25G玻璃体切割术后空气与硅油填充治疗孔源性视网膜脱离的疗效比较

目的:比较25G玻璃体切割术(PPV)联合空气或硅油填充治疗孔源性视网膜脱离(RRD)的疗效。方法:前瞻性随机对照研究。收集2018-01/12经我院确诊的RRD患者146例146眼,根据25G PPV术后眼内填充物分为空气组(60例60眼)和硅油组(86例86眼)。术后随访6~12mo,分析两组患者最佳矫正视力(BCVA)、眼压、视网膜解剖复位率及并发症情况。结果:术后1mo,空气组患者BCVA为0.45±0.5,硅油组为0.78±0.65,两组患者BCVA均较术前明显改善,且空气组患者BCVA明显优于硅油组(均P<0.05)。术后3mo,空气组患者视网膜解剖复位率(93.3%)低于硅油组(97.7%),但无差异;术后6mo,两组患者视网膜解剖复位率均为100.0%。本研究纳入患者术中主要并发症是医源性裂孔(6.8%),术后主要并发症是高眼压,术后早期(7d内)硅油眼高眼压比例明显高于空气组(P<0.001),但随访期间两组患者均未出现感染性眼内炎、脉络膜出血等严重并发症。结论:对于简单新鲜的RRD患者,25G PPV术后空气和硅油填充视网膜解剖复位率无差别,术后早期空气填充眼视力优于硅油填充眼,术后高眼压发生率更低。     

25G玻璃体切除联合空气填充术治疗孔源性视网膜脱离

目的:观察玻璃体切除联合空气填充术治疗孔源性视网膜脱离的临床疗效,评价空气填充的有效性及安全性。方法:对2017-08/2018-12就诊于遵义市第一人民医院的孔源性视网膜脱离并接受玻璃体切除联合空气填充术的患者30例30眼进行回顾性分析,观察术眼术前、术后1 wk,1 mo最佳矫正视力(BCVA,LogMAR)、眼压、术后视网膜复位情况及术后并发症情况等。结果:术前,术后1wk,1mo BCVA分别为0.87±0.71、0.64±0.36、0.37±0.22,手术前后术眼BCVA有差异(F=3.74,P=0.047)。术前,术后1wk,末次随访眼压分别为13.61±3.57、15.74±4.84、14.05±2.88mmHg,手术前后眼压无差异(F=4.13,P=0.051)。术后1wk视网膜复位率97%(29/30)。术后OCT监测1眼出现持续视网膜下积液,术后3mo积液吸收。结论:玻璃体切除联合空气填充术治疗孔源性视网膜脱离疗效确切,术后恢复快,提高视觉质量,同时减少患者经济负担。     

玻璃体切除术联合巩膜扣带术治疗伴玻璃体牵引的孔源性视网膜脱离的临床效果

目的观察玻璃体切除术、空气填充联合节段性巩膜扣带术治疗伴玻璃体牵引的孔源性视网膜脱离的临床效果。方法回顾性病例系列研究。纳入2020年2月至2022年2月于郑州大学第一附属医院收治的伴玻璃体牵引的孔源性视网膜脱离患者101例(101只眼), 所有患者均接受玻璃体切除术、空气填充联合节段性巩膜扣带术治疗。术后随访6个月, 对单次手术视网膜复位情况、术后最佳矫正视力(BCVA, logMAR)及并发症进行分析。结果单次手术实现视网膜解剖复位94只眼, 占93.07%(94/101);首次手术后复发视网膜脱离7只眼, 占6.93%(7/101)。再次行玻璃体切除术伴硅油填充治疗后视网膜复位率为100.00%。不同术眼视网膜裂孔大小和裂孔数量的视网膜复位率比较, 差异有统计学意义(χ2=10.55, 7.15;P=0.005, 0.018)。手术前和术后6个月BCVA分别为1.27±0.93、0.43±0.35, 差异有统计学意义(t=9.82, P=0.001)。相关性分析结果显示, 手术后BCVA和术前BCVA呈正相关(r=0.40, P<0.001)。术前BCVA(P=0.024)...     

玻璃体切除治疗玻璃体视网膜疾病临床观察

目的 探讨玻璃体切除手术治疗玻璃体视网膜疾病的临床疗效.方法 对30例(31眼)玻璃体视网膜疾病施行玻璃体切除手术,根据病情术中或联合晶状体切除、剥膜、视网膜激光光凝、硅油或C3F8填充、巩膜外冷凝、玻璃体腔注射曲安奈德,术后观察视力、眼压、前房炎症反应、视网膜复位、裂孔封闭、玻璃体视网膜出血情况.结果 术后随访3 ～18个月,平均(10±2.3)个月.术后视力有不同程度提高,与术前相比差异有统计学意义(P＜0.05).术后眼压升高者3眼(9.68％),前房均不同程度炎症反应,应用药物治疗恢复正常;医源性视网膜裂孔2眼(6.45％).术前15眼视网膜脱离在术后视网膜解剖复位成功、视网膜裂孔封闭、黄斑裂孔闭合,玻璃体视网膜未发生严重出血.结论 玻璃体切除手术治疗玻璃体视网膜疾病效果肯定,能够改善视功能.     

玻璃体切割术治疗视网膜脱离合并脉络膜脱离

目的探讨玻璃体切割术治疗视网膜脱离合并脉络膜脱离的临床疗效及适应证.方法对23例(23眼)视网膜脱离合并脉络膜脱离的患者,术前7 d即开始口服强的松,采用标准平坦部三切口玻璃体切割及眼内填充(C3F8或硅油),酌情联合巩膜扣带术,术后随访6～12个月.结果术中新发现裂孔 5个(21.74%);术后6个月,视网膜完全复位20眼(86.96%),部分复位2眼(8.70%),未复位1眼(4.35%);术后视力有不同程度的提高,其中0.1以上为5眼(21.74%);术后并发症较少,增生性玻璃体视网膜病变(proliferativevitreore tinopathy,PVR)的发生率较低.结论对眼内增殖明显,视网膜裂孔位于大范围脉络膜脱离区或术前未发现裂孔的视网膜脱离合并脉络膜脱离,玻璃体切割术是可以优先考虑的术式.     

显微内镜下玻璃体视网膜手术治疗人工晶状体眼视网膜脱离

目的探讨眼科显微内镜在人工晶状体眼视网膜脱离玻璃体视网膜手术中的应用。方法对32例(32眼)人工晶状体术后视网膜脱离在眼科显微内镜下行玻璃体视网膜手术,观察视网膜解剖复位率、裂孔检出、视力、并发症。平均随诊时间14.6月。结果首次玻璃体切除术后视网膜复位29眼(90.63%),最终视网膜完全复位30眼(93.75%);术后6个月时矫正视力0.1以上者21眼,0.5以上者4眼。术前6眼未发现裂孔者术中内镜下全部找到裂孔,裂孔检出26眼中,术中发现新裂孔6眼,手术后10眼一时性高眼压,2眼人工晶状体移位。结论眼科内镜在人工晶状体眼视网膜脱离玻璃体视网膜手术中的应用,降低了裂孔的遗漏,使视网膜解剖复位率显著提高。     

27G玻璃体切割手术联合Healaflow覆盖视网膜裂孔治疗孔源性视网膜脱离的初步研究

目的观察27G玻璃体切割手术(PPV)联合Healaflow覆盖封闭视网膜裂孔和空气填充治疗原发性孔源性视网膜脱离(RRD)的安全性和有效性。方法以临床为基础的前瞻性连续研究。2017年3月至2018年5月于天津医科大学眼科医院检查确诊并行PPV治疗的原发性RRD患者50例51只眼纳入研究。患眼均行27G PPV,视网膜完全复位后,视网膜裂孔周围及变性区行激光光凝;使用27G钝性针头将Healaflow完全覆盖于视网膜裂孔表面,注射量根据视网膜裂孔大小确定,以裂孔完全被包含为标准。手术后无体位限制。手术后平均随访时间(15.8±6.3)个月。观察首次和最终视网膜复位率、BCVA、视网膜脱离复发情况;手术中、手术后并发症等。结果50例51只眼纳入研究。其中,男性29例(58.0%),女性21例(42.0%)。平均年龄(58.5±11.2)岁。单一裂孔28只眼(54.9%);2~5个裂孔23只眼(45.1%)。是否累及黄斑区分别为32(62.7%),19(37.3%)只眼。首次视网膜复位50只眼(98.0%),最终所有患眼均复位(100.0%)。手术前、手术后3个月logMAR BCVA分别为0.95±0.80、0.22±0.17;手术前后logMAR BCVA比较,差异有统计学意义(t=7.336,P<0.001)。手术后一过性眼压升高31只眼(60.8%)。随访期间无其他并发症发生。结论27G PPV联合Healaflow覆盖视网膜裂孔和空气填充治疗原发性RRD,成功率高,视功能恢复快;安全、有效。     

玻璃体切除术治疗人工晶状体眼视网膜脱离

目的探讨以玻璃体切除术治疗人工晶状体眼视网膜脱离的临床效果。方法对50例（50眼）人工晶状体眼视网膜脱离施用玻璃体切除术。其中16眼行硅油填充术，34眼行C3F8眼内填充。术后随访6～24月。结果术后视网膜最终完全复位49眼（98．00％）。15眼（30．00％）术中新发现裂孔。术后视力均有不同程度的提高。结论玻璃体切除术治疗人工晶状体眼视网膜脱离具有术野清晰、易于寻找隐匿性裂孔、提高视网膜复位率及复发率低的优点。     

23G高速玻璃体切除手术治疗孔源性视网膜脱离的初步临床观察

目的:探讨23G高速玻璃体切除手术治疗孔源性视网膜脱离的临床效果。方法:前瞻性选择2009-03/2009-10一组合并较明显玻璃体混浊、玻璃体视网膜粘连牵拉或合并玻璃体积血的孔源性视网膜脱离病例共20例20眼,应用23G玻璃体切除手术联合膨胀气体全氟丙烷(C3F8)填充。统计分析视网膜解剖复位率、术后3mo时最佳矫正视力、术中、术后并发症、手术时间及术后眼部刺激征的严重程度,术后平均随访6mo。结果:所有20眼均一次手术后视网膜完全复位。未发生器械损伤晶状体或医源性视网膜裂孔等术中并发症。15眼黄斑已脱离眼的术前最佳矫正视力为0.02～0.5(log-MAR视力为0.3～2.0,平均1.187±0.616),术后3mo时最佳矫正视力为0.3～0.8(logMAR视力为0.1～0.52,平均0.276±0.114),差异具有统计学意义(t=5.756,P<0.01);5眼黄斑未脱离眼的术前最佳矫正视力为0.8～1.0(logMAR视力为0～0.52,平均0.218±0.276),术后3mo时最佳矫正视力为0.6～1.0(logMAR视力为0～0.52,平均0.312±0.285),差异没有统计学意义(t=-1.0,P=0.374)。手术后未发生低眼压、脉络膜脱离或眼内炎等切口相关并发症,无增生性玻璃体视网膜病变(PVR)发生。3眼术后第1d出现轻度晶状体后囊下羽毛状混浊,1wk内消退。至随访结束时,4眼(20%)晶状体核密度增加,其余病例无新生白内障或原白内障明显加重。5眼(25%)术后一过性眼压升高,眼压均<30mmHg,经局部使用1～2种降眼压滴眼液,3d内恢复正常,平均术后第7d眼压为14.6±3.4mmHg。结论:23G玻璃体切除手术治疗孔源性视网膜脱离安全有效,缝合手术切口可避免并发症,是值得推广的技术。     

空气填充联合内界膜翻转治疗伴有后巩膜葡萄肿的高度近视黄斑裂孔性视网膜脱离

目的：评估空气填充联合内界膜翻转及自体血治疗伴有后巩膜葡萄肿的高度近视黄斑裂孔性视网膜脱离(MHRD)的疗效。

方法：回顾性非对照研究分析高度近视眼MHRD患者的治疗效果。玻璃体切割术中使用曲安奈德染色清除玻璃体后皮质,内界膜翻转后应用自体血固定翻转的内界膜后空气填充。记录术后黄斑裂孔闭合率、视网膜复位率及术后最佳矫正视力(BCVA)。

结果：研究共纳入高度近视MHRD患者24例24眼。患者随访至少6mo,平均13.58±7.00mo。末次随访时21眼(88%)黄斑裂孔闭合,20眼(83%)视网膜复位。其中17眼(71%)黄斑裂孔闭合且视网膜复位,3眼(13%)黄斑裂孔未闭合但视网膜复位,4眼(17%)黄斑裂孔闭合但仍有视网膜下液。所有病例无需接受二次玻璃体切割手术。末次随访BCVA(LogMAR)较术前显著提高(0.65±0.34 vs 1.36±0.49,P<0.001)。12眼(50%)的BCVA提高大于等于2行。

结论：玻璃体切割术联合内界膜翻转、自体血及空气填充是治疗高度近视眼MHRD的有效方法。     

Air tamponade and without heavy liquid usage in pars plana vitrectomy for rhegmatogenous retinal detachment repair

AIM: To report the results of rhegmatogenous retinal detachment (RRD) repair after pars plana vitrectomy (PPV) without operative use of heavy liquid, and utilizing air tamponade in selected cases. METHODS: RRD patients without severity of proliferative vitreoretinopathy C2 or more underwent PPV without operative use of heavy liquid, and utilizing air tamponade were consecutively enrolled. Alternative postoperative facedown position or lateral position was required for 3-5d. RESULTS: Totally 36 eyes of 36 patients (24 males, 66.7%) aged 53.8±10.9y underwent this modified surgery. The mean number of retinal break was 2.1±1.3. Most of the eyes (29, 80.6%) had retinal detachment involving more than one quadrant. Twenty-two (61.1%) eyes with cataract had combined phacoemulsification and intraocular lens implantation. The mean follow up time was 4.6±1.8mo. Two eyes with retinal redetachment underwent a second retinal repair surgery with silicone oil tamponade, yielding the primary reattachment rate to 94.4% (34/36). Six (16.7%) eyes had intraocular pressure higher than 25 mm Hg. The visual acuity (logMAR) improved from 0.98±0.74 preoperatively to 0.52±0.31 postoperatively (P<0.001). CONCLUSION: The success rate of this modified retinal repair surgery is comparable with traditional surgery. This technique can be considered for certain retinal detachment patients, since its apparent advantages included lower surgical complications, reduced surgery expenditure, shorter time for postoperative facedown position, and avoiding silicone oil removal surgery.     

Air tamponade in retinal detachment surgery followed by ultra-widefield fundus imaging system

AIM: To report the surgical result of pars plana vitrectomy (PPV) with air tamponade for rhegmatogenous retinal detachment (RRD) by ultra-widefield fundus imaging system. METHODS: Of 25 consecutive patients (25 eyes) with fresh primary RRD and causative retinal break and vitreous traction were presented. All the patients underwent PPV with air tamponade. Visual acuity (VA) was examined postoperatively and images were captured by ultra-widefield scanning laser ophthalmoscope system (Optos). RESULTS: Initial reattachment was achieved in 25 cases (100%). The air volume was >60% on the postoperative day (POD) 1. The ultra-widefield images showed that the retina was reattached in all air-filled eyes postoperatively. The retinal break and laser burns in the superior were detected in 22 of 25 eyes (88%). A missed retinal hole was found under intravitreal air bubble in 1 case (4%). The air volume was range from 40% to 60% on POD 3. A double-layered image was seen in 25 of 25 eyes with intravitreal gas. Retinal breaks and laser burns around were seen in the intravitreal air. On POD 7, small bubble without effect was seen in 6 cases (24%) and bubble was completely disappeared in 4 cases (16%). Small oval bubble in the superior area was observed in 15 cases (60%). There were no missed and new retinal breaks and no retinal detachment in all cases on the POD 14 and 1mo and last follow-up. Air disappeared completely on a mean of 9.84d postoperatively. The mean final postoperative best-corrected visual acuity (BCVA) was 0.35 logMAR. Mean final postoperative BCVA improved significantly relative to mean preoperative (P<0.05). Final VA of 0.3 logMAR or better was seen in 13 eyes. CONCLUSION: PPV with air tamponade is an effective management for fresh RRD with superior retinal breaks. The ultra-widefield fundus imaging can detect postoperative retinal breaks in air-filled eyes. It would be a useful facility for follow-up after PPV with air tamponade. Facedown position and acquired visual rehabilitation may be shorten.     

玻璃体切除联合空气填充治疗下方裂孔的孔源性视网膜脱离的短期疗效

目的 尝试应用玻璃体切除联合玻璃体腔空气填充治疗下方裂孔的孔源性视网膜脱离(RRD),观察其可行性.设计 回顾性病例系列.研究对象 2017年6月至2020年10月间在南京爱尔眼科医院接受23G经睫状体平坦部三通道行微创玻璃体切除术(PPV)联合玻璃体腔无菌空气填充治疗的下方裂孔的RRD患者45例(45眼).方法 所有...     

Primary rhegmatogenous retinal detachment: evaluation of a minimally restricted face-down positioning after pars plana vitrectomy and gas tamponade

AIM: To systematically understand the genetic association between methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism and primary open angle glaucoma (POAG). METHODS: A comprehensive literature search in Google Scholar, PubMed, SCI, foreign medical literature retrieval service, CNKI and Wanfang databases was performed to collect all eligible studies up to August 2019. Study selection, data abstraction and study quality evaluation were performed by two independent investigators. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the strength of association. Publication bias was tested by funnel plot and Begg’s test. RESULTS: Totally 18 case-control studies involving 2156 cases and 2201 controls were retrieved. There was no evidence of significant association in the Caucasian population (for allelic model: OR=1.11, 95%CI=0.88-1.39; for additive model: OR=1.01, 95%CI=0.76-1.36; for dominant model: OR=1.15, 95%CI=0.84-1.58 and for recessive model: OR=1.02, 95%CI=0.78-1.33). However, significant associations were revealed in the Asian population (for allelic model, OR=1.34, 95%CI=1.12-1.59; for dominant model: OR=1.41, 95%CI=1.14-1.76). CONCLUSION: This Meta-analysis shows that there were significant associations between MTHFR C677T polymorphism and POAG in allelic model and dominant model for Asians subgroup indicating that the T allele or TT +TC genotype might increase the risk of POAG.     

25G玻璃体切除术联合空气填充治疗原发性孔源性视网膜脱离的短期疗效

目的 观察25G玻璃体切除术联合眼内无菌空气填充治疗原发性孔源性视网膜脱离的疗效。设计 回顾性病例系列。研究对象 2016年8-12月北京同仁医院接受25G经睫状体平坦部三通道微创玻璃体切除术联合无菌空气填充治疗的原发性孔源性视网膜脱离患者13例（13眼）。上方单一裂孔8例,多发裂孔4例,黄斑裂孔1例。方法 术前均行矫正视力、眼压、裂隙灯检查、间接检眼镜、彩色眼底照相、眼部彩色多普勒超声和相干光断层扫描检查。术后平均随访（67±26）天。主要指标 矫正视力、眼压、视网膜复位及手术并发症情况。 结果 末次随访时13眼（100%）视网膜脱离全部复位。3例在术后第3天发生脉络膜脱离,口服糖皮质激素治疗后好转。术后平均logMAR矫正视力（0.63±0.43）,与术前比较差异有统计学意义（配对秩和检验S=-34, P=0.005）。末次随访平均眼压（15.95±4.12）mmHg,与术前比较差异有统计学意义（t=-2.65,P=0.02）。 结论 空气短期填充可作为25G玻璃体切除术治疗脱离位于上方、未超过3个象限的原发性孔源性视网膜脱离的一种选择方法。（眼科,2018, 27： 377-380）     

巩膜扣带术治疗合并视网膜下增生的孔源性视网膜脱离的疗效观察

目的：分析巩膜扣带术(SB)治疗合并视网膜下增生的孔源性视网膜脱离(RRD)的有效性。

方法：回顾性临床分析研究。收集2016-10/2020-01于北京同仁医院眼科就诊的合并视网膜下增生的RRD患者54例54眼,其中男36眼,女18眼,平均年龄24.92±11.99岁,视网膜脱离范围<1、1～2、>2个象限分别为12、25、17眼; 累及黄斑47眼; 视网膜下增生范围<1、1～2、>2个象限分别为26、23、5眼; 术前平均最佳矫正视力(LogMAR)为1.21±0.77; 所有患者均采用全身麻醉下SB,观察术后视网膜复位率、最佳矫正视力及并发症。

结果：术后视网膜复位52眼(96%),视网膜未复位2眼(4%),再行玻璃体手术后复位。平均随访时间为19.17±11.15mo,末次随访平均最佳矫正视力(LogMAR)0.61±0.40,手术前后最佳矫正视力比较有差异(P<0.01)。所有患者术中及术后均未发生严重的并发症。

结论：在正确适应证选择的前提下,SB治疗合并视网膜下增生的RRD有较好的成功率。