冷针巩膜穿刺放液在裂孔性视网膜脱离手术中的应用

目的 探讨视网膜脱离复位中冷针放出现网膜下液的临床效果。方法 对３０例裂孔性视网膜脱离患者采用冷针巩膜穿刺放出视网膜下液。结果 ３０例视网膜脱离术后裂孔封闭、视网膜复位。无一例患者出现视网膜新裂孔及脉络膜出血等并发症。结论 冷针巩膜穿刺放液法具有方法简单、安全可靠、并发症少等优点。     

巩膜外路手术联合术后眼底激光治疗孔源性视网膜脱离

目的讨论巩膜外路手术联合术后眼底激光治疗单纯孔缘性视网膜脱离的临床疗效。方法对591例592眼单纯性视网膜脱离病人行巩膜外路手术，包括：巩膜外加压、放液或不放液，部分病人联合环扎或玻璃体腔注C，R气体，术后氩激光或532激光治疗视网膜裂孔。结果视力提高414眼，不变166眼，下降12眼。视网膜复位情况：完全复位561眼（成功率95％），部分复位24眼，未复位7眼。接受一次手术558眼，接受二次手术（包括玻璃体手术）29眼，接受三次手术1眼，7例7眼病人自动放弃。视网膜复位不良手术失败的原因依次为：玻璃体出血、脉络膜脱离型网脱、马蹄形视网膜裂孔伴牵引、黄斑裂孔、锯齿缘离断，以上均与PVR关系密切。结论选择适当病例，巩膜外路手术联合术后激光治疗孔源性视网膜脱离是一种安全、可行、简便、易操作、效果良好的方法。     

显微镜下外路孔源性视网膜脱离复位术的疗效

目的：探讨在手术显微镜下外路手术治疗孔源性视网膜脱离的疗效。 方法：对55例55眼孔源性视网膜脱离采用在手术显微镜下放视网膜下液,寻找视网膜裂孔,巩膜外冷凝,巩膜外垫压,玻璃体腔注无菌空气等方法进行治疗。 结果：患者50例一次外路手术视网膜脱离完全复位。随访6~12mo,最终复位率为91%,1例二次外路手术复位,4例复发视网膜脱离,行玻璃体切割手术复位。55例患者视力不同程度提高。 结论：在显微镜直视下行外路手术治疗孔源性视网膜脱离是一种简便、安全、有效的方法。     

改良视网膜脱离外路手术临床观察

目的 探讨改良视网膜脱离外路手术的临床效果.方法 对63例63只眼孔源性视网膜脱离,先在直肌下留置牵引线,预置环扎带,然后经巩膜排出视网膜下液、视网膜冷凝,环扎带下放置加压块,利用间接眼底镜观察硅胶填压块顶压裂孔位置是否正确,必要时修正加压块位置.术后观察视力、视网膜复位和并发症等情况.结果 术中显微镜直视下冷凝视网膜裂孔清晰可见,通过间接眼底镜观察视网膜复位情况、裂孔顶压位置全面,术后63只眼视网膜完全复位.结论 改良视网膜脱离外路手术具有简单、方便、直视、可靠和效果良好等优点.     

孔源性视网膜脱离术中放液方式改进和应用

目的 总结并讨论孔源性视网膜脱离术中改良的放液方式及其临床效果.方法 选择孔源性视网膜脱离患者85例(87只眼),手术方式为“巩膜外冷凝+冷针穿刺放液+外加压(或联合环扎术)”.结果 一次手术治愈82只眼,占94.25％;经2次手术治愈3只眼,占3.45％,总的外路手术成功率97.70％.有2只眼出现放液时出血,经治痊愈,无其他并发症出现.结论 直接巩膜冷针放液方法简单、安全、并发症少,值得应用.     

缝针巩膜穿刺放液法在视网膜脱离手术中的应用

目的:探讨缝针巩膜穿刺放液法在视网膜脱离术中应用的有效性和安全性。方法:选取64例孔源性视网膜脱离患者,均采用外路视网膜脱离手术。分为A,B两组,A组采用巩膜切开放液法,B组采用缝针巩膜放液法。比较手术的成功率和并发症。结果:两组手术均获成功,成功率和并发症无显著性差异(P>0.05)。结论:缝针巩膜放液法是一种有效、安全的放液方法。     

三面镜视网膜裂孔定位联合外路显微手术治疗孔源性视网膜脱离的临床观察

目的观察术前三面镜裂孔定位联合外路显微手术治疗孔源性视网膜脱离的临床效果。方法回顾性分析2013年1月至2013年9月因孔源性视网膜脱离而做视网膜脱离外路显微手术的患者30例（30只眼）。术前用三面镜检查确定视网膜裂孔位置,作为手术中指导裂孔定位、术中放液和冷凝部位的的依据。手术时在显微镜直视下先预置环扎带和缝线,放视网膜下液,然后经巩膜外视网膜冷凝、垫压,最后核实裂孔、扎紧环扎带和眼内注气。术后随访6~12个月。结果在30例（30只眼）中,一次手术视网膜完全复位25只眼,手术成功率为83%。术后矫正视力,〈0.1者3例,0.1~0.3者9例,〉0.3者18例;视力提高者20例,不变者8例,下降者2例。无严重手术并发症发生。结论术前三面镜检查定位视网膜裂孔方法可靠,对视网膜脱离外路显微手术具有指导意义。而视网膜脱离外路显微手术具有操作简单、方便、治疗效果良好等优点。     

显微镜直视下巩膜外顶压及冷凝术治疗孔源性视网膜脱离

目的观察显微镜直视下巩膜外顶压及冷凝术治疗孔源性视网膜脱离的疗效。方法142例（142眼）孔源性视网膜脱离应用显微镜直视下用冷凝头顶压巩膜，确定裂孔及变性区的部位并冷凝，巩膜外加压，术中不引流视网膜下液，术后观察视力、眼压、视网膜复位情况。结果142眼全部一次视网膜完全复位，视网膜下液1d吸收者98眼，2～3d吸收者44眼，术后视力均有不同程度的提高。随访3～6月，复发1眼。结论显微镜直视下巩膜外顶压及冷凝术治疗原发性视网膜脱离，在成功封闭裂孔后，视网膜下液可自行吸收，可有效减少放液所带来的并发症，具有方便、准确、可靠的特点。     

显微镜直视下外路孔源性视网膜脱离手术的临床应用及术后OCT的观察

目的探讨手术显微镜直视下视网膜裂孔定位、冷凝在外路孔源性视网膜脱离手术中的应用及治疗效果。方法 35例（35只眼）孔源性视网膜脱离行外路手术,术中均采用巩膜扣带、外放液、手术显微镜直视下视网膜裂孔定位、冷凝。结果 33例眼硅胶垫压准确,视网膜复位良好,无异常炎症反应。34例肉眼下无黄斑部视网膜下积液,黄斑部OCT随访3~6个月。结论手术显微镜直视下裂孔定位准确,操作简单,疗效确切。     

用一次性皮试针头穿刺引流视网膜下积液的临床研究

目的:探讨一次性皮试注射针头用于外引流视网膜下积液的有效性、实用性及安全性。方法:对41例行视网膜脱离手术的患者选用一次性皮试注射针头,垂直巩膜穿刺放液。结果:患者41例中,39例一次性放液成功,2例排液不畅,用针头侧刃扩大巩膜穿刺口后放液成功。所有患者均未发生严重的并发症。结论:一次性皮试注射针头穿刺放液是一种简单、快速、高效而又安全的放液方法。     

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.     

显微镜下视网膜脱离复位手术临床应用

目的探讨显微镜下视网膜脱离复位手术的临床效果。方法孔源性视网膜脱离36例(36眼)由同一术者进行外路手术,均在术中应用手术显微镜进行裂孔定位。冷凝封闭及巩膜外垫压。定期观察术后视力、眼内反应和视网膜复位情况。结果经显微镜直视下外路手术患者,术后随访15d-167d,视网膜完全复位35眼(97.2%),视力较术前提高33只眼(91.7%),不变2只眼,下降1只眼。最好矫正视力0.3以上33只眼(91.7%)。术后所有患者视网膜冷凝反应Ⅰ-Ⅱ级,无Ⅲ-Ⅳ级。轻度屈光介质浑浊不影响手术过程。结论经手术显微镜直视下外路治疗孔源性视网膜脱离安全有效、简单可行,值得推广。     

Clinical Experience of External-route Retinal Detachment Surgery under a Surgical Microscope

 Purpose: To evaluate the efficacy of external-route retinal reattachment surgery under a surgical microscope. Methods: A total of 86 patients (86 eyes) with rhegmatogenous retinal detachment underwent external-route retinal detachment surgery under a surgical microscope. Drainage of subretinal fluid, transscleral cryotherapy, scleral buckling, and intravitreal injection of gas were performed intraoperatively. Results: Among 85 patients, 81 achieved postoperative retinal re-attachment after the first surgery and 5 after two surgeries. The visual acuity was elevated in 67 patients, unchanged in 15, and decreased in 4. Conclusion: External-route retinal reattachment surgery under a surgical microscope is a convenient procedure for physicians to master and worthy of widespread application in clinical settings.     

巩膜扣带术治疗陈旧性孔源性视网膜脱离

目的探讨巩膜扣带术治疗陈旧性孔源性视网膜脱离的临床疗效。方法对41例（46眼）巩膜扣带术治疗陈旧性孔源性视网膜脱离的临床资料,及其临床特征、手术方式、手术并发症及手术效果等进行回顾性分析。结果30眼采用巩膜环扎外加压术,12眼采用巩膜环扎术,4眼采用巩膜外加压术治疗;术中36眼放液,10眼未放液治疗。一次手术成功39眼（84.78%）。术中是否选择放液对一次成功的视网膜复位率无明显影响。最终随访44眼视网膜复位,治愈率达到95.65%。术后35眼（76.09%）视力较术前提高。结论巩膜环扎,外加压术联合术中放液或不放液是治疗陈旧性孔源性视网膜脱离的有效方法。     

球形孔源性视网膜脱离的手术探讨

目的：探讨球形孔源性视网膜脱离的手术方法选择与手术预后,方法：回顾性分析1999年在我院手术的球形视网膜脱离患者161例161眼资料。最终手术采用环扎加压不放液53眼,环扎加压放液75眼,玻璃体手术33眼,平均随访3个月。结果：出院时手术复位159眼,复位率98．8％,随访期间复发2眼,最终手术成功157眼,成功率97．5％,术后视力有明显提高,结论：球形孔源性视网膜脱离由于其发病急,就诊快,只要手术方法选择适当,大部分还是可以取得成功,对于膜形成严重,裂孔多,大,靠后,或再手术病例,采用玻璃体手术,其术后解剖复位率和视功能恢复还是相当满意的。     

Modified external needle drainage of subretinal fluid in primary rhegmatogenous retinal detachment: a prospective, consecutive, interventional, single-surgeon study

PURPOSE: We describe surgical outcomes in a single-surgeon, consecutive series of patients who received scleral buckle placement for primary retinal detachment using a modified external needle drainage technique. METHODS: Eighty-two eyes of 80 patients with primary retinal detachment underwent scleral buckle placement with modified external needle drainage. Preoperative, postoperative, and surgical data were collected. Regression analysis was used to evaluate the association between preoperative clinical data and number of surgeries. RESULTS: The retinal detachment most commonly involved 41% to 50% of the retina. Seventy-six eyes (92.7%) were repaired after 1 surgical procedure, 98.8%, after 2 procedures, and 100%, after 3 procedures. No preoperative clinical variables were found to be significantly correlated with the number of surgeries performed. Vision improved an average of 0.3 logarithm of the minimal angle of resolution or 3 lines of vision (P < 0.001). One eye (1.2%) developed a localized subretinal hemorrhage at the drainage site that resolved spontaneously. CONCLUSIONS: The modified external needle drainage technique used during scleral buckle placement appears to be safe and effective in patients with primary retinal detachment.     

下直肌牵引巩膜外垫压不放液手术治疗上方孔源性视网膜脱离

目的观察下直肌牵引及单纯巩膜外垫压不放液手术治疗上方孔源性视网膜脱离的临床效果。方法对上方孔源性视网膜脱离56例（56眼）术前进行下直肌缝线牵引制动，采用视网膜裂孔冷凝、巩膜环扎、外垫压及术中不放液的手术方法，对治疗结果进行分析。结果56例（56眼）经下直肌牵引制动3～5天后，52眼（92．86％）的视网膜脱离特别是上方球形脱离有明显消退，视网膜下液均有消散，其中28眼（50．00％）完全复位。53眼（94．64％）均行不放液术达到准确封闭孔源的目的。出院前治愈率为96．43％，未愈3．57％。结论下直肌缝线牵引制动可促进视网膜下液消退、平复，有利于术中裂孔准确定位、扣压位置适当，从而有效封闭裂孔。扩大了不放液手术适应范围，提高不放液手术成功率。     

Modified needle drainage. A safe and efficient technique of subretinal fluid drainage in scleral buckling procedure

PURPOSE: To compare modified needle drainage (MND) with conventional drainage (CD) of subretinal fluid (SRF) as described by Schepens in surgery for primary rhegmatogenous retinal detachment. METHODS: Prospective randomised clinical trial of 80 patients undergoing scleral buckling with subretinal fluid drainage for primary rhegmatogenous retinal detachment. In 40 patients modified needle drainage of subretinal fluid (SRF) was done using a perpendicular trans-scleral entry with a 26-gauge needle and the appearance of SRF in the hub of needle as end point. In 40 patients conventional drainage was done as described by Schepens using a diathermy needle. Adequacy of SRF drainage, intraoperative complications, anatomical and functional outcome were noted. RESULTS: 100% adequate drainage was achieved in all cases. The complication rate was 32.5% (n=13) in the CD group and 15% (n=6) in the MND group. In the CD group, 17.5% (n=7) patients had subretinal haemorrhage and in 2 eyes it was clinically significant. In the MND group 15% (n=6) of cases had subretinal haemorrhage and in one patient it was clinically significant. In the CD group, more serious SRF drainage complications were observed; these were absent in the MND group. CONCLUSION: Modified needle drainage is a safe and effective procedure for SRF drainage. In comparison with CD, MND is technically easy, less cumbersome and requires no special equipment.