玻璃体切除术治疗牵拉性视网膜脱离34例

目的：探讨玻璃体切除术治疗牵拉性视网膜脱离的方法和疗效.方法：各种病因导致的牵拉性视网膜脱离34例36眼,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3-6（平均3.8）mo.结果：术后视网膜复位,视力有不同程度的提高者32眼（89%）;术后3mo内视网膜再脱离4眼,其中2眼经再次手术后复位,2眼眼球萎缩未再手术.手术并发症主要有术中牵拉性裂孔、术中及术后玻璃体积血、术后高眼压、视网膜再脱离等.结论：玻璃体切除术是治疗牵拉性视网膜脱离的有效方法,尤其对于存在广泛固定牵拉、视网膜大范围脱离、玻璃体积血、合并严重的增殖性玻璃体视网膜病变的患者是唯一有效的手术方法.     

玻璃体手术联合黄斑裂孔光凝治疗高度近视黄斑裂孔性视网膜脱离

目的 探讨高度近视黄斑裂孔性视网膜脱离玻璃体手术中行黄斑裂孔光凝的适应证及手术技巧并评价治疗效果.方法 选择21例高度近视黄斑裂孔性视网膜脱离患者,行常规经平坦部玻璃体切除、重水下行黄斑裂孔激光光凝、气-液交换、C3F8填充玻璃体腔,术后保持头低位,随访1～6个月.结果 18例术后视网膜全部复位,3例气体吸收后视网膜脱离复发;术后视力提高者16例,不变者2例,下降者3例.结论 对于某些高度近视黄斑裂孔性视网膜脱离,行玻璃体手术,并在手术中行激光封闭黄斑裂孔能够到达复位视网膜、防止视网膜脱离复发的目的.     

值得重视的眼底病研究热点与难点:原发性视网膜脱离的治疗和手术后视力恢复

视网膜裂孔是主要致盲性眼病原发性视网膜脱离的原因,封闭裂孔是其治疗原则.尽管手术疗法已能使现今大多数视网膜脱离成功复位,但视网膜裂孔发生的原因、能否预防视网膜脱离的发生以及怎样才能获得视网膜复位后满意的视力恢复等基本问题,仍然困扰原发性视网膜脱离的防治.近年研究提示,视网膜裂孔的形成与玻璃体液化、后玻璃体脱离过程中异常的玻璃体视网膜附着牵拉有关.完全性后玻璃体脱离可在玻璃体基底部后缘形成裂孔,而部分性后玻璃体脱离则可引起后部裂孔,尤其是表现为视网膜外层缝隙样增厚(中心凹劈裂)和玻璃体黄斑牵拉等特征性的近视牵拉性黄斑病变.已知黄斑的微结构改变、视网膜萎缩、前膜形成等是视网膜复位后视力不良的原因.因此,应加深对玻璃体病变和牵拉机制的认识,探索其临床评估与防治途径,促进视网膜复位后的视力恢复,将原发性视网膜脱离的防治提高到新的水平.     

玻璃体手术治疗继发于视网膜分支静脉阻塞的视网膜脱离

目的 探讨继发于视网膜分支静脉阻塞（BRVO）的视网膜脱离（RD）的临床特点和玻璃体手术的治疗效果。方法 回顾分析45例（45眼）继发于BRVO的RD的临床特点、治疗方法和预后。结果 45眼RD患者术前和术中检查发现，合并视网膜裂孔25眼，完全玻璃体后脱离（PVD）16眼。44眼均完成玻璃体手术，术后随访6—84个月。视力提高28眼（63．64％），稳定11眼（25．00％），下降5眼（11．36％）。手术后视力与手术前视力比较，差别有显著统计学意义（χ^2=4．04，P〈0．01）；完全PVD组与无或仅部分PVD组的手术后视力比较，差别有显著统计学意义（χ^2=2．97，P〈0．01）。第1次手术后视网膜成功复位39／45眼（88．64％），最终视网膜成功复位44／45眼（97．78％）。结论 继发于BRVO的RD有其独特的临床表现。玻璃体手术能有效地治疗继发于BRVO的RD，术后绝大多数患者视力改善，视网膜成功复位。     

高度近视黄斑裂孔性视网膜脱离的再次手术

目的 评价高度近视黄斑裂孔性视网膜脱离再次手术的治疗效果。方法 对需再次手术的黄斑裂孔性视网膜脱离17例17眼，其中11例是第1次经玻璃体切割联合膨胀气体填充后黄斑裂孔未闭合，6例是黄斑裂孔闭合后晚期复发的患者行玻璃体切割，彻底黄斑前膜剥离，2例行视网膜内界膜剥离，全部病例联合硅油内填充，11例术后补充氩激光光凝。结果 17例17眼黄斑裂孔闭合，视网膜全部复位，最终视力较术前提高。随访3—24个月，视网膜复位良好，无1眼复发。结论 黄斑裂孔性视网膜脱离再次手术中彻底剥离黄斑前膜，剥离视网膜内界膜，硅油填充和激光光凝可有效封闭黄斑裂孔。     

玻璃体切除联合C3F8治疗黄斑裂孔性视网膜脱离

目的探讨玻璃体切除联合C3F8注入治疗黄斑裂孔视网膜脱离的临床疗效及失败原因.方法采用经睫状体平坦部玻璃体切除联合C3F8注入治疗黄斑裂孔性视网膜脱离18例18眼.结果16眼获得解剖复位,黄斑裂孔封闭,14眼视力不同程度提高,成功率达88.9%;2眼于1月后出现视网膜再脱离.结论玻璃体切除联合C3F8注入手术是治疗黄斑裂孔视网膜脱离简单有效的方法,可大大提高初次手术复位率.术中切除干净玻璃体增殖条索、松解展平黄斑皱褶是手术成功的关键.     

玻璃体切除联合C3F8治疗黄斑裂孔性视网膜脱离

目的探讨玻璃体切除联合C3F8注入治疗黄斑裂孔视网膜脱离的临床疗效及失败原因.方法采用经睫状体平坦部玻璃体切除联合C3F8注入治疗黄斑裂孔性视网膜脱离18例18眼.结果16眼获得解剖复位,黄斑裂孔封闭,14眼视力不同程度提高,成功率达88.9%;2眼于1月后出现视网膜再脱离.结论玻璃体切除联合C3F8注入手术是治疗黄斑裂孔视网膜脱离简单有效的方法,可大大提高初次手术复位率.术中切除干净玻璃体增殖条索、松解展平黄斑皱褶是手术成功的关键.     

玻璃体切割术治疗人工晶状体眼视网膜脱离的结果分析

目的探寻人工晶状体眼裂孔性视网膜脱离(pseu-dophakicretinaldetachment,PRD)玻璃体切割术后视网膜再脱离和视力差的原因。方法106例PRD患者均选择玻璃体切割作为首选手术,其中术前27例未发现裂孔,26例曾行Nd:YAG激光后囊膜切开术。术后随访6~94.8月,平均20.8月。结果术后视网膜首次复位77例,29例视网膜再脱离的原因主要是视网膜新裂孔出现和增生性玻璃体视网膜病变。术后视力>0.3者63例,≤0.3者43例。视力≤0.3的主要原因是术后黄斑功能异常(13例)、黄斑前膜(8例)、黄斑水肿(3例)和视神经萎缩(3例)。结论PRD玻璃体切割术后视网膜再脱离的原因主要是新裂孔出现和增生性玻璃体视网膜病变,而视力差的主要原因是术后黄斑功能异常、黄斑前膜、黄斑水肿和视神经萎缩。     

内界膜剥除治疗周边裂孔合并黄斑孔的视网膜脱离

目的探讨内界膜剥除对周边裂孔合并黄斑孔的视网膜脱离的疗效及并发症。方法15例（15眼）周边裂孔合并黄斑孔的视网膜脱离，行玻璃体手术，吲哚青绿染色内界膜剥除，长效气体填充。观察术后视网膜复位、黄斑裂孔闭合、视力等情况。结果平均随访13月。14眼1次手术视网膜复位，一次手术的成功率93．33％，OCT检查13眼黄斑裂孔完全闭合；1眼黄斑与脉络膜贴服紧密，黄斑孔完全闭合率86．67％。术后视力均有不同程度的提高。并发症有一过性高眼压、白内障等。结论内界膜剥除治疗周边裂孔合并黄斑孔的视网膜脱离是有效的方法。     

高度近视黄斑裂孔视网膜脱离的手术治疗

目的 探讨高度近视黄斑裂孔视网膜脱离手术的方法，并分析有关因素。方法 对18例高度近视眼黄斑裂孔视网膜脱离患者行玻璃体切割光凝联合眼内填充18％C3F8或硅油手术。结果 17例黄斑裂孔闭合，视网膜复位，1例因玻璃体积血患者放弃治疗。视力提高14例，视力不变2例，视力下降2例。并发症：玻璃体积血1例（未治），视网膜出血1例，眼压升高2例。结论 玻璃体切割、光凝联合眼内填充18％C3F8或硅油是治疗高度近视黄斑裂孔视网膜脱离安全有效的方法。     

Retinal detachment associated with macular hole surgery: characteristics, mechanism, and outcomes.

OBJECTIVE: To study the frequency, features, and outcomes of retinal detachment (RD) occurring after macular hole surgery. METHODS: Retrospective review of all cases of macular hole surgery. Cases with postoperative RD were identified for study. Outcome measures included baseline demographic and ocular characteristics, RD features, surgical procedure, macular hole status, and final visual and anatomic outcomes. RESULTS: Retinal detachment occurred in 8 (1.8%) of 438 eyes undergoing macular hole surgery. The rate of RD was 3.5% early in the course of the surgeon's experience (first 200 cases) and 0.4% later in the surgeon's experience (after 200 cases) (P = 0.026). Two of the eight eyes with RD had undergone previous macular hole surgery. All six primary cases occurred after repair of stage 3 macular holes, which had involved peeling of the posterior cortical face. The RD involved the inferior quadrants in seven eyes and the macula in two eyes. The pathogenic retinal break was in the equatorial region in four eyes, was anterior to the equator in two eyes, and remained undetermined in two eyes. The retina was attached and the macular hole was closed in all cases at the final follow-up examination (mean 30 months). The macular hole reopened 2 years following successful reattachment of the RD in one eye. Final visual acuity was > or =20/60 in four eyes and <20/200 in one eye. CONCLUSION: Retinal detachment after macular hole surgery is uncommon, and may be related to posterior cortical vitreous stripping. Early detection of RD minimizes adverse visual and anatomic outcomes.     

Epiretinal membranous tissue in retinal detachment due to macular holes in highly myopic eyes

Objective: To determine the frequency of occurrence of epiretinal membranous tissue in retinal detachment due to macular hole and to evaluate the efficacy of vitreous surgery including removal of the membrane.Design: Noncomparative case series.Participants: Eighteen highly myopic eyes with retinal detachment due to macular holes. Results: Epiretinal membranous tissue was removed from 7 eyes (39%) and retinal reattachment was obtained in 14 eyes (78%) after the initial vitreous surgery. Of 4 eyes that required reoperation, 2 eyes achieved reattachment after a long term of internal tamponade. Histological examination of an epiretinal membrane from one case revealed that it was composed of glial cells, connective tissue, and fragments of inner limiting membrane. An intraoperative use of autologous serum as a tissue adhesive for macular holes had no effect on surgical success.Conclusion: The first therapeutic choice for this disease should be vitreous surgery with removal of the epiretinal membrane when practical, though the membrane cannot always be identified in every case.     

Epiretinal membranous tissue in retinal detachment due to macular holes in highly myopic eyes]

OBJECTIVE: To determine the frequency of occurrence of epiretinal membranous tissue in retinal detachment due to macular hole and to evaluate the efficacy of vitreous surgery including removal of the membrane. DESIGN: Noncomparative case series. PARTICIPANTS: Eighteen highly myopic eyes with retinal detachment due to macular holes. RESULTS: Epiretinal membranous tissue was removed from 7 eyes (39%) and retinal reattachment was obtained in 14 eyes (78%) after the initial vitreous surgery. Of 4 eyes that required reoperation, 2 eyes achieved reattachment after a long term of internal tamponade. Histological examination of an epiretinal membrane from one case revealed that it was composed of glial cells, connective tissue, and fragments of inner limiting membrane. An intraoperative use of autologous serum as a tissue adhesive for macular holes had no effect on surgical success. CONCLUSION: The first therapeutic choice for this disease should be vitreous surgery with removal of the epiretinal membrane when practical, though the membrane can not always be identified in every case.     

Vitreous surgery in highly myopic retinal detachment resulting from a macular hole

Purpose: This study aimed to assess the therapeutic effect of vitreous surgery in conjunction with photocoagulation for highly myopic retinal detachment resulting from a macular hole. Methods: Sixty‐two consecutive highly myopic patients (65 eyes) with retinal detachment from macular holes underwent vitreous surgery. Gas tamponade in conjunction with laser photocoagulation was performed in 46 eyes (44 cases, group 1); gas tamponade only was performed in 12 eyes (11 cases, group 2); and silicone oil tamponade only was performed in seven eyes (seven cases, group 3). Additional laser photocoagulation was given in group 1 if necessary. The anatomical and functional success rates were compared between the groups. Results: Primary retinal reattachment was achieved in 43 eyes (93.5%) in group 1, seven eyes (58.3%) in group 2 and four eyes (57.1%) in group 3. Final visual acuity was 6/60 or more in 24 eyes (52.2%) in group 1, in six eyes (50.0%) in group 2 and in three eyes (42.9%) in group 3. The initial retinal reattachment rate was significantly higher in group 1 than in group 2 (P = 0.0075) and group 3 (P = 0.0248). The macular hole was completely closed in 18 eyes in group 1 and one eye in group 2 after 2 months or longer. A thin fibrous membrane and scar could be easily noticed beneath the macula in 15 eyes. Conclusion: Vitreous surgery in conjunction with laser photo­coagulation can improve the surgical success rate for highly myopic retinal detachment resulting from a macular hole.     

Efficacy of internal limiting membrane removal for retinal detachments resulting from a myopic macular hole

PURPOSE: To evaluate the efficacy of internal limiting membrane (ILM) or epiretinal membrane removal during pars plana vitrectomy for a retinal detachment resulting from a macular hole in myopic eyes. METHODS: A retrospective study was conducted in a single institution. Twenty-six highly myopic eyes with a retinal detachment resulting from a macular hole were studied. During pars plana vitrectomy, ILM peeling (ILM-peeled group) was performed on 13 eyes, and the ILM was not removed (ILM-preserved group) in 12 eyes. Main outcome measures were anatomic reattachment, optical coherence tomography-determined macular hole closure, and visual acuity. Follow-up periods were longer than 12 months in all cases. RESULTS: The anatomic reattachment rate after the initial surgery was significantly higher in the ILM-peeled group (92.3%) than in the ILM-preserved group (50%). The macular holes of 8 (72.7%) of the 11 ILM-peeled and reattached eyes and 2 (50%) of the 4 ILM-preserved and reattached eyes were successfully closed by the initial surgery. No significant difference was found in the postoperative visual acuity and the improvement of visual acuity between the ILM-peeled group and the ILM-preserved group. There was also no significant difference of the postoperative visual acuity and improvement of the visual acuity between the two groups in cases with an initial anatomic success. CONCLUSION: These results indicate that removal of the ILM contributes to a successful reattachment and is an effective treatment for macular hole and retinal detachment in highly myopic eyes. The authors suggest that the higher success rate after ILM peeling resulted from the release of the traction of the prefoveal vitreous and the epiretinal membrane over the detached retina.     

Visual and surgical outcomes of retinal detachment following macular hole repair

OBJECTIVE: To characterize 20 cases of retinal detachment (RD) following surgical repair of macular holes. METHODS: Retrospective review of 20 eyes in 16 patients (4 patients [25%] had bilateral macular hole repairs with subsequent RD) who developed RD in the same eye in which surgical repair of a macular hole had been performed. RESULTS: Twenty detachments in 16 patients were reviewed. The average duration between macular hole repair and presentation of RD was 5.5 weeks. The inferior retina was involved more frequently than the superior retina. A total of 76% of all breaks were located inferiorly. Ten of the 20 eyes were asymptomatic at the time the detachment was diagnosed. Of the 20 eyes, 19 underwent surgical repair, all with anatomic reattachment. At final follow-up, the macular hole was closed in all 20 eyes, and 60% of the patients had final visual acuity improved by 2 lines or more over that before their macular hole repair. CONCLUSION: Retinal detachment is a complication of macular hole surgery. These detachments tend to occur within the first 2 months of follow-up, and have a high success rate of anatomic reattachment with surgery. The occurrence of RD does not preclude improved final visual acuity.     

New approach for management of retinal detachment with macular hole

Three kinds of unconventional methods were used to treat retinal detachment with macular hole in 17 cases (17 eyes). A combination of vitrectomy, transscleral drainage and intraocular air injection was used for the cases of retinal detachment with macular hole and evident vitreous traction. Transcleral drainage combined with air injection was used for those of macular hole without vitreous traction. For the cases of combined peripheral and macular holes, we treated only peripheral holes, ignoring the macular hole. After a 3-16 months follow-up, 15 out of the 17 eyes obtained retinal anatomic reattachment (88.2%), 10 eyes had their vision improved, 4 eyes remained unchanged. 9 eyes obtained a visual acuity of better than 0.05 postoperatively. Compared with the conventional method of macular buckling, these procedures have the advantages of less damage to macula, less complications and more satisfactory visual improvement.     

孔源性视网膜脱离术后黄斑裂孔形成的原因分析

目的 探讨孔源性视网膜脱离术后黄斑裂孔形成的原因.方法 回顾性分析2017年10月至2019年12月武汉大学人民医院东院眼科所有孔源性视网膜脱离手术患者的临床资料,筛选术后发生黄斑裂孔的患者,结合光学相干断层扫描(OCT)检查结果分析黄斑裂孔形成的原因.结果 本研究共纳入孔源性视网膜脱离手术患者409例(423眼),其...     

Scleral resection technique combined with vitrectomy for a macular hole retinal detachment in highly myopic eyes

PURPOSE: To evaluate scleral resection technique combined with vitrectomy for macular hole retinal detachment of highly myopic eyes. MATERIALS AND METHODS: Seventeencases (17 eyes) of macular hole retinal detachment in highly myopic eyes, in which the patient underwent vitrectomy combined with scleral resection technique formacular hole retinal detachment between January 1996 and December 2003 at Fukuoka University Chikushi Hospital, were studied.Following pars plana vitrectomy, as much as possible of the residual vitreous and/or epiretinal membrane was removed. A scleral resection was performed in 2 quadrants of the equatorial region of the temporal sclera. Finally, a fluid-air exchange with SF(6) gas injection was performed to achieve retinal attachment. Pre- and postoperative axial length of the eyeballs were measured by B-scan ultrasonography. RESULTS: All cases had the retina reattached at the initial surgery, and visual acuities were stabilized or improved after the surgery. The posterior staphyloma became obscure in 13 out of 17 eyes (76.8%). The macular hole closed in 14 of 17 eyes (82.4%) ophthalmoscopically. There were no cases in which retinal redetachment occurred during follow-up periods of more than 6 months. CONCLUSION: In cases of macular hole retinal detachment of a highly myopic eye, scleral resection technique combined with vitrectomy changed the shape of the eyeballs and allowed successful retinal reattachment at the initial surgery.