闭合式玻璃体切除术472例分析

本文总结了４７２例４９１眼玻璃体除术的疗效，临床上分为６组，外伤性玻璃体浑浊机化，外伤性玻璃浑浊机化合并视网膜玻璃，眼内异物合并玻璃体混浊机化，眼内异物合并玻璃体浑浊及视网膜脱离，眼内炎及视网膜血管病所致的玻璃体浑浊机化，４９１眼中有３４７眼进行了联合手术，本文对各组的视力结果，手术时机，手术并发症，外伤性视网膜脱离的特点及预后作了分析讨论。     

视网膜大动脉瘤合并玻璃体积血的手术疗效

目的：分析评价视网膜大动脉瘤合并玻璃体积血行玻璃体切割术联合眼内视网膜光凝治疗的临床疗效。 方法：回顾分析2009-01/2011-02在我院住院治疗的11例11眼视网膜大动脉瘤合并玻璃体积血的患者,给予玻璃体切割术联合眼内激光治疗;并对其手术疗效、视力和并发症进行观察分析。 结果：术后随访6～24mo,11例患者玻璃体腔均无再次出血,视网膜大动脉瘤周边血管闭塞,瘤体萎缩、瘢痕化;术后视力0.05～0.4,均有不同程度提高;其中2例2眼术后眼压一过性升高,局部给予降眼压药物治疗后恢复正常。 结论：玻璃体切割术联合眼内视网膜光凝治疗,对视网膜大动脉瘤合并玻璃体积血患者是一种疗效确切的治疗方法。     

玻璃体切除联合曲安奈德治疗视网膜脱离合并脉络膜脱离的临床观察

目的 评价玻璃体切除联合曲安奈德治疗视网膜脱离合并脉络膜脱离的临床效果.方法 视网膜脱离合并脉络膜脱离32例(32眼).发现合并裂孔者23例.行玻璃体切除术,术中将曲安奈德注射于玻璃体腔,术后随访3～24个月,观察术后视网膜复位率,视力恢复情况.结果 术后随访3～24个月,复位率为81.2%,术后视力均有不同程度提高,矫正视力最高为0.5,最低0.03,平均矫正视力0.2.结论 玻璃体切除联合曲安奈德玻璃体腔注射治疗视网膜脱离合并脉络膜脱离,阻止增生性玻璃体视网膜病变的再生,提高了视网膜复位率.     

Terson综合征的治疗及预后分析

目的探讨Terson综合征的治疗选择及预后。方法本组病例共纳入我科2003年1月至2009年12月间确诊并治疗的24(35只眼)Terson综合征患者连续病例,术前视力为光感至0.2,病程为1～10个月,年龄16～67岁。所有患眼均进行了玻璃体切割手术,根据视网膜具体情况选择硅油充填9只眼,C3F8眼内充填3只眼。结果所有Terson综合征患者通过手术清除玻璃体腔内积血后视力均有一定的提高,35只眼中有14只眼术后视力≥0.5,病程较长或合并视网膜脱离者术后视力恢复欠佳。结论玻璃体切割手术可以有效治疗Terson综合征患者发生的玻璃体积血,对于较长时间玻璃体腔内积血未能吸收或是合并视网膜脱离的患者应积极手术介入。     

玻璃体切除联合曲安奈德玻璃体腔注射治疗孔源性视网膜脱离

目的 探讨玻璃体切除联合曲安奈德(TA)玻璃体腔内注射治疗合并脉络膜脱离的孔源性视网膜脱离的临床疗效和安全性.方法 观察采用玻璃体切除联合曲安奈德玻璃体腔内注射治疗合并脉络膜脱离的孔源性视网膜脱离15例患者(15眼),术后不再全身应用糖皮质激素,仅给予激素眼液点眼.结果 术后随访时间6～30个月,平均(19±9.5)个月.一次手术视网膜复位率100%.术后3个月硅油取出后,2例视网膜脱离复发,1例再次剥膜充填硅油后视网膜复位;另1例放弃治疗.视网膜总复位率为93.3%(14/15).术后并发症包括:4例术后眼压升高,均局部用药控制,5例出现晶状体后囊下皮质局限性混浊.结论 玻璃体切除联合(TA)玻璃体腔内注射治疗合并脉络膜脱离的孔源性视网膜脱离,可以明显减轻术后葡萄膜炎症反应,从而减少PVR的发生,显著提高手术的成功率.     

玻璃体切除治疗视网膜分支静脉阻塞引起玻璃体积血的临床效果

目的:探讨玻璃体切除手术治疗视网膜分支静脉阻塞引起的玻璃体积血的临床效果。方法:回顾分析28例28眼视网膜分支静脉阻塞引起的玻璃体积血患者进行闭合式玻璃体切除,联合增殖膜剥离、眼内激光光凝及玻璃体腔长效气体、硅油或灌注液填充手术的临床疗效。结果:该28例患者术中均可见视网膜分支静脉阻塞闭锁呈白线状。视网膜静脉阻塞颞上方20例,颞下方8例。合并视盘新生血管2例,18例阻塞区可见视网膜新生血管及交通支。并发视网膜脱离7例,患者术前及术后视力比较有统计学差异(P<0.05)。结论:玻璃体切除是视网膜分支阻塞的有效手术方法,术中应谨慎去除阻塞区增殖病灶,光凝视网膜无灌注区,术后注意观察阻塞部位的视网膜复位及增殖情况。     

玻璃体视网膜联合手术治疗复杂性眼外伤

目的探讨玻璃体视网膜联合手术治疗复杂性眼外伤的手术方法。方法2006年9月至2007年9月83例复杂性眼外伤,进行玻璃体视网膜联合手术。对合并白内障影响后段手术操作者,先行晶状体切除术或晶状体超声粉碎术;合并眼内异物者,用异物镊摘出之;合并前部增生性玻璃体视网膜病变者,行周边部视网膜切开,并取出视网膜下增生膜或增生条索,同时行巩膜环扎术。最后根据视网膜情况行长效气体或硅油等充填玻璃体腔;无晶状体眼则视视力恢复情况行二期人工晶状体植入术。术后随访12—24个月,观察视网膜复位及视力恢复情况。结果视网膜完全复位77眼,视网膜部分复位、硅油维持跟3跟,低眼压、硅油维持眼2眼,眼球萎缩者1眼。术后视力提高者68眼,不变13眼,下降2眼。其中矫正视力0．5以上者22眼,0．1～0．4者37眼,最佳矫正视力为1．0。结论玻璃体视网膜联合手术是治疗复杂性眼外伤的理想方法,可有效保留伤眼,挽救、改善患眼的视功能。     

玻璃体腔内超声乳化治疗晶状体后脱位的疗效观察

目的 评价玻璃体腔内超声乳化治疗晶状体后脱位的疗效.方法 选取2007年11月至2009年11月,18例(18只眼)因眼伤或白内障摘除术中后囊破裂晶状体核脱位于玻璃体腔的患者,应用标准睫状体扁平部闭合式三切口,先行全玻璃体切除术,再采用去硅胶袖套的超声乳化头乳化摘除脱位的晶状体,并根据病情行眼内异物取出术、视网膜激光光凝术等.术后观察视力、眼压、视网膜、巩膜伤口等恢复情况.结果 在没有使用全氟化碳(重水)的情况下,所有晶状体均成功摘除,没有发生严重的并发症.13只眼术后视力不同程度提高,其余5例保持不变;术前合并继发性青光眼的6例患者,术后眼压控制良好;术前合并球内异物的3例均成功取出异物;视网膜、巩膜无明显医源性损伤.结论 玻璃体腔内超声乳化联合玻璃体切割治疗晶状体后脱位疗效好,具有方便、快捷、不需应用重水的特点.超声乳化头可以代替超声粉碎头用于晶状体脱位于玻璃体腔的治疗.     

ILMP及玻璃体腔注药联合硅油填充治疗高度近视MHRD合并脉络膜脱离

目的:观察内界膜剥除(internal limiting membrane peeling,ILMP)和玻璃体腔注射曲安奈德联合硅油填充治疗高度近视黄斑裂孔性视网膜脱离合并脉络膜脱离的临床疗效.方法:高度近视黄斑裂孔性视网膜脱离合并脉络膜脱离患者28例28眼,均行玻璃体切割(pars plana vitrectomy,PPV)吲哚菁绿辅助的ILMP以及硅油填充手术,术中将曲安奈德注射于玻璃体腔,术后随访6~24mo,观察术后视网膜复位率、视力恢复情况和术后并发症.结果:术后随访6~24mo,患者手术后平均LogMAR矫正视力为1.01± 0.31,与手术前平均LogMAR矫正视力比较,差异有统计学意义(t=-39.28,P<0.01).黄斑裂孔闭合19眼(68%),黄斑裂孔未闭合9眼(32%),26眼视网膜复位(93%),6眼出现高眼压.结论:玻璃体切割联合ILMP及硅油填充和玻璃体腔注射曲安奈德治疗高度近视黄斑裂孔性视网膜脱离合并脉络膜脱离,可阻止增生性玻璃体视网膜病变的再生,提高视网膜复位率.     

全氟萘烷在玻璃体视网膜手术中应用的临床分析

目的 探讨全氟萘烷(Perfluorodecalin,PFDL)在睫状体扁平部玻璃体切除术(ParsPlana Vitrectormv,PPV)中的独特作用及在眼内长期残留时对眼组织的影响.方法 回顾分析在PPV中应用PFDL的临床病例239例239只眼,其中裂孔源性视网膜脱离(retinaldetachment,RD)130例,晶状体脱位于玻璃体腔4例,外伤性RD41例,增殖性糖尿病性视网膜病变导致玻璃体出血合并牵拉性RD21例,视网膜静脉栓塞和视网膜静脉周嗣炎导致玻璃体腔出血合并牵拉性RD27例,陈旧性脉络膜出血1例,急性视网膜坏死合并视网膜脱离2例,眼内炎3例,Coats病合并牵拉裂孔性RD1例,眼内填充硅油合并RD9例.采用PPV,膜剥离,PFDL使用,眼内激光,气液交换,惰性气体及硅油眼内填充.探讨防止PFDL眼内残留的方法 ,对黄斑裂孔或后极部裂孔采用"气液交换后置换PFDL法",对巨大裂孔性视网膜脱离采用"PFDL联合部份气液交换法",对360°视网膜切开采用"逐步使用PFDL法".结果 随访12～15个月,212例212只眼获得随访,视网膜复位181例181只眼,有效率85.37%,术后PFDL残留22只眼,随访期间,角膜、前房及视网膜均未见功能及结构上的改变.结论 PFDL可有效地应用于PPV中,提高治疗巨大裂孔性视网膜脱离、外伤性视网膜脱离、眼内填充硅油合并RD等复杂性视网膜脱离的手术成功率,PFDL小滴在眼内长期存留,临床上未观察到明显眼部损害.     

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.     

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.     

有/无填充物微创玻璃体切割术治疗增生性糖尿病视网膜病变合并牵拉性视网膜脱离的疗效比较

目的　比较有／无填充物的微创玻璃体切割术治疗增生性糖尿病视网膜病变（ｐｒｏｌｉｆｅｒａｔｉｖｅｄｉａｂｅｔｉｃｒｅｔｉｎｏｐａｔｈｙ,ＰＤＲ）合并牵拉性视网膜脱离的疗效。方法　回顾性分析２０１０年１月至２０１３年１月我院收治的ＰＤＲ合并牵拉性视网膜脱离患者的临床资料,所有患者均采用微创玻璃体切割术治疗,根据术中是否进行玻璃体填充分为无填充物组（Ａ组）和有填充物组（Ｂ组）。术后随访３个月以上,比较两组患者的一般资料（包括性别、年龄、血糖、糖尿病病程等）、手术前后眼压、视力以及术后并发症等。结果　本研究共入组８０例（８０眼）患者,其中Ａ组患者４２例,Ｂ组患者３８例。２组患者术前、术后７ｄ、术后１个月的眼压比较,差异均无统计学意义（均为Ｐ＞０．０５）。２组患者术前、术后３个月的视力比较,差异均无统计学意义（均为Ｐ＞０. ０５）,而Ａ组术后１个月时的视力高于Ｂ组,差异有统计学意义（Ｐ＜０．０５）。术后Ａ组２例患者出现低眼压,１例出现玻璃体积血;Ｂ组２例患者出现玻璃体积血,２例出现晶状体混浊,１例出现低眼压;２组患者术后并发症发生率差异无统计学意义（χ２ ＝０．８０２,Ｐ＝０．３７）。结论　ＰＤＲ合并牵拉性视网膜脱离患者采用微创玻璃体手术治疗可取得较好的疗效,且无填充物患者术后视力恢复更快。     

Combined surgery, phacoemulsification, implantation of intraocular lens and pars plana vitrectomy

PURPOSE: To evaluate the effectiveness, technical feasibility and incidence of complications after combining pars plana vitrectomy, phacoemulsification and intraocular lens implantation. MATERIAL AND METHODS: The results of combined vitreoretinal and cataract surgery in 100 eyes of 96 patients were retrospectively and prospectively analyzed. The mean follow-up period was 8.4 months. All patients had clinically significant lens opacities and vitreoretinal pathology requiring pars plana vitrectomy. Indications for vitreoretinal surgery included: persistent vitreous haemorrhage (28 eyes), vitreous hemorrhage combined with tractional retinal detachment (50 eyes), tractional retinal detachment without vitreous haemorrhage caused by proliferative diabetic retinopathy (7 eyes), rheumatogenous retinal detachment with proliferative vitreoretinopathy (10 eyes) and dislocated crystalline lens in the vitreous (5 eyes). RESULTS: Postoperatively, best corrected visual acuity improved in 81 eyes (81%)- by two lines or more in 31 eyes (31%) - by less than two lines in 50 eyes (50%). In 14 eyes (14%) visual acuity was unchanged and was worse in 5 cases (5%). Postoperative complications included fibrin reaction, posterior synechias of the iris, vitreous hemorrhage, neovascular glaucoma, posterior capsule opacification, redetachment of retina. CONCLUSIONS: Our cases confirm previous study, that performing phacoemulsification, IOL implantation and vitrectomy in one operation is safe and allows visual recovery with good technical results.     

Intraocular pressure during vitrectomy in diabetic patients

23 eyes underwent vitrectomy for diabetic proliferative retinopathy complications: vitreous hemorrhage with or without tractional retinal detachment. After 6 months of follow-up, 64% of eyes had final visual acuities of 1/40 or better. Preoperative iris neovascularization and preoperative detachment of the macula have a worse prognosis. Decrease of peroperative complications is allowed by checking of intraocular pressure during vitrectomy.     

Intraocular pressure during vitrectomy in the diabetic patient

23 eyes underwent vitrectomy for diabetic proliferative retinopathy complications: vitreous hemorrhage with or without tractional retinal detachment. After 6 months of follow-up, 64% of eyes had final visual acuities of 1/40 or better. Preoperative iris neovascularization and preoperative detachment of the macula have a worse prognosis. Decrease of peroperative complications is allowed by checking of intraocular pressure during vitrectomy.     

Incidence of rhegmatogenous retinal detachment after vitrectomy in eyes of diabetic patients

PURPOSE: To assess the incidence of rhegmatogenous retinal detachment (RRD) after pars plana vitrectomy (PPV) among diabetic patients with complications of proliferative diabetic retinopathy. METHODS: Ninety-three eyes of diabetic patients-who underwent PPV with or without intraocular gas tamponade for complications of proliferative diabetic retinopathy-were reviewed retrospectively. Indication for vitrectomy was vitreous hemorrhage in 80 patients (86.1%), tractional retinal detachment in 3 (3.2%), and vitreous hemorrhage associated with tractional retinal detachment in 10 (10.7%). RESULTS: Four (4.3%) of 93 eyes developed an RRD after vitrectomy. The primary reason for vitrectomy was recurrent or nonresolving vitreous hemorrhage. The retina was attached with one additional surgical procedure in two of these eyes; the other two had to undergo a third operation before attachment was achieved. CONCLUSION: RRD occurs in a small percentage of patients after PPV with or without gas tamponade for vitreous hemorrhage or tractional retinal detachment caused by proliferative diabetic retinopathy. Thorough postoperative follow-up is important to make early diagnosis and intervention possible.     

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。     

严重PDR玻璃体切割术后雷珠单抗注射的效果观察

目的：对严重增殖性糖尿病视网膜病变的患者行玻璃体切割术后行雷珠单抗注射的效果观察。方法：回归性分析。12例严重增殖性糖尿病视网膜病变患者(12眼)接受睫状体平坦部玻璃体切割术,同时给予硅油、惰性气体或者平衡液的玻璃体腔填充。在手术结束的同时给予雷珠单抗的玻璃体腔注射。结果：随访时间平均为2.75 mo。这12眼中分别包括玻璃体积血(1眼);玻璃体积血伴纤维血管化增生(1眼);玻璃体积血伴牵拉性视网膜脱离(3眼);纤维血管化增生伴牵拉性视网膜脱离(2眼);玻璃体积血伴新生血管性青光眼伴牵拉性视网膜脱离(1眼);玻璃体积血伴纤维血管化增生伴牵拉性视网膜脱离(2眼);玻璃体积血伴纤维血管化增生伴新生血管性青光眼伴牵拉性视网膜脱离(1眼);玻璃体积血伴牵拉性孔源性视网膜脱离(1眼)。12眼中,8眼行玻璃体腔硅油填充,2眼行惰性气体填充,2眼行平衡液填充。所有的患者之前均未接受任何治疗。视网膜脱离复位率为10/10(100%)。1眼术后出现前房积血。9眼术后最佳矫正视力较术前提高,2眼无明显变化,1眼较术前下降。 OCT检查显示8眼术后未见黄斑水肿。结论：玻璃体切割术后雷珠单抗注射对严重增殖性糖尿病视网膜病变患者有明显的治疗效果：手术成功率明显提高;患者视力显著提高;糖尿病黄斑水肿的发生概率减少;术中及术后并发症的发生率降低。     

Studies on vitrectomy cases associated with complicated branch retinal vein occlusion

PURPOSE: To study the preoperative factors leading to vitrectomy, and to demonstrate the postoperative conditions causing the decreased visual acuity that results from branch retinal vein occlusion (BRVO). METHODS: In 113 patients (114 eyes) with BRVO, the following data were analyzed: age, general complications, distribution of occluding vessels, location of retinal breaks, classification of vitreoretinal pathology, and the number of cases, period from onset of BRVO to vitreous hemorrhage and from vitreous hemorrhage to vitrectomy, number of operations, relationship between posterior vitreous detachment (PVD) and number of operations, preoperative photocoagulations, pre- and postoperative visual acuity, and cases with poor visual outcome. RESULTS: The visual prognosis was much better in cases with vitreous hemorrhage only than in those with proliferative membrane and retinal detachment (P =.0023). Repeated surgeries were needed in the cases where there was only partial PVD (P =.0029). Macular disorders and optic nerve atrophy were the main causes of postoperative visual acuity < 0.1. CONCLUSIONS: Early vitrectomy before development of vitreo retinal proliferation and retinal detachment, especially in cases where there is only partial PVD, seems to be essential for case management and treatment to attain better visual acuity for the patient.