜脱离与放液比较具有手术难度小、时间短、并发症少等优点,且疗效可靠,但对周边超过90°的巨大裂孔、黄斑后极部裂孔不适应该术式。     

不放液巩膜外加压术治疗陈旧性视网膜脱离

目的:探讨不放液巩膜外加压术治疗陈旧性视网膜脱离的临床疗效。方法:回顾性分析不放液单纯巩膜外加压术治疗32例32眼陈旧性视网膜脱离的临床病例资料,观察术后最佳矫正视力、手术并发症和视网膜复位情况。结果:术后随访6～12(平均9.2)mo,最佳矫正视力>0.1者17例17眼,2例2眼术后短期内眼压升高,首次手术解剖复位30例30眼,成功率94%。2例2眼术后视网膜下增殖继续发展,行玻璃体切除术后视网膜复位。结论:不放液巩膜外加压术对视网膜下增殖不严重的陈旧性视网膜脱离简单有效。     

Modified external needle drainage procedure for rhegmatogenous retinal detachment

PURPOSE: To describe the results of a modified external needle subretinal fluid drainage technique to treat eyes with a rhegmatogenous retinal detachment. METHODS: One hundred eighty-seven consecutive patients with a rhegmatogenous retinal detachment who underwent scleral buckle and modified external needle drainage at Duke Eye Center or Vistar Eye Associates were included in this study. Subretinal fluid was drained by a technique whereby the intraocular pressure was raised to a supranormal level by tightening an encircling scleral buckle and then the subretinal space was entered by a needle introduced externally while the retina was directly viewed with an indirect ophthalmoscope. Subretinal fluid drainage success rate, one-operation reattachment rate, final retinal reattachment rate, intraoperative and postoperative complication rates, and final visual acuity were the main outcome measures. RESULTS: Subretinal fluid was successfully drained in all eyes. The one-operation reattachment rate was 91%, and the final reattachment rate was 98%. Intraoperatively, 15% of eyes required corneal debridement to obtain an adequate view for safe subretinal fluid drainage. Subretinal hemorrhage of no more than one clock hour occurred in 4.2% of eyes. A total of 2.6% of eyes developed an epiretinal membrane postoperatively that required a vitrectomy to improve the visual acuity. The postoperative visual acuity, 0.54 by logMAR (20/69 by Snellen), was significantly better than the preoperative visual acuity, 1.1 logMAR (20/250 by Snellen) (P < 0.0001). CONCLUSIONS: The modified external needle drainage technique is a flexible, effective method to drain subretinal fluid in eyes with a rhegmatogenous retinal detachment. The retinal reattachment rate and complication rate compare favorably to alternative subretinal fluid drainage techniques.     

Visual recovery after scleral buckling for macula-off retinal detachments: an optical coherence tomography study

PURPOSE: To assess the postoperative macular reattachment through OCT3 in eyes treated with episcleral surgery due to macula-off rhegmatogenous retinal detachment, as well as to verify if there is a statistically relevant relation between the persistence of a subfoveal detachment and poor postoperative functional recovery. METHODS: Twelve eyes of 12 patients who underwent episcleral surgery due to macula-off rhegmatogenous retinal detachment were enrolled and examined in a prospective study. Exclusion criteria were the following: traumatic retinal detachments, detachment relapses, macular holes, amblyopia, and grade B proliferative vitreoretinopathy or higher. The time period from the onset of subjective symptoms of retinal detachment to retinal surgery ranged from 3 to 7 days. All patients were evaluated in the preoperative and the postoperative period (after 1, 3, and 6 months) through measurement of visual acuity by ETDRS charts, fundus photographs, and macular tomography with OCT3. The postoperative tomography outcomes and the visual acuity were statistically examined using the Mann-Whitney U-test. RESULTS: One month after surgery, despite the macular reattachment assessable ophthalmoscopically and through fundus photographs, the OCT examination showed macular subretinal fluid persistence in 66.6% of cases. After 3 and 6 months, the persistence of such foveal detachment was respectively observed in 41.6% and in 33.3% of cases. Moreover, the macular subretinal fluid persistence in the postoperative period showed a statistically significant relation with poor functional recovery. CONCLUSIONS: Delayed or incomplete visual recovery after episcleral surgery for macula-off retinal detachment may be related to macular subretinal fluid persistence, assessable with tomography and not visible ophthalmoscopically.     

Anatomic and visual results in asymptomatic clinical rhegmatogenous retinal detachment repaired by scleral buckling

PURPOSE: To report presenting characteristics as well as anatomic and visual results in asymptomatic clinical rhegmatogenous retinal detachment repaired by scleral buckling. METHODS: Review of 28 eyes of 27 patients with an asymptomatic clinical retinal detachment-defined as a rhegmatogenous retinal detachment with subretinal fluid extending more than 2 disk diameters posterior to the equator-which were repaired by scleral buckling from January 1989 through December 1996 with follow-up of 6 months or longer. RESULTS: With a single scleral buckling procedure, anatomic reattachment of the retina occurred in all eyes; one eye redetached 14 months after the initial surgery secondary to a new retinal break and was successfully reattached. All eyes had best-corrected presenting and final visual acuity of 20/50 or better. Final best-corrected Snellen visual acuity was within 1 line of best-corrected presenting visual acuity in 82% of eyes; three eyes improved more than 1 line of Snellen visual acuity and two eyes lost more than 1 line. CONCLUSION: Anatomic and visual results in asymptomatic clinical rhegmatogenous retinal detachment after scleral buckling surgery are excellent. Strong consideration should be given to repair of these detachments.     

改良环扎垫压术治疗视网膜脱离千例报告

目的 探讨以环扎垫压改良术式治疗视网膜脱离的意义。方法 对974例1024眼应用改良式环扎垫压术治疗视网膜脱离,手术时间、视网膜复位率、视力改善程度及并发症发生率等,进行分析研究。结果 1024眼均采用改良术式,其中86.6％眼并放出视网膜下液,25％眼并眼内注气术,手术时间0.4～10h,平均30min,一次手术成功率98.4,出院后半年成功率97.2％。术后视力≥0.1者785例,占76.7％,与术前的34.2％相比,差异具有非常显著性(X~2=166.7,P相似文献   

视网膜脱离术后顽固性视网膜下积液的治疗

目的 分析视网膜脱离术后顽固性视网膜下液的形成原因，并对其治疗方法进行了探讨。方法 对285例视网膜脱离术后出现顽固性视网膜下液的23例（23只眼）患者，在常规治疗1月无效后，对玻璃体牵引不明显的12例进行药物治疗，其中5例不吸收者行针刺放液和巩膜外环扎，3例行激光堤坝式光凝，11例玻璃体牵引明显者行玻璃体切割术。结果 随访一年，牵引不明显的12例视网膜下液在8－39周内吸收，牵引明显的11例中3例出现复发性网脱，经再次玻璃体切割术后恢复，余视网膜均复位良好。讨论 顽固性视网膜下液的发生与裂孔的位置、患者年龄、冷凝强弱、玻璃体牵引及巨大裂孔放液位置有关，为减少增生性玻璃体视网膜病变，尽可能恢复视功能，应针对不同病因及时进行相应的治疗。     

Tomographic image and visual recovery of acute macula-off rhegmatogenous retinal detachment

Purpose To observe the macula of acute rhegmatogenous retinal detachment involving the macula with optical coherence tomography (OCT) after scleral buckling and to study the relation between pre- and postoperative visual acuity and the OCT image.Methods Prospective study of 15 eyes of 15 patients with macula-off rhegmatogenous retinal detachment. We selected cases with preoperative visual acuity worse than 0.5 to analyze the improvement in postoperative visual acuity. The time period between macula-off retinal detachment and surgery was less than 1 week.Results Indirect ophthalmoscopy indicated that all retinal detachments were reattached at 2 weeks postoperatively. Accumulation of subretinal fluid at the fovea was observed in nine (60%) cases with OCT. In four of these nine eyes, the accumulation of subretinal fluid persisted up to 6 months after the operation. The presence of residual subretinal fluid did not influence visual recovery during the 6 months postsurgical follow-up.Conclusions OCT revealed postoperative residual subretinal fluid at the macula in some acute macula-off retinal detachment cases. Residual subretinal fluid did not influence the recovery of visual acuity for at least 6 months after surgery.Presented at the 26th Congress of the Ophthalmic Surgery of Japan, Kyoto, Japan, 31 January 2003None of the authors have a proprietary interest in any material related to this research     

Tomographic assessment of vitreous surgery for diabetic macular edema

PURPOSE: To evaluate the retinal structure before and after vitrectomy for diabetic macular edema and to assess the correlation between thickness of neurosensory retina and best-corrected visual acuity. METHODS: Tomographic features of 13 eyes (nine patients) with diabetic macular edema were prospectively evaluated with optical coherence tomography before and after vitrectomy. The foveal thickness (the distance between the inner retinal surface and the retinal pigment epithelium) and the retinal thickness (thickness of neurosensory retina) were measured by optical coherence tomography preoperatively and postoperatively. The correlation of the best-corrected visual acuity with foveal and retinal thickness was determined. RESULTS: All 13 eyes had retinal swelling with low intraretinal reflectivity. In addition to retinal swelling, there were cystoid spaces in five (38%) of 13 eyes, a serous retinal detachment in three (23%), and both cystoid spaces and serous detachment in three (23%). Six months postoperatively, the mean foveal thickness significantly decreased from 630 +/- 170 to 350 +/- 120 microm (P <.01, paired t test) and the mean thickness of neurosensory retina decreased from 540 +/- 160 to 320 +/- 140 microm (P <.01, paired t test). A serous retinal detachment occurred transiently in 3 eyes. Compared with the preoperative level, the postoperative best-corrected visual acuity level improved by more than 2 lines in five of the 13 eyes (38%), remained the same in seven eyes (54%), and decreased in one eye (8%). The postoperative thickness of neurosensory retina at the fovea and best-corrected visual acuity level at the sixth postoperative month had a strong negative correlation (correlation coefficient, -0.76; P <.01, Spearmans rank test). CONCLUSIONS: Vitrectomy was generally effective in treatment of diabetic macular edema. Optical coherence tomography demonstrated the intraretinal changes of macular edema and the process of edema absorption. During the process of macular edema absorption, intraretinal fluid appeared to move into the subretinal space in some cases. Best-corrected visual acuity improvement was greater in eyes with less preoperative increase in thickness of neurosensory retina.     

手术显微镜直视下巩膜外加压治疗孔源性视网膜脱离的临床观察

目的观察显微镜直视下巩膜外加压治疗孔源性视网膜脱离(RRD)的临床疗效。 方法纳入2016年9月至2017年9月于中国中医科学院眼科医院玻璃体视网膜病科诊断为RRD,并首次接受巩膜外加压术的患者18例(20只眼)的临床资料,在显微镜下进行巩膜外加压手术,所有患者随访1～12个月,平均(6.1±1.2)个月,观察视力、视网膜复位率及并发症等。术前与术后患者的视力按照<0.05,0.05～0.30和>0.30分为三类,采用眼数和百分比进行描述,比较采用Kruskal－Wallis H秩和检验。 结果在本研究所观察的病例中,视网膜全部复位,无重大并发症发生。其中,有6例(6只眼)患者需联合玻璃体腔注气术治疗,术后1～2周完全吸收。所有病例均予以巩膜穿刺放液,残余视网膜下液多在术后2周左右完全消退,但有2例(2只眼)患者在术后半年才完全吸收。此外,有4例(4只眼)患者术后补充视网膜裂孔周围激光光凝。随访过程中观察到病例中原病变区视网膜裂孔全部闭合,视网膜复位率100%。12例(13只眼)术后视力得以提高,6例(7只眼)术后视力无变化。因巩膜外加压导致眼球形态由原来的近似正球形发生改变。部分病例屈光度发生改变,视网膜脱离累及黄斑区者在视网膜下液吸收、黄斑复位后,视力有部分提高,经Kruskal－Wallis H秩和检验,差异有统计学意义(Hc＝8.62,P<0.05)。有4例(4只眼)出现术后轻度双眼复视,5～7 d后症状消失,眼球运动无受限;13例(13只眼)术后因结膜缝线刺激主诉异物感,拆除缝线后无不适;1例(1只眼)术后结膜切口延期愈合。 结论显微镜下外路视网膜脱离复位手术可以提高视网膜裂孔的封闭率,提高手术成功率,避免一部分手术并发症。     

Exudative retinal detachment and retinitis associated with acquired syphilitic uveitis

PURPOSE: To describe three cases of exudative retinal detachment and focal retinitis associated with acquired syphilitic uveitis. METHODS: Three patients who were referred for evaluation of uveitis were examined. Slit-lamp examination, ophthalmoscopy, B-scan ultrasonography, fundus photography, and fluorescein angiography were performed before and after therapy. RESULTS: Each patient had uveitis with exudative retinal detachment, periphlebitis, and focal retinitis. Laboratory testing (fluorescent treponemal antibody absorption) revealed positive serology for active syphilis in all cases. Human immunodeficiency virus antibody testing was negative in all patients. Retinal detachment resolved in all cases after treatment with intravenous penicillin. Despite resolution of subretinal fluid, visual acuity remained poor in eyes in which the macula was detached. CONCLUSION: Syphilis is a cause of exudative retinal detachment. Antibiotic therapy can lead to retinal reattachment. Early recognition and treatment may prevent severe vision loss.     

Chronic macular detachment following pneumatic retinopexy

In a consecutive series of 73 retinal detachments managed with pneumatic retinopexy, three (4.1%) of 73 eyes sustained chronic detachment of the posterior retina involving the macula even though all retinal breaks were closed. This shallow subretinal fluid persisted for 12 to 21 months but reabsorbed spontaneously. Two cases presented with a detached macula, one of which had pre-existing macular degeneration. The other case presented with an attached macula but it became detached immediately after pneumatic retinopexy. The visual acuities in the two patients who did not have macular pathology before the development of retinal detachment were 20/50 and 20/40 even with persistent subretinal fluid under the macula. In both cases the visual acuity improved to 20/30 after resolution of the subretinal fluid. Patients with a longstanding component to the retinal detachment and small retinal breaks may be at risk of developing chronic macular detachment following pneumatic retinopexy. Pockets of subretinal fluid can persist following scleral buckling, with or without drainage of subretinal fluid. However, it is unknown whether scleral buckling has a lower incidence of this complication than pneumatic retinopexy.     

中药联合激光治疗糖尿病视网膜病变的临床探讨

目的:探讨中药联合激光治疗糖尿病视网膜病变的临床疗效。方法:随机选择30例36眼视网膜病变患者,随机分为观察组(中药联合激光组)和对照组(激光组)。观察组15例17眼,对照组15例19眼,治疗1～2a。分别于治疗前后对所有患者的视力、眼底病变情况进行观察记录及统计分析。结果:观察组患者的视力及眼底改善要优于对照组(P<0.05)。结论:中药联合激光是治疗糖尿病视网膜病变的可行有效方法之一。     

在显微镜下联合间接眼底镜行视网膜脱离非凝固手术

目的:探讨显微镜联合间接眼底镜行外路视网膜脱离非凝固手术的可行性及效果。方法:2007-01/08对50例50眼孔源性视网膜脱离患者,在显微镜下行球结膜环形剪开、四直肌预置牵引线、巩膜外放液或不放液、放置或不放置环扎条带、巩膜缝线固定硅胶(或硅海绵)外加压块、缝合球结膜,在间接眼底镜下行视网膜裂孔定位及术毕眼底检查,术中对裂孔未作凝固处理。术后裂孔周围行激光光凝。手术后随访3~9mo。结果:所有患者手术过程顺利,平均手术时间缩短。手术中并发症:1例术中视网膜下出血;手术后随访3~9mo,视网膜完全复位47眼,1眼出血性视网膜脱离经保守治疗后视网膜复位,1眼手术后视网膜脱离复发经玻璃体手术后视网膜复位,1眼手术后视网膜脱离未复位经二次环扎带调位术后视网膜复位;手术后视力提高43眼,不变5眼,下降2眼。结论:显微镜下联合间接眼底镜操作巩膜扣带术及对裂孔未作凝固处理,使手术创伤小、时间缩短、术中及术后并发症少、手术效果好,患者满意度高。     

不放液的巩膜外垫压治疗孔源性视网膜脱离的疗效

目的:探讨不放液的巩膜外垫压治疗孔源性视网膜脱离的临床疗效.方法:回顾性分析2012-01/2017-01我院收治的孔源性视网膜脱离患者111例113眼,所有纳入研究的病例均采用双目间接检眼镜下视网膜裂孔定位、巩膜外冷凝、巩膜外垫压的手术方法.术中98眼单纯巩膜外垫压,15眼术后玻璃体腔注射消毒空气,所有病例均行变性区及裂孔处巩膜外冷凝,结扎缝线前行前房穿刺放液.术后观察最终视网膜复位率、术后最佳矫正视力、眼压、并发症情况.结果:术后随访6 mo.视网膜最终复位率97.4%;术后视力提高91眼(80.5%).术后高眼压均能控制.术中发生并发症共7眼,术后并发症3眼.结论:不放液的巩膜外垫压术治疗孔源性视网膜脱离的并发症少,疗效肯定.     

显微镜直视下视网膜脱离术

目的探讨显微镜直视下视网膜脱离手术的可能性。方法对裂孔性视网膜脱离患者36例36只眼,预置硅胶块和/或环扎带后,在手术显微镜直视下经巩膜电凝排出视网膜下液、视网膜冷凝、最后顶起硅胶填压块检查裂孔是否封闭。术后观察视力恢复及网膜复位情况。结果视网膜完全复位35眼,再次外路手术复位1眼。视力提高32眼,不变2眼,下降2眼,矫正视力在0.3以上33眼。除电凝外排液穿透视网膜和引起视网膜下出血1例外,其它病例排液顺利。所有病例在显微镜直视下冷凝反应均清晰可见,并且轻度屈光间质混浊不影响观察冷凝反应和裂孔定位。结论显微镜下行视网膜脱离手术具有简单、方便、清晰、可靠等优点。     

视网膜动脉阻塞中西医结合治疗疗效观察

目的:观察中西医结合治疗视网膜动脉阻塞的疗效。方法:采用随机研究方法,将视网膜动脉阻塞的患者78例随机分为葛根素组(48例),丹参组(30例)。在基本治疗的基础上,丹参组采用丹参注射液,葛根素组采用葛根素注射液,两组疗程约为30d。两组以视力、视野、眼底改变做为疗效判断指标。结果:丹参组与葛根素组治疗前各项主要指标具有可比性(P>0.05)。有效率葛根素组75%,丹参组63.3%,两者比较其差异有显著性意义(P<0.05)。结论:葛根素结合西医治疗是治疗视网膜动脉阻塞有效的方法。     

Recurrent bullous retinal detachments from photodynamic therapy for idiopathic polypoidal choroidal vasculopathy

PURPOSE: To report the recurrent bullous retinal detachments as complications of photodynamic therapy (PDT) for idiopathic polypoidal choroidal vasculopathy (IPCV). DESIGN: Interventional case report. METHODS: A pseudophakic 84-year-old-woman had IPCV and decreased vision. Angiography demonstrated macular leakage. PDT with verteporfin was applied. Two days later, visual acuity decreased from 20/50 to 20/400. Examination revealed extensive inferior subretinal fluid, which mimicked a pseudophakic rhegmatogenous retinal detachment. A scleral buckle was placed; no retinal breaks were identified. RESULTS: Vision and fluid resolved over three weeks. Four months later, examination revealed decreased vision and persistent leakage. Two days after repeat PDT, bullous exudative macular detachment recurred. Detachment resolved over two weeks; visual acuity returned to 20/50. CONCLUSION: IPCV that is treated with PDT may be complicated by iatrogenic bullous exudative retinal detachments that resemble rhegmatogenous detachments. Modified treatment parameters may reduce the risk of recurrence. The natural history likely includes spontaneous resolution and visual recovery.