三面镜联合显微镜直视下定位视网膜裂孔的临床观察

目的:探讨三面镜裂孔定位法联合显微镜直视下裂孔定位法在视网膜脱离外路显微手术中运用的疗效观察。方法:回顾性分析2007-10/2009-05因裂孔性视网膜脱离而做视网膜脱离外路显微手术的连续患者52例52眼(70个裂孔)。术前用三面镜检查确定视网膜裂孔距离角膜缘的直线距离和钟点位置,作为手术中指导硅胶填压在已发现裂孔对应巩膜上的依据,放液后在显微镜直视下更精确的定位裂孔并360°常规检查9～20mm以前的视网膜,处理变性区及新裂孔。结果:在52例52眼70个裂孔(包括术中发现的3个新裂孔及1个医源性孔)患者术后复诊观察,仅1例术后视网膜没有复位,因为该患者在三面镜及显微镜下都没有发现明显裂孔,仅仅处理了可疑变性区。还有1例为术后1mo因外伤视网膜脱离复发。术后视网膜脱离复位率达到了98%。结论:术前三面镜裂孔定位法联合术中显微镜下裂孔定位更准确,并可消除裂孔的漏诊,对周边的变性区可以进行预防性的冷冻处理,提高了手术的成功率及视功能的恢复,减少了视网膜脱离的复发。     

巩膜扣带术治疗陈旧性孔源性视网膜脱离

目的:观察巩膜扣带术治疗陈旧性孔源性视网膜脱离的疗效。方法:陈旧性孔源性视网膜脱离患者12例12眼,术前均在裂隙灯下用三面镜进行裂孔定位,术中均在显微镜下行巩膜扣带术,按术前裂孔的定位预置巩膜缝线,放出黏稠视网膜下液,冷凝封闭裂孔,预置缝线下植入硅胶,根据病情,部分患者植入环扎带,结扎缝线固定。术后随访,观察视网膜复位情况。结果:本组病例初次手术视网膜解剖复位率100%。结论:巩膜扣带术对于部分陈旧性孔源性视网膜脱离可以取得较好的效果。     

三面镜联合显微镜直视下裂孔定位的视网膜脱离手术

目的 探讨术前三面镜裂孔定位联合显微镜直视下裂孔定位法在视网膜脱离外路显微手术中运用的临床疗效观察.方法 回顾性分析2010-01/2011-05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45例45只眼.术前用三面镜检查确定视网膜裂孔位置和距离,作为手术中指导裂孔定位、术中放液和冷冻部位的的依据,放液后在显微镜下更精确的定位冷冻裂孔并360°常规检查周边部视网膜.硅胶局部垫压,随访6 ～18个月.结果 在45例45只眼中,一次手术视网膜完全复位42只眼(93.3％);矫正视力在0.3以上者31只眼,0.3以下14只眼;最终视力提高40只眼,不变3只眼,下降2只眼;无严重手术并发症;显微镜直视下裂孔定位准确不易遗漏,冷凝反应清晰可见.结论 术前三面镜裂孔定位法联合术中显微镜下裂孔定位更准确,操作简单,疗效可靠.     

角膜接触镜辅助的直视下显微巩膜扣带术

目的研究角膜接触镜辅助显微镜直视下巩膜扣带术治疗孔源性视网膜脱离的效果。方法回顾性分析2012年7月至2014年12月孔源性视网膜脱离连续病例40例（40只眼）的临床资料。患者均接受角膜接触镜辅助直视下显微巩膜扣带术。其中男26例,女14例。年龄13—87岁,平均（34．48±16．47）岁。病程3—180d,平均（36．20±4．80）d。术后随访1年。结果全组40例术中均能准确定位裂孔。术后视网膜复位39例,复位率97．50％。1例（2．50％）因视网膜下液呈凝胶样,致裂孔边缘不能与手术嵴贴附,改行玻璃体切除术。1例术中放液后发现视网膜新裂孔,术中及时准确定位和冷凝。无其它术中并发症。术后视力较术前明显提高（X^2=10．453,P=0．001）。结论角膜接触镜辅助直视下显微巩膜扣带术治疗孔源性视网膜脱离,术中视野清晰,能准确定位视网膜裂孔,冷凝和垫压程度准确,并发症少,视网膜复位良好。     

手术显微镜下的孔源性视网膜脱离手术

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131例(133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129只眼硅胶填压准确,视网膜复位良好,无异常炎症反应。结论手术显微镜直视下裂孔定位准确,操作简单,疗效确切。     

视网膜裂孔术中定位法

到目前为止眼科界公认视网膜裂孔是原发性视网膜脱离的原因,因此要治愈视网膜脱离必须将裂孔准确的定位,从而进行电凝、冷凝等以封闭裂孔。视网膜裂孔定位法分术前视野计定位法和术中定位法两种,而后者更为重要与手术成败有着密切的关系。现将几种术中定位方法讨论如下: (一)巩膜透热定位法:在手术中暴露裂孔所在象限的巩膜后,按照术前定位查明的子午线方向和角膜缘的距离,用两脚规和钢尺测量之,如裂孔距     

改良结膜切口行巩膜外垫压手术的临床观察

目的:探讨改良结膜切口行巩膜外垫压手术治疗视网膜脱离的可行性及效果。方法:2007-08/2008-04对30例30眼经术前仔细检查确定适合行单纯巩膜外垫压手术的孔源性视网膜脱离患者,术中先根据术前检查的裂孔位置,经结膜缝线预置裂孔所在象限的相邻两直肌牵引线,再行结膜外裂孔定位,根据裂孔位置行结膜切口,根据裂孔的形态、大小及方向,平行或垂直于角膜缘剪开该处球结膜及筋膜,充分暴露裂孔相对应的巩膜,再次巩膜外裂孔定位、标记,巩膜缝线硅海绵外加压块,检查眼底确保正确的孔嵴关系,连续缝合球结膜。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2～8mo。结果:所有患者手术过程顺利,结膜切口缝合后均呈直线状,长约1.0～1.8cm,切口最前端距离角膜缘0.8～1.4cm。手术后随访2～8mo,所有患者均未见发生垫压带暴露的情况。视网膜完全复位27眼,1眼手术后视网膜脱离未复位经二次外加压块调位术后视网膜复位,2眼术后复发,1眼经玻璃体手术后视网膜复位,1眼行巩膜外环扎外垫压而均获视网膜复位;手术后视力提高23眼,不变5眼,下降2眼。结论:改良结膜切口行巩膜外垫压手术治疗视网膜脱离不仅符合最小量手术原则,而且初步体现了尽量避免损伤角膜缘干细胞的切口设计思想,手术创伤小,术后视网膜复位率与以往常规结膜切口手术相同,是一种在临床上值得应用的手术方法。     

非外伤性巨大视网膜裂孔对侧眼临床观察

目的探讨非外伤性巨大视网膜裂孔对侧眼视网膜裂孔及视网膜脱离的发病因素，预防对侧眼发生巨大视网膜裂孔，提高对于对侧眼患病的认识。方法随访36例非外伤性巨大视网膜裂孔对侧眼，散瞳后用双目间接眼底镜及三面镜详查其眼底，观察并记录视网膜裂孔及周边视网膜变性，对于对侧眼不伴有视网膜脱离的视网膜裂孔行光凝或透过结膜的巩膜外冷凝术，对伴有视网膜脱离的视网膜裂孔行巩膜扣带术，对巨大视网膜裂孔行玻璃体视网膜手术。结果随访13～88个月(平均36．5个月)，对侧眼视网膜裂孔及视网膜脱离发生率为36．1％(13眼)，其中4眼(11．1％)发生了巨大视网膜裂孔。对侧眼平均屈光度为-7．00D( 1．50～-18．00D)，其中高度近视眼占57．6％(19眼)。周边视网膜变性发生率为72．2％(26眼)，其中12眼(33．3％)有格子样变性，9眼(25．0％)有不压变白。结论非外伤性巨大视网膜裂孔对侧眼是视网膜裂孔及视网膜脱离的高发眼。高度近视、格子样变性、不压变白是发生视网膜裂孔及视网膜脱离的高危因素。     

视网膜脱离裂孔定位的新方法——三点缝线顶压定位法的设计和实践

目的 探讨视网膜脱离裂孔定位新方法--三点缝线顶压定位法在基层陕院施行的效果.方法 31例(31眼)原发性视网膜脱离术中以三点缝线及顶压定位法行裂孔定位后做冷凝及巩膜扣带术,随访3～9个月观察其疗效.结果 31例中28例裂孔封闭视网膜贴附;1例因玻璃体机化条索牵引而使脱离未能复位,1例裂孔巨大未能封闭,1例术后45天再脱离.结论 以三点缝线顶压定位法进行视网膜脱离裂孔定位做冷凝封闭裂孔及扣带术,定位比较准确可靠,方法简单,适合基层医院应用.     

准分子激光原位角膜磨镶术后视网膜脱离分析

目的 探讨准分子激光原位角膜磨镶术(LASIK)后视网膜脱离的临床特征及治疗。方法 回顾性分析了我院收治的LASIK术后视网膜脱离17例，观察其临床特点及手术治疗方式及效果。结果 17例中圆形裂孔13例(76．47％)，17例中16例行单纯巩膜外加压或联合环扎术，一次手术视网膜解剖复位16例(94．12％)。术后视力较术前提高者13例(76．47％)，矫正视力≥0．4者7例(41．18％)。结论 LASIK术后视网膜脱离巩膜扣带术手术成功率高，手术难度不大。但术后可再次造成近视，因此预防LASIK术后视网膜脱离至关重要。     

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。     

孔源性视网膜脱离对侧眼无症状视网膜裂孔的预防性治疗

目的:探讨孔源性视网膜脱离患者的对侧眼无症状视网膜裂孔预防性激光光凝的疗效。方法:用三面镜和间接眼底镜观察孔源性视网膜脱离患者的对侧眼,对917例无症状视网膜裂孔进行预防性激光光凝术,记录其年龄、性别、屈光状态、晶状体的状态、对侧眼玻璃体状态、裂孔的类型和位置、预防性治疗的方法;术后随诊时间6mo～5a;记录术后视网膜和玻璃体的情况,视网膜新裂孔或视网膜脱离形成的例数,形成的时间和新裂孔发生时玻璃体的状态、新发生裂孔的类型和位置、治疗的方法。结果:孔源性视网膜脱离对侧眼裂孔发生的危险因素与年龄、性别、近视、部分玻璃体后脱离(posterior vitreous de-tachment,PVD)高度相关,裂孔以变性萎缩孔多见,马蹄孔次之;裂孔常发生的位置依次是颞上、颞下、鼻上、鼻下象限。术后发现对侧眼视网膜新裂孔或视网膜脱离形成共21例(2.3%),形成的时间平均为21.6mo(7d～3a),平均年龄41.3岁,15例(71.4%)为男性,全部为近视眼,其中16例(76.2%)高度近视(大于6.00D),全部为有透明晶状体眼,病变类型:15例(71.4%)为变性萎缩孔,6例(28.6%)为马蹄孔伴随广泛视网膜格子样变性(变性区大于6个钟点),术前部分PVD2例(9.5%),无明显的色素颗粒。新裂孔或视网膜脱离形成后,部分PVD伴色素颗粒18例(85.7%),全部均为马蹄形裂孔,马蹄孔伴后缘卷边2例(9.5%),9例(42.9%)新裂孔形成的位置位于激光光凝区的边缘,12例(57.1%)位于正常或未治疗的视网膜上,发展为视网膜脱离18例(85.7%),累及黄斑6例(28.6%),16例行视网膜裂孔冷凝联合巩膜环扎和外加压术,2例行玻璃体切除联合惰性气体填充术;单纯视网膜裂孔3例(14.3%),再次行氩激光光凝术,术后平均随访6mo。结论:孔源性视网膜脱离患者的对侧眼无症状视网膜裂孔预防性激光光凝疗效好;中青年高度近视不伴随PVD是对侧眼无症状视网膜裂孔光凝术后发生视网膜裂孔或视网膜脱离的高危因素;预防性激光治疗与玻璃体后脱离牵拉新裂孔形成有密切相关。     

A New Microsurgical Technique to Correct Retinal Detachment

Purpose: To evaluate the efficacy of a new technique to repair retinal detachments (RD) under the microscope. Methods : Thirty-six consecutive patients (36 eyes) who presented to our clinic with rhegmatogenous RD without severe proliferative vitreoretinopathy ( ≤C1) were included. The sutures for buckling and/or encircling bands were preplaced according to the preoperative location of the breaks using a three-mirror contact lens. Drainage of subretinal fluid, retinal cryotherapy, buckling, locating the retinal breaks, and intravitreal gases injection were performed under surgical microscopy. The surgical effects were compared with those in 37 consecutive patients with rhegmatogenous RD who underwent surgery under binocular indirect ophthalmoscopy. Results: The simultaneous intraoperative observation of fundus details and the sclera through the microscope was excellent in all cases. The effect of retinal cryotherapy was clearly visible. Mild opacity of the refractive media did not interfere with observing cryotherapy and locating the breaks. Retinal reattachment was obtained in 31 eyes (86%) during the primary surgery and in three eyes after a second surgery (94% total). The best-corrected visual acuity was <0.1 in 6 eyes (16.7%) , 0.1-0.4 in 15 eyes (41.7%) and ≥ 0.5 in 15 eyes (41.7%). The results were similar to that of RD surgery performed under indirect ophthalmoscopy. Conclusions : This microsurgical procedure to correct RD is simple, convenient, reliable, provides an upright image, and facilitates good recovery similar to conventional RD surgery.     

Preoperative laser photocoagulation to mark tiny retinal breaks in eyes with retinal detachment

We used preoperative argon laser photocoagulation to create a white intraretinal color change to mark the location of a tiny retinal break in an aphakic eye with rhegmatogenous retinal detachment. The break was visible only by fundus biomicroscopy with a three-mirror contact lens and could not be seen by indirect ophthalmoscopy. Intraretinal uptake of laser energy is accomplished with a small spot size and moderate energy levels. This technique facilitates rapid intraoperative identification and localization of small retinal breaks that are otherwise difficult to visualize.     

A New Microsurgical Technique to Correct Retinal Detachment

Purpose: To evaluate the efficacy of a new technique to repair retinal detachments (RD) under the microscope. Methods: Thirty-six consecutive patients (36 eyes) who presented to our clinic with rhegmatogenous RD without severe proliferative vitreoretinopathy (≤ C1) were included. The sutures for buckling and/or encircling bands were preplaced according to the preoperative location of the breaks using a three-mirror contact lens. Drainage of subretinal fluid, retinal cryotherapy, buckling, locating the retinal breaks, and intravitreal gases injection were performed under surgical microscopy. The surgical effects were compared with those in 37 consecutive patients with rhegmatogenous RD who underwent surgery under binocular indirect ophthalmoscopy.Results: The simultaneous intraoperative observation of fundus details and the sclera through the microscope was excellent in all cases. The effect of retinal cryotherapy was clearly visible. Mild opacity of the refractive media did not interfere with observing cryotherapy and locating the breaks. Retinal reattachment was obtained in31 eyes (86%) during the primary surgery and in three eyes after a second surgery(94% total). The best-corrected visual acuity was ＜0.1 in 6 eyes (16.7%), 0.1～0.4 in 15 eyes (41.7%) and ≥ 0.5 in 15 eyes (41.7%). The results were similar to that of RD surgery performed under indirect ophthalmoscopy.Conclusions: This microsurgical procedure to correct RD is simple, convenient,reliable, provides an upright image, and facilitates good recovery similar to conventional RD surgery.     

Biostatistical analysis of pseudophakic and aphakic retinal detachments

Removal of the crystalline lens increases the risk of rhegmatogenous retinal detachment (RD) by creating changes in the ocular environment that predispose to development of retinal breaks. The evolution of cataract surgery from intracapsular cataract extraction (ICCE) to extracapsular cataract extraction (ECCE) and phacoemulsification has reduced the incidence of RD, while advances in vitreoretinal surgery have resulted in improved outcomes when retinal detachment does occur. The incidence of RD varies between 0.4-3.6% for ICCE and between 0.55-1.65% for ECCE. In eyes having undergone phacoemulsification the incidence is similar to those of ECCE and ranges between 0.75-1.65%. In this article the authors review the incidence and risk factors associated with pseudophakic and aphakic RD. The risk factors discussed include pre-operative risk factors such as age, status of the fellow eye and myopia, and surgical risk factors such as vitreous loss, posterior capsular integrity and Nd : YAG capsulotomy.     

Biostatistical analysis of pseudophakic and aphakic retinal detachments

Removal of the crystalline lens increases the risk of rhegmatogenous retinal detachment (RD) by creating changes in the ocular environment that predispose to development of retinal breaks. The evolution of cataract surgery from intracapsular cataract extraction (ICCE) to extracapsular cataract extraction (ECCE) and phacoemulsification has reduced the incidence of RD, while advances in vitreoretinal surgery have resulted in improved outcomes when retinal detachment does occur. The incidence of RD varies between 0.4–3.6% for ICCE and between 0.55–1.65% for ECCE. In eyes having undergone phacoemulsification the incidence is similar to those of ECCE and ranges between 0.75–1.65%. In this article the authors review the incidence and risk factors associated with pseudophakic and aphakic RD. The risk factors discussed include pre-operative risk factors such as age, status of the fellow eye and myopia, and surgical risk factors such as vitreous loss, posterior capsular integrity and Nd : YAG capsulotomy.     

激光光凝辅助角膜原位磨镶术前眼底病变分析及治疗

目的探讨近视LASIK术前眼底病变及治疗方法.方法对385例(721只眼)LASIK术前患者行散瞳眼底三面镜检查并作详细眼底记录.结果发现各种视网膜变性136只眼(18.86%),视网膜干性裂孔16只眼(2.22%),亚临床视网膜脱离(RD)5只眼(0.69%).其中37只眼严重视网膜变性、16只眼干孔和4只眼亚临床RD行氩激光光凝治疗,仅1例亚临床RD需行视网膜脱离手术.结论近视LASIK术前及术后眼底常规检查和病变治疗是必要的.同时本文提出眼底病变光凝的指征.     

Scleral buckling technique without retinopexy for treatment of rhegmatogeneous: a pilot study

PURPOSE: To evaluate the role of retinopexy in the surgical management of primary rhegmatogenous retinal detachment (RD) without proliferative vitreoretinopathy. The primary outcome was retinal attachment, and secondary outcomes were visual acuity results and complications. METHODS: A randomized controlled trial including 60 patients with RD caused by a break or a group of breaks no larger than one clock hour. Thirty eyes received no retinopexy (group 1), and 30 eyes received transscleral cryotherapy (group 2). An encircling buckle was placed in all eyes. In eyes with posterior breaks, segmental buckles were also added. In some eyes, subretinal fluid drainage or anterior chamber paracentesis and/or intravitreal air bubble injection was performed. RESULTS: No differences were found between the groups in terms of the preoperative clinical variables evaluated: age; sex; axial length; lens status; type, number, and location of breaks; extension of detachment; and macula status. There were no differences in the surgical procedures performed. The reattachment rate in group 1 was 90%, and in group 2, it was 87% (a difference that was not significant [P = 1.00]). Final visual acuity improved by two lines or more in 22 patients in group 1 and in 20 patients in group 2 (P = 0.317). CONCLUSIONS: Our results indicate that primary rhegmatogenous RD can be successfully treated with scleral buckling without retinopexy.