有晶体眼硅油入前房继发青光眼的手术处理

目的：总结前房硅油排出术治疗有晶体眼硅油入前房继发青光眼的临床效果。方法：对６例玻璃体切除,硅油填充术后有晶体眼硅油入前房者,行１２点位角膜缘穿刺注入Ｈｅａｌｏｎ,６点位角膜缘切开排除硅油,悬韧带断裂超过２点钟同时行６点位虹膜周边切除术。结果６眼术后眼压控制正常、硅油在位、视网膜在位、除１例角膜轻度混浊外无其他并发症。结论：采用Ｈｅａｌｏｎ注入硅油排出虹膜周边切除术治疗有晶体眼硅油入前房继发青光眼     

有晶状体眼前房硅油的原因分析和处理

目的:探讨有晶状体眼在玻璃体切割术后硅油进入前房的原因及处理方法.方法:对19例视网膜脱离的患者行常规玻璃体切割联合硅油填充手术,对术后发生的硅油进入有晶状体眼前房的原因进行回顾性分析,并根据不同原因及发生程度采取不同处理.结果:有2例(2眼)硅油进入前房发生于二次环扎术中,17例(19眼)发生于术后2～11 d之内(其中1例取出前房硅油3d后硅油再度进入前房并形成瞳孔阻滞继发青光眼,二次取出前房硅油并行虹膜6点位周边切除后再未发生硅油进入前房).所有病例均在硅油进入前房1wk内取出前房硅油,并对其中13例出现继发性青光眼患者行6点位虹膜周边切除;全部病例眼压控制于20mmHg以下,视力均恢复至硅油进入前房之前的矫正视力,取出前房硅油后未出现严重角膜并发症,无1例出现视网膜脱离.结论:有晶状体眼在玻璃体切割术后硅油进入前房原因主要为眼外伤、高度近视、术中医源性损伤等造成悬韧带损伤.对于玻璃体切割术后有晶状体眼前房进入硅油应注意体位及观察角膜、眼压,尽早取出前房硅油,有瞳孔阻滞继发性青光眼的患者必要时行虹膜6点位周边切除.可保护角膜、视网膜及有效的视力.     

硅油进入前房的原因分析及处理

目的 探讨硅油进入前房的原因及防治方法。方法 对不同情况硅油进入前房的病例加以分析并手术治疗。结果 全部病例并发症缓解。视网膜在位，随访3-6月，硅油未再入前房。结论 前房内注入黏弹剂排出硅油的方法简便易行，手术损伤小，虹膜6点方位周边切除可以预防硅油入前房。     

硅油充填眼的白内障囊外摘除及人工晶体植入术

硅油的主要并发症之一是引起晶体后囊膜混浊，影响视力。通常可在硅油取出后施行白内障手术，但在视网膜脱离很可能复发、先前取出硅油后失败或患者拒绝取出硅油等情况下则需将硅油保留于限内。作者介绍了在硅油眼中行白内障囊外摘出及人工晶体植入的手术方法及经验。5例5眼，硅油注入后6～13个月未被取出，3眼因患者拒绝取出，2眼因先前取出视网膜脱离复发。所有眼超声生物测量均在玻璃体手术前进行，因眼内硅油妨碍测量。球后麻醉后，在角膜缘10点和2点钟位做二个穿刺切口入前房，其一为BSS液入前房通道，另一为注入Healon等前房内操作…     

超声乳化吸出联合小梁切除术中做与不做周边虹膜切除的比较

目的 比较超声乳化吸出人工晶状体植入联合小梁切除术中,同时做与不做周边虹膜切除术的手术效果.方法 对32例(38眼)青光眼合并白内障手术回顾性分析.采用双切口晶状体超声乳化吸出、折叠式人工晶状体植入联合小梁切除术,分成做周边虹膜切除术(PI组)20眼,不做周边虹膜切除术(NoPI组)18眼,经Pentacam测量术前术后前房参数变化,比较两组在统计学上的差异,比较视力、眼压和并发症发生情况.随访12个月.结果 术前、术后1周、1个月、3个月、6个月、12个月前房角角度、中央前房深度、上方周边前房深度两组间差异无统计学意义(P＞0.05).两组术后12个月平均眼压均明显低于术前(P＜0.05),且两组间差异无统计学意义(t=0.04,P＞0.05).术后1周矫正视力≥0.3者34眼(89.5％),明显高于术前者4眼(10.5％)(P＜0.05),两组间术后矫正视力差异无统计学意义(P＞0.05).术后早期并发症为角膜水肿和前房渗出,PI组前房少量积血1眼,NoPI组术后1d,1眼出现周边虹膜堵塞小梁滤口,经周边虹膜切除处理后恢复正常.余无严重并发症.结论 超声乳化吸出、人工晶状体植入联合小梁切除术中,做与不做周边虹膜切除术治疗青光眼合并白内障的效果无明显差异,均具有提高视力、降低眼压、加深前房、手术并发症少的效果.     

老年性白内障膨胀期继发青光眼的人工晶状体植入术

目的：探讨膨胀期白内继发青光眼的药物及手术治疗。方法：筛选膨胀期白内障继发青光眼的病例20例21只眼行人工晶状体植入手术,术式为（1）白内障囊外摘除合并人工晶状体植入（ECCE＋IOL）＋虹膜周边切除或切段性虹膜切除,（2）ECCE＋IOL＋小梁切除术。结果：（1）术后矫正视力提高者20只眼（95．2％）,其中0．3－1．0者16只眼（76．2％）。（2）眼压15只眼（71．4％）正常,6只眼（28．6％）局部用药后正常,总有效率100％。（3）并发症较高,其中后囊破裂2只眼（9．5％）瞳孔区渗出膜7只眼（33．3％）。结论：（1）膨胀期内白内障继发青光眼可用缩瞳剂治疗。（2）白内障囊外摘除合并抗青光眼手术的同时植入人工晶状体是恢复视力治疗继发青光眼的有效手段,术式首选人工晶状体植入＋虹膜周边切除术。（3）膨胀期白内障继发青光眼术后 并发症较普通白内障发生率高,故应在膨胀期继发青光眼前早手术。（4）膨胀期内障患者为预防继发青光眼可给予缩瞳剂。     

增生性玻璃体视网膜病变伴无虹膜症的治疗--玻璃体晶状体切除硅油填充视网膜复位联合虹膜型人工晶状体植入术

由Sundmacher等设计研制的虹膜型人工晶状体为先天性和外伤性无虹膜提供了一个既能提高视力，又能减轻和／或消除畏光的有效方法。我们于2001年11月收治了一位眼挫伤所致严重增生性玻璃体视网膜病变伴无虹膜的患儿，施行了玻璃体晶状体切除硅油填充视网膜复位联合虹膜型人工晶状体植入术，利用该型晶状体作为虹膜隔以阻挡硅油进入前房，取得满意效果。     

玻璃体手术硅油充填继发青光眼的原因分析及治疗

目的 :探讨复杂性视网膜脱离玻璃体切割硅油注入继发青光眼的发病相关因素及治疗。方法 :对玻璃体切割硅油注入 36 2只眼患者术后随访结果进行回顾性研究。结果 :本组硅油术后继发青光眼发病率 11 6 % ,随着硅油在眼内时间延长继发青光眼的发病率增高。术后无晶体眼 ,硅油进入前房是眼压升高主要原因。其次为硅油乳化。 42只眼注硅油眼继发青光眼患者经药物和 /手术治疗眼压可有效控制。结论 :玻璃体手术硅油充填继发青光眼是术后常见并发症 ,其发病与硅油在眼内时间 ,硅油进入前房 ,硅油乳化有关。经药物和 /手术治疗眼压可有效控制。     

超声乳化治疗早期闭角型青光眼是否联合周边虹膜切除术的研究

目的:探讨白内障超声乳化并人工晶状体植入术治疗闭角型青光眼临床前期或先兆期患者术中是否需要联合周边虹膜切除术。方法:40例40眼原发性闭角型青光眼临床前期或先兆期病例,术前随机分成A组(白内障超声乳化+人工晶状体植入)和B组(白内障超声乳化+人工晶状体植入+周边虹膜切除术),对比两组术后视力、眼压、前房深度、Scheie前房角分级进行统计分析。结果:两组病例都未发生黄斑囊样水肿、驱逐性大出血等并发症。1例联合周边虹膜切除的患者出现前房积血,对症治疗后出血吸收。两组病例术后视力较术前提高,术后两组视力、眼压、前房深度、Scheie前房角分级比较差异无显著性。结论:闭角型青光眼临床前期、先兆期采用白内障超声乳化摘除晶状体,可有效预防青光眼的急性发作,并显著提高患者的视力,术中不需要另行周边虹膜切除术。     

无晶状体和人工晶状体眼青光眼的联合手术治疗

无晶状体或人工晶状体植入眼继发青光眼的发病机制复杂，手术治疗成功率较低。常规滤过手术失败的确切原因尚不清楚，可能与结膜下易形成瘢痕和玻璃体进入前房、玻璃体阻滞瞳孔、玻璃体阻塞滤过口及虹膜周边切除术等因素有关.本研究针对这些原因，采用玻璃体切割联合滤过手术及丝裂霉素C（mitomycin C，MMC）以及玻璃体腔注射曲安奈德，可调节缝线治疗无晶状体和人工品状体眼继发青光眼，     

硅油填充术后前房硅油分析

目的：评估硅油填充术后前房硅油及其对眼压的影响。方法：对110例112眼行硅油填充术的患者的临床资料进行回顾性分析。结果：术后1－21月随访发现19眼（17％）前房硅油,其中16眼（84％）为无晶体眼：12眼下方6点虹膜周切闭锁,4眼周切大于2mm。前房硅油中继发青光眼的发生率为53％（10／19）,角膜混浊21％（4／19）。结论：虹膜周发闭锁为无晶体眼中硅油入前房的首要原因。前房硅油继发性青光眼发生率率,应予及早取出。     

Intravitreal silicone oil injection: complications and treatment of 415 consecutive patients

Silicone oil injection in conjunction with pars plana vitrectomy was carried out by five surgeons in 415 consecutive patients using the same surgical equipment, the same surgical techniques and the same highly purified silicone oil (viscosity, 5000 mPa·s). Indications for silicone oil injection after vitrectomy included advanced stages of proliferative vitreoretinopathy following rhegmatogenous retinal detachment (49%), severe proliferative diabetic retinopathy (38%), and proliferative vitreoretinopathy following retinal detachment due to ocular trauma (13%). Postoperative complications were noted in a 6- to 30-month follow-up period. Cataractous changes of varying degree were seen in all phakic eyes. Silicone oil entered the anterior chamber in 6% of all phakic and pseudophakic eyes. Subretinal silicone oil was noted in 4%. Other complications associated with the use of intravitreal silicone oil included biomicroscopically visible silicone oil emulsification (0.7%), keratopathy (5.5%), glaucoma (6%), closure of the inferior iridectomy (6%), and reproliferation of epiretinal and subretinal fibrous membranes (40%). We anticipate that the physicochemical characteristics of the highly purified silicone oil (viscosity, 5000 mPa·s) and the routine performance of an inferior iridectomy in all aphakic eyes had a positive impact on the low incidence of silicone-oil-related complications such as emulsification, keratopathy and secondary glaucoma.     

硅油填充术后青光眼及房角变化

目的评估硅油填充术后青光眼及房角变化。方法对33例34只眼行硅油填充术的患者的眼压和房角进行前瞻性研究。结果硅油注入术后9只眼发生了青光眼,占26%,直接由硅油引起的 有7只眼,占78%(7/9);1～4.5个月上方房角变化：11只眼不同程度虹膜周边前粘连,22只 眼有硅油乳化小滴;下方虹膜周边切除孔闭锁的7只眼中有6只眼发生了青光眼(P<0.05)。 结论硅油填充术后青光眼发生率高,虹膜周边切除孔闭锁,硅油乳化是引起硅油术后青光眼的主要原因。(中华眼底病杂志,2001,17:105-107)     

One-step extracapsular cataract extraction and silicone oil-injection in the management of proliferative vitreoretinopathy.

A combined technique of extracapsular cataract extraction and silicone oil injection is described. The anterior capsule is preserved to prevent movement of the silicone oil from the vitreous cavity to the anterior chamber. An anterior chamber tap ensures that the vitreous cavity is completely filled with silicone oil, while a peripheral iridectomy prevents postoperative pupillary block glaucoma.     

Pupil block glaucoma in phakic and pseudophakic patients after vitrectomy with silicone oil injection

PURPOSE: To describe pupil block glaucoma in phakic and pseudophakic patients after vitrectomy with silicone oil injection. DESIGN: Interventional case series. METHODS: Cases were collected from January 1997 to July 2000 from three tertiary referral centers. RESULTS: Seven phakic patients (seven eyes) and one pseudophakic patient (one eye) presented 1 to 90 days after vitrectomy and silicone oil injection with intraocular pressures of 36 to 70 mm Hg. Five patients had an observed or potential weakness of the iris-lens diaphragm. Treatment with Nd:YAG-laser peripheral iridotomy or inferior iridectomy provided a temporary reduction in intraocular pressure for some patients, but all eventually required removal of silicone oil. CONCLUSION: Pupil block glaucoma after silicone oil injection is well recognized in aphakic patients, but ophthalmologists should be aware that it can occur in phakic and pseudophakic patients, particularly in complicated cases and patients with a weakness of the iris-lens diaphragm.     

硅油填充术后继发青光眼的临床分析

目的:探讨硅油填充术后早期继发青光眼的常见原因及处理方法。方法:回顾2007-01/2008-12我院128眼玻璃体切割联合硅油填充术后出现继发青光眼的原因、类型及处理方法。结果:术后128眼中发生继发青光眼26眼(20%)。常见的原因是术后眼部炎症反应、硅油入前房、全视网膜激光光凝以及巩膜环扎术。术后发现有继发性青光眼者,局部或联合全身降眼压治疗,并积极寻找病因并针对病因治疗。结论:硅油充填术后继发青光眼发生率较高,药物和手术治疗可以有效控制眼压。     

Basal iridectomy at 6 o''clock in the aphakic eye treated with silicone oil: prevention of keratopathy and secondary glaucoma.

In the aphakic eye, with intact iris diaphragm, silicone oil has frequently caused a pupillary block. In this situation aqueous humour accumulates behind the iris and forces silicone oil through the pupil into the anterior chamber. An iridectomy at the 6 o'clock position can effectively prevent this pupillary block. The iridectomy allows free passage of aqueous to the anterior chamber which remains free of silicone oil. No permanent contact with silicone oil and the cornea is established, and development of keratopathy is prevented. The effect of this iridectomy in 62 eyes with intact iris diaphragm in patients in Rotterdam (35 cases) and Nagoya (27 cases) is demonstrated. Only in 6.5% of the cases was silicone oil present in the anterior chamber at the end of the follow-up period of 7 months.     

Management of glaucoma after retinal detachment surgery

Secondary glaucoma may complicate retinal detachment surgery. Intraocular pressure (IOP) elevation has been described after scleral buckling procedures and vitrectomy with intravitreal injection of gas or silicone oil. Angle-closure glaucoma after scleral buckling develops because of congestion and anterior rotation of the ciliary body. Medical therapy and laser iridoplasty are usually successful in controlling IOP, but the presence of conjunctival scarring and recession and retinal hardware after scleral buckling procedures can make surgical management challenging. Intravitreal injection of expansile gases like sulfur hexafluoride (SF6) and perfluoropropene (C3F8) may produce secondary angle-closure glaucoma with or without pupillary block. Aspiration of a portion of the intraocular gas may be needed, especially if IOP is elevated to a level that may compromise ocular perfusion. Glaucoma also can develop after intravitreal injection of silicone oil secondary to pupillary block, inflammation, synechial angle closure, rubeosis iridis, or migration of emulsified or nonemulsified silicone oil into the anterior chamber. A prophylactic inferior iridectomy at the time of surgery serves to prevent pupillary block. Patients with medically uncontrolled glaucoma after silicone oil injection may require oil removal with or without concurrent glaucoma surgery.     

玻璃体切除硅油填充术后高眼压的临床治疗

目的探讨玻璃体切除硅油填充术后高眼压的治疗方法。方法对视网膜脱离患者行玻璃体切除硅油填充术,术后眼压大于25 mm Hg的86例（86只眼）进行药物或手术治疗。结果 61只眼（70.9%）经药物治疗眼压控制。14只眼（16.2%）经前房穿刺术后眼压控制。8只眼（9.3%）出现虹膜周切口阻塞,其中6只眼经激光打孔再通,2只眼只行手术切除周边虹膜。3只眼（3.4%）出现新生血管性青光眼,其中1只眼行睫状体冷凝,2只眼行睫状体光凝联合硅油取出后眼压控制。眼压控制后8,4只眼（97.6%）视力有不同程度提高。结论及时发现并针对病因进行药物或手术治疗可有效控制玻璃体切除硅油填充术后高眼压。