Macular buckling for retinal detachment due to macular hole in highly myopic eyes with posterior staphyloma

PURPOSE: To evaluate the efficacy of macular buckling surgery using a special exoplant. METHODS: The authors reviewed 33 cases of patients with retinal detachment due to macular hole with posterior staphyloma who underwent a macular bucking procedure and 11 cases of patients with the same condition due to macular hole without posterior staphyloma or due to a hole along the edge of the posterior staphyloma who underwent gas injection or vitrectomy. The reattachment rate, visual acuity (VA), and area size (V-4, I-4 isopter) by Goldmann perimetry were calculated. RESULTS: Reattachment rate for the macular buckling procedure was 94% (initial) and 100% (final), and that for the gas injection or vitrectomy was 100% (both initial and final). Twenty of the 33 eyes (60.6%) had VA of 20/400 or better, and none of these 33 eyes had a VA at the level of finger counting or poorer following macular buckling. Nine of the 11 eyes (81.8%) had VA of 20/400 or better, and none of these 11 eyes had a VA at the level of finger counting or poorer following the gas injection or vitrectomy. The area size of V-4 isopter in the macular buckling group was significantly larger than that in the gas injection or vitrectomy group (P = 0.017). CONCLUSION: The macular buckling procedure is effective when considered both from an anatomic and a functional perspective for retinal detachment due to macular hole with posterior staphyloma.     

玻璃体手术治疗高度近视眼黄斑裂孔引起的原发性视网膜脱离

目的 报告一组高度近视眼由黄斑裂孔引起的原发性视网膜脱离经玻璃体手术治疗的结果。 方法 回顾性分析自1996年3月至2004年3月连续进行的一组病例，纳入标准为原有屈光不正≥－6.00 D，或眼轴≥26 mm，未发现周边视网膜裂孔，且经玻璃体手术治疗、由黄斑裂孔引起的原发性视网膜脱离。 结果 本组患者83例， 其中女63例，男20例，85只眼，平均年龄54.1岁。手术前视力光感~数指49只眼，0.01~0.1者33只眼，0.12~0.2者3只眼。视网膜脱离范围仅限于黄斑部15只眼，1~2个象限11只眼，3 ~4个象限59只眼。手术中同时做晶状体切除或超声粉碎62只眼（72.9%），黄斑前膜切除37只眼，注入C3F829只眼（34.1%），注入硅油56只眼（65.9%）。手术后视网膜复位77只 眼（90.6%），未复位8只眼。手术后视力改善47只眼（55.3%），不变25只眼（29.4%），下降13只眼（15.3%）。 结论 由于黄斑裂孔引起的原发性视网膜脱离多发生在年龄较大、女性高度近视眼，玻璃体手术具有同时进行玻璃体后皮质和黄斑前膜切除、晶状体摘除和眼内填充的优势，手术后大多数眼能改善或保持视力。 （中华眼底病杂志， 2006，22：287-290）     

高度近视黄斑部视网膜劈裂和非裂孔性视网膜脱离

目的 观察高度近视黄斑部视网膜劈裂(MRS)和非裂孔性视网膜脱离(MRDH)的临床表现和影像学特征.方法 高度近视患者186例349只眼中合并MRS和MRDH的19例24只眼纳入研究.所有患者均进行了主觉验光、双目间接检眼镜、裂隙灯显微镜联合Goldmann三面镜检查,以及眼底照相、A/B型超声和光相干断层扫描(OCT)检查.结果 349只眼中后极部存在MRS和(或)MRDH 24只眼,占6.9%.眼底检查结果 显示.所有患跟均有后巩膜葡萄肿(PS),占100.0%;玻璃体黄斑牵引条带(VMT)2只眼.占8.3%;黄斑部局限性视网膜浅脱离2只眼,占8.3%;黄斑全层裂孔1只眼,占4.2%.B型超声检查结果 显示,所有患眼均伴有PS,占100.0%;黄斑部局限性视网膜浅脱离7只眼,占29.2%,脱离的视网膜与PS锥顶形成弓样结构;VMT条带2只眼,占8.3%.OCT检查结果 显示,黄斑部外层视网膜劈裂(ORS)22只眼,占91.7%,其中合并黄斑部内层视网膜劈裂(IRS)8只眼,占黄斑部ORS的36.4%.MRDH 5只眼,占20.8%,其中合并ORS 3只眼,占MRDH的60.0%;单纯性MRDH 2只眼,占MRDH的40.0%,其中合并VMT 1只眼.VMT 13只眼,占54.2%;黄斑囊样水肿(CME)3只眼,占12.5%;黄斑板层裂孔4只眼,占16.7%.结论 MRS和MRDH是伴有PS的高度近视眼的常见并发症.与常规眼底检查和B型超声相比,OCT是发现MRS和MRDH的更为有效的检查手段.     

高度近视黄斑部视网膜劈裂和非裂孔性视网膜脱离

目的 观察高度近视黄斑部视网膜劈裂(MRS)和非裂孔性视网膜脱离(MRDH)的临床表现和影像学特征.方法 高度近视患者186例349只眼中合并MRS和MRDH的19例24只眼纳入研究.所有患者均进行了主觉验光、双目间接检眼镜、裂隙灯显微镜联合Goldmann三面镜检查,以及眼底照相、A/B型超声和光相干断层扫描(OCT)检查.结果 349只眼中后极部存在MRS和(或)MRDH 24只眼,占6.9%.眼底检查结果 显示.所有患跟均有后巩膜葡萄肿(PS),占100.0%;玻璃体黄斑牵引条带(VMT)2只眼.占8.3%;黄斑部局限性视网膜浅脱离2只眼,占8.3%;黄斑全层裂孔1只眼,占4.2%.B型超声检查结果 显示,所有患眼均伴有PS,占100.0%;黄斑部局限性视网膜浅脱离7只眼,占29.2%,脱离的视网膜与PS锥顶形成弓样结构;VMT条带2只眼,占8.3%.OCT检查结果 显示,黄斑部外层视网膜劈裂(ORS)22只眼,占91.7%,其中合并黄斑部内层视网膜劈裂(IRS)8只眼,占黄斑部ORS的36.4%.MRDH 5只眼,占20.8%,其中合并ORS 3只眼,占MRDH的60.0%;单纯性MRDH 2只眼,占MRDH的40.0%,其中合并VMT 1只眼.VMT 13只眼,占54.2%;黄斑囊样水肿(CME)3只眼,占12.5%;黄斑板层裂孔4只眼,占16.7%.结论 MRS和MRDH是伴有PS的高度近视眼的常见并发症.与常规眼底检查和B型超声相比,OCT是发现MRS和MRDH的更为有效的检查手段.     

高度近视黄斑裂孔性视网膜脱离解剖复位后的视力预后

目的 研究高度近视黄斑裂孔性视网膜脱离(retinal detachment,RD)解剖复位后视力预后与预计影响因素之间的关系.方法 对71例行玻璃体切割联合硅油填充术后解剖复位的高度近视黄斑裂孔性RD患者进行回顾性分析.单因素或多因素分析法分析性别、年龄、屈光度、眼轴长度、后巩膜葡萄肿、病程、孔径、RD脱离范围、内界...     

Scleral buckling with macular plombe for eyes with myopic macular retinoschisis and retinal detachment without macular hole

PURPOSE: To determine the effectiveness of scleral buckling with a macular plombe in eyes with myopic macular retinoschisis and retinal detachment without a macular hole. DESIGN: A prospective, consecutive interventional case series. METHODS: Setting: Clinical practice at university hospitals. Patient Population: Six eyes of five consecutive patients with myopic macular retinoschisis and retinal detachment without a macular hole. Intervention Procedure: Scleral buckling with a macular plombe. Main Outcome Measures: The best-corrected visual acuity (BCVA), ophthalmoscopic appearance of fundus, and optical coherence tomographic images were recorded preoperatively, and at two weeks, at one, three, and six months, and then every three months thereafter. RESULTS: The mean retinal thickness was reduced significantly by the macular plombe (P < .05). The BCVA was improved by 2 lines or more in four eyes (66%), and remained within 2 lines of the preoperative BCVA in two eyes (34%). The complications were subretinal hemorrhage without choroidal neovascularization in one eye, and a progression of choroidal neovascularization with subretinal hemorrhage, which caused a transient visual impairment in one eye. CONCLUSIONS: We recommend that macular scleral buckling with a macular plombe be considered for eyes with myopic macular retinoschisis and retinal detachment without a macular hole.     

Macular hole diameter after vitrectomy for macular hole and retinal detachment

PURPOSE: We measured postoperative macular hole (MH) size after vitrectomy for MH and retinal detachment (MHRD) in high myopia and investigated potentially associated factors. METHODS: Eleven patients (11 eyes) with high myopia (axial length, 25.6-30.8 mm; mean patient age +/- SD, 64.0 +/- 4.31 years) who had retinal attachment without MH closure after vitrectomy for MHRD were included in the study. Postoperative MHs were measured using optical coherence tomography. A horizontal 5.65-mm-long scan of the retina was obtained, and the MH size was measured as the length between the edges of the MH using the retinal thickness mode of the optical coherence tomography system. RESULTS: The mean postoperative MH size +/- SD was 1,220 +/- 450 microm. Only axial length was significantly associated with postoperative MH size (P < 0.05). There was a tendency for smaller MH sizes to be associated with better postoperative best-corrected visual acuity (P = 0.06). CONCLUSIONS: Persistent MHs after vitrectomy were enlarged according to axial length elongation in highly myopic eyes. Even if MH closure was not successful, the maximum effort to shorten postoperative MH size led to a better postoperative outcome.     

Episcleral macular buckling for posterior retinal detachment in silicone oil filled eyes associated with myopic macular hole

AIM:To evaluate anatomical and visual outcomes of episcleral macular buckling (EMB) for posterior retinal detachment in silicone oil filled eyes associated with myopic macular hole.METHODS: Five cases of EMB for initial failure of retinal reattachment after internal limiting membrane (ILM) peeling and silicone oil tamponade caused by myopic macular hole were retrospectively reviewed. A silicone sponge sutured directly across the macular region was performed on the silicone oil filled eyes. Silicone oil was removed no sooner than 1 month post-EMB. The duration of follow-up time after removal of silicone oil was more than 3 months.RESULTS: Retinas of five eyes were all reattached at the last follow-up. The postoperative vision ranged from counting fingers to 0.08.CONCLUSION: Anatomical results improved after EBM for posterior retinal detachment in silicone oil filled eyes associated with myopic macular hole, which was not evident for visual outcome.     

玻璃体切割联合黄斑加固术治疗高度近视合并黄斑裂孔性视网膜脱离

目的　观察玻璃体切割联合黄斑加固术治疗高度近视合并黄斑裂孔性视网膜脱离患者术后视网膜的解剖复位率和黄斑裂孔的闭合率。方法　收集自２０１２年１月至２０１４年１２月在我院手术的高度近视合并黄斑裂孔性视网膜脱离的患者６４例（６４眼）,根据手术方式不同分成２组:一组行单纯玻璃体切割术为单纯玻切组,另一组行玻璃体切割联合黄斑加固术为联合手术组,观察两组视力及视网膜解剖复位率和黄斑裂孔闭合率。结果　６４例６４眼中,单纯玻切组３６例,术前视力平均为０．９０ｌｏｇＭＡＲ,术后平均为０．４１ｌｏｇＭＡＲ;联合手术组２８例,术前视力平均为０．８９ｌｏｇＭＡＲ,术后平均为０．６２ｌｏｇＭＡＲ;两组术前视力差异无统计学意义,术后差异有统计学意义（Ｐ＝０．０４）。两组患者术后视网膜复位均率为１００％;联合手术组的黄斑裂孔闭合率较高,为９２．９％,单纯玻切组为４１．７％,两组比较差异有统计学意义（Ｐ＝０．０２）。结论　在高度近视合并黄斑裂孔性视网膜脱离的患者中,联合行黄斑加固术较单纯玻璃体切割术患者的黄斑裂孔闭合率要高。     

高度近视黄斑裂孔性视网膜脱离的玻璃体视网膜手术治疗进展

黄斑裂孔性视网膜脱离(macular hole retinal detachment,MHRD)是高度近视眼常见的并发症,常造成不可逆的视力损害。玻璃体视网膜手术(vitreoretinal surgery,VRS)是MHRD的主要治疗方式,但是由于此类患者伴有视网膜脉络膜萎缩、后巩膜葡萄肿、眼轴增长等异常解剖结构,故手术难度大、患者视力预后差,易复发。近年来,随着眼内填充物选择的多样化、内界膜处理技巧的发展以及眼科机器人等新技术的兴起,VRS治疗高度近视MHRD取得了令人满意的视网膜解剖复位率。如何在提高视网膜复位率及黄斑裂孔闭合率的基础上实现患者视功能的改善是目前VRS治疗高度近视MHRD的重点与难点。本文现就高度近视MHRD的VRS治疗进展进行综述。     

黄斑裂孔视网膜脱离再手术分析

１９９０年１月至１９９５年１２月，我院黄斑裂孔视网膜脱离再手术的病例１２１眼，占同期黄斑裂孔视网膜脱离病人数的１８．０％。再手术原因以ＰＶＲ发展、黄斑孔周玻璃体视网膜牵引、后巩膜葡萄肿、黄斑区脉络膜萎缩斑为主；再次手术以玻璃体手术为主，总治愈率达８０．２％。手术后视力有明显提高。术后激光的使用对视力无明显影响。     

高度近视黄斑裂孔性视网膜脱离手术的治疗进展

黄斑裂孔性视网膜脱离(macular hole retinal detachment,MHRD)常常引起严重的视力损害,主要发生于伴有后巩膜葡萄肿的高度近视患者。高度近视患者MHRD的发病机制尚不明确,目前普遍认为其发生涉及多种复杂牵拉力。许多学者尝试了多种手术方法解除视网膜牵拉,促进视网膜复位和黄斑裂孔闭合。本文对目前临床上用于治疗高度近视患者MHRD的手术方法进行综述。     

高度近视眼黄斑裂孔视网膜脱离的手术治疗

目的 探讨治疗高度近视眼黄斑裂孔视网膜脱离手术的方法。方法 对172只眼（169例）高度近视眼黄斑裂孔视网膜脱离行玻璃体切除联合眼内光凝黄斑裂孔、12％C3F8填充术。术后取面向下体位两周。结果 172只眼黄斑裂孔闭合、视网膜复位。1只眼在气液交换过程中出现脉络膜大出血而作硅油填充术。172只眼术后视力均有不同程度的提高。结论 玻璃体切除联合眼内光凝黄斑裂孔、12％C3F8填充术是治疗高度近视眼黄斑裂孔视网膜脱离和提高手术成功率的安全有效的方法。     

高度近视黄斑裂孔视网膜脱离的玻璃体手术和激光光凝治疗

目的 探讨高度近视黄斑裂孔视网膜脱离患者玻璃体手术联合激光光凝治疗的成功率及并发症。 方法 高度近视黄斑裂孔视网膜脱离患者35例38只眼，11例12只眼单行经睫状体平部的玻璃体手术及惰性气体眼内填充，未作激光光凝治疗；24例26只眼在玻璃体手术术中及术后作黄斑裂孔缘激光光凝。术后均作6个月以上的随访(平均随访时间21．7个月)。 结果 非光凝组5只眼黄斑裂孔性视网膜脱离复发，占41．7%，术后0．1以上视力6只眼，占50.0%；光凝组2只眼黄斑裂孔复发，占7.7%，1只眼因周边新裂孔形成而复发视网膜脱离，术后有13只眼视力在0.1以上，占50.0%。统计学检验两组黄斑裂孔复发率概率P=0.024,视网膜脱离复发率概率P=0.0487。两组患者术后视力无显著差异。 结论 玻璃体手术联合黄斑区激光光凝治疗可提高高度近视黄斑裂孔视网膜脱离的手术成功率。 (中华眼底病杂志,1998,14:199-201)