玻璃体替代物在玻璃体视网膜疾病中的应用研究进展

玻璃体替代物是玻璃体-视网膜手术中用于治疗视网膜疾病（如复杂的视网膜脱离、黄斑裂孔、糖尿病视网膜病变的并发症以及后段眼外伤）的玻璃体内填塞剂。在玻璃体切除治疗视网膜脱离的手术中,术者需在玻璃体切除后在玻璃体内填充玻璃体替代物,以使脱离的视网膜重新附着。但目前临床上可用的玻璃体替代物仅能做到短期维持。尽管研究人员进行了多年的深入研究,但仍未找到理想的玻璃体替代物。本综述列举了临床上需要应用玻璃体替代物的眼部疾病,并从临床和科研两个角度总结了现有玻璃体替代物的临床应用和研究进展。其中,聚合物水凝胶由于其具有良好的生物相容性,并且和天然玻璃体具有相似的物理性质,被认为是人工玻璃体替代物的未来,尤其是热敏智能水凝胶,最有可能成为理想的玻璃体替代物。     

玻璃体替代物在玻璃体视网膜手术中的应用进展

玻璃体手术是治疗视网膜脱离的重要手术方式之一,玻璃体替代物的产生和发展扩大了玻璃体视网膜手术的适应证并提高了手术疗效.目前临床应用的玻璃体替代物有膨胀气体、硅油、重硅油、全氟化碳液体、半氟化物等.本文就玻璃体替代物的理化性质、实验室研究,临床应用等做一综述.     

重硅油玻璃体替代物及其临床应用

玻璃体替代物的产生和发展扩大了玻璃体视网膜手术的适应证并提高了手术疗效，目前临床常用的玻璃体替代物如空气、长效气体（SF6、C2F6、C3F8）和硅油比重都小于水，对于下方视网膜顶压效果都不理想，术后要保持一定的体位。重硅油比重大于水，可以对下方视网膜产生有效顶压。本文对重硅油的理化性质、实验室研究，临床应用等方面进行综述。     

折叠式人工玻璃体球囊的临床应用及研究进展

玻璃体替代物是玻璃体切割术后的必需品，用于填充玻璃体腔，恢复玻璃体的支撑视网膜、屈光和细胞屏障等功能。严重眼外伤及复杂视网膜脱离引起的视网膜/脉络膜脱离，如选用传统的玻璃体替代物(如硅油)填充，部分患者会出现硅油依赖眼或眼球萎缩，眼球难以保全。折叠式人工玻璃体球囊(foldable capsular vitreous body,FCVB)是我国独立研发的挽救眼球的人工玻璃体，属于国际首创，可以精细模拟自然玻璃体的结构，恢复玻璃体的部分功能。目前临床研究证实FCVB不仅可以有效避免硅油的并发症，还可以维持后房空间，缓慢恢复睫状体的功能，从而治疗硅油依赖眼，阻止眼球进一步萎缩。该文综述了FCVB的研究背景、结构特点、临床应用和拓展研究进展。     

折叠式人工玻璃体球囊研究与应用的新进展

折叠式人工玻璃体球囊(FCVB)是我国自主研发的新型玻璃体替代物,属于全球创新产品.折叠式人工玻璃体球囊由计算机模拟的具有玻璃体形态的球囊、引流管及引流阀组成,由改良性液体硅橡胶作为基本材料,具有良好的物理特性及生物相容性.在折叠植入眼内后,可在球囊内注入硅油、生理盐水或水凝胶等介质对视网膜起到360度的支撑作用.主要...     

全氟化碳液在眼科临床及实验研究进展

全氟化碳液(PRCLs)是玻璃体视网膜手术(VRS)中重要的玻璃体替代物，PFCLs是一种高碳液态氟化物，具有比重高、粘度低、无色透明、沸点高及很强的氧结合力等特点。本就有关PFCLs的临床应用及实验研究进展作一综述。     

25％全氟丙烷全气液交换眼眼压动态观察

目的：探讨25％C3F8气体玻璃体切割术后作为玻璃体临时替代物的效果。方法：玻璃体切割术后应用25％C3F8气体作全气液交换,前瞻性研究术后眼压动态变化情况。结果：术中控制眼压正常,术后观察眼压变化平衡,球内气体半衰期为19天,结论：在较复杂玻璃体,手术中应用25％C3F8作为体临时替代物是有效和安全的。     

过氟化碳液体的临床应用

视网膜脱离是眼科重要的致盲疾病，自20世纪20年代由Gonin开创了视网膜脱离手术到1968年Kasner首次进行玻璃体次全切手术及1970年玻璃体切割器的诞生，自这以后开始了玻璃体切割手术的迅速发展和普及。在这个发展过程中也对玻璃体的暂时替代物进行了孜孜探求，自1902年Gradenigo用澄清液体替代混浊的玻璃体以后，     

玻璃体视网膜手术继发性青光眼

近年来随着玻璃体视网膜手术的发展,其适应证不断扩大,玻璃体视网膜手术继发的青光眼也越来越多见,是一种术后常见并发症.本文主要就玻璃体视网膜手术继发性青光眼的发生率、术后早期眼压变化规律及不同术式(巩膜环扎扣带术或硅胶垫压术、玻璃体切除联合气体填充术或联合硅油填充术)继发性青光眼的发生情况、可能的发病机制及治疗等方面的研究进展进行综述.     

玻璃体切割联合白内障手术治疗增生性糖尿病视网膜病变

目的观察玻璃体视网膜手术联合晶状体超声乳化人工晶状体植入术及硅油填充术治疗增生性糖尿病视网膜病变的疗效。方法将63例(67眼)增生性糖尿病视网膜病变患者进行玻璃体视网膜手术联合晶状体超声乳化人工晶状体植入术,剥膜、眼内激光、硅油填充或气体填充等,术后随访3～18个月观察治疗效果。结果单纯玻璃体视网膜手术23眼,联合晶状体超声乳化人工晶状体植入术25眼,术中注入硅油37眼。术后矫正视力不同程度改善52眼,11眼不变,4眼下降。术中眼内出血5眼;术后玻璃体积血2眼,视网膜上出血2眼,一过性高眼压14眼,继发性青光眼2眼,白内障加重或形成13眼,后发性白内障形成6眼。结论玻璃体视网膜手术联合晶状体超声乳化人工晶状体植入术,剥膜、眼内激光、硅油填充或气体填充等治疗增生性糖尿病视网膜病变安全有效,联合手术可避免再次行白内障手术,减少视网膜脱离、白内障、继发性青光眼等并发症的发生率。     

Vitreous substitutes: a comprehensive review

Vitreoretinal disorders constitute a significant portion of treatable ocular disease. Advances in vitreoretinal surgery have included the development and characterization of suitable substitutes for the vitreous. Air, balanced salt solutions, perfluorocarbons, expansile gases, and silicone oil serve integral roles in modern vitreoretinal surgery. Vitreous substitutes vary widely in their properties, serve different clinical functions, and present different shortcomings. Permanent vitreous replacement has been attempted with collagen, hyaluronic acid, hydroxypropylmethylcellulose, and natural hydrogel polymers. None, however, have proven to be clinically viable. A long-term vitreous substitute remains to be found, and recent research suggests promise in the area of synthetic polymers. Here we review the currently available vitreous substitutes, as well those in the experimental phase. We classify these compounds based on their functionality, composition, and properties. We also discuss the clinical use, advantages, and shortcomings of the various substitutes. In addition we define the ideal vitreous substitute and highlight the need for a permanent substitute with long-term viability and compatibility. Finally, we attempt to define the future role of biomaterials research and the various functions they may serve in the area of vitreous substitutes.     

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。     

玻璃体积血的形态结构与玻璃体后脱离的图像特征

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.     

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。     

Anterior segment complications related to vitreous substitutes

Vitrectomy is the most common surgical technique performed in eyes with vitreoretinal disease. The development and widespread use of vitreous substitutes has revolutionized vitreoretinal surgery and improved anatomic and visual results. The three most common types of vitreous substitutes available in North America include silicone oil, intraocular gas, and perfluorocarbon liquid. Each of these agents has unique properties, allowing completely different roles of the agents in vitreoretinal surgery. The physical properties, clinical indications, and potential complications of these agents are described.     

Anatomical findings of vitreoretinal interface in eyes with asteroid hyalosis

Purpose  To investigate the anatomical features of vitreoretinal interface in eyes with asteroid hyalosis (AH) with optical coherence tomography (OCT) and intravitreal triamcinolone acetonide (TA) during vitreous surgery. Methods  This study was an interventional clinical case series. Records relating to ten eyes from ten patients who underwent a TA-assisted vitrectomy for the treatment of diverse vitreoretinal diseases complicated with AH. The posterior vitreoretinal interface was examined by preoperative OCT and by intraoperative visualization of posterior vitreous cortex utilizing TA. Results  In eight of ten AH eyes, preoperative OCT revealed abnormal vitreoretinal adhesions. In four of these eight eyes, posterior vitreoschisis could be seen on OCT. In the other four of these eight eyes, a clear no posterior vitreous detachment (PVD) pattern could be seen on OCT. Although posterior vitreous cortex could not be clearly identified with preoperative OCT in two of ten AH eyes, a complete PVD was refuted by intraoperative visualization of the posterior vitreous cortex with TA identical to the other eight eyes. Conclusion  These results indicate that complete PVD appears to be unlikely to occur in eyes with AH. In addition, spontaneous PVD in eyes with AH might lead to vitreoschisis or residual whole layer or posterior vitreous cortex, possibly due to anomalous vitreoretinal adhesion.     

Retained perfluorodecalin after retinal detachment surgery

Liquid perfluorocarbons such as perfluorodecalin are widely used as intraoperative vitreous substitutes in certain complicated vitreoretinal conditions. Retained perfluorodecalin postoperatively has been reported to be associated with retinal damage and other complications. We report on a case of retained intraocular perfluorodecalin for eleven postoperative days after retinal detachment surgery with good anatomical and visual outcome after one year follow-up.     

A new strategy to replace the natural vitreous by a novel capsular artificial vitreous body with pressure-control valve

PURPOSE: The current vitreous substitutes such as silicone oil, heavy silicone oil, and polymeric gels that are directly injected into vitreous cavity frequently cause severe intraocular complications. There is a very urgent need to find a more suitable artificial vitreous substitute for pars plana vitrectomy (PPV) surgery.METHODS: We have devised a novel capsular artificial vitreous using tailor-made silicone rubber elastomer. The novel device was implanted into the vitreous cavity of rabbit after PPV and the eye was examined by ophthalmoscopy, fundus photography, and tonometry during an 8-week treatment period. B-scan ultrasonography, electroretinogram (ERG), and histological studies by light microscopy were also performed at the end of 8 weeks.RESULTS: The novel artificial vitreous body consists of a thin vitreous-like capsule with a silicone tube-valve system. The capsule can be folded and implanted into vitreous cavity through 1.5 mm incision on sclera. Physiological balanced solution (PBS) was then injected into the capsule and inflated to support retina and control intraocular pressure (IOP) through the tube-valve system subsequently fixed under the conjunctiva. Experiments using rabbits showed that the novel vitreous body could effectively support the retina and apparently induced no significant pathological changes in the eye over 8 weeks.CONCLUSION: This approach may provide a new research strategy in the vitreous replacement technology. The novel artificial vitreous body device can effectively support retina, control IOP, and has good biocompatibility. It may be a good alternative to injecting artificial vitreous although its tamponade properties and usefulness still have to be proven in complex vitreoretinal diseases.