23G玻璃体切除早期治疗Terson综合征

目的 评价23G微创玻璃体切除早期治疗Terson综合征的临床效果.方法 回顾性总结Terson综合征8例(11眼).术前视力光感～0.12,病程15 ～42 d.11眼均采用23G微创玻璃体手术,术中根据视网膜情况,C3 F8填充3眼,硅油填充1眼,平衡液(BSS)填充7眼.结果 Terson 综合征玻璃体积血表现为弥散性玻璃体积血、积聚于后极部视网膜前、部分视网膜下出血.随访时间36 d～7个月.最终视力:0.1者1眼、0.12～0.3者4眼、＞0.3者6眼.随诊中未出现视网膜脱离或黄斑视网膜前膜等并发症.结论 Terson综合征早期玻切治疗手术效果较好,能有效避免并发症.     

Terson综合征的临床特征与手术效果分析

目的探讨Terson综合征的病因、病变特征、手术时机及手术方式的选择和疗效关系。方法回顾性总结2004年5月至2007年12月Terson综合征11例（17眼）。术前视力光感～0.3,病程25d～5月。17眼均行玻璃体视网膜手术,术中根据视网膜情况,采用眼内气体充填5眼,硅油充填3眼。结果Terson综合征玻璃体积血均沉于后极视网膜前,部分视网膜下积血,黄斑部视网膜前膜的发生率较高（82.35%）,术后视力较术前有显著提高（P=0.001）。结论Terson综合征患者因有头部外伤史及伤后昏迷史,就诊晚,全视网膜前膜及黄斑部视网膜前膜发生率高,及时有效的玻璃体手术能够提高患者的视力和生活质量。     

Terson综合征16例玻璃体视网膜病变特征及疗效分析

目的：探讨Terson综合征的患者玻璃体与视网膜的病变发展与手术时机选择和疗效关系。 方法：Terson综合征16例29眼,术前视力光感～0．02,病程2～9（平均4．1）mo。行玻璃体视网膜手术,术中根据玻璃体视网膜情况,采用眼内气体充填12眼,采用硅油充填17眼。 结果：术中发现玻璃体出血大都集中在后极部;同时存在视网膜前出血10眼,且两眼基本对称,出血在黄斑区9眼,积血池可扩大到上下血管弓,并形成牵引的堤坝,多灶性出血4眼。首次术后29眼视力显著提高,无黄斑区视网膜前出血16眼视力提高到0．4～1．0（平均0．67）;有黄斑区视网膜前出血9眼视力提高到0．1～0．5（平均0．36）。前者较后者术后视力显著提高（P〈0．05）。术后随访25眼,约5～33（平均17．6）mo。术后发生视网膜脱离3眼,行巩膜外加压视网膜复位术,视网膜复位。 结论：Terson综合征患者及时行玻璃体切割手术安全有效,伴有黄斑区视网膜前出血患者视力的恢复较差,说明黄斑区视网膜前出血对黄斑的视功能有损害。     

玻璃体手术治疗Terson综合征

目的：评价玻璃体手术治疗Terson综合征的疗效。方法：3例（4眼）Terson综合征行平部三切口玻璃体切除术，术中采用玻切头负压吸引及剥膜等方法造成玻璃体完成后脱离并彻底切除，用剥膜钩和剥膜镊剥除后极部视网膜前的圆顶状玻璃纸样前膜，结果：随访6－12月，患者视力均在0．5以上，视网膜平伏，结论：玻璃体手术治疗Terson综合征效果满意。     

玻璃体切割手术治疗Terson综合征的疗效分析

目的:探讨玻璃体切割手术治疗Terson综合征的疗效。方法:伴有严重玻璃体积血的8例(11眼)Terson综合征患者,经保守治疗无效后进行玻璃体切割术治疗,术中根据视网膜情况进行剥膜和硅油填充术。观察并总结术后情况。结果:术后所有患者的视力均有明显提高,73%的病例术后视力≥0.5,2眼因术前存在严重的玻璃体视网膜增殖性病变和视网膜脱离,术后视力低于0.1。结论:玻璃体切割术是治疗严重Terson综合征的有效手段,大部分患者术后视力恢复较好,但增殖性病变严重的患者术后视力欠佳。     

玻璃体切除治疗出血性玻璃体视网膜疾病

目的探讨玻璃体切除术对出血性玻璃体视网膜疾病的临床效果。方法对39例(40眼)玻璃体积血施行三通道经睫状体平坦部玻璃体切除术,联合膜剥离,水下透热,眼内光凝(或经巩膜冷凝),并根据病情选用眼内长效填充材料。结果视网膜静脉阻塞15眼,外伤性玻璃体积血9眼,视网膜孔源性玻璃体积血6眼,珠网膜下腔出血合并玻璃体积血(Terson综合症)4眼,静脉周围炎(Eales病)5眼,老年性黄斑变性1眼。术后随访2~40月,平均(12±3.4)月,40眼视力均有不同程度的提高,0.05以上者33眼(82.50%),与术前相比差异有统计学意义(P<0.05),视力0.2~0.8者26眼占65.00%。结论出血性玻璃体视网膜疾病经药物治疗无效,B超探示出现玻璃体后脱离或B超显示伴有牵引性视网膜脱离者,玻璃体切除术是消除玻璃体积血并使视网膜复位的有效方法。     

23G微创玻璃体切割术治疗Terson综合征的疗效观察

目的：探讨23G微创玻璃体切割术治疗Terson综合征的疗效。

方法：对伴有严重玻璃体积血的6例11眼Terson综合征患者在保守治疗无效后行23G微创玻璃体切割术,术中根据视网膜情况行剥膜或硅油填充,观察术后视力、视网膜及并发症情况。

结果：术后所有患者的视力均有明显提高,11眼中8眼(73%)术后视力≥0.5,1眼(9%)因术前存在严重的玻璃体视网膜增殖性病变和视网膜脱离,术后视力低于0.1。

结论：23G微创玻璃体切割术是治疗Terson综合征的有效手段,大部分患者术后视力恢复较好,但增殖性病变严重的患者术后视力欠佳,对于Terson综合征在保守治疗无效的情况下建议早期行23G微创玻璃体切割术干预。     

视网膜静脉阻塞玻璃体积血的手术治疗

目的 分析2型糖尿病患者（T2DM）玻璃体积血合并视网膜分支静脉阻塞（BRVO）玻璃体切除手术的效果.方法 回顾分析因玻璃体积血在我院接受玻璃体切除手术治疗的T2DM 228例（289只眼）的临床资料.根据术中观察,其中16例（17只眼）的玻璃体积血由BRVO引起.玻璃体切除手术前视力手动～0.04.随访时间9～60个月,平均（32.80±16.70）月.结果 T2DM玻璃体积血合并BRVO的发生率为5.9％;玻璃体切除手术后视力0.01～1.0,颞上分支静脉阻塞者术后视力较差;手术时机≥6个月者易发生牵引性视网膜脱离,且术后视力较差.结论 颞上分支静脉阻塞、手术迟于6个月者术后视力较差.     

玻璃体切除治疗复发性出血性玻璃体视网膜疾病

目的探讨玻璃体切除术对复发性出血性玻璃体视网膜疾病的临床效果。方法对43例(44眼)玻璃体积血施行三通道经睫状体平坦部玻璃体切除术,联合膜剥离,水下透热,眼内光凝(或经巩膜冷凝),并根据病情选用眼内长效填充材料。结果视网膜静脉阻塞18眼,外伤性玻璃体积血9眼,视网膜裂孔致玻璃体积血6眼,静脉周围炎5眼,增生性糖尿病视网膜病变3眼,蛛网膜下腔出血合并玻璃体积血(综合症)2眼,老年性黄斑变性1眼。术后随访2～24月,44眼视力均有不同程度的提高,随访视力较术前相比差异有统计学意义(P<0.05),视力0.05以上者36眼(81.82%),0.2～0.8者27眼(61.36%)。结论复发性出血性玻璃体视网膜疾病经药物治疗无效,B超显示出现玻璃体后脱离或B超显示伴有牵引性视网膜脱离者,玻璃体切除术是消除玻璃体积血并使视网膜复位的有效方法。     

四切口双手操作复杂性玻璃体视网膜手术的临床研究

目的评估四切口双手操作进行复杂性玻璃体切割手术治疗严重玻璃体视网膜病变的临床效果。设计回顾性病例系列。研究对象39例（39眼）复杂性玻璃体视网膜病变患者。方法对以上患者行助手照明、四切口双手操作法玻璃体切割手术,切除机化玻璃体和积血、剥除增生膜或取出异物、复位视网膜。术后随访6～18个月,观察视力,视网膜复位情况等。主要指标手术时间,手术前后患眼视力,术中、术后并发症。结果39眼术中顺利切除机化玻璃体,剥离视网膜增生膜,剥膜时间4～50min（平均16．2min）,取出异物,复位视网膜,手术时间32—65min（平均48min）。术后1个月随访时,视力明显提高者35眼（视力表提高2行或者光感到指数）,随访中4跟再次发生视网膜脱离,2眼视网膜出血。39例术中及术后随访期内均未发生明显并发症。结论四切口双手操作玻璃体切割手术容易进行剥膜、取异物等操作,对复杂性玻璃体手术有较大的临床应用前景。（眼科,2010．19：122—124）     

Terson综合症的玻璃体切割手术治疗

目的：报道并分析玻璃体切割手术治疗Terson综合症的临床疗效。方法：对15例Terson综合症患(21眼)行玻璃体切割手术治疗并进行追踪观察,平均随诊时间为19．1mo。结果：手术中发现15眼(71．4％)出现了不完全性的玻璃体后脱离(PVD),7眼(33．3％)有视网膜前膜形成,4眼(19．0％)发生视网膜脱离。术后所有眼的视力均得到明显的改善,其中17眼(80．9％)视力达到或超过0．5;4眼(19．0％)发生晶状体混浊。结论：玻璃体切割手术治疗Terson综合症能显提高视力,其并发症包括白内障等的发生率低。     

Results of vitrectomy in Terson syndrome

BACKGROUND: To report visual results of vitrectomy in Terson syndrome MATERIALS AND METHODS: In 11 patients, 15 eyes underwent vitreous surgery for Terson syndrome. The mean follow up was 18.3 months. RESULTS: An incomplete posterior vitreous separation was noted in 10 eyes (66.7%). An epiretinal membrane was present in 4 eyes (26.7%), and in 3 eyes, a retinal fold along the arcade was noticed. Significant visual improvement occurred in all eyes; visual acuity of 20/40 or better was achieved in 14 eyes (93.3%). Only 3 eyes developed lens opacity after surgery. CONCLUSION: Vitrectomy in Terson syndrome provides excellent visual recovery. The complication rate, including the development of cataract, is low.     

Referral delay and ocular surgical outcome in Terson syndrome

BACKGROUND: In Terson syndrome, vitreous hemorrhage can result from intracranial hypertension associated with intracranial bleeding. The vitreous hemorrhage can cause a considerable visual handicap. The aim of this study was to determine the outcome of surgery in patients with Terson syndrome and any delay in referral to an ophthalmologist. METHODS: Retrospective case review of 25 eyes of 17 patients undergoing vitrectomy for Terson syndrome. Delay in presentation to an ophthalmologist, intraoperative and postoperative complications, and the final visual acuity were noted. RESULTS: The mean interval between visual symptoms and referral to an ophthalmologist was 5.2 months for the nine unilateral cases and 4.9 months for the eight bilateral cases. Intraoperative complications included retinal break (2) and retinal dialysis (3). Late complications included epiretinal membrane (4), ghost cell glaucoma (1), and cataract (8). Twenty-two of the 25 eyes achieved a final visual acuity of 20/30 or better. CONCLUSION: Vitrectomy for vitreous hemorrhage in Terson syndrome is a safe and effective procedure, offering a rapid and prolonged improvement in vision. There is good reason to consider early vitrectomy, particularly when the hemorrhage is bilateral and dense.     

玻璃体切除术治疗Terson综合征的临床疗效研究

目的:探讨、评价并分析玻璃体切除术治疗Terson综合征的临床疗效。方法:对11例12眼Terson综合征患者进行玻璃体切除术治疗,根据术中视网膜情况辅以剥膜、硅油充填。结果:术后所有患者12眼玻璃体腔清晰,视力较术前明显提高,其中8眼(67%)术后视力0.4～0.7。随访3mo,仅1眼发生晶状体混浊。结论:玻璃体切除术是治疗Terson综合征的有效方法。早期手术治疗,患者术后视力恢复较理想,且术后并发症发生率较低。     

Long-term visual outcome in Terson syndrome.

The presentation and long-term visual outcome in 30 eyes with Terson syndrome is evaluated. In 25 of 30 eyes (83%), visual acuity of 20/50 or better was attained. This occurred in 12 of 16 eyes (75%) managed by observation alone and 12 of 14 eyes (86%) treated by pars plana vitrectomy. The most common long-term sequelae in all eyes studied was the formation of an epiretinal membrane. These occurred in 14 of 18 eyes (78%) followed for 3 or more years but accounted for significant visual loss in only 2 eyes. There was no difference in final visual outcome between those patients undergoing vitrectomy and those managed conservatively. However, visual recovery was more rapid in eyes undergoing vitrectomy despite the fact that vitrectomy was reserved for eyes with more dense vitreous hemorrhage.     

Outcome of vitrectomy in patients with Terson syndrome

PURPOSE: To report findings and evaluate the results of vitrectomy in 22 eyes with Terson syndrome. METHODS: We reviewed retrospectively the records of patients who underwent pars plana vitrectomy as a result of vitreous haemorrhage. Twelve cases concerned unilateral vitrectomy and five concerned bilateral vitrectomy. The time interval between intracranial haemorrhage and vitrectomy was 1-10 months (mean 5.9 months). RESULTS: During a mean follow-up of 23.3 months (range 1-69 months) visual acuity (VA) improved in 21 of 22 eyes. Preoperative VA was < or = 0.1 in 20 of 22 eyes, while postoperative VA was > or = 0.5 in 16 of 21 eyes. Poor visual outcomes were mainly caused by retinal detachments (seven eyes, in which three were caused by proliferative vitreoretinopathy), epiretinal membranes (seven eyes) and optic atrophy (one eye). Our study concurs with recent reports suggesting early vitrectomy in bilateral cases and in cases where ultrasonography shows epiretinal membrane or proliferative retinopathy formation.     

Terson综合征的治疗及预后分析

目的探讨Terson综合征的治疗选择及预后。方法本组病例共纳入我科2003年1月至2009年12月间确诊并治疗的24(35只眼)Terson综合征患者连续病例,术前视力为光感至0.2,病程为1～10个月,年龄16～67岁。所有患眼均进行了玻璃体切割手术,根据视网膜具体情况选择硅油充填9只眼,C3F8眼内充填3只眼。结果所有Terson综合征患者通过手术清除玻璃体腔内积血后视力均有一定的提高,35只眼中有14只眼术后视力≥0.5,病程较长或合并视网膜脱离者术后视力恢复欠佳。结论玻璃体切割手术可以有效治疗Terson综合征患者发生的玻璃体积血,对于较长时间玻璃体腔内积血未能吸收或是合并视网膜脱离的患者应积极手术介入。     

玻璃体手术治疗特发性黄斑前膜临床观察

目的探讨玻璃体切除联合黄斑前膜剥离术治疗特发性黄斑前膜的手术效果及手术时机的选择。方法回顾性分析手术治疗的特发性黄斑前膜58例（59眼）,所有病例均行三切口玻璃体切除及黄斑前膜剥除术,其中20眼同时进行了内界膜撕除术。32眼行气液交换。6眼联合行晶状体超声乳化及人工晶状体植入术。手术后随访1～24月,平均4．7月。对视力、黄斑结构及手术并发症等进行了临床观察。结果随访期末视力提高43眼,占72．88％（其中提高2行以上者29眼占49．15％）;不变15眼,占25．42％;下降1眼,占1．70％。随访期内未见前膜复发。OCT显示所有患眼的前膜均已消除,黄斑水肿不同程度逐渐减轻。并发症：术中少许点状出血6眼;手术后11d发生玻璃体积血1眼;周边小牵引孔3眼（其中视网膜脱离1眼）;术中中心凹处小牵引孔1眼;手术后1a并发性白内障2眼。结论玻璃体切除术联合膜剥离治疗特发性黄斑前膜的手术效果较好,但也可能出现一些较严重的并发症。在手术技巧比较娴熟的情况下,较早手术治疗可能有助于恢复较好视功能。     

Pars plana vitrectomy for epiretinal membrane associated with sarcoidosis

PURPOSE: To examine retrospectively the visual outcomes in patients undergoing vitrectomy for epiretinal membranes secondary to sarcoid uveitis. METHODS: Eleven consecutive patients (11 eyes) with epiretinal membrane and uveitis associated with sarcoidosis underwent pars plana vitrectomy. RESULTS: Nine eyes (82%) gained two or more lines of Snellen visual acuity at 1-12 months after surgery. However, 4 of these 9 eyes lost two or more lines of Snellen visual acuity by the final visit. Overall, 5 eyes (45%) had attained at least two Snellen lines of visual acuity improvement, 5 eyes (45%) were unchanged, and 1 eye (10%) had worsened by two lines at the final visit. Nine eyes (81%) achieved visual acuity of 20/40 or better by the final visit. Slit-lamp biomicroscopy and fluorescein angiography showed that cystoid macular edema had resolved in 4 of 7 eyes postoperatively; vitritis improved in all cases. Postoperative complications included cataract formation, glaucoma, and membrane recurrence. Subsequent surgeries consisted of cataract extraction in 2 eyes and membrane peeling in 1 eye. CONCLUSIONS: Pars plana vitrectomy appears to have a beneficial effect on restoring vision in eyes with epiretinal membrane and uveitis associated with sarcoidosis, but final visual acuity was limited by the development of cataract and membrane recurrence.     

Outcome indicators for vitrectomy in Terson syndrome

Purpose: There is no general agreement on the best indication and timing of vitrectomy in patients suffering from Terson syndrome. Therefore, we reviewed our cases in order to assess factors interfering with the functional outcome and complication rates after vitrectomy. Methods: In this retrospective consecutive case series, the records from all patients undergoing vitrectomy for Terson syndrome between 1975 and 2005 were evaluated. Results: Thirty‐seven patients (45 eyes) were identified, 36 of whom (44 corresponding eyes) were eligible. The best‐corrected visual acuity (BCVA) at first and last presentation was 0.07 ± 0.12 and 0.72 ± 0.31, respectively. Thirty‐five eyes (79.5%) achieved a postoperative BCVA of ≥ 0.5; 26 (59.1%) eyes achieved a postoperative BCVA of ≥ 0.8. Patients operated on within 90 days of vitreous haemorrhage achieved a better final BCVA than those with a longer latency (BCVA of 0.87 ± 0.27 compared to 0.66 ± 0.31; P = 0.03). Patients younger than 45 years of age achieved a better final BCVA than older patients (0.85 ± 0.24 compared to 0.60 ± 0.33; P = 0.006). Retinal detachment developed in four patients between 6 and 27 months after surgery. Seven patients (16%) required epiretinal membrane peeling and seven cataract surgery. Conclusion: Ninety‐eight per cent of our patients experienced a rapid and persisting visual recovery after removal of a vitreous haemorrhage caused by Terson syndrome. A shorter time between occurrence of vitreous haemorrhage and surgery as well as a younger patient age are predictive of a better outcome. Generally, the surgical risk is low, but complications (namely retinal detachment) may occur late after surgery.