玻璃体替代物的研究进展

复杂的玻璃体视网膜手术中,常常需要玻璃体替代物支撑玻璃体腔、维持眼内压.气体、膨胀气体、全氟化碳液体、硅油是现代玻璃体视网膜手术中常用的玻璃体替代物,胶原、透明质酸、水凝胶等被尝试用作长期的玻璃体替代物.理想的人工玻璃体一直是研究的热点.本文就目前应用的以及仍处于实验阶段的玻璃体替代物进行综述,根据其功能、构成及特性进行分类,并讨论它们的临床应用及优缺点,同时定义理想人工玻璃体的标准.     

玻璃体替代物在玻璃体视网膜疾病中的应用研究进展

玻璃体替代物是玻璃体-视网膜手术中用于治疗视网膜疾病（如复杂的视网膜脱离、黄斑裂孔、糖尿病视网膜病变的并发症以及后段眼外伤）的玻璃体内填塞剂。在玻璃体切除治疗视网膜脱离的手术中,术者需在玻璃体切除后在玻璃体内填充玻璃体替代物,以使脱离的视网膜重新附着。但目前临床上可用的玻璃体替代物仅能做到短期维持。尽管研究人员进行了多年的深入研究,但仍未找到理想的玻璃体替代物。本综述列举了临床上需要应用玻璃体替代物的眼部疾病,并从临床和科研两个角度总结了现有玻璃体替代物的临床应用和研究进展。其中,聚合物水凝胶由于其具有良好的生物相容性,并且和天然玻璃体具有相似的物理性质,被认为是人工玻璃体替代物的未来,尤其是热敏智能水凝胶,最有可能成为理想的玻璃体替代物。     

Anterior segment complications related to vitreous substitutes

Vitrectomy is the most common surgical technique performed in eyes with vitreoretinal disease. The development and widespread use of vitreous substitutes has revolutionized vitreoretinal surgery and improved anatomic and visual results. The three most common types of vitreous substitutes available in North America include silicone oil, intraocular gas, and perfluorocarbon liquid. Each of these agents has unique properties, allowing completely different roles of the agents in vitreoretinal surgery. The physical properties, clinical indications, and potential complications of these agents are described.     

Anatomical findings of vitreoretinal interface in eyes with asteroid hyalosis

Purpose  To investigate the anatomical features of vitreoretinal interface in eyes with asteroid hyalosis (AH) with optical coherence tomography (OCT) and intravitreal triamcinolone acetonide (TA) during vitreous surgery. Methods  This study was an interventional clinical case series. Records relating to ten eyes from ten patients who underwent a TA-assisted vitrectomy for the treatment of diverse vitreoretinal diseases complicated with AH. The posterior vitreoretinal interface was examined by preoperative OCT and by intraoperative visualization of posterior vitreous cortex utilizing TA. Results  In eight of ten AH eyes, preoperative OCT revealed abnormal vitreoretinal adhesions. In four of these eight eyes, posterior vitreoschisis could be seen on OCT. In the other four of these eight eyes, a clear no posterior vitreous detachment (PVD) pattern could be seen on OCT. Although posterior vitreous cortex could not be clearly identified with preoperative OCT in two of ten AH eyes, a complete PVD was refuted by intraoperative visualization of the posterior vitreous cortex with TA identical to the other eight eyes. Conclusion  These results indicate that complete PVD appears to be unlikely to occur in eyes with AH. In addition, spontaneous PVD in eyes with AH might lead to vitreoschisis or residual whole layer or posterior vitreous cortex, possibly due to anomalous vitreoretinal adhesion.     

辅助玻璃体视网膜手术的药物研究进展

玻璃体切割术的主要目的是切除病变玻璃体和解除玻璃体对视网膜的牵拉。难度在于玻璃体与视网膜之间存在紧密粘连或有玻璃体后脱离。药物辅助的玻璃体视网膜手术是指先于玻璃体切割操作即应用药物促进玻璃体的液化或使玻璃体内纤维增生膜溶解,以解除玻璃体对视网膜的牵引,从而提高手术效率和安全性。就玻璃体视网膜手术辅助药物的研究进展进行综述。     

Branch retinal vein occlusion associated with vitreoretinal traction

CASE REPORT: Branch retinal vein occlusion (BRVO) is believed to arise at arteriovenous crossing sites. Surgical dissection of the arteriovenous sheath has been proposed as a treatment option, yet induction of a posterior vitreous detachment may be as important in obtaining a successful surgical outcome, suggesting that vitreoretinal traction may play a role in the development of BRVO. A retrospective review of 3 patients presenting with clinical features of BRVO and evidence of vitreoretinal traction at the occlusion site was conducted. COMMENTS: All patients presented with mild vitreous hemorrhage. Intraretinal hemorrhages were distributed in an unusual linear pattern along the involved venous segment, suggesting the presence of vitreoretinal traction. Fluorescein angiography demonstrated blocked fluorescence secondary to hemorrhage with delay of venous flow at the avulsion site. Partial avulsion of the involved venous segment was evident on clinical examination, B-scan ultrasound, or optical coherence tomography. Vitreoretinal traction may contribute to the pathogenesis of BRVO in some patients.     

环扎加压术后玻璃体的短期改变

目的 分析环扎加压手术后玻璃体的短期改变。方法 采用超声和临床检查分析接受环扎加压术的76眼术前到术后短期内玻璃体的改变。结果41眼（53.9％）术后玻璃体内混浊物质增多。术前超声检查下后极区完全玻璃体后脱离（PVD）、部分PVD和无PVD者分别为20,34和22眼,而术后初次超声检查时则为46,26和4眼。结论在环扎加压术后,相当一部分眼术后短期内出现后极区PVD的范围迅速扩大。与黄斑中心凹周围相比,这种急性的PVD更多地首先发生于视盘区。     

Examination of the vitreous. A comparison of biomicroscopy using the Goldmann and El Bayadi-Kajiura lenses

Vitreous examinations using the three-mirror Goldmann and the preset El Bayadi-Kajiura lenses were performed on 222 eyes. The presence of posterior vitreous detachment, vitreous traction, liquefaction, lacunae, and cells was noted. Clinical findings using the two lenses differed in 10% of the variables studied. The accuracy of the El Bayadi-Kajiura technique was confirmed by clinical and histological examination of 20 animal eyes with experimentally altered vitreous. The Goldmann lens afforded examination of peripheral vitreous and better identification of cells in the vitreous, whereas the El Bayadi-Kajiura lens permitted better visualization of complex vitreoretinal relationships.     

Retained perfluorodecalin after retinal detachment surgery

Liquid perfluorocarbons such as perfluorodecalin are widely used as intraoperative vitreous substitutes in certain complicated vitreoretinal conditions. Retained perfluorodecalin postoperatively has been reported to be associated with retinal damage and other complications. We report on a case of retained intraocular perfluorodecalin for eleven postoperative days after retinal detachment surgery with good anatomical and visual outcome after one year follow-up.     

玻璃体手术治疗黄斑孔性视网膜脱离的初步报告

本文对１５例伴有玻璃体视网膜异常粘连的黄斑孔性视网膜脱离进行了玻璃体切除、视网膜前膜剥离、玻璃体注惰性气体及巩膜扣带术。术中重点在于玻璃体后界膜的分离。追踪观察６￣１２个月，视网膜解剖及功能复位率为９３．３％。根据术中所见，本文提出针对其发病机制进行有目的、有选择的治疗方案，同时注射到玻璃体后界膜对黄斑孔的形成、视网膜脱离的发生，以及增殖性玻璃体视网膜病变中的决定性作用。     

Vitreous substitutes:challenges and directions

Thenatural vitreous body has a fine structure and complex functions. The imitation of the natural vitreous body by vitreous substitutes is a challenging work for both researchers and ophthalmologists. Gases, silicone oil, heavy silicone oil and hydrogels, particularly the former two vitreous substitutes are clinically widely used with certain complications. Those, however, are not real artificial vitreous due to lack of structure and function like the natural vitreous body. This article reviews the situations, challenges, and future directions in the development of vitreous substitutes, particularly the experimental and clinical use of a new artificial foldable capsular vitreous body .     

Optic disc haemorrhages in posterior vitreous detachment

Posterior vitreous detachment (PVD) is a common clinical entity but is not often associated with a significant ocular disorder. Optic disc haemorrhages are rarely associated with a PVD and are more commonly associated with other local or systemic disease. The symptoms of a PVD, combined with a careful examination of the vitreoretinal interface allows a confident diagnosis of secondary disc haemorrhage to be made. Two cases of acute symptomatic PVD complicated by disc haemorrhage are presented.     

玻璃体视网膜界面早期变化的研究

在解剖上,玻璃体后皮质与视网膜相邻,玻璃体与视网膜的关系是既相互独立,又紧密联系的。病理状态时,玻璃体的改变为许多玻璃体视网膜疾病的发生、发展提供了一个良好的生长环境,玻璃体在许多玻璃体视网膜疾病的发生发展中起了关键性作用。消除玻璃体改变在疾病中的作用,是近年来眼科界极为关注的一个问题。本文通过对玻璃体和玻璃体视网膜交界面结构和黏连机制、玻璃体与视网膜界面变化的危险因素、对视网膜疾病影响的描述,阐述了玻璃体后脱离对玻璃体视网膜界面疾病的影响及采用的检测方法及意义。     

Age-related changes in vitreous mobility as measured by video B scan ultrasound

Many vitreoretinal disorders increase in incidence with age. The vitreous is known to liquefy and separate from the retina in aging patients. Liquefaction and partial vitreous separation alter the biomechanics of the vitreous and change the tractional forces exerted by the vitreous on the retina. These forces may play a role in the development of a variety of vitreoretinal pathologies including retinal tears, cystoid macular edema, and macular holes. The purpose of this study is to test the hypothesis that the biomechanical properties of the vitreous change with aging and can be quantified by analysis of kinetic B scan ultrasound recordings. Kinetic B scan ultrasound recordings were made of the vitreous gel of 38 subjects from ages 18 to 91 during standard eye motions. The recordings were graded for speckle density (hyperreflective areas on ultrasound) and were examined for the presence or absence of posterior vitreous detachment. Tracking of the speckles on a polar grid allowed for the calculation of the angle travelled by the speckle relative to the angle travelled by the eye. The recordings were also analysed for "overshoot time", or the amount of time that the speckles continued to travel after the cessation of eye movement.The vitreous of subjects of age less than 46 years demonstrated significantly less speckle density (P < 0.001), less overshoot time (P < 0.001), and less angle travelled by the speckle relative to the angle travelled by the eye when compared to older subjects (P = 0.006). The presence or absence of PVD as diagnosed by kinetic ultrasound was not a significant predictor for speckle density, overshoot time, or ratio of angular motions. The results indicate that aging affects the biomechanics of the vitreous in ways which can be quantified with kinetic ultrasound analysis using the grading system described above.     

非接触广角观察系统在玻璃体视网膜手术中的应用和进展

广角观察系统(wide-angle viewing system)作为玻璃体手术中重要的辅助装置,通过此装置可以清晰地观察到全眼底视野,使玻璃体视网膜手术更加快捷、安全和有效,在眼科手术治疗中,具有很高的应用价值。本文通过对近年来,广角观察系统在玻璃体视网膜手术中的应用和发展进行研究,总结出非接触广角观察系统在临床上的发展优势,并指出其不足之处,以期望非接触广角观察系统在玻璃体手术中的应用得到更好的发展。     

Vitreoretinal Complications of the Boston Keratoprosthesis

Abstract

The Boston Keratoprosthesis has allowed for visual restoration in patients with corneal blindness; however, vitreoretinal complications remain a significant cause of ocular morbidity. Retroprosthetic membranes, infectious endophthalmitis, sterile vitritis, vitreous hemorrhage, vitreous opacities, retinal detachment, cystoid macular edema, choroidal detachments, retinal vascular occlusion, and epiretinal membrane have all been described, may require the intervention of a vitreoretinal specialist, and are reviewed herein. A strong familiarity with associated posterior segment complications is important to maximizing patient outcomes.     

复杂玻璃体视网膜疾病的彩色多普勒超声诊断特征

目的探讨彩色多普勒血流成像(CDFI)技术对复杂玻璃体视网膜疾病的超声诊断特征。方法对518例(678只眼)复杂玻璃体视网膜疾病包括玻璃体积血、玻璃体后脱离、玻璃体劈裂、视网膜脱离、脉络膜脱离、糖尿病视网膜病变等,应用眼科专用B超和CDFI诊断仪对同一患者进行检查,分别按照B超和CDFI的诊断标准予以诊断,再经手术证实,最终判断B超及CDFI检查结果的准确性。结果 CDFI检测复杂玻璃体视网膜疾病的阳性眼数高于B超诊断仪。视网膜脱离、玻璃体后脱离组的B超与CDFI检测结果比较、脉络膜脱离和玻璃体机化膜组的B超与CDFI检测结果比较,差异均有统计学意义(均P＜0.05)。结论综合应用CDFI的形态观察和血流特征两种分析方法,可显著提高诊断复杂玻璃体视网膜疾病的准确性,为临床提供可靠的诊断依据。     

玻璃体积血的形态结构与玻璃体后脱离的图像特征

目的探讨玻璃体积血的形态结构和治疗特点.方法对74例(79只眼)增生性糖尿病视网膜病变、视网膜血管炎、视网膜静脉阻塞所致玻璃体积血的临床资料进行比较分析.术前超声检查、术中手术显微镜观察患者的玻璃体形态特点,分析玻璃体与视网膜的关系.结果所有患者均有不同程度的玻璃体后脱离,根据图像的形态特征可归纳为完全后脱离和部分后脱离两种.部分后脱离又分为"V"型、"L"型及后部玻璃体劈裂型,劈裂型多见于视网膜缺血性疾病的增生期.结论了解和掌握玻璃体后脱离及玻璃体劈裂的形态特点,可提高手术治疗的成功率并改善其预后.     

BASIC ASPECTS AND PRACTICAL CONSIDERATIONS IN RETINAL DETACHMENT SURGERY

Factors responsible for retinal attachment include structural factors such as the integrity of the retina and the interdigitation of receptor cells with the retinal pigment epithelium combined with dynamic factors which include the movement of water from the vitreous to the choroid under the influence of colloid osmotic pressure in the presence of an intact posterior blood-ocular barrier.
In successful retinal detachment surgery an intact cortical vitreous is important. Retinal detachments can be subdivided into simple or complex according to the degree of vitreous abnormality present. Complex detachments demand vitreous surgery and the use of vitreous substitutes. Silicone oil may have a dual role in the eye, tamponade of retinal breaks and waterproofing of the retina with which it is in contact, so reducing transretinal water movement and lightening the load on the mechanisms responsible for retinal reaffachment.     

硅油对视神经的毒性作用

硅油作为一种安全有效的长期玻璃体替代物(vitreous substitute,VS),已有50余年的应用历史。目前临床上广泛应用于严重眼外伤和各种复杂玻璃体视网膜疾病的手术患者,改善了一些以往不可治愈眼的预后。关于硅油长期滞留玻璃体腔带来的一系列毒性作用备受关注,本文根据硅油的理化性质,针对硅油填充后对视神经的影响及其机制进行综述。