视网膜冷冻手术联合玻璃体注射曲安奈德治疗伴有渗出性视网膜脱离Coats病的初步观察

目的 观察视网膜冷冻手术联合玻璃体注射曲安奈德治疗伴有渗出性视网膜脱离Coats病的疗效.方法 前瞻性连续病例研究.21例伴有渗出性视网膜脱离的Coats病患者的21只眼纳入研究,其中,男性19例,女性2例,年龄2～18岁;部分视网膜脱离15只眼,属3A期,完全视网膜脱离6只眼,属3B期.所有患眼均接受视网膜冷冻手术联合玻璃体注射曲安奈德治疗,3只眼辅助巩膜切开引流视网膜下液.经视网膜冷冻手术联合玻璃体注射曲安奈德治疗后,4只眼针对残余异常血管再行视网膜光凝或冷冻手术.治疗后随访3～15个月,平均随访时间(7±3)个月.观察视力、眼压、眼位及眼球运动、裂隙灯、间接检眼镜及彩色眼底像,比较异常血管变化,视网膜下液及渗出的吸收情况等.以末次随访为疗效判定时间点.结果 治疗后眼压增高6只眼,均局部药物控制.随访结束时,视网膜复位19只眼,局限视网膜脱离1只眼,视网膜全脱离1只眼.视力提高3只眼,不变14只眼,下降2只眼.新发生斜视1只眼.新发生白内障或白内障加重4只眼.结论 视网膜冷冻手术联合玻璃体注射曲安奈德治疗伴有渗出性视网膜脱离Coats病,可使大部分患者视网膜复位,视功能可以有效保存.     

视网膜毛细血管瘤手术切除及激光光凝治疗观察

目的 探讨视网膜毛细血管瘤(retinal capillary hemangioma,RCH;)激光光凝及血管瘤切除手术适应证及治疗效果.方法 回顾性分析8例(9只眼)RCH患者,采用激光光凝治疗以及玻璃体切除联合血管瘤切除手术治疗前后临床资料,根据肿瘤生长部位、大小以及生长特点采用不同治疗方法.其中2例中周边部RCH患者采用单纯激光光凝肿瘤及滋养血管治疗;1例行单纯玻璃体切除术后激光治疗,1例激光治疗后又作玻璃体切除术中冷冻治疗;4例5只眼行玻璃体切除联合肿瘤切除术.结果 位于后极部及中周部瘤体较小(约<1.5PD)的RCH激光光凝可以使瘤体萎缩.明显凸出于玻璃体内生长的RCH采用玻璃体切除联合血管瘤体切除术,顺利摘除肿瘤.结论 RCH瘤体<1.5PD或外生型RCH,均可激光光凝治疗,内生型RCH,尤其瘤体直径>1.5PD时手术切除肿瘤更合适,安全有效.     

家族性渗出性玻璃体视网膜病变治疗观察

目的 观察家族性渗出性玻璃体视网膜病变（FEVR）激光光凝和玻璃体视网膜手术治疗的疗效。 方法 回顾性分析1997年1月至2005年8月 期间临床诊断的FEVR患者17例32只眼的临床资料。根据患眼病变轻重程度不同选择治疗方法 ,其中7只眼(1期2只眼、2A期1只眼和2B期4只眼)采用周边视网膜激光光凝治疗，治疗后随访 6～108个月,平均随访时间30.29个月。13只眼(3B期2只眼、4A期1只眼、4B期6只眼和5A期4 只眼)采用玻璃体视网膜手术治疗，手术后随访3～72个月，平均随访时间23.19个月；另外 12只眼因病变太严重、年龄及家属选择等原因未接受治疗。 结果 接受激光光凝治疗的7只眼随访期间病情稳定,视力保持不变。接受玻璃体视网膜手术治疗的13只眼,除1只眼外12只眼黄斑区均达到解剖复位。9只眼手术后视力提高,3只眼手术后视力保持不变,1只眼视力检查不合作。 结论 激光光凝能控制FEVR病情发展；玻璃体视网膜手术有利于促进FEVR患者视网膜复位和提高视力。两种治疗方法是治疗FEVR的有效手段。 （中华眼底病杂志，2006，22：302-304）     

眼内激光光凝术在视网膜血管性疾病的玻璃体手术中的应用

目的：探讨眼内激光在视网膜血管性疾病的玻璃体切除术中的应用及有效性。方法：将眼内激光应用于24例(28只眼)视网膜血管性疾病的玻璃体手术中。眼内光凝的方式：全视网膜光凝21只眼；环形激光视网膜拦截并封闭视网膜裂孔2只眼：局限性光凝5只眼。结果：术后随访1～24个月(平均9个月)，3只眼术后再次视网膜出血，其余25只眼均视网膜平伏、裂孔封闭、视力不同程度提高，未再有玻璃体积血发生，治愈率达89．2％。结论：眼内激光光凝是现代玻璃体手术中重要的辅助工具，是视网膜血管性疾病玻璃体切除手术中一个重要而有效的步骤。     

眼内激光光凝术在玻璃体切除手术中的应用

目的 探讨眼内激光在玻璃体切除术中的用途及有效性。方法 将眼内激光应用于18例22眼玻璃体手术中。眼内光凝的方式：广泛视网膜光凝术14眼；环形激光视网膜拦截并封闭视网膜裂孔2眼；局限性光凝1眼；原发性或医源性裂孔光凝4眼；视网膜切开处光凝1眼。结果 术后随访1～24月(平均9月)，2眼术后再次视网膜出血，其余20眼均达到视网膜平伏、裂孔封闭、视力不同程度提高。结论 眼内激光是现代玻璃体手术中重要的辅助措施，它的应用明显提高手术成功率。     

视网膜血管瘤病的现代治疗

５例７眼视网膜血管瘤病患者，２眼接受单纯激光治疗，瘤体控制在１ＰＤ以下，视力保持正常；３眼接受冷冻联合激光治疗，成功地使视网膜下液吸收，瘤体缩小至１ＰＤ以下，视力明显提高；２眼接受玻璃体切除联合眼内激光治疗，１眼术中眼内出血而放弃治疗，１眼成功地将玻璃体积血和增殖膜清除，并封闭瘤体供养动脉，达到较好效果。本文对该病进行光凝、冷冻和玻璃体手术的适应证和治疗方法进行了讨论。提出对该病应长期追踪，早期发现，早期治疗（尤其瘤体多或进行性增大者）。     

高度近视黄斑裂孔视网膜脱离的玻璃体手术和激光光凝治疗

目的 探讨高度近视黄斑裂孔视网膜脱离患者玻璃体手术联合激光光凝治疗的成功率及并发症。 方法 高度近视黄斑裂孔视网膜脱离患者35例38只眼，11例12只眼单行经睫状体平部的玻璃体手术及惰性气体眼内填充，未作激光光凝治疗；24例26只眼在玻璃体手术术中及术后作黄斑裂孔缘激光光凝。术后均作6个月以上的随访(平均随访时间21．7个月)。 结果 非光凝组5只眼黄斑裂孔性视网膜脱离复发，占41．7%，术后0．1以上视力6只眼，占50.0%；光凝组2只眼黄斑裂孔复发，占7.7%，1只眼因周边新裂孔形成而复发视网膜脱离，术后有13只眼视力在0.1以上，占50.0%。统计学检验两组黄斑裂孔复发率概率P=0.024,视网膜脱离复发率概率P=0.0487。两组患者术后视力无显著差异。 结论 玻璃体手术联合黄斑区激光光凝治疗可提高高度近视黄斑裂孔视网膜脱离的手术成功率。 (中华眼底病杂志,1998,14:199-201)     

高度近视黄斑裂孔视网膜脱离的玻璃体手术和激光光凝治疗

目的探讨高度近视黄斑裂孔视网膜脱离患者玻璃体手术联合激光光凝治疗的成功率及并发症。方法高度近视黄斑裂孔视网膜脱离患者３５例３８只眼，１１例１２只眼单行经睫状体平部的玻璃体手术及惰性气体眼内填充，未作激光光凝治疗；２４例２６只眼在玻璃体手术术中及术后作黄斑裂孔缘激光光凝。术后均作６个月以上的随访（平均随访时间２１．７个月）。结果非光凝组５只眼黄斑裂孔性视网膜脱离复发，占４１．７％，术后０．１以上视力６只眼，占５０．０％；光凝组２只眼黄斑裂孔复发，占７．７％，１只眼因周边新裂孔形成而复发视网膜脱离，术后有１３只眼视力在０．１以上，占５０．０％。统计学检验两组黄斑裂孔复发率概率Ｐ＝０．０２４，视网膜脱离复发率概率Ｐ＝０．０４８７。两组患者术后视力无显著差异。结论玻璃体手术联合黄斑区激光光凝治疗可提高高度近视黄斑裂孔视网膜脱离的手术成功率。     

玻璃体切除硅油充填联合眼内光凝治疗晚期Coats病

目的：探讨玻璃体切除硅油充填联合眼内光凝治疗伴有广泛渗出性视网膜脱离的晚期Coats病的临床治疗效果。方法：伴有广泛渗出性视网膜脱离的晚期Coats病患13例(13眼)进行玻璃体切除硅油充填联合眼内光凝治疗,其中并发性白内障同时行晶状体切除3眼。术后随访时间0．5～2a。观察术后视力、眼压、视网膜复位情况、视网膜血管改变及术后并发症。结果：术后3mo,13例患视网膜均复位,经FFA检查见异常扩张的血管逐渐闭塞和退缩;其中9眼最佳矫正视力均有不同程度提高,≥0．31眼,0．1～0．33眼,≤0．15眼;另有4眼术后视力没有明显变化。术后6和14mo时各有1例因血管渗漏致下方局限性渗出性视网膜脱离,经补行激光治疗后视网膜下液吸收,视网膜复位。结论：玻璃体切除硅油充填联合眼内光凝是治疗伴有广泛渗出性视网膜脱离的晚期Coats病的最为安全有效的方法。     

急进性后部型早产儿视网膜病变的临床特征及治疗

目的 观察急进性后部型早产儿视网膜病变（AP-ROP）的临床特征和治疗效果。 方法回顾分析18例AP-ROP患儿35只眼的临床资料。暗室条件下,采用双目间接检眼镜配合28 D透镜、巩膜压迫器、广角数码视网膜成像系统(RetCam)检查所有患儿视网膜并记录病变。所有患儿在确诊后12 h内,采用半导体倍频532 nm波长激光,应用双目间接检眼镜激光输出系统对病变周边部视网膜无血管区进行激光光凝。其中,因激光光凝治疗后病变继续进展再行玻璃体手术治疗者13只眼,占37.1%;单纯行激光光凝治疗者22只眼,占62.9%。治疗后随访6个月~5年,平均随访时间为23.5个月。观察视网膜病变的转归。结果 所有患眼均为后极部病变,位于1区或2区的后部。4个象限的视网膜血管高度扩张纡曲,难以区分视网膜小动静脉,出现视网膜内血管短路、动静脉弓;视网膜无血管区和血管化区域边界不清,新生血管网呈扁平形态,不易识别;无明显的分界线或嵴等典型病变形成。单纯行激光光凝治疗的22只眼,治疗后血管形态及走向趋于正常,病变消退,无血管区光凝斑均匀覆盖。行玻璃体切割手术的13只眼,激光光凝治疗后玻璃体在后极部环形增生收缩引起牵拉性视网膜脱离。手术治疗后视网膜复位8只眼;玻璃体渗出及出血,视网膜未复位5只眼。结论 AP-ROP临床表现特殊。及时激光光凝治疗可使大部分患眼病变消退。激光光凝治疗后病变继续进展者行早期玻璃体手术干预,可使大部分患眼视网膜复位。     

Inadvertent perforation of the globe during regional anaesthesia

Purpose: This retrospective study was undertaken to review the clinical signs and management of patients with perforating eye injuries associated with regional anaesthesia for ophthalmic surgery.
Methods: Fifteen consecutive patients presenting with inadvertent perforation of the globe were evaluated. Eleven required vitreoretinal surgery. The indications were retinal detachment (six eyes), vitreous haemorrhage (four) and an epiretinal membrane (one eye).
Results: Those eyes with retinal detachments generally had a poor functional outcome in spite of the retinae being attached in five of the six eyes. The operative findings of those eyes with vitreous haemorrhage but attached retina demonstrated varying retinal tear configurations.
Conclusions: Eyes with perforating injuries following intraorbital anaesthesia are at risk of developing a retinal detachment. In those eyes presenting with dense vitreous but attached retina, consideration of vitrectomy and laser photocoagulation is advised.     

预防性玻璃体手术治疗急性视网膜坏死综合征

目的 报告一组Ⅰ～Ⅱ期急性视网膜坏死综合征患者经预防性玻璃体手术治疗的临床效果.方法 回顾性分析2006年2月至2008年7月20例(20只眼)Ⅰ～Ⅱ期急性视网膜坏死综合征患者接受预防性玻璃体手术治疗的临床资料.所有患者接受完全玻璃体切除联合激光光凝及硅油填充,术中用曲安奈德玻璃体腔注射以增加玻璃体可视性,术后常规面朝下体位,术前、术后均给予阿昔洛韦等药物治疗.随防10～12月.结果 20例20只眼中,硅油取出后,18只眼视网膜在位;2只眼出现视网膜脱离,其中1只眼再次行视网膜前膜剥除+硅油注入+激光光凝术,硅油取出后,视网膜在位;另1只眼因术前视网膜坏死广泛,视网膜动脉广泛闭塞,再次手术后,视网膜未能复位.术后视力提高13只眼、不变5只眼、下降2只眼.结论 预防性玻璃体切除联合激光光凝及硅油填充是治疗急性视网膜坏死综合征的有效方法,术后患者能改善或保持视力,减少视网膜脱离的发生率.     

玻璃体视网膜手术治疗视网膜坏死

目的评价玻璃体视网膜手术治疗急性视网膜坏死综合征（ARNS）的疗效。方法对1例（1眼）玻璃体炎症明显和6例（6眼）伴有视网膜脱离的ARNS患者行玻璃体切除术,切除玻璃体、视网膜剥膜、视网膜切开、硅油填充及眼内光凝。结果所有病例视网膜均获得满意复位。5眼行取硅油术后、随访6-12个月均未发生视网膜再脱离,所有病例术后均保留视力。结论玻璃体视网膜手术是治疗急性视网膜坏死综合征有效的方法,可明显改善预后。     

玻璃体切除治疗复发性出血性玻璃体视网膜疾病

目的探讨玻璃体切除术对复发性出血性玻璃体视网膜疾病的临床效果。方法对43例(44眼)玻璃体积血施行三通道经睫状体平坦部玻璃体切除术,联合膜剥离,水下透热,眼内光凝(或经巩膜冷凝),并根据病情选用眼内长效填充材料。结果视网膜静脉阻塞18眼,外伤性玻璃体积血9眼,视网膜裂孔致玻璃体积血6眼,静脉周围炎5眼,增生性糖尿病视网膜病变3眼,蛛网膜下腔出血合并玻璃体积血(综合症)2眼,老年性黄斑变性1眼。术后随访2～24月,44眼视力均有不同程度的提高,随访视力较术前相比差异有统计学意义(P<0.05),视力0.05以上者36眼(81.82%),0.2～0.8者27眼(61.36%)。结论复发性出血性玻璃体视网膜疾病经药物治疗无效,B超显示出现玻璃体后脱离或B超显示伴有牵引性视网膜脱离者,玻璃体切除术是消除玻璃体积血并使视网膜复位的有效方法。     

Familial exudative vitreoretinopathy mimicking persistent hyperplastic primary vitreous

PURPOSE: To report an unusual case of familial exudative vitreoretinopathy in an infant. METHODS: Case report. A 6-day-old girl had unilateral microphthalmia in the right eye, with a retrolental plaque initially diagnosed as persistent hyperplastic primary vitreous. Three months later, peripheral retinal vascular changes and a fibrovascular ridge were noted in the left eye, suggesting familial exudative vitreoretinopathy as the cause in both eyes. RESULTS: The microphthalmic right eye was unsalvageable. The left eye developed an exudative retinal detachment despite photocoagulation of the peripheral avascular retina. Additional cryotherapy resulted in resolution of the detachment and regression of the vascular changes. CONCLUSIONS: With highly asymmetric involvement, neonatal familial exudative vitreoretinopathy can mimic persistent hyperplastic primary vitreous. Fellow eye involvement can progress rapidly.     

Early retinal adhesion from laser photocoagulation

Histopathologic examination of eight cynomolgus monkey eyes and one human eye revealed that both argon and krypton laser photocoagulation cause adhesion between the neurosensory retina and the retinal pigment epithelium (RPE) within 24 hours of treatment. The neurosensory retina remained attached at the sites of laser burns despite surrounding retinal detachment in untreated areas. This early adhesion with the laser is useful for the treatment of eyes in which the retina has been recently reattached such as at the end of a vitrectomy for a retinal detachment with proliferative vitreoretinopathy (PVR) or after a pneumatic retinopexy. It is also useful for the treatment of retinal breaks without detachment.     

Vitrectomy for Tractional Retinal Detachment with Twin Retinal Capillary Hemangiomas in a Patient with Von Hippel-Lindau Disease: A Case Report

PurposeThe purpose of this study was to report a case of Von Hippel-Lindau disease (VHL) with twin retinal capillary hemangiomas that was successfully treated by vitreous surgery for tractional retinal detachment following laser photocoagulation.CaseA 44-year-old male presented at our university hospital after noticing decreased visual acuity in his right eye. The patient had previously undergone multiple operations for cerebellar, thoracic, and lumbar spine hemangioblastomas when he was approximately 19 years old. Upon initial examination, ocular findings revealed twin connected retinal capillary hemangiomas around the temporal upper area of the patient''s right eye. The patient was subsequently diagnosed with VHL based on his medical history and current observations of the ocular fundus. Tractional retinal detachment had occurred as the result of the formation of proliferative membranes following laser photocoagulation. The patient underwent vitreous surgery to treat the tractional retinal detachment, resulting in a successful postoperative outcome.ConclusionThe findings of this study show the possibility that proliferative changes and tractional retinal detachment can arise following photocoagulation for retinal capillary hemangiomas in patients with VHL.     

Diode laser photocoagulation for retinopathy of prematurity: a histopathologic study

Laser photocoagulation has largely supplanted cryotherapy as an effective treatment for retinopathy of prematurity. This case describes the ocular histopathologic findings of a pair of eyes in a severely premature male infant treated with diode laser photocoagulation for bilateral stage 3 retinopathy of prematurity (ROP) for 360 degrees in zone 1 with severe plus disease. The right eye responded to treatment; the left eye developed persistent vitreous hemorrhage and total retinal detachment. The histopathologic examination of laser burns in the right eye disclosed segmental areas of chorioretinal scarring with retinal atrophy and gliosis, loss of RPE and extensive atrophy of the choroid and its vasculature, which involved both the choriocapillaris and larger vessels. The left eye had iris neovascularization, a chronic organized vitreous hemorrhage and a totally detached retina. The histopathologic findings in an eye of a premature infant with threshold ROP treated with diode laser photocoagulation resembled those reported after transsceral cryotherapy. Diode laser photocoagulation may produce less severe chorioretinal damage.     

Early surgical management in bilateral acute retinal necrosis

One patient with bilateral acute retinal necrosis underwent encircling scleral buckle, vitrectomy, and intravitreal acyclovir on both eyes. This procedure was performed on the right eye while the retina was attached. The retina of the right eye was reattached by performing fluid-gas exchange and modified panretinal photocoagulation when the retina subsequently detached. Soon after the development of retinal detachment in the left eye, the above surgical procedures were performed on the left eye, and the retina was successfully reattached. Bilateral acute retinal necrosis with significant vitreous opacification, which is a devastating ocular disease causing possible blindness in both eyes, requires more aggressive, early surgical management.