硅油填充眼视网膜脱离的手术治疗

目的探讨硅油填充眼视网膜脱离的治疗方法。方法 回顾性分析解放军总医院2年来收治的硅油填充术后发生视网膜脱离32只眼行硅油取出,视网膜前膜剥离,视网膜切开,激光光凝和眼内C₃ F₈填充手术治疗的结果 。结果视网膜完全复位28只眼,复位率为87．5%,部分复位4只眼;术后视力提高12只眼,不变16只眼,下降4只眼;术后发生并发症6只眼;其中继发性青光眼3只眼,低眼压1只眼,前房积血2只眼。结论视网膜前膜剥离、视网膜切开、眼内激光光凝、C₃ F₈填充是治疗硅油填充眼视网膜脱离的有效方法。 (中华眼底病杂志,2001,17:214-215)     

硅油填充下牵引性视网膜脱离的手术治疗

目的总结硅油填充眼牵引性视网膜脱离在硅油下视网膜复位手术的疗效，探讨该手术的手术技巧及并发症的处理。方法观察19例(19只眼)硅油填充术后发生牵引性视网膜脱离患者，在保留硅油的条件下，做常规睫状体平坦部巩膜三切口，原灌注口接硅油灌注管，在导光纤维的导引下行膜剥离、视网膜增殖疤痕切开松解、内排液、补充硅油、眼内光凝等手术使视网膜复位的手术治疗。结果19只眼中，术后视网膜基本复位，术后发生一过性高眼压14例，前房、玻璃体出血2例，视网膜创伤疤痕增殖病灶过大，周边局部牵引性脱离复发2例。结论有硅油眼牵引性视网膜脱离在硅油填充下的膜剥离松解手术，具有方法简便、节省时间、剥膜止血容易等优点，是严重增殖性复发性视网膜脱离手术最终获得成功的关键过程。     

硅油填充眼复发视网膜脱离的再手术治疗

目的 探讨硅油填充眼复发视网膜脱离的原因、手术方式选择及临床疗效。方法 对24例（24只眼）硅油填充术后复发视网膜脱离的患者再手术眼进行回顾性分析。结果 9只眼选择视网膜冷凝联合扣带术,7只眼视网膜复位;15只眼选择硅油取出、剥膜、再次眼内填充术,其中视网膜切开达4个象限2只眼,3个象限1只眼,2个象限2只眼,局部松解性切开3只眼,10只眼视网膜复位。结论 增生膜的形成是硅油填充眼复发视网膜脱离的主要原因,但只要根据视网膜裂孔及增生膜情况遗择适当的手术方式,仍可取得较为理想的疗效。     

玻璃体视网膜手术治疗复发性视网膜脱离

目的：探讨玻璃体视网膜手术治疗复杂性视网膜脱离的效果。方法：应用玻璃体切割联合剥膜、视网膜切开、重水注入、眼内激光光凝、气液交换眼内气体C3F8或硅油充填术治疗42例各种复杂性视网膜脱离进行回顾性分析。结果：随访2-28月，解剖性复位33只眼（78.6%），视力≥0.02的功能性成功31只眼（73.8%），术中并发症眼内出血2只眼，医源性裂孔5只眼，重水进入视网膜下1只眼，术后并发高眼压3只眼，角膜变性混浊1只眼。结论：玻璃体视网膜手术是治疗复杂性视网膜脱离的理想的有效方法。彻底地剥膜，正确并有技巧的应用重水，选择合适的玻璃体腔填充物及避免并发症发生是手术成功的关键。     

单纯巩膜扣带术治疗硅油填充眼视网膜脱离

目的　探讨单纯巩膜扣带术治疗硅油填充眼复发性视网膜脱离的临床疗效。方法　选取我院行玻璃体切割联合眼内硅油填充术后复发性视网膜脱离 2 1例 2 1眼 ,采用单纯巩膜扣带术 ,术中放出少许硅油调整至正常眼压。结果2 0眼视网膜复位 ,1眼 2月后视网膜脱离复发 ,行硅油取出、膜剥离再次硅油填充术后视网膜复位。 2 1例最终视力较术前提高 ,随访 3～ 2 4个月 ,视网膜复位好。结论　单纯巩膜扣带术治疗硅油填充眼视网膜脱离中的部分病例具有一定价值 ,特别是对未合并广泛前部和 (或 )后部增生性视网膜病变的下方象限或周边部裂孔引起的视网膜脱离有较好的治疗效果 ,不一定需再行玻璃体切割术     

重硅油玻璃体腔充填治疗复杂性视网膜脱离的临床研究

目的 评价重硅油作为眼内填充剂治疗复杂性视网膜脱离的有效性和安全性.方法 采用标准的玻璃体切割联合重硅油Oxane HD充填术治疗复杂性视网膜脱离患者13例13只眼,术中根据病情联合白内障摘除、巩膜环扎、增殖膜剥除、视网膜切开、重水压平视网膜行眼内激光光凝等.观察重硅油充填期及取出后术眼的最佳矫正视力、视网膜解剖复位情况、手术后并发症等.结果 重硅油充填期平均为93d,取出后平均随访170d.13只眼中有12只眼最佳矫正视力提高,1只眼视力无改善.有10只眼在眼内充填重硅油至取出后保持稳定的视网膜复位至随访结束.术后主要并发症包括轻至中度的眼压升高、眼前段炎症反应、晶状体混浊、增殖膜形成和硅油乳化等.结论 重硅油Oxane HD作为眼内填充物可以有效安全地治疗复杂性视网膜脱离,尤其是伴下方或后极部裂孔的视网膜脱离.     

硅油下视网膜复位术疗效探讨

目的 总结硅油填充术后视网膜再脱离行硅油正视网膜复位术的疗效,探讨该手术的适应证及手术技巧。方法 对１７例（１７只眼）硅油填充术后视网膜再脱离者,在保留硅油的条件下,做睫状体扁平部３切口,在导光纤维的导引下行剥膜、断膜、视网膜切开、内放液、内激光光凝、视网膜下全氟化碳液体取出、补充硅油等使视网膜得位。结果 １７只眼中,术后视网膜重位１４只眼,成功率为８２．４％。术中硅油误入前房１只眼,误入脉络膜上     

玻璃体视网膜手术治疗复杂性视网膜脱离

目的　探讨玻璃体视网膜手术治疗复杂性视网膜脱离的效果。方法　应用玻璃体切割联合剥膜、视网膜切开、重水注入、眼内激光光凝、气液交换眼内气体 C3F8或硅油充填术治疗 4 2例各种复杂性视网膜脱离进行回顾性分析。结果　随访 2～ 2 8月 ,解剖性复位 33只眼 (78.6 % ) ,视力≥ 0 .0 2的功能性成功 31只眼 (73.8% ) ,术中并发症眼内出血 2只眼 ,医源性裂孔 5只眼 ,重水进入视网膜下 1只眼 ,术后并发高眼压 3只眼 ,角膜变性混浊 1只眼。结论　玻璃体视网膜手术是治疗复杂性视网膜脱离的理想的有效方法。彻底地剥膜 ,正确并有技巧的应用重水 ,选择合适的玻璃体腔填充物及避免并发症发生是手术成功的关键     

高度近视黄斑裂孔性视网膜脱离的再次手术

目的 评价高度近视黄斑裂孔性视网膜脱离再次手术的治疗效果。方法 对需再次手术的黄斑裂孔性视网膜脱离17例17眼，其中11例是第1次经玻璃体切割联合膨胀气体填充后黄斑裂孔未闭合，6例是黄斑裂孔闭合后晚期复发的患者行玻璃体切割，彻底黄斑前膜剥离，2例行视网膜内界膜剥离，全部病例联合硅油内填充，11例术后补充氩激光光凝。结果 17例17眼黄斑裂孔闭合，视网膜全部复位，最终视力较术前提高。随访3—24个月，视网膜复位良好，无1眼复发。结论 黄斑裂孔性视网膜脱离再次手术中彻底剥离黄斑前膜，剥离视网膜内界膜，硅油填充和激光光凝可有效封闭黄斑裂孔。     

玻璃体切除和硅油填充手术后视网膜再脱离及其治疗

目的：探讨玻璃体切除和硅油填充手术手视网膜再脱离的治疗。 方法：回顾总结增殖性玻璃体视网膜病变（proliferative vitreorinapthy PVR）5例5只眼和外伤性PVR3例3只眼的视网膜脱离手术后再脱离的治疗效果。治疗方法为经睫状体平坦部闭合式玻璃体切除、膜剥离、视网膜切开、内排溶剂化物、硅油填充，2只眼加视网膜下膜剥离取出。 结果：术后视网膜解剖复位6只眼，2只眼下方仍有浅脱离，术后视力提高6只眼，不变2只眼。 结论：视网膜再脱离的原因与增殖性视网膜前膜和下膜形成有关，治疗原则为玻璃体切除、解除增殖膜的牵引和充分地液/油交换. （中华眼底病杂志，1996，12：13-15）     

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)     

Transscleral diathermy: an additional tool in the management of retinal detachment due to posterior breaks in highly myopic eyes

PURPOSE: To investigate the usefulness of transscleral diathermy for the treatment of retinal detachment due to breaks located at the posterior pole in areas of advanced chorioretinal atrophy or staphyloma in highly myopic eyes. METHODS: We reviewed the charts of seven consecutive patients who were operated on between 1984 and 1994 and for whom transscleral diathermy was used during intraocular retinal reattachment surgery to reduce posterior staphyloma. Mean refraction of the seven eyes was -24 diopters (range -16 to -35 diopters). RESULTS: After surgery, which included diathermy, the retina was reattached in six eyes (86%) that also had undergone vitrectomy and silicone oil tamponade, but remained detached in one eye (14%) that had undergone pneumopexy and diathermy; in this eye, the retina was subsequently reattached after vitrectomy and silicone oil injection. Silicone oil was removed from all seven eyes after a mean duration of 2.5 months. During a mean follow-up of 3 years, a recurrent retinal detachment developed in one eye 8 months after silicone oil removal. This retina was reattached after reinjection of silicone oil. CONCLUSIONS: In the treatment of retinal detachment in highly myopic eyes, closure of posterior holes in areas of advanced chorioretinal atrophy or staphyloma can be achieved by transscleral diathermy in conjunction with vitrectomy and temporary silicone oil tamponade. The main benefit of transscleral diathermy results from its posterior pole scleral buckling effect due to shrinkage of the sclera.     

Extended retinal tamponade in the treatment of retinal detachment with proliferative vitreoretinopathy.

We have used intraocular sulphur hexafluoride or liquid silicone as an adjunct to vitreous surgery in the treatment of a non-randomised sequential series of 19 eyes with retinal detachment complicated by proliferative vitreoretinopathy. We have studied the surgical results and complications of these two tamponades and drawn preliminary conclusions on their use in retinal reattachment surgery. After a seven-month minimum follow-up 13 (68%) of the eyes have reattached retinas. Six (60%) of 10 eyes treated only with silicone have reattached retinas, and four (67%) of six eyes treated only with sulphur hexafluoride gas tamponade have reattached retinas. An additional three eyes treated initially with silicone oil subsequently developed retinal detachments; all were successfully reattached with sulphur hexafluoride tamponade after silicone oil removal. Intraoperative pneumatic retinal reattachment to assess relief of retinal traction combined with the production of widespread chorioretinal adhesions to wall off persistent anterior traction and detachment, as well as extended postoperative gas tamponade of the retina, appears to enhance the surgical results in retinal detachment complicated by proliferative vitreoretinopathy. Silicone oil tamponade of the retina appears to be useful in cases where retinal traction cannot be entirely relieved and in patients who are unable to tolerate the head positioning required for effective gas tamponade of the retina. A controlled clinical study recently begun will be required to define further the precise role of these methods of retinal tamponade.     

预期眼硅油取出术后视网膜再脱离的危险因素

目的:探讨预期眼硅油取出术后视网膜再脱离的临床危险因素。方法:回顾性分析临床资料。入选病例(104例,105只眼)符合以下条件:因复杂的孔源性视网膜脱离、行玻璃体切割联合硅油填充术;硅油眼内填充期间视网膜复位良好;预期将硅油取出;手术由同一术者完成。结果:硅油取出术后平均随访310d,视网膜完全平复94只眼,再脱离11只眼,总复发率为10.4%。无晶状体眼术后视网膜脱离复发率为21.1%(8/38),明显高于有晶状体眼(包括人工晶状体眼)(4.5%)(OR5.69,P<0.05)。术后视网膜再脱离与术前巨大裂孔、增生性玻璃体视网膜病变(PVR)-C3级以上、有视网膜脱离手术失败史、高度近视等因素无显著相关性(Ps>0.05)。硅油取出前予以预防性360°光凝治疗的77只眼中4只眼(5.2%)再脱离,优于非光凝治疗组(OR0.16,P<0.05)。结论:无晶状体眼可能是硅油取出术后视网膜再脱离的危险因素;硅油取出前行预防性360°视网膜光凝治疗可有效防止再脱离。     

双通道27G玻璃体切除术治疗硅油填充眼复发性视网膜脱离

目的:研究双通道27G玻璃体切除术在硅油填充状态下治疗复发性视网膜脱离的可行性及优缺点.方法:回顾性研究.7例硅油填充眼在随访时发现下方视网膜浅脱离.在硅油填充状态下行双通道27G玻璃体切除术.术中完成视网膜表面增殖膜剥离、视网膜下液抽吸,并在视网膜复位后行硅油下视网膜激光光凝术,根据患眼病情辅以巩膜外垫压或环扎.结果:术后所有患眼视网膜均成功复位,术中未发生严重并发症.所有患眼术后眼表反应轻且视力迅速恢复至术前水平.1眼在术后20d出现视网膜再脱离,经传统的硅油取出联合视网膜复位术成功复位视网膜.结论:双通道27G玻璃体切除术是一个治疗硅油填充眼早期视网膜再脱离的有效方法,可能具有更高的性价比.     

Retinal redetachment after removal of intraocular silicone oil tamponade

AIM: To evaluate frequency and risk factors of retinal redetachment after removal of intraocular silicone oil tamponade. METHODS: The study included 225 patients who consecutively underwent intraocular silicone oil removal at a mean interval of 10 months after pars plana vitrectomy had been performed by one of two surgeons. Mean follow up time was 17.37 (SD 14.40) months (range 3.02-67.42 months). RESULTS: In 57 of 225 (25.3%) patients, the retina detached after removal of silicone oil. Risk factors for retinal redetachment were the following: number of previously unsuccessful retinal detachment surgeries (p=0.0008); surgeon (p=0.007); visual acuity before silicone oil removal (p=0.009); incomplete removal of vitreous base (p=0.01); absence of an encircling band in eyes with proliferate vitreoretinopathy in which an inferior retinotomy had not been performed (p=0.01); and indication for pars plana vitrectomy. Rate of retinal redetachment was statistically (p>0.05) independent of the technique of silicone oil removal and duration of silicone oil endotamponade. CONCLUSION: Retinal redetachment after removal of silicone oil endotamponade can occur in approximately a fourth of patients, depending on the criteria to use and to remove silicone oil. Risk factors for recurrent detachment included the following: number of previously unsuccessful retinal detachment surgeries, surgeon, preoperative visual acuity, incomplete removal of the vitreous base, absence of an encircling band, and reason for pars plana vitrectomy. The rate of retinal redetachment is independent of the technique of silicone oil removal and duration of silicone oil endotamponade, with a minimal duration of silicone oil tamponade of about 3 months in the present study.     

Combined 5-fluorouracil, low-molecular-weight heparin, and silicone oil in the management of complicated retinal detachment with proliferative vitreoretinopathy grade C.

BACKGROUND AND OBJECTIVE: To determine whether combined 5-fluorouracil (5-FU) and low-molecular-weight heparin (LMWH) could improve the outcome of vitreoretinal surgery with silicone oil for the management of complicated retinal detachment with proliferative vitreoretinopathy (PVR) grade C. PATIENTS AND METHODS: In an interventional, controlled, nonrandomized clinical trial, 33 eyes with complicated retinal detachment and PVR underwent vitrectomy with silicone oil and perioperative infusion of 5-FU and LMWH (study group) and 31 eyes underwent vitrectomy with silicone oil without adjunctive medication (control group). RESULTS: In the study group, 24 eyes (72.7%) had the retina attached and 9 had a retinal redetachment (27.3%) at 6 months. In the control group, 25 eyes (80.6%) had the retina attached and 6 eyes (19.4%) had a retinal redetachment at 6 months (chi-square: 0.53, P > .05). One-year postoperative data were available for 17 eyes in the study group and 19 eyes in the control group. Four eyes in each group (23.5% and 21%, respectively) developed retinal redetachment (chi-square: 0.03, P > .05). CONCLUSIONS: Combined 5-FU and LMWH does not seem to improve the outcome of vitreoretinal surgery with silicone oil for the management of complicated retinal detachment with PVR grade C.     

视网膜脱离合并脉膜脱离的手术治疗

目的：探讨视网膜脱离合并脉膜脱离的手术方法、效果及失败原因,全部眼有脉络膜脱离和增殖性玻璃体视网膜病变（VR）,采用玻璃体切割及视网膜前膜,眼内惰性气或硅油填充。结果：31例患视网膜全部复位者22例（70．9％）部分复位5例（16．1％）,未复位4例（12．9％）。25眼和有增进,5眼无变化,1眼下降。手术失败的主要原因可能与严重的前部PVR有关,结论：伴有脉膜脱离的视网膜脱离患者采用VR手术,可提高其手术成功率。