玻璃体视网膜手术136例疗效分析

目的 为玻璃体视网膜手术对玻璃体积血及视网膜脱离的治疗效果。方法 对１９９６年１１月￣１９９７年１１月间行玻璃体多膜手术的１３６例（１３９眼）进行回顾性分析。结果 术后视力提高者达８９．９％，视网膜复位率达８８．８％。结论只要掌握好手术适应证，时机及手术技巧，能成功地治疗一些复杂性玻璃体视网膜病变。     

玻璃体切除术治疗玻璃体视网膜病变

本文介绍了对各种原因引起的玻璃体视网膜病变４０例４２眼做了玻璃体切割术，中共伤性玻璃体出血与机化２１眼，眼底病合并玻璃体视网膜病变１６眼，其它原因引直怕玻璃体病变５眼。术后视力０．５以上者８眼（１９．０％），视力有增进者３２眼（７６．２％）。本文着重叙述了我们的经验体会，并对手术适应症，手术进机和手术并发症的预防及处理作了讨论。     

玻璃体手术联合氩离子激光治疗严重玻璃体积血

采用现代玻璃体切割手术，部分病例联合氩离子激光治疗严重的玻璃体积血４８例４９眼，其中发生于穿孔伤者１３例１３眼，挫伤９例９眼，分枝静脉阻塞１３例１３眼，静脉周围炎５例５眼，增殖性糖尿病性视膜病变５例５眼，急性淋巴细胞白血病１例２眼，原因不明玻璃体积血２例２眼，单纯玻璃体积血２５眼，功能性成功１２眼（５０％），解剖成功者５眼（２１％），失败７眼（２９％）。以发生于分枝静脉阻塞者疗效最佳。     

彩色多普勒诊断仪在眼内病变中的应用

目的探讨彩色多普勒超声诊断仪（ｃｏｌｏｒＤｏｐｐｌｅｒｕｌｔｒａｓｏｎｏｇｒａｐｈｙ，ＣＤＵ）对眼内病变的辅助诊断价值。方法用高频率（７．５ｍＨｚ）的ＣＤＵ对８２例眼内病变进行检查，在二维特征的基础上分析其血管血流特征。结果ＣＤＵ显示２１例视网膜脱离至少部分脱离的视网膜血管血流；而２２例玻璃体积血和机化膜病例中，２１例玻璃体腔内无血流显示，仅在１例糖尿病增殖型视网膜病变中可见细小的血管血流。在１８例脉络膜黑色素瘤中的１７例和４例脉络膜转移癌中的３例可见肿瘤内呈枝状分布的血管血流，频谱显示为较高阻力的供血血流波形；５例脉络膜血管瘤显示肿瘤内充满或呈弥散星点状的混杂血流，频谱显示为含动脉血流和静脉血流的波形；而在类似的肿瘤病变中，５例脉络膜积血和２例视网膜下出血未见病变区内血流。在３例（４只眼）永存性原始玻璃体增殖症中，玻璃体腔内可见呈条索状由视乳头向晶体后延伸的动脉血管血流。结论ＣＤＵ对眼内病变（视网膜脱离与玻璃体积血或机化膜、恶性脉络膜黑色素瘤或转移癌与良性脉络膜血管瘤、永存性原始玻璃体增殖症等）的诊断与鉴别具有重要意义。     

Terson综合征继发视网膜脱离和严重增殖性玻璃体视网膜病变

Ｔｅｒｓｏｎ综合征继发视网膜脱离和严重增殖性玻璃体视网膜病变［英］／ＶｅｌｉｋａｙＭ…Ｏｐｈｔｈａｌｍｏｌｏｇｙ．－１９９４，１０１（１）．－３５～３７作者报告４例患者５只眼由自发性动脉瘤破裂所致的Ｔｅｒｓｏｎ综合征，这些患者均发生了视网膜脱离和增殖...     

玻璃体手术和眼内光凝治疗伴玻璃体积血和新生血管膜的视网膜静脉阻塞

目的评估玻璃体手术和眼内光凝治疗伴玻璃体积血、新生血管膜或牵拉性视网膜脱离的视网膜静脉阻塞（ｒｅｔｉｎａｌｖｅｉｎｏｃｃｌｕｓｉｏｎ，ＲＶＯ）的疗效。方法复习连续的３７例ＲＶＯ患者经玻璃体手术和眼内光凝治疗的３８只眼临床资料。视网膜分支静脉阻塞（ｂｒａｎｃｈｒｅｔｉｎａｌｖｅｉｎｏｃｃｌｕｓｉｏｎ，ＢＲＶＯ）１９例２０只眼，视网膜中央静脉阻塞（ｃｅｎｔｒａｌｒｅｔｉｎａｌｖｅｉｎｏｃｃｌｕｓｉｏｎ，ＣＲＶＯ）１８例１８只眼。结果手术中确认２７只眼有新生血管膜，２３只眼有牵拉性视网膜脱离。手术后３４只眼视力改善，占８９．５％，其中２２只眼有０．１以上的视力。４只眼视力未变。ＣＲＶＯ组病史较长，手术后视力改善较少。结论玻璃体手术和眼内光凝能改善多数伴有玻璃体积血、新生血管膜和牵拉性视网膜脱离的ＲＶＯ眼预后。     

玻璃体视网膜手术治疗Terson综合征

目的：探讨下班体视网膜手术（ＶＲＳ）在Ｔｅｒｓｏｎ综合征治疗中的作用。方法：对５例（１０眼）Ｔｅｒｓｏｎ综合征病人均采用玻璃体视网膜手术进行治疗。结果：１０ 术后玻璃体腔清晰,视力恢复至０．１,半数达０．５,长期随访大部分没有术后并发症,仅两倒术后发生了视网膜脱离,经再入院手术平伏。结论：玻璃体现网膜手术是治疗Ｔｅｒｓｏｎ综合征的有效方法,早期手术,切除玻璃体出血,不仅能够尽早恢复病人的视力,而且     

玻璃体切除术治疗玻璃体积血临床效果分析

目的探讨玻璃体切除术治疗玻璃体积血的临床疗效。方法采用玻璃体切除术治疗的玻璃体积血58例（58眼）。分析玻璃体积血的病因，并观察玻璃体切除术后视力变化和并发症。结果本组主要病因为视网膜静脉阻塞和视网膜静脉周围炎；视力在0．01～0．05者术前为6眼（10．35％），术后1周为35眼（60．35％），随访2～4月的50例中为33眼（66．00％）。术中并发症有医源性裂孔和眼内出血；术后并发症有玻璃体再次积血，视网膜脱离，晶状体浑浊等。结论对药物治疗不能吸收的玻璃体积血施行玻璃体切除术后视力可显著提高，术中术后并发症少。     

玻璃体切除术治疗糖尿病性视网膜病变玻璃体积血

目的：探讨玻璃体切除术治疗糖尿病性视网膜病变后单纯性玻璃体积血的临床疗效。方法：回顾性分析1998年8月－2000年10月我院采用玻璃体切除方法治疗糖尿病性视网膜病变单纯玻璃体积血患者40例（40眼），观察其临床疗效及术后并发症，随访期术后3－12月。结果：所有患者均顺利完成玻璃体积血切割术，术后3月视力≥0.6者10眼，视力0．1－0．6者20眼，视力数指－0．1者5眼，3眼术后发生视网膜脱离视力下降，2眼术后发生新生血管性青光眼，后行睫状体冷凝术视力丧失。结论：玻璃体切除术对于糖尿病性增生性视网膜病变所致的玻璃体积血性药物治疗长期不吸收的患者是安全有效的治疗方法，术后并发症少，手术效果好。     

增生性糖尿病视网膜病变的手术治疗观察

目的探讨玻璃体视网膜手术对增生性糖尿病视网膜病变的治疗效果。方法回顾性分析增生性糖尿病视网膜病变（PDR）12眼。经标准的玻璃体视网膜手术治疗后的临床观察，对术前术后视力、于术并发症等进行重点观察分析。结果术后视力提高至0．1及以上者9眼（75．00％），数指～0．1者2眼（16．67％），未提高1眼（8．33％）。结论玻璃体视网膜手术可以部分改善PDR的视功能，建议玻璃体积血后应早期进行手术治疗。     

Pars plana vitrectomy for severe penetrating injury with posterior segment involvement

We studied 50 consecutive cases of severe penetrating ocular trauma with posterior segment involvement for which vitreous surgery and scleral buckling were performed as secondary reparative procedures. Eyes with a better prognosis, such as those with anterior segment injuries alone and intraocular foreign bodies, were excluded. Of 50 eyes, 31 (62%) had a successful outcome. There was a significant difference in visual outcome between those eyes that had received blunt and sharp penetrating trauma. Visual acuity of 20/50 or better was more frequently attained in eyes with sharp penetrating trauma (P = .002). Thirty-three eyes had initial retinal detachment; 17 (52%) were successfully repaired. Blunt penetrating trauma produced retinal detachment more frequently than sharp penetrating trauma (22 of 29 vs 11 of 21). Retinal detachment was more often successfully repaired after sharp penetrating trauma (8 of 11 vs 9 of 22). Contusive damage to the choroid and retina limited final visual and anatomic results after blunt rupture of the globe.     

眼球钝挫伤39例临床分析

目的 初步观察和探讨眼球钝挫伤的常见原因、临床表现、治疗经过和效果.方法 对39例(53只眼)的眼球钝挫伤患者的病因、病情、治疗经过及结果进行详细记录,随访时间3～15个月,平均7个月.根据损伤的病程、部位和严重程度,结合眼底荧光m管造影(fundus fluorescence angiography,FFA)、超声生物显微镜(ultrasound biomieroscope,UBM)、眼B超、光学相干断层扫描(optical coherence tomography,OCT)、视诱发电位(visual evoked potential,VEP)等辅助检查,对其进行药物或手术治疗并观察疗效,分析眼球钝挫伤的主要原因和视力预后及其主要影响因素.结果 拳击伤是引起眼球钝挫伤的最主要原因,其次分别为物体撞击伤、车祸外伤及爆炸伤.16只眼(30.19%)损伤仪累及眼前节,表现为角膜擦伤、水肿,前房积血,虹膜睫状体炎,外伤性扩瞳,虮膜根部断离,房角后退,睫状体脱离,晶状体混浊伴(或不伴)晶状体不全或全脱位;26只眼(49.57%)损伤仅累及眼后节,表现为玻璃体积血,视网膜震荡、裂孔及脱离,脉络膜破裂,视神经水肿、萎缩;其余11只眼(20.75%)前、后节均受累.伤后初诊时最佳矫正视力(best corrected visual acuity,BCVA)0.1者占32.08%;经药物或手术治疗,末次随访时51只眼(96.23%)视力较前有所提高,13只眼(24.52%)BCVA 0.5.伤后24h内就诊的患者中,41.18%末次随访时BCVA0.5.结论 通过及时和有效的治疗,大部分眼钝挫伤患者的视功能可有所提高.视力预后与损伤部位、严重程度和伤后就诊时间有关,钝挫伤臻眼后节并发症者视力预后相对较差.     

Management of intra-ocular foreign bodies impacting or embedded in the retina

Purpose: To identify both the clinical features of eyes suffering penetrating ocular injury with intra-ocular foreign bodies (FB) impacting or embedded in the retina and the results of surgical outcome and complication rates. Methods: Thirty-eight consecutive cases of penetrating ocular injuries with intra-ocular FB impacting or embedded in the retina were retrospectively analysed. Results: The FB were metallic in 30 eyes (78.9%; 19 ferromagnetic) and were non-metallic in eight eyes (21.1%). Magnetic extraction was performed in 17 cases (44.7%) and instrumental extraction was performed in 21 cases (55.3%). In two cases, pars plana vitrectomy and FB removal was combined with penetrating keratoplasty, temporary keratoprosthesis and anterior segment reconstruction because of severe explosive injury to the eye. At the final postoperative examination, 32 eyes (84.2%) had completely attached retinas. Visual acuity (VA) improved postoperatively in 18 eyes (47.4%). A final VA of 0.5 or better was achieved in nine of 23 eyes (39.1%) with FB in the peripheral retina and in one of 15 eyes (6.7%) with posterior pole and/or optic nerve head involvement. There was no difference in the final VA regarding the time elapsed between trauma and the removal of the FB. Conclusion: The late anatomical and functional outcome in eyes with penetrating ocular injury and FB impacting or embedded in the retina is mostly uncertain, despite immediate and complex surgery. Final anatomical and functional outcome in the present study was influenced by location and extent of the initial damage to the posterior pole. The time that had elapsed between trauma and removal of the FB did not influence final visual function.     

Predictors of scleral rupture and the role of vitrectomy in severe blunt ocular trauma

We reviewed retrospectively 40 eyes that had received blunt trauma and had been explored for scleral rupture. Twenty-nine eyes had scleral rupture. Of these 29, ten had ruptures seen preoperatively. Nineteen had occult ruptures. The preoperative findings predictive of scleral rupture were a visual acuity of light perception or no light perception, an intraocular pressure of less than 10 mm Hg, hyphema, and chemosis. Of the 29 ruptures, 27 involved the superior hemisphere and 25 involved the anterior hemisphere of the globe. Ten of 29 eyes (34%) with scleral rupture and eight of 11 eyes (73%) without rupture achieved a final visual acuity of 5/200 or better over an average follow-up period of 6.7 months. Factors prognostic of ambulatory vision for eyes with ruptured and intact globes included an initial visual acuity of 5/200 or better, absence of scleral rupture, and a rupture length of less than 11 mm in eyes with ruptures. The vitrectomized eyes also had a better result, suggesting that early pars plana vitrectomy is of benefit in selected rupture cases.     

玻璃体切除在巩膜破裂伤手术中的应用

目的探讨玻璃体切除技术在巩膜破裂伤中的应用。方法对28例(28眼)巩膜裂伤采用前段玻璃体切除器,边暴露边切除边缝合巩膜伤口,伤后2周内再行闭合式玻璃体切除术,重建眼后段结构。结果28眼巩膜裂伤中出现牵拉性网脱16眼、单纯性玻璃体浑浊12眼。术后视网膜复位14眼,视网膜脱离复发2眼。视功能提高者18眼,不变者8眼,下降者2眼。视网膜复位与巩膜裂伤的位置、长短及手术时间有关。结论前段玻璃体切除在巩膜裂伤修补中,有效地防止了视网膜或脉络膜的嵌顿,为进一步重建眼后段结构创造了基础。     

Long-term follow-up and the role of vitrectomy in the treatment of perforating eye injuries without intraocular foreign bodies

The long-term results of 292 consecutive eyes with a perforating eye injury without an intraocular foreign body treated with or without pars plana vitrectomy are reported. With the mean follow-up time of 31.0 months 45 eyes (15%) were enucleated and another 47 eyes (16%) were blind (visual acuity less than 0.05). The retina was attached in 87% of the non-enucleated eyes. The visual outcome was considerably better in eyes with anterior segment injuries (ASI) compared to posterior segment injuries (PSI). Eyes with primary vitreous haemorrhage had poorer visual prognosis than eyes without haemorrhage. Vitrectomy improved the prognosis of the former eyes, but in the whole series the visual acuity was better in eyes in which vitrectomy was not performed (not considered indicated). Of the vitrectomized eyes, 55% in the ASI group and 25% in the PSI group received useful vision (visual acuity greater than or equal to 0.05). Excluding the very late vitrectomies, a statistically significant correlation was found between the timing of vitrectomy and the late visual outcome.     

外伤性白内障后囊破裂人工晶体植入的手术方式选择

目的探讨外伤性白内障晶体后囊不存在时,采用前房型人工晶体植入,抑或后房型人工晶体巩膜缝线固定术。方法外伤性白内障患者８６例（８６只眼）,其中前房型人工晶体（新型弹性开放襻）植入５６例,Ⅰ期植入２９例,Ⅱ期植入２７例;后房型人工晶体巩膜缝线固定（大Ｃ型襻,两根缝线睫状沟固定）３０例,Ⅰ期植入１４例,Ⅱ期植入１６例。结果术后随访１～４２个月。矫正视力≥０．５者,前房型人工晶体组４０例,占７１．４％;缝线固定组２７例,占９０．０％。矫正视力≥１．０者,前房型人工晶体组２２例,占３９．３％;缝线固定组１４例,占４６．７％。结论新型前房型人工晶体植入和后房型人工晶体巩膜缝线固定术均不失为常规后房型人工晶体植入失败的补救措施,但前房型人工晶体适用于年龄较大、眼前段（角膜、虹膜和前房角）条件较好,而眼后段（玻璃体、视网膜）条件较差者;后房型人工晶体巩膜缝线固定术则适用于年龄较小、眼前段条件较差而眼后段条件较好者。     

Outcome of combined penetrating keratoplasty with vitreoretinal surgery for management of severe ocular injuries

PURPOSE: To assess the effectiveness of a combined procedure (pars plana vitrectomy with temporary keratoprosthesis, vitreoretinal surgery, and penetrating keratoplasty) and to determine which factors influence corneal transplant success rates. METHODS: Records for 34 severely injured eyes of 31 consecutive patients who underwent penetrating keratoplasty in combination with vitreoretinal surgery between 1991 and 1998, with a follow-up of at least 12 months, were evaluated retrospectively. Analysis was focused on ocular history, functional and anatomic anterior and posterior segment outcome, and complications. RESULTS: Penetrating keratoplasty was performed in 10 eyes (29%) within 8 weeks of trauma and in 24 eyes (71%) as a secondary procedure. Initial improvement in visual acuity (VA) was achieved in 47% of eyes; at the end of the follow-up, 74% of the eyes had attained equal or better VA than the initial postsurgical VA. Reasons for poor final VA were hypotony or phthisis (35%) and recurrent retinal detachment (11%). Corneal grafts remained clear for 1 year in 65% of eyes. Transplant failure was less in eyes that did not need a permanent silicone oil tamponade, when the retina was attached before surgery, and in eyes that were grafted later after trauma and received no further surgery. These were some conditions that were associated with a longer mean graft survival time, but without statistical significance. There was no difference in eyes according to the trauma mechanism, preoperative intraocular pressure, or graft size. CONCLUSIONS: Penetrating keratoplasty in severely injured eyes is often complicated by ciliary body malfunction and secondary transplant failure. Although the functional outcome of a combined procedure is limited by primary and secondary tissue destruction, preserving ambulatory vision is possible and thus improves the quality of life, at least in patients with single remaining eyes.     

Temporary keratoprosthesis for combined penetrating keratoplasty, pars plana vitrectomy, and repair of retinal detachment

The Landers-Foulks temporary keratoprosthesis was used to combine penetrating keratoplasty, pars plana vitrectomy, and scleral buckling in the management of 13 eyes with opaque cornea and posterior segment abnormalities. In seven cases, trauma precipitated the ocular disease. Complications of cataract surgery resulted in anterior and posterior segment pathology in six cases. The corneal graft was initially clear in all cases. However, corneal edema complicated phthisis bulbi in four cases and followed homograft reaction in two cases. Eight eyes with retinal detachment (RD) preoperatively were successfully reattached. In five eyes, the retina redetached as these eyes became phthisical. Visual function improved in six cases. In general, eyes with a history of trauma had a much poorer outcome than did eyes with anterior and posterior segment problems related to previous cataract surgery.     

Use of retinotomy for retinal redetachment in the silicone oil filled eye

PURPOSE: Retinal redetachment after primarily successful vitreous surgery with silicone oil tamponade is quite often observed. Extensive peripheral retinotomy is required. The aim of our study is to present the results of relaxing retinotomy. MATERIAL AND METHODS: 94 consecutive patients who underwent retinotomy for retinal redetachment in the silicone oil filled eyes were examined. Indications for this procedure were: proliferative vitreoretinopathy (81.1%), trauma (12.6%) and diabetic retinopathy (6.3%). These eyes were previously treated with scleral buckling, vitrectomy, membrane peeling and silicone tamponade without success. RESULTS: After a minimum of 6 months follow-up, the retina was completely attached in 73 (76.8%) cases. Sixty three (66.3%) eyes achieved final visual acuity 1/50 or better, and 37 (38.9%) achieved visual acuity of 5/50 or better. If the size of retinotomy was < 180 degrees minimal visual acuity 5/50 was observed in 40% and if retinotomy size was 180 degrees-360 degrees this visual acuity was achieved in 38.7% of cases. CONCLUSIONS: Retinotomy can be an effective procedure in cases of repeated retinal detachment in the silicone oil filled eyes. Both, timing of this procedure and extent of retinotomy have no influence on final functional results.