先天性青光眼术后视网膜脱离的手术治疗

目的 探讨先天性青光眼术后视网膜脱离的病因、临床特点及手术效果.方法 对8例(8眼)先天性青光眼术后视网膜脱离行平坦部闭合式玻璃体切除联合视网膜切开、剥膜、硅油充填等治疗.术后观察视力、眼压、视网膜复位情况及并发症.结果 随访6～24个月,视力提高4眼(50％),不变3眼(37.5％),下降1眼(12.5％);眼压正常(10～21mmHg)者5眼(62.5％),使用前房穿刺联合降压药物后,眼压正常者2眼(25.0％),经药物及睫状体光凝术后,眼压正常者1眼(12.5％);7眼首次手术后视网膜复位(87.5％),1眼二次手术后视网膜复位(12.5％);8眼手术均无严重并发症发生.结论 先天性青光眼术后视网膜脱离的病情复杂,玻璃体切除联合视网膜切开有助于视网膜复位,提高视功能,控制眼压的稳定.     

视网膜脱离伴发青光眼

本文报道９７例（１０３眼）视网膜脱离伴发青光眼，其中原已有明确诊断青光眼病史、抗青光眼手术史的视网膜脱离２１例（２５眼）。视网膜脱离合并葡萄膜炎继发青光眼３例。视网膜脱离术后继发青光眼７０例（７２眼）。视网膜脱离与青光眼交替发病型３例。并重点讨论了各类型的临床特点，发病机理及治疗。     

先天性白内障术后视网膜脱离的手术治疗

目的 探讨先天性白内障术后视网膜脱离的特点及手术方法。 方法 对42例先天性白内障患者44只白内障术后孔源性视网膜脱离眼的临床资料进行回顾分析,比较不同的视网膜脱离手术方法治疗后的效果。先天性白内障术后发生视网膜脱离平均间隔时间为14.8年。绝大多数白内障手术为吸出术并有后囊膜切开史 ;多数瞳孔不能散大并有后发性白内障形成。16只眼曾测眼轴,平均轴长(26.80±1.90) mm。视网膜脱离手术前裂孔发现率仅43.2%。 结果 巩膜手术成功率80.3%,玻璃体手术成功率85.7%。 结论 先天性白内障术后发生视网膜脱离间隔时间长;因瞳孔因素,周边眼底检查困难,巩膜手术成功率低,玻璃体手术是较理想的手术方式。 （中华眼底病杂志,2000,16：71-138）     

黄斑裂孔性视网膜脱离的手术治疗

目的 探讨黄斑裂孔性视网膜脱离的术式选择及与疗效的关系。方法 经单纯注气术,巩膜环扎注气术、冷凝环扎注气术治疗１５例黄斑裂孔视网膜脱离。结果 经不同术式手术治疗,１５例１５眼均获得了较满意的近期疗效。结论 对黄斑裂孔性视网膜脱离的手术治疗,应根据病情选择术式,最大可能避免黄斑部进一步损伤,从而提高有限的中心视力。     

后部先天性视网膜皱襞伴视网膜脱离

后部先天性视网膜皱襞伴视网膜脱离西安市第四医院眼底病研究室石一宁铁道部第一工程局西安中心医院眼科雷功祖我们自１９９１年６月－１９９５年１２月间遇到４例先天性视网膜皱襞伴视网膜脱离，并进行了玻璃体切除及视网膜复位术。因与以往国内报告的临床表现不完全相同...     

伴视网膜后膜的视网膜脱离及手术治疗

伴视网膜后膜的视网膜脱离及手术治疗西安市第四医院眼底病研究室石一宁，王煊，延琼视网膜后膜的临床表现及其病理作用以往常不被人们所关注。随着玻璃体手术的开展，这种增殖性玻璃体视网膜病变（ＰＶ）的特殊表现正逐渐被人们认识Ｎ＂．我们采用单纯的巩膜扣带术联合局...     

不放液手术治疗视网膜脱离

介绍３０例在门诊不放液治疗视网膜脱离手术方法要点和结果。手术成功率为９６．７％。讨论了不放液手术视网膜复位原理、优点及其适应证。     

巨大裂孔视网膜脱离的手术治疗

目的：探讨针对不同条件的巨大裂孔视网膜脱离如何采取更为有效的手术方案。方法：回顾2000年1月～2001年8月间我院手术治疗的巨大裂孔视网膜脱离37眼，其中单纯型6眼，复杂型31眼，手术采用环扎加压和玻璃体手术。结果：37眼手术后平均6月总的视网膜解剖复位率为81．1％，单纯型100％，复杂型77．4％，膜形成Ⅰ～Ⅱ级的复位率为96％，Ⅲ级以上的复位率为50％，术后视力改善不明显。结论：首选完善的玻璃体手术治疗单纯型比环扎加压术更有效：复杂型首选玻璃体手术；全氟碳液应选择病例使用；在眼内条件尚可的情况下，适宜首选全氟化碳气体填充；环扎加压术适合作为补充治疗方法使用；充分利用冷凝和激光封闭裂孔十分关键；严密细致的术后观察和补充治疗有决定性的作用；PVR是导致手术失败和复发的主要原因。     

儿童巨大裂孔视网膜脱离的手术治疗

目的 探讨儿童巨大裂孔视网膜脱离的手术特点。方法 观察10例10眼儿童巨大裂孔视网膜脱离患者的手术方法及其疗效、预后。结果 9眼应用玻璃体切割手术,其中7眼术中应用过氟化碳展平后瓣,3眼术后玻璃体腔充硅油,4眼未结合环扎加压。术后1眼由于周连视网膜严重PVR、1眼裂孔未封,视网膜再次脱离。结论 儿童巨大裂孔视网膜脱离首选玻璃体切割术、环扎加压适当放松;术中应用过氟化碳有非常重要作用,术后玻璃体腔填充物选择硅油最合适。     

先天性白内障术后视网膜脱离

目的 :探讨先天性白内障术后视网膜脱离的特点、治疗效果及其影响因素。方法 :回顾分析 2 7例 2 7只眼先天性白内障术后视网膜脱离的临床资料。结果 :视网膜完全复位 2 0只眼 ,占 74 1% ;限局脱离 4只眼 ,占 14 8% ;完全脱离 3只眼 ,占 11 1%。术后视力 0 0 2以下者 8只眼 ,占 2 9 6% ;0 0 2～ 0 0 4者 6只眼 ,占 2 2 2 % ;0 0 5～ 0 0 9者 7只眼 ,占 2 5 9% ;0 1者 3只眼 ,占 11 1% ;0 2者 3只眼 ,占 11 1%。结论 :先天性白内障术后视网膜脱离经手术治疗可以取得较好的效果。增生性玻璃体视网膜病变 (PVR) ,尤其是前部增生性玻璃体视网膜病变 (aPVR)是影响手术预后的主要原因。     

睫状体脉络膜脱离与恶性青光眼

目的 讨论抗青光眼术后睫状体脉络膜脱离与恶性青光眼的关系。方法 回顾性总结我两 小梁切除术后睫状体脉络膜脱离并发恶性青光眼８例８只眼。结果 ８只眼均于术后１月内出现扁平前房,周边虹膜与角人皮相贴眼压２４￣５０ｍｍＨｇ,平均２９．５ｍｍＨｇ,其中７只眼行脉络膜上腔放液＋前房注气术,１眼行白内障囊外摘出＋人工晶状体植入＋脉络膜上腔放液术,术中８眼均于脉络膜上腔放出淡黄色液体,术后前房加深 ,眼压降至正     

屈光手术后视网膜脱离

屈光手术为屈光不正患者视力的维持或改善提供了有效的治疗途径，但术后也可发生视网膜脱离，尽管其发生原因尚不安全明了，但这种并发症发生率较低，并且视网膜手术复位率高。本文就角膜，晶状体屈光手术后视网膜脱离研究进展进行了综述。     

Retinal detachment after cataract surgery

Background: A study of the characteristics and the results obtained in 99 consecutive eyes operated on for rhegmatogenous retinal detachment associated with aphakia or pseudophakia in order to find the predictive factors of poor anatomical and functional results. Methods: The authors retrospectively reviewed the files of 99 consecutive cases of aphakic and pseudophakic retinal detachment operated on by the same surgeon between January 1992 through July 1993 with a minimum follow-up of 6 months. Multivariate and chi square analysis were carried out. Results: Of the pseudophakic eyes, 25 had an anterior chamber lens and 48 had a posterior chamber lens. The posterior capsule was disrupted using a Yag laser in 58% of those with an posterior chamber lens but only 14% of them developed detachment within 6 months. The rate of vitreous loss was 27% with 5% in case of intracapsular extraction, 31% in case of extracapsular extraction and 54% in case of phacoemulsification. PVR was present in 30% of the patients and 51% of detachments occurred more than 24 months as a mean after cataract surgery. The overall anatomic reattachment rate was 88% with no significant difference between the aphakic and the pseudophakic patients, either with an anterior chamber of posterior chamber lens. Visual results were significantly worse in the anterior chamber lens group and in the aphakic eyes (P < 0.02). Negative prognostic indicators for reattachment included poor preoperative vision, extension of the retinal detachment to the macula (P < 0.05) and grades B, C or D proliferative vitreoretinopathy (P < 0.01). In addition to the above factors, eyes with vitreous loss, anterior chamber lens, aphakia and a larger extent of the retinal detachment had a poor visual outcome. Conclusion: Most aphakic or pseudophakic retinal detachment can now be reattached with either scleral or vitreo retinal surgery. The main difficulties are the localisation of the breaks and the treatment of PVR. Indirect ophthalmoscopy associated with vitrectomy does well in cases of an opacified posterior capsule. In cases of severe PVR long term internal tamponade either with C3F8 or silicone oil improves anatomical results but the functional results remain inferior.     

Rhegmatogenous retinal detachment associated with primary congenital glaucoma

Background The development of rhegmatogenous retinal detachments (RRDs) in eyes with a history of congenital glaucoma (CG) is very rare. We present the characteristics and surgical outcomes of three cases with a RRD who had CG and had undergone surgery many years earlier. Cases Three men, ages 14, 43, and 48 years of age, each with a history of surgery for primary CG, presented with a RRD. All of the eyes were highly myopic. The retinal tears were located at the equator in all cases. The degree of RRD were superior half, total, and total (proliferative vitreoretinopathy). Observations Vitrectomy was performed and the retinas were reattached in all cases. However, the visual acuity in all cases remained poor. Conclusions Our findings indicate that a posterior vitreous detachment due to advanced vitreous liquefaction in the highly myopic eyes may have been the cause of the RRD. We recommend periodic fundus examinations in patients with CG, because while the RRD in patients with CG can be reattached the functional recovery may not be good.     

Retinal detachment and infantile-onset glaucoma in Stickler syndrome associated with known and novel COL2A1 mutations

Background: Few reports on surgical outcomes after retinal detachment in Stickler syndrome exist. Also, infantile-onset glaucoma associated with Stickler syndrome has been rarely reported and no reports exist that examine outcomes after glaucoma surgery. This study describes the clinical and genetic associations and the long-term outcomes of retinal detachment repair or glaucoma surgery in patients with Stickler syndrome.

Materials and Methods: Retrospective, single-center, case series of patients with Stickler syndrome. Demographics, clinical features, genetic mutations, and long-term surgical outcomes of eyes that experienced retinal detachment or diagnosed with infantile-onset glaucoma were assessed.

Results: Fifteen patients were identified with a mean age of 13 years at presentation and followed for a mean of 6 years. Two-thirds were male. Genetic analysis was performed as part of routine examination in nine patients from eight families. All were identified as having variants in COL2A1, three of which were novel. Six eyes of six patients experienced retinal detachment. Fifty percent of eyes without prophylactic laser treatment experienced retinal detachment, whereas only 5% of eyes that underwent prophylactic therapy detached. Despite surgical intervention for retinal detachment, five eyes became phthisical. Five eyes of three patients were diagnosed with infantile-onset glaucoma. All five eyes required multiple glaucoma surgeries, and three eyes became phthisical.

Conclusions: This study illustrates the surgical challenges encountered in patients with Stickler syndrome. Additionally, infantile-onset glaucoma may be more prevalent than previously reported and presents a challenge in terms of management. A multidisciplinary approach is recommended to provide optimal care to these patients.     

Marfan综合征伴孔源性视网膜脱离

目的：分析Marfan综合征伴孔源性视网膜脱离眼发病特征与治疗原则。方法：回顾并随访了1998年至2001年间上海市第一人民医院进行视网膜脱离手术治疗的10例12眼。结果：平均随访5．2个月，总的视网膜解剖复位率83．3％(10／12)，其中只作巩膜外手术7眼，复位率100％，玻璃体手术5眼，复位率60％。视力提高7眼(58．3％)。结论：仔细采用多种方法检查可以提高术前裂孔检出率。经巩膜环扎加压手术可以有效处理简单视网膜脱离眼，而毋实施玻璃体手术联合晶体摘除术。治疗中需加倍警惕对侧眼病变。     

Glaucoma following retinal detachment operations

After retinal detachment operations 1–5% of the patients develop glaucoma. If this occurs directly after the operation it is the result of mechanical narrowing of the chamber angle.This can be the result of indentation due to an exoplant or encircling band causing forward displacement of the lens/iris diaphragm. Other causes are torsion of the ciliary body or a ciliary block due to serous detachment of the choroid caused by venous compression or diathermy.Ischaemia of the anterior segment sometimes leads to glaucoma in the long run; this is then the result of rubeosis iridis. Conducive factors are detachment of the recti muscles, arterial and venous compression by the exoplant or encircling band and the use of diathermy. When performing such operations it is advisable to take these risks into account and to keep a check on the intraocular pressure after the operation.A patient is described who, as the result of ischaemia, eventually developed ribeosis iridis with neovascular glaucoma, leading to loss of the eye.     

伴脉络膜脱离的孔源性视网膜脱离复位术

目的 探讨伴脉络膜脱离孔源性视网膜脱离的手术方法。方法 术前不用糖皮质激素治疗。以低眼压，视网膜下液少为手术时机不放液手术。结果 手术一次性复位率91.66%，裂孔封闭后炎症消退，玻璃体改善，眼压回升，视力提高。结论 术前不同糖皮质激素治疗。有利于不放液手术和术中顶压找孔，缩短了术前等待的时间。     

准分子激光原位角膜磨镶术后视网膜脱离

目的：分析LASIK治疗近视术后发生视网膜脱离的临床特征和处理原则。方法：回顾性分析LASIK术后发生视网膜脱离的3只眼（3例患者）。结果：术前平均屈光度（等值球间，下同）为－9．3D（范围－7．37－－11．50D）。LASIK与网脱发生的间隔时间为0．5－26个月（平均11．8个月）。视网膜裂孔类型和数目：1例为马蹄形，1个；1例为锯齿缘断离；1例为小圆形裂孔，3个，裂孔位置；3例均在赤道部前方，3例通过一次手术后即成功复方。结构：具有视网膜病变的高度近视病在LASIK术后易发生视网膜脱离。