玻璃体积血的形态结构与玻璃体的后脱离的图像特征

目的 探讨玻璃体积血的形态结构和治疗特点。方法 对74例（79只眼）增生性糖尿病视网膜病变、视网膜血管炎、视网膜静脉阻塞所致玻璃体积血的临床资料进行比较分析。术前超声检查、术中手术显微镜观察患者的玻璃体形态特点，分析玻璃体与视网膜的关系。结果 所有患者均有不同程度的玻璃体后脱离，根据图像的形态特征可归纳为完全后脱离和部分后脱离两种。部分后脱离又分为“V”型、“L”型及后部玻璃体劈裂型，劈裂型多见于视网膜缺血性疾病的增生期。结论 了解和掌握玻璃体后脱离及玻璃体劈裂的形态特点，可提高手术治疗的成功率并改善其预后。     

增生型糖尿病视网膜病变玻璃体切除后玻璃体再积血原因

目的 探讨增生型糖尿病视网膜病变(PDR)玻璃体切除手术后再积血原因及防治.方法 98例(128眼)增生性糖尿病视网膜病变行玻璃体手术治疗,对术后玻璃体积血的发生率及发生原因进行回顾性分析.结果 在98例(128眼)PDR玻璃体切除手术并发症中,发生玻璃体积血46眼(36.0％).结论 增生型糖尿病视网膜病变玻璃体切除手术后玻璃体积血发生因素主要与病变程度、手术时机、玻璃体腔填充物的选择有关.对术后玻璃体积血应重视并积极预防治疗.     

玻璃体切割手术治疗不同类型玻璃体积血的临床研究

目的:观察不同原因导致玻璃体积血玻璃体切割的疗效及年龄等相关因素对玻璃体切割手术疗效影响。 方法:回顾性分析76例通过玻璃体切割手术治疗的玻璃体积血患者76眼的资料,按玻璃体积血原因、发病年龄和玻璃体积血时间分组,并进行统计学分析。 结果:在导致玻璃体积血原因中,糖尿病性视网膜病变（增生性）患者31例(41%),孔源性视网膜脱离24例(32%),视网膜分支静脉阻塞10例(13%),视网膜中央静脉阻塞3例(4%)。视网膜血管炎2例(3%),眼球钝挫伤2例(3%),单纯玻璃体积血2例(3%),增生性玻璃体视网膜病变1例(1%),息肉样脉络膜血管病变1例(1%)。各年龄组病因构成存在统计学差异（χ2=21.89,P<0.01）。年龄<45岁的青年组中,有26例,孔源性视网膜脱离导致玻璃体积血患者最多,共11例,占42%。年龄在45~59的中年组中,有19例,孔源性视网膜脱离导致玻璃体积血患者最多,共9例,占47%。年龄>60的老年组中,有31例,糖尿病性视网膜病变（增生性）导致玻璃体积血患者最多,共24例,占77%。在玻璃体积血时间分组中,各时间组术后视力存在统计学差异（χ2=2037,P<001）。1mo组共26例,术后视力主要为>0.3,共13例,占50%。2mo组共24例,术后视力主要为0.1~0.3,共10例,占42%。3mo组共11例,术后视力主要为0.01~0.09,共5例,占45%。>3mo组共15例,术后视力0.01~0.09和0.1~0.3,各6例,分别占40%。 结论：糖尿病性视网膜病变（增生性）、孔源性视网膜脱离和视网膜分支静脉阻塞是导致玻璃体积血的主要原因。玻璃体切割手术治疗玻璃体积血安全有效,可以在一定程度上提高患者视力。玻璃体积血患者在1~2mo内手术,疗效较好。     

玻璃体视网膜手术治疗先天性视网膜劈裂及其并发症的疗效观察

目的 观察玻璃体视网膜手术治疗先天性视网膜劈裂(XLRS)及其并发视网膜脱离和(或)玻璃体积血的疗效.方法 回顾分析接受玻璃体视网膜手术治疗的XLRS并发视网膜脱离和(或)玻璃体积血患者21例27只眼的临床资料.所有患眼眼底及光相干断层扫描(OCT)检查均发现黄斑微囊样劈裂病变合并周边部视网膜劈裂.平均视力0.11±0.09,黄斑劈裂平均面积为(1.09±0.56) mm2.12只眼并发孔源性视网膜脱离,5只眼并发牵拉性视网膜脱离,6只眼并发玻璃体积血,4只眼同时合并视网膜脱离和玻璃体积血.均行经扁平部三通道闭合式玻璃体切割手术.根据情况行内界膜剥离,眼内激光光凝,C3 F8或硅油填充.手术后随访9～122个月,平均随访时间51个月.观察视力以及视网膜解剖结构改善情况.结果 末次随访视力提高者20只眼,占74.1％;维持不变者7只眼,占25.9％.平均视力提高至0.26±0.15.与治疗前平均视力比较,差异具有统计学意义(t=-6.320,P=0.000).27只眼视网膜解剖结构复位良好,视网膜平伏.OCT检查显示,黄斑劈裂平均面积(0.29±0.21) mm2,较治疗前黄斑劈裂平均面积显著缩小(t=10.358,P=0.000);黄斑微囊样病变得到明显的改善.随访期间4只眼出现并发症,占14.8％.其中,2只眼分别在手术后6、8个月并发增生性玻璃体视网膜病变伴牵拉性视网膜脱离;1只眼在手术后4个月出现并发性白内障;1只眼在手术后15个月因新发视网膜裂孔而发生玻璃体积血.给予再次手术治疗后,4只眼视网膜复位良好.结论 玻璃体视网膜手术能有效提高XLRS患者视力,恢复视网膜解剖结构,获得良好的治疗效果.     

玻璃体积血合并视网膜裂孔或脱离的玻璃体切割手术疗效观察

目的:探讨玻璃体积血合并视网膜裂孔或脱离采用玻璃体切割手术治疗的疗效及必要性。 方法:对28例28眼玻璃体积血合并视网膜裂孔或脱离患者采用玻璃体切割手术治疗,观察治疗前后视力改变,并分析玻璃体积血与视网膜裂孔或脱离的关系。 结果:不同原因所导致的玻璃体积血28例中,7例术前B超未发现视网膜脱离,而在术中发现3例裂孔,4例伴裂孔周围浅脱;28例患者术后视力（包括术后随访最佳视力）均有不同程度的提高,数指/眼前以上者27例(96%),≥0.05者20例(71%),≥0.3者5例(18%),手术前后视力比较,具有统计学差异(P＜0.05)。 结论:玻璃体积血合并视网膜裂孔或脱离采用玻璃体切割手术治疗,安全有效,且能尽早发现视网膜裂孔及浅脱离,阻止视网膜脱离进一步扩大。     

急性视网膜裂孔伴玻璃体积血早期误诊临床分析

目的分析急性视网膜裂孔伴玻璃体积血的早期误诊原因,探讨对急性视网膜裂孔伴玻璃体积血的早期诊断和治疗方法。方法早期给予急性玻璃体积血的患者药物治疗,一旦发现视网膜裂孔或视网膜脱离,及时根据病情给予激光封闭视网膜裂孔治疗、视网膜脱离外路手术治疗、玻璃体视网膜手术治疗。结果急性玻璃体积血患者早期给予药物治疗,612天发现其中12例视网膜裂孔或视网膜脱离。术后1年随访,12例患者视力均较手术前有所提高,其中3例患者在取出硅油后再次出现视网膜脱离,二次行硅油填充术,至今尚未取出硅油。结论对于Ⅱ级以上的急性玻璃体积血,尤其是老年患者,在早期给予药物治疗的同时,密切观察玻璃体积血吸收情况和视网膜情况,一旦发现视网膜裂孔或视网膜脱离,应尽快给予手术治疗。     

玻璃体积血与玻璃体劈裂

目的：观察玻璃体积血后玻璃体的形态变化及玻璃体劈裂的影像特征。探讨玻璃体劈裂形成的机制及术前认识玻璃体劈裂的意义。方法：总结玻璃体积血88例(97只眼)，其中增殖性糖尿病性视网膜病变(PDR)32例38只眼：视网膜血管炎28例30只眼；视网膜静脉阻塞28例29只眼。术前进行B型超声波检查，部分进行彩色超声多普勒检查，将超声图像与玻璃体切除术中所见相对比。结果：PDR组玻璃体劈裂发生率为18／38(47．4％)，视网膜血管炎组为10／30(33％)，视网膜静脉阻塞组为4／29(13．8％)。结论：不同原因所致的玻璃体积血均可能发生玻璃体劈裂，对玻璃体劈裂的认识有助于成功完成玻璃体切除术和减少术后并发症。     

进展型增生性糖尿病视网膜病变玻璃体 切割手术的价值与意义

目的了解有不同并发症的进展型增生性糖尿病视网膜病变眼进行玻璃体手术的结果。方法将患有Ⅰ、Ⅱ型糖尿病进展型增生性糖尿病视网膜病变的314只眼分为玻璃体积血合并局限牵拉性视网膜脱离组;广泛纤维血管膜合并牵拉性视网膜脱离组;牵拉孔源混合性视网膜脱离组;玻璃体积血视网膜脱离合并老年性白内障行玻璃体手术联合白内障摘除及人工晶状体植入组,分别进行回顾性分析。结果玻璃体积血合并局限牵拉性视网膜脱离组中Ⅰ、Ⅱ型糖尿病患 者手术后获得0.1以上视力的分别占39.4%和66.7%,广泛纤维血管膜合并牵拉性视网膜脱离组中Ⅰ、Ⅱ型糖尿病患者手术后获得0.1以上视力的分别占31.6%和51.6%,牵拉孔源混合性视网膜脱离组手术后获得0.1以上视力者占31.6%,玻璃体积血视网膜脱离合并老年性白内障行玻璃体手术联合白内障摘除及人工晶状体植入组手术后获得0.1以上视力者占62.5%。首要的术中 并发症是医源性视网膜裂孔,术后视力丧失的主要原因包括新生血管性青光眼、视网膜脱离和视网膜中央动脉阻塞。结论玻璃体切割手术联合全视网膜光凝术,能有效地改善进展性糖尿病视网膜病变患者的视力。(中华眼底病杂志,2001,17:171-174)     

玻璃体切除治疗老年性黄斑变性玻璃体积血的临床分析

且的：探讨老年性黄斑病变相关性玻璃体积血患者的临床特点、手术治疗效果及手术时机。方法：对31例老年性黄斑病变玻璃体积血患者，采用玻切治疗。并根据患者情况采取黄斑部剥膜3例、视网膜切开1例。结果：术后患者视力均有不同程度的提高；病程在12个月以上者，黄斑区形成黄斑前膜和固定皱折，术后视力提高较少，均低于0.01；视网膜切开行黄斑下积血冲洗1例术后并发新生血管青光眼；27例发生完全玻璃体后脱离并且玻璃体腔为降解的血块。手术无并发症发生。结论：玻璃体切除术对老年性黄斑变性玻璃体积血有一定疗效，但手术最好在出血后半年内进行；视网膜切开冲洗易出现并发症，效果不好；对老年性黄斑病变玻璃体积血的手术因玻璃体后脱离及血块的降解使得手术操作较容易，不易出现并发症。     

玻璃体切割手术治疗视网膜静脉阻塞引起的玻璃体积血

视网膜静脉阻塞 (retinal vein occlusion,RVO)是常见的眼底血管性疾病 ,经常引起玻璃体积血 ,少量玻璃体积血可自行吸收 ,但大量的积血往往难以吸收 ,严重影响视力甚至由于积血机化可导致牵拉性视网膜脱离。玻璃体切割手术可治疗伴有玻璃体积血和牵拉性视网膜脱离的 RVO。现将我们通过玻璃体切割手术治疗的 RVO导致的玻璃体积血病例报道如下。1　对象和方法自 1995年 1月至 1999年 12月我院通过玻璃体切割手术治疗的 RVO引起的玻璃体积血患者 72例 72只眼 ,其中男性5 0例 ,占 6 9.4 % ,女性 2 2例 ,占 30 .6 % ;年龄 17～ 78岁 ,平均…     

复杂玻璃体视网膜疾病的彩色多普勒超声诊断特征

目的探讨彩色多普勒血流成像(CDFI)技术对复杂玻璃体视网膜疾病的超声诊断特征。方法对518例(678只眼)复杂玻璃体视网膜疾病包括玻璃体积血、玻璃体后脱离、玻璃体劈裂、视网膜脱离、脉络膜脱离、糖尿病视网膜病变等,应用眼科专用B超和CDFI诊断仪对同一患者进行检查,分别按照B超和CDFI的诊断标准予以诊断,再经手术证实,最终判断B超及CDFI检查结果的准确性。结果 CDFI检测复杂玻璃体视网膜疾病的阳性眼数高于B超诊断仪。视网膜脱离、玻璃体后脱离组的B超与CDFI检测结果比较、脉络膜脱离和玻璃体机化膜组的B超与CDFI检测结果比较,差异均有统计学意义(均P＜0.05)。结论综合应用CDFI的形态观察和血流特征两种分析方法,可显著提高诊断复杂玻璃体视网膜疾病的准确性,为临床提供可靠的诊断依据。     

Comparison between clinical and ultrasound findings in patients with vitreous hemorrhage

PURPOSE: To ascertain the causes of vitreous hemorrhage and to determine the accuracy of ultrasound (U/S) in these cases, based on the degree of agreement between ultrasound and clinical findings. METHODS: A chart review of 96 consecutive patients (106 eyes) with dense vitreous hemorrhage who underwent A- and B-scan U/S by one examiner between June 1996 and June 1999. U/S records were evaluated to determine the presence and exact distribution of areas of retinal detachment and the presence of posterior vitreous detachment, retinal tear, intraocular foreign body, or choroidal detachment. Clinical information was obtained from the medical records after the vitreous hemorrhage was reabsorbed or following vitreous surgery. Clinical and U/S findings were compared. False-positive and False-negative rates for U/S were calculated based on clinical findings. RESULTS: In 37 eyes (35%) the vitreous hemorrhage was because of proliferative diabetic retinopathy and in 33 eyes (31%) because of ocular trauma. The false-positive rate for retinal detachment (retinal detachment by U/S without clinical confirmation) was 18.9% (seven of 37 eyes). Retinal tears were diagnosed and localized accurately in only four of nine eyes (44%). CONCLUSIONS: The most common cause of vitreous hemorrhage was proliferative diabetic retinopathy, followed by ocular trauma. U/S correctly diagnosed all cases of retinal detachment, but less than 50% of retinal tears. A total of 18.9% of the eyes were falsely diagnosed as having retinal detachment. U/S is an effective diagnostic tool in patients with vitreous hemorrhage.     

Lens-sparing vitreous surgery for infantile amblyogenic vitreous hemorrhage

PURPOSE: To report on a series of infants with amblyogenic vitreous and/or subinternal limiting membrane hemorrhage managed by lens-sparing vitrectomy. DESIGN: Retrospective case series studying retinal attachment status and visual acuity. RESULTS: Eleven eyes sustained vitreous hemorrhage as a consequence of shaken baby syndrome, 1 due to hyaloidal canal hemorrhage extending into the vitreous, 1 due to Terson syndrome, 1 due to birth trauma, and 2 due to a presumed coagulation disorder. Age of the patients at the time of surgery ranged from 2 to 23 months (age adjusted for prematurity). Follow-up ranged from 7 to 81 months (mean, 28 months). Ten eyes had visual improvement. Two infants with shaken baby syndrome had bilateral nonrecordable flash visual evoked potential before surgery; one eye of one infant had a better than expected visual outcome after surgery. One eye sustained a retinal tear without detachment. One eye in an infant with severe shaken baby syndrome and traumatic retinopathy developed a total rhegmatogenous retinal detachment with proliferative vitreoretinopathy. CONCLUSIONS: Infantile amblyogenic vitreous hemorrhage may be effectively managed by lens-sparing vitreous surgery. Visual outcome of shaken baby syndrome may be limited as a consequence of structural damage to the retina, optic nerve, or posterior visual pathways.     

Long-term results of vitreous surgery for proliferative diabetic retinopathy

In order to study long-term anatomical and functional results the authors evaluated the data from 260 patients who underwent pars plana vitrectomy for proliferative diabetic retinopathy. Indications for surgery were: vitreous hemorrhage, 68 eyes (26.2%); vitreous hemorrhage & tractional retinal detachment, 84 eyes (32.3%); tractional retinal detachment, 82 eyes (31.5%); and combined tractional-rhegmatogenous retinal detachment, 26 eyes (10%). In 118 eyes vitreoretinal surgery was combined with silicone-oil tamponade.The retina was completely attached posterior to a scleral buckle in 251 eyes (96%) at the time of the last examination. After a follow-up period of at least 12 months in a group of patients with vitreous hemorrhage, visual acuity improved in 88% of the eyes. Visual acuity was better than 0.5 in 31% of eyes. In group of eyes with nonresorbing vitreous hemorrhage & tractional retinal detachment visual acuity improved in 52% of eyes. Visual acuity improved in 76% of eyes with tractional retinal detachment and in 81% of eyes with combined tractional & rhegmatogenous retinal detachment. When comparing the latest postoperative visual acuity to visual acuity after three months postoperatively, visual acuity was unchanged in 88%, in 10% it became worse and in 3 cases (1%) became better. In the postoperative period, recurrent vitreous hemorrhage occurred in 33 (13%) eyes, reproliferation in 12 eyes.Cataract developed in 45 of 168 phakic eyes. If postoperative visual acuity before cataract formation was good, extracapsular cataract extraction with posterior chamber intraocular lens implantation was performed. Otherwise simple intra or extracapsular cataract extraction was performed. In 19 cases cataract operation was performed together with silicone oil extraction. Neovascular glaucoma developed postoperatively in 15 eyes (6%). Retinal detachment occurred postoperatively in 21 eyes (8%). In 15 eyes the retina was successfully reattached after additional operations.     

Proliferative diabetic retinopathy: pathophysiology of extraretinal complications and principles of vitreous surgery

Extraretinal complications of proliferative diabetic retinopathy are caused by neovascular and/or fibrovascular tissue growth and include vitreous hemorrhage, retinal detachment, and other effects damaging the retina and/or optic nerve. Exact features of fibrovascular tissue growth and secondary complications vary widely from case to case. However, the structural pathogenesis of this disease process is consistent because the abnormal tissue nearly always grows along the posterior vitreous surface. Therefore, differing topographic features and secondary complications are dependent on: (1) the places of origin and amount of fibrovascular proliferation, and (2) the location and extent of any posterior vitreous separation. The latter influences the configuration of the fibrovascular tissue growth and determines the effect on the underlying and adjacent retina. Surgical treatment of proliferative diabetic retinopathy is based on this fundamental structural pathophysiology. The -principles of surgery are to minimize damaging effects by reversing the optical and structural complications and preventing recurrence of similar problems. Therefore, the objectives of surgery are to remove any intravitreal opacities and to excise the posterior vitreous surface. To achieve these objectives, various specialized techniques are required, depending on the complexity of the vitreoretinal anatomy in each case. Still, when the objectives are achieved, the operation has similar beneficial immediate and long-term effects in most eyes. This paper discusses and illustrates the structural pathology of proliferative diabetic retinopathy and the principles and methods of surgical therapy, and it presents the results obtained and the complications encountered.     

玻璃体手术治疗黄斑孔性视网膜脱离的初步报告

本文对１５例伴有玻璃体视网膜异常粘连的黄斑孔性视网膜脱离进行了玻璃体切除、视网膜前膜剥离、玻璃体注惰性气体及巩膜扣带术。术中重点在于玻璃体后界膜的分离。追踪观察６￣１２个月，视网膜解剖及功能复位率为９３．３％。根据术中所见，本文提出针对其发病机制进行有目的、有选择的治疗方案，同时注射到玻璃体后界膜对黄斑孔的形成、视网膜脱离的发生，以及增殖性玻璃体视网膜病变中的决定性作用。     

Causes and treatment of vitreous hemorrhage

Vitreous hemorrhage is common, with varied clinical manifestations and causes. The most common causes include proliferative diabetic retinopathy, vitreous detachment with or without retinal breaks, and trauma. Less common causes include vascular occlusive disease, retinal arterial macroaneurysm, hemoglobinopathies, age-related macular degeneration, intraocular tumors, and others. The natural history depends on the underlying cause, and is generally more favorable in eyes without underlying disease. Treatment is directed at the underlying cause, such as laser photo-coagulation for proliferative diabetic retinopathy or for retinal breaks. Occasionally, hemorrhage does not resolve spontaneously and vitrectomy surgery is necessary and beneficial. New strategies for the treatment of vitreous hemorrhage, such as pharmacologic vitreous liquefaction, may be important in the future.     

Different outcome among eyes with proliferative diabetic retinopathy indicated for vitrectomy

PURPOSE: The postoperative outcome was evaluated in each group of surgical indications of vitreous surgery for proliferative diabetic retinopathy (PDR), to investigate the factors responsible for postoperative visual prognosis. METHODS: Primary vitrectomy was performed in 119 eyes of 92 patients with PDR. Average postoperative follow-up period was 19 months. The indications for vitrectomy included vitrous hemorrhage in 58 eyes, macular tractional retinal detachment in 17 eyes, extramacular tractional retinal detachment in 10 eyes, macular heterotopia in 11 eyes, and progressive fibrovascular proliferation in the posterior fundus in 23 eyes. RESULTS: The visual acuity finally improved by 2 lines or more in 91 eyes (77%), remained unchanged in 10 eyes (8 %), and decreased by 2 lines or more in 18 eyes (15%). Final postoperative visual acuity was significantly better in cases of vitreous hemorrhage or progressive fibrovascular proliferation in the posterior fundus than in others. Preoperative rubeosis iridis and macular tractional retinal detachment were probably responsible for the final visual impairment, and intraocular tamponade affected the difference in visual prognosis between the groups of surgical indication. Multivariate analysis in all cases revealed that factors influencing visual outcome were preoperative rubeosis iridis and anemia. CONCLUSION: Rubeosis iridis and macular tractional retinal detachment were prognostic factors of the surgery. Vitrectomy for PDR may be effective in improving postoperative visual acuity if performed in the early stage of progressive fibrovascular proliferation in the posterior fundus after sufficient retinal photocoagulation.     

Incidence of retinal detachment and visual outcome in eyes presenting with posterior vitreous separation and dense fundus-obscuring vitreous hemorrhage

PURPOSE: To determine visual outcomes and the incidence of retinal detachment in eyes presenting with posterior vitreous separation and dense fundus-obscuring vitreous hemorrhage. DESIGN: Retrospective consecutive noncomparative interventional case series. PARTICIPANTS: Thirty-six eyes (15 right eyes and 21 left eyes) of 34 patients (18 female and 16 male) ranging in age from 42 to 94 years. Mean follow-up was 14 months. METHODS: A comparison of the best-corrected initial visual acuities versus final visual acuities after spontaneous resolution of vitreous hemorrhage or surgical intervention. The number of eyes that were found to have retinal tears or that had a rhegmatogenous retinal detachment develop was documented. Logarithm of the minimum angle of resolution-converted visual acuities was used for comparison. Categorical data were analyzed by Fisher's exact test, and population means were compared by Student's t test. MAIN OUTCOME MEASURES: Final mean visual acuities, number of eyes with at least one retinal tear, location of retinal tears, number of eyes that had retinal detachment develop, and the number of eyes repaired with scleral buckling surgery and/or pars plana vitrectomy. RESULTS: Twenty-four of 36 eyes (67%) were found to have at least one retinal break (range, 0-4 breaks), with 88% of breaks located in the superior retina. Eleven eyes (31%) had more than one retinal break. Fourteen of 36 eyes (39%) had a rhegmatogenous retinal detachment develop that was repaired with pars plana vitrectomy and scleral buckling. An additional 14 eyes (39%) underwent vitrectomy for nonclearing vitreous hemorrhage. The incidence of retinal detachment in eyes with a history of retinal detachment in the contralateral eye was 75% (P = 0.04). Seven of 14 eyes (50%) with retinal detachment had coexisting proliferative vitreoretinopathy. Most retinal breaks and detachments occurred in emmetropic or myopic eyes. For all 36 eyes the mean preoperative visual acuity was 20/1233, and the mean final visual acuity was 20/62 (P < 0.0001). Eyes that had a macula-off retinal detachment develop had worse final visual outcomes (20/264; P = 0.01), as did eyes that had proliferative vitreoretinopathy develop (20/129; P = 0.04). CONCLUSIONS: Acute, spontaneous, nontraumatic posterior vitreous separation with dense fundus-obscuring vitreous hemorrhage is associated with a high incidence of retinal tears and detachment. Close follow-up with clinical examination and ultrasonography is necessary, because many of these eyes may eventually require surgical intervention. Aggressive management with early vitrectomy should be considered when there is a history of retinal detachment in the contralateral eye.