眼外伤无光感眼手术治疗效果的临床观察

目的 评价玻璃体视网膜手术治疗眼外伤无光感眼的效果。方法 对11例（11只眼）外伤后的无光感眼行玻璃体视网膜手术,并观察其。随诊6－24个月,平均11个月。结果 在11例外伤后无光感眼中,7例恢复了光感或光感以上的视力,4例仍无光感,其中1例行眼球摘除。眼外伤后无光感的主要原因为严重的屈光间质混沌,视网膜脱离,破损及脉络膜水肿。结论 部分眼外伤后无光感眼经及时的玻璃体视网膜手术治疗可获得一定的视力。     

眼外伤无光感眼22例手术疗效临床分析

目的观察视网膜玻璃体手术治疗眼外伤无光感眼的疗效。方法对22例（22眼）外伤后的无光感眼行玻璃体视网膜手术，随诊6～24个月，平均11个月，并观察其疗效。结果在22例外伤后无光感眼中，17例恢复了光感或光感以上的视力，4例仍无光感，其中1例行眼球摘除。结论部分眼外伤后尤光感眼经及时的玻璃体视网膜手术治疗可获得一定的视力。     

玻璃体切除术拯救外伤后无光感眼

目的观察外伤后无光感眼采用玻璃体切除术治疗的效果。方法回顾性分析10例（10眼）行玻璃体切除术的眼外伤后无光感眼的临床资料。开放性眼外伤8例,闭合性眼外伤2例。术前并发症有视网膜脱离10眼、脉络膜脱离8眼、睫状体脱离4眼、玻璃体积血10眼、无晶状体5眼、无虹膜3眼及角膜血染1眼。所有病例均为硅油填充者。随访6个月以上。结果术后9眼视网膜解剖复位。5眼硅油填充眼压正常,2眼硅油填充眼压低,2眼取硅油后眼压正常,1眼眼球萎缩行眼球摘除术。术后视力5眼仍为无光感。2眼为手动,1眼为数指,1眼为0．05,1眼最佳矫正视力为0．2。结论玻璃体切除术可以拯救部分外伤后早期无光感眼,甚至可以恢复部分视功能。     

玻璃体切除术治疗严重眼挫伤所致玻璃体积血

目的观察玻璃体切除术治疗严重眼挫伤所致大量玻璃体积血的效果。方法回顾性分析76例（76只眼）严重眼外伤所致大量玻璃体积血玻璃体切除术的术前及术后情况。结果76只眼中术后视力提高者73只眼。术前无光感的4眼中术后仍无光感1只眼,光感2只眼,1只眼视力恢复至0．6。22只眼视网膜脱离者中,21只眼成功复位,复位率为95．45％。外伤性晶状体脱位28只眼,玻璃体术后一期人工晶状体植入5例。外伤性黄斑孔4只眼,3只眼玻璃体切除术中联合内界膜剥离,术后黄斑孔闭合。1例因黄斑区视网膜下大量积血,内界膜未剥离,孔未闭合,进行激光光凝,以防止孔周围视网膜脱离。结论严重眼挫伤所致大量玻璃体积血,均可在外伤后及时进行玻璃体切除术治疗,对于术前无光感眼,当眼B超显示玻璃体团块状回声,未能分清视网膜及脉络膜结构者,需待玻璃体机化后,经过恰当的玻璃体切除术联合其他相应的治疗措施,大多能解剖治愈,部分患者可功能治愈。     

玻璃体手术治疗开放性眼外伤无光感眼的临床探讨

目的探讨玻璃体切割术治疗开放性眼外伤无光感眼的预后。方法对15例(15只眼)开放性眼外伤后无光感眼行玻璃体视网膜手术,并观察其疗效。结果在15例外伤后无光感眼中,11例视网膜解剖复位,光感至手动2例,指数1例,0.05者1例。结论玻璃体切割术是治疗开放性眼外伤无光感眼的有效手段,可使大多数伤眼获得解剖修复,部分可获得一定的视功能,术后无视力者外观短期内能得到维持。     

玻璃体视网膜手术治疗严重眼外伤无光感眼的效果

目的评价玻璃体视网膜手术治疗严重眼外伤所致的无光感眼的效果。方法对13例13只眼严重眼外伤所致的无光感眼进行玻璃体视网膜手术,观察其疗效。随访时间为3m～18m,平均为12m。结果13只严重眼外伤后无光感的眼中,有9例术后有了光感或光感以上的视力,最终4例仍无光感。结论眼外伤后无光感的主要原因是严重的玻璃体混浊积血、屈光间质混浊、视网膜脱离及视网膜、色素膜的损伤、缺损。眼外伤后无光感在一些病例中并不意味着视力永久性的丧失,及时进行玻璃体视网膜手术,使尚存的视网膜复位,可使这些伤眼再获得光感以上的视力。     

Coats病的手术治疗

目的总结手术治疗Coats病的效果。方法对Coats病伴不同程度渗出性视网膜脱离的患者16例17只眼行巩膜外冷凝术和玻璃体手术治疗，手术后随访时间4.25～62.25个月, 平均随访时间13.10个月。结果手术治疗后8只眼视网膜完全复位(无硅油充填)，视网膜复位率47%；1只眼在硅油充填的情况下视网膜在位；8只眼手术后视网膜未能完全复位。5只眼手术后视力提高，2只眼视力稳定，7只眼视力下降。手术并发症有一过性渗出性视网膜脱离加重，视网膜前局限性增生，白内障形成，继发青光眼和玻璃体积血。结论Coats 病伴视网膜脱离经手术治疗后大多数病例视网膜可复位，部分患者视力提高。(中华眼底病杂志,2005,21:145-147)     

伴致密玻璃体出血的外伤后无光感眼的玻璃体手术探查

目的评估对一些外伤后无光感眼施行玻璃体手术探查的效果。方法对１０例外伤后无光感眼行玻璃体手术探查和处理，其中８例为开放性眼外伤，２例为闭合性钝挫伤。结果术后６例恢复了光感至０．２５的视力，４例仍为无光感。术中发现一些眼仍保留有功能的后极部视网膜和视盘。结论致密玻璃体积血可能是一些严重外伤眼术前无光感的主要原因。因此，无光感并不总是意味着永久性视力丧失。正确的初期修复和适时地对经选择的眼施行二期玻璃体手术探查，可能为有些伤眼提供复明机会。     

玻璃体切除治疗Ⅲ区开放性眼外伤的效果

目的 评价玻璃体切除治疗Ⅲ区开放性眼外伤的效果.方法 本研究为前瞻性分析.2012年7月至2013年8月收治Ⅲ区开放性眼外伤36例（36只眼）,记录致伤原因、术前最佳矫正视力、外伤眼特征、手术时机、手术方式、手术效果,分析影响治疗效果的因素.结果 36例Ⅲ区开放性眼外伤巩膜全层裂伤达角膜缘后（以最远距离为准）5 ～20 mm,平均（9.0±3.7）mm.术后最佳矫正视力提高者21只眼（59.3％）.术前无光感的11只眼中术后无光感2只眼,光感3只眼,手动2只眼,眼内容摘除4只眼;术前视力光感的19只眼中术后光感3只眼,视力提高13只眼,眼内容摘除3只眼.视网膜脱离34只眼中视网膜复位26只眼,其中首次玻璃体切除硅油填充术后视网膜复位16只眼;联合巩膜外加压术复位10只眼（包括联合视网膜前膜剥除术8只眼,同时联合2次玻璃体切除和部分视网膜切除只2眼）.结论 Ⅲ区开放性眼外伤,经过玻璃体切除联合手术和相应的治疗,能够在一定程度上挽救眼球,并且恢复一定的视功能.     

开放性眼外伤无光感眼的玻璃体手术救治

目的:探讨玻璃体切割术治疗严重的眼外伤无光感眼的疗效。方法:对9例9眼严重外伤后的无光感眼行玻璃体视网膜手术,并观察其疗效。随诊6～24(平均10)mo。结果:在9例外伤后无光感眼中,4例恢复了光感或光感以上的视力,5例仍无光感。眼外伤后无光感的主要原因是严重的屈光间质混浊,视网膜破损、脱离及脉络膜水肿。结论:严重眼外伤无光感眼经及时的玻璃体切割术可获得一定的视力。     

机械性眼外伤后无光感眼的手术治疗分析

目的 回顾性总结严重机械性眼外伤后视力无光感眼的伤情、相应的手术治疗方式及其手术治疗后效果,分析对手术后视力结果和眼球最终结局的影响因素.方法 对42例42只眼严重眼外伤所致的无光感眼施行玻璃体视网膜联合手术,观察其疗效.术后随访6～36个月,平均15个月.结果 42例外伤后无光感眼中,15例术后恢复了光感或光感以上的视力,27例仍无光感,其中2例行眼球摘除.严重眼外伤无光感眼视功能丧失主要原因为致密浓厚玻璃体积血、视网膜脱离及视网膜、脉络膜严重广泛的损伤、缺损.而术前伤情、玻璃体手术时机等均会影响手术的成功和视力预后.结论 严重眼外伤后无光感并不意味着视力永久性的丧失,正确的早期修复和适时、恰当的玻璃体视网膜手术,可获得一定的视力,视力无法恢复者可暂时维持眼球外观.

Abstract：

Objective To evaluate the efficacy of vitreoretinal surgery in the treatment of traumatized eyes with no light perception. Methods Vitreoretinal surgery on 42 eyes of traumatized eyes with no light perception of 42 patients was performed. The patients after the operations were followed up for 6-36 months (averaged 15 months). Results Postoperatively; 15 of 42 patients had visual acuities of LP to 0.1, 27 eyes remained NLP in which 2 had enucleation. The traumatic condition; the opportunity of vitreoretinal surgery were the most important factors influencing the prognosis of postoperative VA in severe mechanical injuried eye.Conclusions The dense vitreous hemorrhage, the damaged or detached retina and the choroid edema are the main causes of NLP. Therefore; NLP does not always mean permanent loss of vision. Some patients of NLP may get some visual acuities after proper primary repair of the wound and timely vitreoretinal surgery. The eyes with NLP can maintain eyeball- shape.     

机械性眼外伤后无光感眼的手术治疗分析

目的 回顾性总结严重机械性眼外伤后视力无光感眼的伤情、相应的手术治疗方式及其手术治疗后效果,分析对手术后视力结果和眼球最终结局的影响因素.方法 对42例42只眼严重眼外伤所致的无光感眼施行玻璃体视网膜联合手术,观察其疗效.术后随访6～36个月,平均15个月.结果 42例外伤后无光感眼中,15例术后恢复了光感或光感以上的视力,27例仍无光感,其中2例行眼球摘除.严重眼外伤无光感眼视功能丧失主要原因为致密浓厚玻璃体积血、视网膜脱离及视网膜、脉络膜严重广泛的损伤、缺损.而术前伤情、玻璃体手术时机等均会影响手术的成功和视力预后.结论 严重眼外伤后无光感并不意味着视力永久性的丧失,正确的早期修复和适时、恰当的玻璃体视网膜手术,可获得一定的视力,视力无法恢复者可暂时维持眼球外观.     

Predictive factors for final outcome of severely traumatized eyes with no light perception

ABSTRACT: BACKGROUND: An eye injury that causes no light perception (NLP) typically carries an unfavorable prognosis, and NLP because of trauma is a common indication for enucleation. With advances in vitreoretinal surgical techniques, however, the indication for enucleation is no longer determined by posttrauma NLP vision alone. There are limited studies in the literature to analyse the outcome of NLP eyes following open globe injury. The current study was aimed to evaluate the outcome of surgical repair of severely traumatized eyes with no light perception vision as preoperative visual acuity. Secondary objective was to possibly predict the factors affecting the final vision outcome in this eyes. METHODS: Retrospective case analysis of patients with surgical repair of open globe injury over last ten years at a tertiary referral eye care centre in Singapore. RESULTS: Out of one hundred and seventy two eyes with open globe injury 27 (15.7 %) eyes had no light perception (NLP). After surgical repair, final visual acuity remained NLP in 18 (66.7 %) eyes. Final vision improved to Light perception/ Hand movement (LP/HM) in 2(7.4 %) eyes, 1/200 to 19/200(11.1 %) in 3 eyes and 20/50-20/200(14.8 %) in 4 eyes. The median follow up was 18.9 months (range: 4-60 months). The factors contributing to poor postoperative outcome were presence of RAPD (p = 0.014), wound extending into zone III (p = 0.023) and associated vitreoretinal trauma (p = 0.008). CONCLUSIONS: One third of eyes had ambulatory vision or better though two third of eyes still remained NLP. Pre-operative visual acuity of NLP should not be an indication for primary enucleation or evisceration for severely traumatized eyes. Presence of afferent papillary defect, wound extending posterior to rectus insertion and associated vitreoretinal trauma can adversely affect the outcome in severely traumatized eyes with NLP. Timely intervention and state of art surgery may restore useful vision in severely traumatized eyes.     

23G后节灌注辅助下的巩膜扣带术治疗球形视网膜脱离

目的：观察23G后节灌注辅助下的巩膜扣带术治疗球形视网膜脱离的疗效,探讨其可行性。

方法：选取我院2017-02/2018-02被确诊为孔源性视网膜脱离且视网膜下液较多、呈球形脱离外观的患者21例21眼,在行巩膜扣带术中引流视网膜下积液前于睫状体扁平部预置23G后节灌注,术中对裂孔未作凝固处理,术后裂孔周围行激光光凝治疗。术后随访观察3～10mo,观察视网膜复位和并发症情况。

结果：所有患者手术过程顺利,术中均引流出视网膜下液并未见脉络膜出血和视网膜嵌顿; 术后第1d视网膜完全复位者18眼; 术后2～3d残留视网膜下液吸收完毕者2眼,视网膜脱离未复位者1眼,经再次外加压块调位术后视网膜复位,术后视网膜脱离复发者1眼,经玻璃体手术后视网膜复位。术中有视网膜下出血者1眼,出血范围<1PD,3mo后吸收,未见眼压异常、眼前段缺血和其他严重并发症。

结论：在球形视网膜脱离的巩膜扣带术中引流视网膜下积液前预置灌注,可有效维持术中眼内压平稳,减少因引流视网膜下积液时眼压过快下降导致的爆发性脉络膜上腔出血和术后发生脉络膜脱离的可能性,同时术中视网膜基本趋于平伏,裂孔定位相对准确,可提高手术成功率。     

Vitreoretinal Disorders in Anterior Megalophthalmos

Purpose To describe vitreoretinal abnormalities in patients with anterior megalophthalmos (AM) and to report the results of vitreoretinal surgery in these cases. Methods In a retrospective, noncomparative case series, a diagnosis of AM was made according to the following criteria: megalocornea, iris hypoplasia, lens subluxation, cataract formation at an early age, and absence of congenital glaucoma. Vitreous biomicroscopy and funduscopy were performed in all patients. Patient records were also reviewed. Results Twenty-four patients with AM (12 male, 12 female), aged 4 months to 64 years, were included in this study. Funduscopy was possible in 46 eyes. Vitreous degeneration was the most common abnormal posterior segment finding, present in 34 eyes (73.9%). Nine eyes (19.5%) had optically empty vitreous with strands. Lattice degeneration was seen in five eyes (10.8%). Spontaneous vitreous hemorrhage occurred in three eyes, and peripheral retinal neovascularization was detected in two. Retinal detachment occurred in 18 eyes (37.5%); retinal breaks were detected in eight of these before surgery. Thirteen eyes underwent a total of 18 procedures. Retinal reattachment was finally achieved in 12 of the 13 eyes. Conclusions Anterior megalophthalmic eyes seem to be affected by a type of vitreoretinopathy predisposing to retinal detachment. Current vitreoretinal surgical techniques usually achieve good anatomic results in these cases.     

玻璃体视网膜手术136例疗效分析

目的 为玻璃体视网膜手术对玻璃体积血及视网膜脱离的治疗效果。方法 对１９９６年１１月￣１９９７年１１月间行玻璃体多膜手术的１３６例（１３９眼）进行回顾性分析。结果 术后视力提高者达８９．９％，视网膜复位率达８８．８％。结论只要掌握好手术适应证，时机及手术技巧，能成功地治疗一些复杂性玻璃体视网膜病变。     

Visual outcomes of vitreoretinal surgery in eyes with severe open-globe injury presenting with no-light-perception vision

Background  Severe ocular trauma causing no light perception (NLP) typically carries a dismal prognosis, and implies no further therapeutic intervention. We have identified a cohort of patients with verified NLP following open-globe injury who have recovered vision of light perception (LP) or better. We evaluated the outcomes of vitreoretinal surgery performed on eyes that were NLP post open-globe injury. Methods  Retrospective review of outcomes of secondary vitreoretinal surgery performed at Massachusetts Eye and Ear Infirmary from 1 January 2001 to 31 December 2006 on all cases of open-globe repair (OGR) that had NLP prior to OGR or on the first post-operative day. Results  A total of 648 cases of OGR were performed in the study period. Eighty-eight patients had NLP prior to OGR or on the first post-operative day after OGR. Twenty-three patients from the above group (26.1%) spontaneously recovered a vision of light perception (LP) or better. Eight of the 23 patients had a secondary vitreoretinal surgery. All eyes that did not undergo vitreoretinal surgery returned to NLP or became phthisical within 7 months. Among the eight eyes that underwent surgery, five had improvement, with vision ranging from hand motion to 20/70. Prognostic indicators for successful surgical outcome were hand motion or better vision prior to vitreoretinal surgery, recovery of vision within 5 days of OGR, and vitreoretinal intervention within 5 weeks of the initial open-globe injury. Conclusion  Patients with severe open-globe injury and NLP occasionally recover LP or better vision. These patients may regain useful vision after vitreoretinal surgery if prompt referral and intervention is attempted and if the spontaneous visual recovery occurs within the first week after OGR. The authors have no financial interests. The authors have full control of all primary data and they agree to allow Graefe’s Archive for Clinical and Experimental Ophthalmology to review their data upon request.     

Surgical results and visual outcomes of vitreous surgery for advanced stages of retinopathy of prematurity

PURPOSE: We evaluated the effectiveness of vitreous surgery for advanced stages of retinopathy of prematurity (ROP) with traction retinal detachment. METHODS: Vitreous surgery was performed in 34 children (51 eyes) with total traction retinal detachment associated with stage 5 ROP between January 1989 and December 1991 at the Fukuoka University Hospital. The first phase of the procedure was composed of pars plicata lensectomy, followed by vitrectomy, membrane delamination, and hyaluronic acid injection. For unsuccessful cases, the second phase of the procedure, comprising scleral encircling, vitrectomy, membrane delamination, retinotomy fluid-air exchange, and SF6 or temporary silicone injection with endophotocoagulation, was performed. In cases with surgical success, visual acuity was measured using the Landolt ring test. RESULTS: Of the 33 eyes with unsuccessful phase 1 surgery, 15 underwent the second phase procedure. Retinal reattachment was achieved in 7 of these 15 eyes (46.7%). Our composite rate of successful retinal reattachment for advanced stages of ROP was 47% (24 of 51 eyes). In 15 of the 24 eyes with surgical success, visual acuity was more than 20/600 in 3 eyes and no light perception in 1 eye. CONCLUSION: In vitreous surgery for advanced stages of ROP, retinal breaks and vitreous hemorrhage are important factors leading to surgical failure. In this series, we could achieve visual acuity of more than light perception for several cases.     

内窥镜引导玻璃体视网膜手术治疗伴有角膜混浊的外伤性视网膜脱离

目的探讨眼内窥镜引导玻璃体视网膜手术治疗伴有角膜混浊的外伤性视网膜脱离的效果及安全性。方法 2010年8月至2011年6月我院13例(13眼)伴有角膜混浊的外伤性视网膜脱离患者,在眼内窥镜引导下行玻璃体切割、视网膜激光光凝术及玻璃体硅油或重硅油填充术,术后随访6～15个月,观察视力、眼压、眼前段及眼底视网膜复位情况。患者术前视力:无光感者2眼,光感者5眼,手动者3眼,数指者2眼,0.02～0.05者1眼。结果所有患者视网膜均平伏,裂孔均封闭。术中1眼玻璃体内发现术前未能诊断的非磁性异物(睫毛)。术后4眼早期眼压偏低,2眼一过性眼压增高,经观察或药物治疗后恢复正常。术后6个月最佳矫正视力:无光感者2眼,光感者2眼,手动者2眼,数指者5眼,0.02～0.20者2眼。结论眼内窥镜扩展了玻璃体切割术的适应范围,提高了对伴有角膜混浊的外伤性视网膜脱离,尤其是伴有周边部视网膜裂孔者,实施玻璃体视网膜手术的准确性和安全性。