氪多波长激光治疗和预防视网膜脱离临床分析

目的 分析氪多波长激光治疗和预防视网膜脱离的效果。方法 用氪多波长激光治疗和预防视网膜脱离患者188例（193眼）。结果 视网膜周边干性裂孔和视网膜周边变性单纯用氪多波长激光治疗15眼，成功100％；局限性孔源性视网膜浅脱离10眼，先使用脱水剂、卧床休息、单眼加压包扎等措施，而后行激光治疗，成功率80％，2眼因玻璃体有牵引结合局部垫压术后成功；巩膜外扣带术后激光封孔141眼，成功率96．5％。5眼因玻璃体有牵引行玻璃体手术后眼内激光封闭裂孔成功；复杂性视网膜脱离经玻璃体切割手术，术中及术后激光封闭裂孔27眼，成功100％。结论 氪多波长激光治疗和预防视网膜脱离成功率高，创伤小，对于周边视网膜干性裂孔和变性激光治疗可以预防视网膜脱离的发生。激光可根据病情在术中术后选择，作为常规视网膜脱离手术和玻璃体手术的补充治疗。     

玻璃体切割治疗复杂视网膜脱离45例临床分析

目的：分析玻璃体切割术治疗复杂性视网膜脱离的效果。方法：对45例45眼复杂性视网膜脱离眼行闭合式玻璃体切割术,术毕玻璃体腔行C3F8气体或硅油填充。结果：玻璃体切割联合玻璃体腔注气术15眼,1次手术视网膜复位13眼（87%）;玻璃体切割联合玻璃体腔内硅油填充术30眼,1次手术完全复位27眼（90%）。统计学检验两组1次手术视网膜复位率的差异无显著意义。术后视力：数指/眼前者2眼,0.02～0.05者3眼,0.06～0.1者10眼,0.12～0.25者19眼,≥0.3者11眼。术中常见的并发症有医源性视网膜裂孔,术后并发症最多见是继发性青光眼和白内障。结论：玻璃体切割联合眼内填充能有效地治疗复杂性视网膜脱离,术后大部分患者视力能得到改善。     

非常复杂型视网膜脱离的治疗探讨

目的:探讨治疗非常复杂型视网膜脱离的方法。方法:31例(31眼)非常复杂型视网膜脱离,包括原发性裂孔性视网膜脱离伴PVR-D3级及前段玻璃体严重增殖者14只眼;巨大裂孔性视网膜脱离伴严重PVR 8只眼;严重眼外伤伴眼内容物脱出及严重PVR 9只眼。采用巩膜冷凝、环扎、硅胶填压、玻璃体切割、视网膜前膜剥离/切除,视网膜松解性切开,过氟化碳液体注入,眼内/眼外排液以及硅油眼内填充等方法治疗。结果:随访3～16个月,31眼中,21只眼视网膜完全复位,占67.7％;5只眼大部分复位,占16.1％;5只眼未能复位,占16.1％。术后视力,除了失败的5只眼外,在其余的26只眼中,有一眼视力较术前下降,其余25只眼的视力均有不同程度的提高。结论:PVR及巨大裂孔性视网膜脱离的效果较好,分别有71.4％及87.5％完全复位,严重外伤的治疗效果较差。眼科学报1998;14:90—93。     

单纯气液交换联合环扎治疗玻璃体切割术后视网膜脱离的疗效

目的 分析单纯气液交换联合环扎手术治疗玻璃体切割术后视网膜脱离的效果以及影响因素.方法 收集2005年1月至2007年6月应用单纯气液交换联合环扎手术治疗玻切术后视网膜脱离的临床资料,应用Pierce考马斯亮蓝比色法测定术中取出的玻璃体腔液体蛋白质总浓度.分析影响手术效果的可能因素.结果 单纯气液交换联合环扎手术治疗玻切术后视网膜脱离共19例(19只眼),手术成功率为78.9%.失败4只眼均为下方裂孔,视网膜脱离时间平均11.3d,3只眼为视网膜全脱离.蛋白质浓度手术失败眼与成功眼差异有显著性(P<0.01.结论 单纯气液交换联合环扎治疗玻切术后视网膜脱离可以获得较好的疗效.对于下方裂孔并且视网膜脱离时间长,范围大的患者应采用再次玻璃体手术.     

Optical coherence tomography of tractional macular elevations in eyes with proliferative diabetic retinopathy.

PURPOSE: To document the findings of optical coherence tomography in eyes with tractional macular elevation associated with proliferative diabetic retinopathy, paying special attention to differentiating between tractional retinal detachment and retinoschisis. DESIGN: Observational case series. METHODS: We retrospectively reviewed images of optical coherence tomography obtained from 17 consecutive eyes (17 patients) with proliferative diabetic retinopathy without vitreous opacity and showing tractional macular elevation with or without foveal involvement. RESULTS: Tractional retinal detachment and retinoschisis could be differentiated in the cross-sectional images of optical coherence tomography. Retinoschisis with or without associated retinal detachment was observed in 16 of 17 eyes (94%), whereas retinal detachment was observed in only six of 17 eyes (35%). Five eyes showed both findings of retinal detachment and retinoschisis. CONCLUSIONS: Optical coherence tomography is useful for distinguishing tractional retinoschisis from retinal detachment in eyes with proliferative diabetic retinopathy and macular elevation. Tractional retinoschisis with or without retinal detachment is the most frequent pattern of tractional macular elevation in eyes with proliferative diabetic retinopathy.     

Optical coherence tomography of tractional macular elevations in eyes with proliferative diabetic retinopathy

PURPOSE: To document the findings of optical coherence tomography in eyes with tractional macular elevation associated with proliferative diabetic retinopathy, paying special attention to differentiating between tractional retinal detachment and retinoschisis. DESIGN: Observational case series. METHODS: We retrospectively reviewed images of optical coherence tomography obtained from 17 consecutive eyes (17 patients) with proliferative diabetic retinopathy without vitreous opacity and showing tractional macular elevation with or without foveal involvement. RESULTS: Tractional retinal detachment and retinoschisis could be differentiated in the cross-sectional images of optical coherence tomography. Retinoschisis with or without associated retinal detachment was observed in 16 of 17 eyes (94%), whereas retinal detachment was observed in only six of 17 eyes (35%). Five eyes showed both findings of retinal detachment and retinoschisis. CONCLUSIONS: Optical coherence tomography is useful for distinguishing tractional retinoschisis from retinal detachment in eyes with proliferative diabetic retinopathy and macular elevation. Tractional retinoschisis with or without retinal detachment is the most frequent pattern of tractional macular elevation in eyes with proliferative diabetic retinopathy.     

显微镜直视下巩膜外顶压及冷凝术治疗孔源性视网膜脱离

目的观察显微镜直视下巩膜外顶压及冷凝术治疗孔源性视网膜脱离的疗效。方法142例（142眼）孔源性视网膜脱离应用显微镜直视下用冷凝头顶压巩膜，确定裂孔及变性区的部位并冷凝，巩膜外加压，术中不引流视网膜下液，术后观察视力、眼压、视网膜复位情况。结果142眼全部一次视网膜完全复位，视网膜下液1d吸收者98眼，2～3d吸收者44眼，术后视力均有不同程度的提高。随访3～6月，复发1眼。结论显微镜直视下巩膜外顶压及冷凝术治疗原发性视网膜脱离，在成功封闭裂孔后，视网膜下液可自行吸收，可有效减少放液所带来的并发症，具有方便、准确、可靠的特点。     

脉络膜脱离孔源性视网膜脱离术中不放液观察

目的 观察视网膜裂孔冷凝，巩膜环扎外加压手术不放液治疗脉络膜脱离型孔源性视网膜脱离的疗效。方法 对28眼脉络膜脱离型孔源性视网膜脱离进行裂孔冷凝，巩膜环扎，外加压，术中不引流视网膜下液，对其治疗结果进行分析。结果 28眼中一次成功25眼，视网膜下液在1～2天吸收为13眼，3天～1周内吸收为12眼，术后均有不同程度的视力提高。结论 在成功封闭裂孔后，脉脱型孔源性视网膜脱离视网膜下液可自行吸收，手术成功率高，可有效减少放液所带来的并发症。     

A study on treatment of retinal detachment with unseen retinal breaks

64 cases (66 eyes) of retinal detachment in which no breaks can be found were treated with pars plana vitrectomy, scleral buckling or encircling procedures. The selection of operation depended on the shape and size of retinal detachment, the position of peripheral retinal lattice degeneration, phakia or aphakia, traumatic situation and the appearance of proliferative vitreoretinopathy. The results showed that the detached retina was successfully reattached in 53 eyes (80.3%), 4 eyes were improved (6%), only 9 eyes failed (10.7%). The technic of operation and application are discussed. We consider that suitable active surgical treatment for this kind of cases is encouraging.     

网脱术后并发渗出性视网膜脱离11例报告

目的：探讨网脱术后并发渗出性视网膜脱离的原因、临床表现及预后。方法：分析11例视网膜脱离行外路手术后的病例，裂孔性视网膜脱离6眼，锯齿缘离断性视网膜脱离3眼，巨大裂孔性视网膜脱离2眼，行硅压，环扎，外放液，冷凝手术。结果：11只眼于手术3天一10天出现了不向程度的渗出性视网膜脱离，经保守治疗视网膜下渗液吸收，视网膜复位。结论：渗出性视网膜脱离为视网膜脱离术后并发症，正确诊断、处理可以治愈。     

合并脉络膜脱离的视网膜脱离的临床观察

目的:探讨合并脉络膜脱离的视网膜脱离手术治疗方法和手术时机的选择并观察疗效。方法:总结、分析2010-01/2012-01因视网膜脱离合并脉络膜脱离在我院住院的患者45例45眼,其中原发性裂孔源性视网膜脱离合并脉络膜脱离38例,复发性视网膜脱离合并脉络膜脱离7例。手术方法包括巩膜环扎、经巩膜穿刺口脉络膜上腔引流、玻璃体视网膜手术、眼内光凝、C3F8填充术或硅油填充术。结果:患眼45眼均行巩膜环扎术,均于手术中成功引流脉络膜上腔液体,6眼行C3F8填充,39眼行硅油填充术,45眼视网膜脉络膜全部复位,视网膜裂孔封闭。其中23眼术后视力≥0.1。结论:合并脉络膜脱离的视网膜脱离,采用巩膜环扎和玻璃体视网膜手术联合经巩膜穿刺口脉络膜上腔积液引流的联合手术方式有效。     

巩膜扣带术治疗陈旧性视网膜脱离的临床观察

目的:观察分析巩膜扣带术治疗陈旧性视网膜脱离的临床效果。方法:对68例68眼陈旧性视网膜脱离采用巩膜外环扎、加压、冷凝、放液等手段治疗,对视力、视网膜复位情况和术后并发症进行简要分析。结果:随访4～24mo,57眼均1次手术达到解剖复位,治愈率为84%,术后矫正视力>0.05者45眼(66%)。结论:巩膜扣带术治疗玻璃体增殖不明显的陈旧性视网膜脱离简单有效。     

超声诊断视网膜裂孔伴视网膜脱离

目的 探讨超声诊断视网膜裂孔伴视网膜脱离的方法。方法 选取1999年11月～2000年7月眼科超声检查视网膜脱离伴明确裂孔的连续临床病例48眼,每眼均经过各个方位的超声探测。结果 当连续性脱离视网膜光带中有明显中断,且断端间距大于1mm时,可诊断为视网膜裂孔。马蹄形裂孔中18眼在孔前缘有玻璃体牵引,4眼PVD刚好至后缘,8眼在前后缘均有牵孔;黄斑裂孔中6眼在黄斑处有玻璃体牵引,6眼有完全PVD。巨大裂孔中2眼无明显PVD,大量皮质在裂孔中;1眼后缘有明显牵引。结论 应用超声可以诊断部分视网膜裂孔,视网膜裂孔周围多有玻璃体牵引,手术时应特别注意对此部位的处理,超声诊断对于视网膜脱离术前检查有帮助和补充的作用。     

视网膜切开在复杂性视网膜脱离手术中的应用

目的评价视网膜切开在复杂性视网膜脱离手术中的应用价值。方法回顾性总结了1994年7月至1995年12月在我科做视网膜切开手术的连续病例45例46只眼，其中裂孔性视网膜脱离伴增殖性玻璃体视网膜病变（proliferativevitreoretinopathy．PVR）35例35只眼、外伤性PVRS例8只眼、牵引性视网膜脱离2例3只眼。结果平均追踪7个月，内排液组40只眼一次手术成功24只眼占60％，有12只眼再发视网膜脱离做了第二次同样手术，其中同时取视网膜下膜2眼；取视网膜下膜5只眼和视网膜切开减张3只眼中，有6只眼视网膜复位，失败2只眼。视力改善37只眼占80％。结论在复杂性视网膜脱离中，合理选用视网膜切开、眼内排出视网膜下液、取除视网膜下膜和松解缩短、僵硬的视网膜，可提高手术疗效。     

硅油下玻璃体视网膜手术治疗复发性视网膜脱离

目的研究硅油下玻璃体视网膜手术治疗硅油填充眼复发性视网膜脱离的方法和效果。方法对32例（32眼）硅油填充眼复发性视网膜脱离的原因、手术方式、解剖复位和视功能恢复结果进行分析。结果视网膜脱离复发的原因由PVR引起者21眼，周边未封闭裂孔所致3眼，巨大裂孔后瓣滑脱5眼，黄斑裂孔未贴伏3眼，手术后均获得解剖复位，视力达0．05以上者共15眼，随访0．5a 5眼复发。结论保留硅油的玻璃体视网膜手术操作简单、安全，取得较好的解剖复位和视功能恢复。【眼科新进展2006；2613）：198—199】     

脉络膜脱离型视网膜脱离的玻璃体手术治疗

目的:探讨玻璃体手术治疗脉络膜脱离型视网膜脱离及术后早期临床表现。方法:脉络膜脱离型视网膜脱离患者17例17眼,应用糖皮质激素及玻璃体切除联合硅油填充术治疗,分析手术前后临床表现及早期疗效。结果:患者17眼早期间接眼底镜及B超检查视网膜及脉络膜脱离达到解剖复位;术后眼压略高,之后趋于稳定;炎症反应较轻;视力均有不同程度提高。结论:脉络膜脱离型视网膜脱离采用玻璃体切割联合硅油填充术能够获得良好的早期解剖复位。术前使用糖皮质激素有助于减轻炎症,为手术创造条件,提高手术成功率。术后早期眼压可控制在相对安全范围内。该类患者视力恢复普遍较差。     

视网膜脱离并发脉络膜脱离40例手术疗效分析

目的 提高视网膜脱离并发脉络膜脱离手术成功率。方法 根据视网膜脱离并发脉络膜脱离的不同类型,采用不同的手术方法。结果 40例40眼,出院时复位33眼（83％）;未复位7眼（18％）,2－14胡访结果复位32眼（80％）;未复位8眼（20％）。结论 术前术后早用皮质类固醇,同时尽早手术,提高成功率;花边型脉络膜脱离组手术成功率高,与其它两型差异具有非常显著性意义（P＜0.01）;视功能的恢复与脉络膜、视网膜脱离时间长短有关;严格放液原则,预防术后脉络膜脱离、视网膜脱离复发,减少未复位率。     

硅油下玻璃体视网膜手术治疗复发性视网膜脱离△

目的研究硅油下玻璃体视网膜手术治疗硅油填充眼复发性视网膜脱离的方法和效果。方法对32例(32眼)硅油填充眼复发性视网膜脱离的原因、手术方式、解剖复位和视功能恢复结果进行分析。结果视网膜脱离复发的原因由PVR引起者21眼,周边未封闭裂孔所致3眼,巨大裂孔后瓣滑脱5眼,黄斑裂孔未贴伏3眼,手术后均获得解剖复位,视力达0.05以上者共15眼,随访0.5a5眼复发。结论保留硅油的玻璃体视网膜手术操作简单、安全,取得较好的解剖复位和视功能恢复。     

巩膜扣带术治疗陈旧性视网膜脱离

目的:观察巩膜扣带术治疗陈旧性视网膜脱离的效果。方法:选取38例38眼陈旧性视网膜脱离患者,术中直视下定位、冷凝视网膜裂孔。针对不同病例36眼于裂孔处缝合硅海绵(其中19眼加缝硅胶环扎带),另2眼单纯行环扎术。26眼进行了视网膜下液引流术,7眼在手术前、后联合了激光光凝术。结果:其中33眼单次手术视网膜解剖复位,首次手术复位率87%,2眼再次手术后复位,手术最终解剖复位率92%。术中及术后无严重并发症发生。结论:通过个体化设计手术方案,巩膜扣带术治疗伴有视网膜下增生的陈旧性视网膜脱离可获得较高的手术治愈率。     

Pseudophakic retinal detachment from personal material

PURPOSE: To analyse retinal detachment in pseudophakic eyes. MATERIAL AND METHODS: Analysis of 23 pseudophakic patients with retinal detachment operated at the Department of Ophthalmology in Bydgoszcz in the period from 1996 to 1998. The following factors were evaluated: time interval to retinal detachment surgery from the date of cataract surgery, intraoperative complications during the cataract extraction, state of posterior capsule, type and location of retinal tears, extension of retinal detachment, anatomical and functional results and state of fellow eye. RESULTS: Retinal detachment occurred in 65.2% pseudophakic eyes in the period shorter than 3 years after cataract extraction and IOL implantation and in 34.8% more than 5 years after this operation. In 17.4% pseudophakic eyes posterior capsula was ruptured intraoperatively, in 17.4% YAG capsulotomy and in 4.3% surgical capsulotomy were performed. In 56.5% eyes posterior capsula was intact. CONCLUSIONS: Our results suggest possibility of the occurrence of delayed retinal detachment in pseudophakic eyes. The rupture of posterior capsule is not the only risk factor for this disease.