无晶状体眼视网膜脱离手术方法的探讨

目的 探讨治疗无晶状体眼视网膜脱离(ARD)和人工晶状体眼视网膜脱离(PPRD)的手术方式选择。方法 以无晶状体眼及人工晶状体眼原发生视网膜脱离65例(65只眼)为研究对象，分首次单纯环扎加压组30例(30只眼)及玻璃体手术加环扎或环扎加压组35例(35只眼)，进行临床治疗以及复发后进一步治疗观察。结果 30只眼单纯环扎加压组一次手术成功率86．67％(26／30)。随访3个月～1年，平均5．2个月。视网膜复位27只眼，复位率90％，其中3只眼再次行玻璃体手术治疗。玻璃体手术联合环扎或环扎加压组35只眼作为首次手术，一次手术成功率91．43％(32／35)，3只眼为巩膜手术复发者．共38只眼，随访3个月～1年，平均4．9个月，视网膜复位37只眼，复位率97．37％。总手术成功率93．85％(61／65)。结论 单纯环扎加压术和玻璃体手术加环扎或环扎加压术两种手术方法在选择好手术适应证情况下治疗ARD和PPRD具有较好的效果。玻璃体手术加环扎或环扎加压术对PVR增生较重的病例效果显著。两种手术方法结合治疗ARD和PPRD能明显提高视网膜复位率。     

儿童视网膜脱离临床分析

目的探讨儿童视网膜脱离的发病原因、手术方法及疗效。方法通过对术前、术后视力及不同手术方法的视网膜复位率的观察，对60例(68眼)儿童视网膜脱离进行临床疗效分析。结果25眼行巩膜外加压术，21眼(84．00％)术后6个月视网膜复位，43眼联合玻璃体切割术，24眼(55．81％)术后6个月视网膜复位。随访6个月视网膜最终复位45眼(66．18％)。结论眼外伤是儿童视网膜脱离的主要原因。巩膜外加压术、玻璃体切割术是治疗复杂性儿童视网膜脱离的有效方法之一。     

玻璃体切除联合巩膜环扎术治疗无晶体眼视网膜脱离

目的：探讨玻璃体切除术在治疗无晶体眼及人工晶体眼视网膜脱离中的优越性。方法：以无晶体眼及人工晶体眼原发性视网膜脱离76例为研究对象,分成玻璃体切除联合巩膜环扎或巩膜外垫压术组49例及单纯巩膜环扎或巩膜外垫压术组27例,对其进行临床对照研究。结果：49例玻璃体切除联合巩膜环扎或巩膜外垫压术组术后1周视网膜复位45例(占91．84％),随访3个月～2年,视网膜复位的39例,复位率86．7％;27例单纯巩膜环扎或巩膜外垫压术组术后1周视网膜复位17例(占62．96％),随访3个月-2年,视网膜复位的ll例,复位率64．8％。对两组的视网膜复位率进行z0检验,p<0．05。结论：玻璃体切除联合巩膜环扎或巩膜外垫压术是无晶体眼及人工晶体眼原发性视网膜脱离有效的治疗方法,比单纯巩膜环扎或巩膜外垫压术具有明显的优越性。     

Marfan综合征合并视网膜脱离的治疗

目的观察巩膜扣带术和玻璃体切除术治疗Marfan综合征合并视网膜脱离的效果.方法对15眼中的5眼(33.3%)实行巩膜扣带术,10眼(66.7%)实行玻璃体切除术,观察视网膜的复位率和视力恢复情况.结果在平均4.3年的随访期间,采用巩膜扣带术和玻璃体切除术治疗Marfan综合征合并视网膜脱离的复位率分别为100%和80.0%,总的复位率为86.7%.有7眼术后视力≥0.1.结论只要掌握好适应证,手术治疗Marfan综合征合并视网膜脱离是一种安全有效的方法.     

Marfan综合征合并视网膜脱离的三联手术

目的：探讨晶体玻璃体切除联合巩膜扣压环孔手术（三联术）治疗Marfan综合征视网膜脱离的解剖复位率和视功能结果。方法：回顾性研究连续性的11例（14只眼）Marfan综合征视网膜脱离的患者行晶体玻璃体切除联合巩膜扣压环扎手术后的解剖和功能结果。结果：三联术后随访4－46个月,（平均31．2个月）,12／14只眼（85．7％）视网膜复 位成功,12只眼视力达0．05以上,其中8只眼视力达0．3以上。结论：对于Marfan综合征患者的视网膜脱离,晶体玻璃体切除联合巩膜扣压环扎术是一种安全和有效的治疗方法。     

玻璃体切除术治疗合并脉络膜脱离的孔源性视网膜脱离18例

目的：探讨玻璃体切除术治疗孔源性视网膜脱离并发脉络膜脱离的方法和疗效。方法：18例18眼并发脉络膜脱离的孔源性视网膜脱离,行玻璃体切除术治疗,术后观察视力、视网膜复位情况及手术并发症等,随访2～6(平均3．3)mo。结果：在18眼中13眼(72％)术后视网膜复位,大部分视力均有不同程度的提高;5眼视网膜未复位,其中3眼经再手术后复位,2眼眼球萎缩,未再手术。手术并发症主要有术后葡萄膜炎、玻璃体积血、术后高眼压等。结论：及时的玻璃体手术治疗合并脉络膜脱离的孔源性视网膜脱离,大多数视网膜能够获得复位,部分恢复视功能。     

后房型人工晶状体眼视网膜脱离临床分析

目的：探讨后房型人工晶状体眼视网膜脱离的临床特点及治疗方法。方法：对我院1996年至1998年3年间经常规视网膜脱离复位术及显微玻璃体视网膜联合术治疗的12例（12只眼）后房型人工晶状体眼视网膜脱离的临床资料作回顾性分析。结果：行常规视网膜脱离复位术（巩膜外加压术、巩膜环扎术、巩膜环扎加外加压术）7只眼;玻璃体切除、眼内真充联合巩膜环扎术5只眼。随肪半年至3年,视网膜完全复位10只眼（均为一次手术复位,占83.3%）,部分复位1只眼,总复位率达91.7%。术后视力提高9只眼,不变2只眼,下降1只眼。12只眼均未行人工晶状体取出。结论：人工晶状体眼视网膜脱离具有发病早、发展迅速、眼内病变复杂、易致严重PVR、诊断及治疗难度加大等特点。一旦发现视网膜脱离,即根据不同的情况转择相应的手术方式、施行手术治疗,仍可取得较好疗效。     

环扎加压术治疗陈旧性视网膜脱离疗效观察

目的探讨环扎加压术治疗陈旧性视网膜脱离的疗效。方法陈旧性视网膜脱离患者60例（60只眼）进行环扎加压术治疗，术中巩膜外放液48只眼（80％），不放液12只眼（20％），C3F8玻璃体腔内注入10只眼（16．7％）。结果术后随访6-12个月（平均8．6个月），44只眼（73．3％）视网膜完全复位，14只眼（23．3％）明显好转，2只眼（3．3％）手术后视网膜未复位，后行玻璃体手术。手术后视网膜脱离治愈率73．3％，有效率96．7％。结论环扎加压术治疗不伴有视网膜前膜形成的陈旧性视网膜脱离，疗效良好，创伤小，可作为首先选择的术式。     

人工晶体眼视网膜脱离的手术治疗

目的观察人工晶体眼视网膜脱离的手术治疗效果。方法16例16眼患者，依据增生性玻璃体视网膜病变分级以及固定皱褶的部位，术前是否发现裂孔及裂孔部位选择手术。外路手术以巩膜环扎加外垫压冷凝放液及必要时的眼内注气；内外路结合手术以巩膜环扎加玻璃体切割及必要时的眼内注气或硅油注入加激光或冷凝。结果最终视网膜复位率达100％；一次手术复位12例，复位率75％；3例二次手术复位，1例3次手术复位。结论合理的选择手术方式，可以提高人工晶体眼视网膜脱离的复位率。     

儿童视网膜脱离手术方法及效果的分析

目的 分析探讨儿童视网膜脱离的临床特点，手术方法及效果。方法 对采用不同手术方法的42例(42眼)儿童视网膜脱离病例进行综合临床分析。结果 18眼行巩膜外加压术，1次手术视网膜复位16眼(88．89％)；24眼联合玻璃体切除手术，1次手术视网膜复位15眼(62．50％)。术后视力较术前提高者30眼(71．43％)。结论 眼外伤是儿童视网膜脱离的主要原因。对儿童视网膜脱离的手术治疗，应根据儿童的生理特点首选施行常规巩膜外加压术，但对伴有PVR严重的复杂性视网膜脱离应联合玻璃体切除术。     

Retinal detachment in Marfan syndrome: clinical characteristics and surgical outcome

PURPOSE: To describe the clinical characteristics of retinal detachments in patients with Marfan syndrome and report the surgical outcome of vitreoretinal surgery. METHODS: Records relating to 53 eyes of 45 patients with Marfan syndrome who underwent surgery for rhegmatogenous retinal detachment were reviewed. Of the 53 eyes, 24 (45.3%) underwent scleral buckling as the first procedure and 29 (54.7%) underwent vitrectomy surgery with scleral buckle as the first procedure. Main outcome measures included clinical characteristics of retinal detachment, reattachment rates, and functional improvement in vision. RESULTS: Characteristic findings included total retinal detachment in 40 (75.5%) eyes, atrophic holes in 24 (45.3%) eyes, more than four retinal breaks in 21 eyes (39.6%), preequatorial and postequatorial breaks in 20 (37.7%) eyes, giant retinal tears in six (11.3%) eyes, and proliferative vitreoretinopathy (posterior, anterior, or both) in nine (17%) eyes. In 30 (56.6%) eyes, retinal breaks were located only in the temporal half of the retina. Of the 24 eyes with myopia, 13 (54.2%) had a myopic correction greater than 7 diopters. At the median follow-up of 10.7 months, complete retinal reattachment was obtained in 87.6% and 86.2% of patients undergoing scleral buckling (including additional procedures such as vitrectomy) and vitrectomy surgery, respectively. In eyes with reattached retinas, a final visual acuity of 20/200 or better was obtained in 81% of the patients after scleral buckling and in 56% of the patients after vitrectomy surgery (P = 0.07). CONCLUSIONS: Retinal detachment in Marfan syndrome is complete in 75% of the eyes. More than half (56%) the eyes had a retinal break only in the temporal half of the retina, and 83% had at least a break in the temporal half of the retina. Currently available vitreoretinal surgical techniques result in successful reattachment of the retina in approximately 86% of the eyes.     

马凡综合征合并视网膜脱离的手术治疗

目的探讨马凡综合征合并视网膜脱离患者在不同手术方式的治疗下其视网膜解剖复位率和视功能恢复的结果。方法回顾性的分析14例(16只眼)马凡综合征患者的手术资料。其中有12只眼行巩膜扣带环扎术,4只眼行巩膜扣带环扎联合晶状体玻璃体切除术。手术结果的评估指标包括视网膜的解剖复位率以及视功能是否提高。结果行单纯巩膜扣带环扎术的12只眼中1次手术网膜复位率为91.7%(11/12),行巩膜扣带环扎联合晶状体玻璃体切除术的4只眼中1次手术网膜复位率为75%(3/4),但行2次手术后,术后8个月时随访,14例患者的16只眼达到100%解剖复位。术后最佳矫正视力达0.05以上有12只眼。结论马凡综合征合并视网膜脱离的手术治疗应根据裂孔的位置和视网膜脱离的情况来选择手术的方式。     

Results of retinal detachment surgery in Marfan syndrome in asians

PURPOSE: To report the anatomic and visual results of retinal detachment in patients with Marfan syndrome in an Asian population. METHOD: A retrospective review of all patients with Marfan syndrome and retinal detachment operated on by a single surgeon was conducted. RESULTS: Thirteen eyes of 12 patients were reviewed. Eleven patients were males, with an average age of 24.6 years. Three eyes had a history of trauma. Ten eyes were successfully treated with scleral buckle and encircling band. Three eyes were also treated with vitrectomy, scleral buckle, and encircling band. One hundred percent success was achieved with only one surgery. Best-corrected visual acuity of at least 20/40 was achieved in 7 of 12 eyes (58.3%). Eight of 12 eyes (66.7%) had at least two lines of improvement on the Snellen chart after 6 months. CONCLUSIONS: With appropriate surgical intervention, an excellent anatomic reattachment rate and good visual outcome can be achieved in Marfan syndrome patients with retinal detachment regardless of their lens status.     

Study of surgical procedures for retinal detachment with macular hole

PURPOSE: To evaluate the surgical outcome of retinal reattachment, the reattachment rate according to the range of detachment, and postoperative visual acuity for macular hole retinal detachment (MHRD). SUBJECTS AND METHODS: Sixty-eight eyes of 67 patients with MHRD were analyzed. The mean follow-up period was 54 months. RESULTS: Retinal reattachment occurred in 42/68 eyes (62%) after initial surgery. The reattachment rates were 6/23 eyes (26%) in the gas tamponade group, 13/19 eyes (68%) in the vitrectomy group, 23/ 26 eyes (88%) in the group that underwent removal of internal limiting membrane as adjunct to vitrectomy (ILM) group. In the additional surgery, the reattachment rates were 5/9 eyes (56%) in the gas tamponade group, 13 eyes (100%) in the vitrectomy group, 1/2 eyes (50%) in the ILM group, and 6 eyes (100%) in the macular prombe buckling group. No significant differences were seen in the detachment extent-related reattachment rate within the same surgery and the postoperative visual acuity between the groups. CONCLUSION: The results show that removal of ILM contributes to successful reattachment in the initial surgery, and that for non-reattachable eyes, macular buckling in the second surgery is the most reliable method.     

Surgical outcomes in juvenile retinal detachment

PURPOSE: To evaluate retrospectively clinical features and surgical outcomes of rhegmatogenous retinal detachment in juvenile patients. METHODS: Between 1991 and 1996, 28 patients younger than 15 years of age with rhegmatogenous retinal detachment (32 eyes) underwent the first surgical procedure, scleral buckling and/or pars plana vitrectomy, at our hospital. RESULTS: The major types of juvenile detachment, in order of frequency, were idiopathic, familial exudative vitreoretinopathy, trauma, and high myopia. Proliferative vitreoretinopathy (PVR) of grade C or D was involved in 12 cases (37.5%). Among the 12 eyes with PVR, 7 attained retinal reattachment after the first surgery with scleral buckling. The overall reattachment rate was 28/32 (87.5%) after the first operation and 30/32 (93.8%) after the second operation. CONCLUSION: These findings indicate that the reattachment rate and visual prognosis can be as good in juvenile retinal detachment as in adult cases, when appropriate surgical procedures are used.     

Macular buckling for previously untreated and recurrent retinal detachment due to high myopic macular hole: a 12-month comparative study

Purpose

To evaluate postoperative outcomes after macular buckling together with pars plana vitrectomy (PPV) in previously untreated and recurrent retinal detachment secondary to macular hole (MH) in highly myopic eyes.

Methods

In a retrospective cohort study, 42 eyes of 42 high myopic patients with retinal detachment due to MH were evaluated. Patients were divided into previously untreated retinal detachment (group 1, 21 eyes) and recurrent retinal detachment (group 2, 21 eyes). Macular buckling and PPV were performed in all patients. Main outcomes included retinal reattachment rate, macular hole closure rate and best-corrected visual acuity (BCVA) at 3, 6, and 12 months. Optical coherence tomography (OCT) was performed both pre- and postoperatively in all patients to assess the anatomical status of the macula.

Results

Primary retinal reattachment rate in group 1 was 95% (20/21), which increased to 100% (21/21) after a second surgery. MH closure was achieved in 81% of patients (17/21) after one surgery. The mean preoperative BCVA (logarithm of the minimum angle of resolution, LogMAR) improved from 1.32 (95% CI 1.19;1.44) to 0.76 (95% CI 0.56;0.96) 12 months postoperatively. In all except one case, gas tamponade was preferred. Primary reattachment and MH closure rate in group 2 were 90.5% (19/21) and 57% (12/21) respectively, and did not improve after a second surgery. Preoperative BCVA (LogMAR) was 1.39 (95% CI 1.29;1.49) and improved to 0.95 (95% CI 0.75;1.15) at 12 months. Silicone oil tamponade was used in seven of 21 patients, and finally was removed in five of them.

Conclusions

Macular buckling combined with PPV should be considered a preferred surgical approach both in primary and recurrent retinal detachment secondary to MH in high myopic eyes. Nevertheless, visual outcomes seem to be better when macular buckling is chosen as first-line treatment.     

玻璃体切除术治疗人工晶状体眼视网膜脱离

目的 探讨玻璃体切除术治疗人工晶状体眼视网膜脱离（ｔｒｔｉｎａｌ ｄｅｔａｃｈｍｅｎｔ,ＲＤ）的效果。方法 对３２例（３２只眼）植入人工晶状体后ＲＤ患眼行玻璃体除术,其中首次治疗采用玻璃体切除术１１只眼（３４．４％）,巩膜扣带术失败后再行玻璃体切除术２１只眼（６５．６％）,玻璃体切除术中联合硅油充填１０只眼（３１．３％）,玻璃体切除术同时行人工晶状体取出１２只眼（３７．５％）。术后随诊６个月至５年     

巩膜扣带术治疗视网膜脱离118例临床分析

目的 对原发怍（孔源性）视网膜脱离行巩膜扣带术治疗并对其效果进行评价。方法 对118例118眼原发性视网膜脱离病人行巩膜扣带术治疗。术中直接检眼镜定位，放视网膜下液，巩膜外液氮冷凝，巩膜扣带或环扎术。结果 术后随访1周至半年，视网膜裂孔封闭、完全复位107眼（90．68％），视力提高90眼（76.27％）。结论 巩膜扣带术是治疗原发性视网膜脱离常用有效的方法。     

两种手术方法治疗非后极部多发裂孔性视网膜脱离的比较

目的：观察非后极部多发裂孔性视网膜脱离的临床特征,探讨玻璃体切割术和巩膜扣带术的疗效。

方法：回顾性分析2017-06/2018-08在我院眼科住院行手术治疗的非后极部多发裂孔性视网膜脱离患者40例40眼,按手术方式不同分为玻璃体切割术(PPV)组(18眼)和巩膜扣带术(SB)组(22眼)。术后随访3～6mo,观察两组患者的手术疗效。

结果：至末次随访,PPV组患者视网膜复位率为100%(18/18),去除硅油填充眼后视网膜复位率为56%(10/18)。SB组患者视网膜复位率为86%(19/22),无硅油填充眼。两组患者视网膜复位率比较(包括硅油填充眼),差异无统计学意义(P>0.05),去除硅油填充眼后视网膜复位率比较有差异(P<0.05)。

结论：非后极部多发裂孔性视网膜脱离多为视网膜广泛变性或合并玻璃体牵拉引起。复杂病例宜选择玻璃体切割术,但需多次手术,而巩膜扣带术远期效果稳定。两种手术方法各有利弊,应综合考虑,不应盲目扩大玻璃体切割术适应证。对于年轻或独眼等特殊群体,如有可能应尽可能优先选择巩膜扣带术。