玻璃体切除联合重硅油填充治疗下方PVR视网膜脱离

目的探讨玻璃体切除联合重硅油眼内填充治疗下方严重PVR视网膜脱离的效果。方法对26例（26眼）诊断为合并下方PVR视网膜脱离者行玻璃体切除联合眼内重硅油填充,并同时随机抽取26眼患相似类型的视网膜脱离者,在玻璃体切除术后给予眼内硅油填充作为对照治疗。术后随访7～12月,观察其视网膜复位、视力、眼压及硅油乳化等情况。结果重硅油组视网膜一次性完全复位者24眼,占92．30％,硅油组一次性视网膜完全复位者18眼,占69．23％,（P〈0．05）。视网膜完全复位者绝大部分视力有不同程度提高。所有患者均未见明显炎症反应。结论玻璃体切除联合重硅油眼内填充是治疗下方PVR视网膜脱离的有效方法,可以降低术后视网膜脱离的复发率。     

儿童复杂性视网膜脱离的手术治疗

目的　探讨儿童复杂性视网膜脱离病因、特点及手术方法和疗效。方法　对采用玻璃体切割联合眼内填充术治疗的儿童复杂性视网膜脱离患者 71例 (74眼 )进行临床分析。结果　 9眼膨胀气体填充 ,术后近期 5眼 (5 5 6% )视网膜复位 ;66眼硅油填充 ,近期 5 5眼 (83 3 % )视网膜复位。随访 2～ 3 0月 ,其中 5 1眼随访时间超过 6个月 ,最终视网膜完全复位 3 4眼 (66 7% ) ,视力在 0 0 5以上者 2 8眼 (5 4 9% )。结论　玻璃体切割联合眼内填充术是治疗儿童复杂性视网膜脱离的有效方法之一 ,儿童复杂性视网膜脱离的手术成功率比成年人低 ,手术失败的主要原因是PVR复发     

玻璃体切除硅油填充治疗儿童复杂性视网膜脱离

目的：观察玻璃体切除联合硅油填充（使用5000粘度硅油）治疗儿童复杂性视网膜脱离,并报道其解剖复位,视力改变及并发症,方法：回顾分析了69例69只眼15岁以下儿童行玻璃体切割联合硅油填充治疗情况。结果：视网膜复位情况,完全视网膜复位51／69（74％）,黄斑区视网膜复位56／69（81％）,视力改变：有用视力（≥0．02）占46／69（67％）,保留原术前视力或更好59／69（86％）,并发症：术后高眼压20／69（29％）,低眼压4／69（6％）,角膜改变9／69（13％）,白内障6／32（19％）,前部PVR或PVR再增殖21／69（30％）。结论：玻璃体切割联合硅油填充是治疗儿童复杂性视网膜脱离的有效方法,从视网膜复位,术后视力及术后并发症三方面来看,视网膜巨大裂孔组手术效果最佳,术后的前部PVR形成和PVR再增殖是造成视网膜再脱离的主要原因。     

重硅油填充治疗下方裂孔源性视网膜脱离的临床研究

目的评价用重硅油填充治疗下方裂孔源性视网膜脱离伴严重增生性玻璃体视网膜病变（PVR）的手术效果及并发症。方法对下方视网膜裂孔和严重PVR的复杂性视网膜脱离12例（12只眼）行玻璃体切割联合玻璃体腔重硅油填充术。术后对视力、角膜、眼底及眼压等情况进行随访。结果术后随访2.5～27个月,平均7.7个月,83.3%的病例视网膜裂孔封闭、视网膜完全复位;术后视力6只眼（50%）提高,4只眼（33.3%）不变;2只眼（16.7%）下降;4只眼（33.3%）术后眼压异常,其中2只眼（16.7%）为一过性低眼压,2只眼（16.7%）为一过性高眼压;2只眼（16.7%）并发性白内障;2只眼（16.7%）重硅油乳化;1只眼（8.3%）重硅油进入前房;1只眼（8.3%）严重的前房炎症反应。结论对下方裂孔源性视网膜脱离伴严重PVR,行玻璃体切割联合玻璃体腔重硅油填充术,可获得满意的视网膜复位率,而且并发症的发生率低。     

玻璃体切除联合眼内填充治疗复杂视网膜脱离

目的　探讨复杂性视网膜脱离应用玻璃体切除联合眼内填充手术的效果及并发症的发生情况。方法　对2 9例伴有眼球破裂伤、眼内炎、玻璃体积血、白内障、PVR或糖尿病性视网膜病变等的复杂性视网膜脱离进行玻璃体视网膜手术的连续病例临床资料进行回顾性分析。结果　玻璃体切除联合玻璃体腔注气术12眼,1次手术视网膜复位8眼(66.67%) ;玻璃体切除联合玻璃体腔内硅油填充术2 0眼(包括注气失败的3眼) ,1次手术完全复位13眼(65 .0 0 %)。统计学检验两组1次手术视网膜复位率的差异无显著意义。术后视力较术前提高者2 1眼(72 .41%)。常见的并发症有复发性视网膜脱离、并发性白内障及继发性青光眼等。结论　玻璃体切除联合眼内填充能有效地治疗复杂性视网膜脱离,PVR仍然是术后视网膜脱离复发的主要因素。     

中间型葡萄膜炎并发复杂性视网膜脱离的玻璃体手术治疗

目的:探讨中间型葡萄膜炎并发复杂性视网膜脱离的临床特征及玻璃体切除联合眼内填充术的治疗效果。方法:回顾性分析我院2000-01/2005-06收治的11例(共11眼)中间型葡萄膜炎并发复杂性视网膜脱离病例术前及术后详细的临床资料。所有患者均接受巩膜外环扎,玻璃体切除联合眼内填充术治疗,术中9眼行硅油充填,2眼填充长效惰性气体。术后随访12～66mo。结果:术后11眼均获视网膜良好复位及视力增进。随访期中有7眼于6～12mo取出硅油,硅油取出后2眼因周边部PVR或葡萄膜炎复发导致视网膜脱离复发,未取硅油的4眼(包括2只再手术眼)视网膜平伏。结论:中间型葡萄膜炎并发的复杂性视网膜脱离,尤其存在周边部纤维及血管膜的牵引时,玻璃体切除联合眼内填充术效果确切,周边部PVR和葡萄膜炎复发是术后限制视网膜复位的主要原因。     

玻璃体切割治疗复杂视网膜脱离45例临床分析

目的：分析玻璃体切割术治疗复杂性视网膜脱离的效果。方法：对45例45眼复杂性视网膜脱离眼行闭合式玻璃体切割术,术毕玻璃体腔行C3F8气体或硅油填充。结果：玻璃体切割联合玻璃体腔注气术15眼,1次手术视网膜复位13眼（87%）;玻璃体切割联合玻璃体腔内硅油填充术30眼,1次手术完全复位27眼（90%）。统计学检验两组1次手术视网膜复位率的差异无显著意义。术后视力：数指/眼前者2眼,0.02～0.05者3眼,0.06～0.1者10眼,0.12～0.25者19眼,≥0.3者11眼。术中常见的并发症有医源性视网膜裂孔,术后并发症最多见是继发性青光眼和白内障。结论：玻璃体切割联合眼内填充能有效地治疗复杂性视网膜脱离,术后大部分患者视力能得到改善。     

硅油在复杂性视网膜脱离手术中的应用

目的探讨硅油在治疗复杂性视网膜脱离手术中的应用以及硅油的并发症。方法采用玻璃体切除术联合硅油填充对复杂性视网膜脱离４３只眼进行治疗。结果术后平均随访６个月,视网膜解剖复位者３２只眼,复位率为７６％。术后２３只眼视力≥０．０２。结论玻璃体切除术联合硅油填充是治疗常规手术难以治愈的复杂性视网膜脱离的一种有效的方法。硅油具有一定粘弹性和较高表面张力特性,是较为理想的填充材料。在视网膜复位后,应考虑取出硅油     

晶体玻璃体视网膜手术联合硅油填充治疗复杂性视网膜脱离

目的：探讨晶体玻璃体视网膜手术（Lenticular-retinovetinal surgery,LVR)联合硅油填充治疗复杂性外伤性视网膜脱离的效果。方法：对38例（38眼）应用晶体玻璃体视网膜手术联合硅油填充治疗的外伤性视网膜脱离进行回顾性分析。结果：解剖必忝功者35眼（92 11%),功能成功者32眼(84.21%).结论:LVR联合硅油填充是治疗复杂性外伤性视网膜脱离的主要方法.显著影响手术预后的因素是前部PVR和术中术后眼内出血及角膜外伤性病变.     

玻璃体视网膜手术治疗外伤性视网膜脱离合并增生性玻璃体视网膜病变的临床观察

目的：探讨玻璃体视网膜手术（ VRS）治疗合并增生性玻璃体视网膜病变（ PVR）的外伤性视网膜脱离（RD）患者的临床疗效。方法对2007年6月至2013年3月50例（51只眼）合并PVR的外伤性RD患者行VRS治疗,术后随访5～26个月,平均10．8个月。结果视网膜完全解剖复位47只眼,部分复位3只眼,未复位1只眼,总有效率98．4％。视力提高者41只眼（80．39％）;视力不变者7只眼（13．73％）,视力下降者4只眼（7.84％）。51只眼均行硅油填充术,继发性青光眼14只眼（27．45％）;8只眼因术后硅油进入前房行前房冲洗术（15．69％）;5只眼视网膜复位后Ⅱ期硅油取出术后低眼压或多次复发RD,长期硅油高粘度填充（9．80％）。结论通过VRS手术能有效解除外伤性PVR引起的视网膜牵拉,复位视网膜,提高视力。     

Extended retinal tamponade in the treatment of retinal detachment with proliferative vitreoretinopathy.

We have used intraocular sulphur hexafluoride or liquid silicone as an adjunct to vitreous surgery in the treatment of a non-randomised sequential series of 19 eyes with retinal detachment complicated by proliferative vitreoretinopathy. We have studied the surgical results and complications of these two tamponades and drawn preliminary conclusions on their use in retinal reattachment surgery. After a seven-month minimum follow-up 13 (68%) of the eyes have reattached retinas. Six (60%) of 10 eyes treated only with silicone have reattached retinas, and four (67%) of six eyes treated only with sulphur hexafluoride gas tamponade have reattached retinas. An additional three eyes treated initially with silicone oil subsequently developed retinal detachments; all were successfully reattached with sulphur hexafluoride tamponade after silicone oil removal. Intraoperative pneumatic retinal reattachment to assess relief of retinal traction combined with the production of widespread chorioretinal adhesions to wall off persistent anterior traction and detachment, as well as extended postoperative gas tamponade of the retina, appears to enhance the surgical results in retinal detachment complicated by proliferative vitreoretinopathy. Silicone oil tamponade of the retina appears to be useful in cases where retinal traction cannot be entirely relieved and in patients who are unable to tolerate the head positioning required for effective gas tamponade of the retina. A controlled clinical study recently begun will be required to define further the precise role of these methods of retinal tamponade.     

硅油在复杂性视网膜脱离复位术中应用

目的：探讨硅油在复杂性视网膜脱离手术的临床应用。方法：对1999年1月至2000年12月行玻璃体切割联合硅油填充术的32只眼(28例)进行回顾性分析。结果：27只获得解剖学的复位，成功率84．3％，3只眼部分复位(9．3％)，未复位的2只眼(6．3％)。术后视力进步者18只眼，不变者6只眼，下降者8只眼。术后视力≥0．05者14只眼(43．75％)。结论：玻璃体切除、膜剥离为硅油填充创造了条件并充分发挥了硅油的作用，而硅油填充完善了玻璃体手术并提高了成功率。     

硅油填充治疗外伤感染性眼内炎伴视网膜脱离

目的 探讨硅油填充治疗外伤性感染性眼内炎伴视网膜脱离的效果和影响因素。方法 回顾性分析1995年1月至2002年12月，我院眼科行硅油填充治疗外伤性感染性眼内炎伴视网膜脱离的16例16眼临床资料。结果 感染性眼内炎均得到控制。视网膜完全复位11眼(68．8％)，限局性视网膜脱离3眼(18．8％)，完全脱离2眼(12．5％)。术后视力光感-0．04者11眼，≥0．05者5眼。结论 应用硅油填充术能够有效地治疗外伤性感染性眼内炎伴视网膜脱离，术后并发症主要是视网膜脱离复发和增生性玻璃体视网膜病变(PVR)。     

Long-term anatomical and visual outcome of vitreous surgery for retinal detachment with choroidal coloboma

CONTEXT: Vitreous surgery has been advocated as an alternative treatment of selected retinal detachments with choroidal colobomas. AIM: To study the long term anatomical and visual outcome of choroidal coloboma with retinal detachment managed by pars plana vitrectomy with silicone oil tamponade. SETTING AND DESIGN: Retrospective study conducted in a tertiary eye care hospital. MATERIALS AND METHODS: Fourty two eyes of 40 patients with retinal detachments related to coloboma of the choroid without any peripheral breaks were analyzed. All eyes underwent pars plana vitrectomy with internal tamponade using silicone oil. Endolaser was performed along the coloboma border. Silicone oil was removed in 50% of patients. The main outcome measures were retinal reattachment and visual recovery. SPSS (Statistical Package for the Social Science), version 10.0 was used for analysis. RESULTS: The retina in all cases (100%) undergoing vitrectomy were completely reattached intra-operatively. After a mean follow-up of 14 months, 37 (88.1%) eyes had attached retina. The best corrected visual acuity was 10/200 or better in 33 (78.4%) eyes. The best corrected visual acuity improved from a preoperative median of counting fingers (range 20/40 to perception of light) to median best corrected visual acuity of 20/200 (range 20/40 to perception of light) at the end of 6 months. Of the 50% (21) cases that underwent silicone oil removal, two eyes had re-detachment of retina. CONCLUSION: Pars plana vitrectomy along with silicone oil tamponade for retinal detachment related to choroidal coloboma improves the long-term anatomical and visual outcome.     

玻璃体视网膜手术治疗儿童复杂性视网膜脱离9例报告

目的：对9例（9只眼）儿童复杂性视网膜脱离（retinal detachment,RD)的玻璃体视网膜手术（Vitreoretinal surgery,VR)效果及失败原因进行评价。方法：采用玻璃体切割、视网膜前膜剥除、气液交换、冷凝或激光封孔,眼内C3F8气休或硅油填充。结果：出院时（平均23天）,手术成功8只眼,失败1只眼,采用眼内填充硅油可提高 手术效果。术后平均追踪期为12个月,最终手术成功7只眼（77．77％）。采用VR术可提高儿童孔源性视网膜脱离的手术成功率。     

Silicone oil in the surgical treatment of retinal detachment--indications and clinical experience]

Silicone oil is being used with increased frequency for retinal tamponade during vitreous surgery for complicated retinal detachments. Though it is now possible to reattach most detached retinas, the visual outcome of the silicone oil procedure is often disappointing. This is due to the well known complications of silicone oil (i.e. cataract, glaucoma, corneal opacification), and the necessity to remove the silicone oil in a second surgical procedure with a certain risk of redetachment. Possible toxicity to retina and optic nerve has not yet get been completely evaluated. An alternative method is the use of expanding gases for internal retinal tamponade. Expanding gases are not as effective as silicone oil in advanced stages of proliferative vitreoretinopathy (PVR), but are afflicted with much less complications. We reviewed the charts of our patients, operated on for retinal detachment, to analyse the anatomical and functional results with silicone oil versus gas tamponade. Regarding the last 421 consecutive surgical procedures for retinal detachment (368 eyes), silicone oil has been used in 5%, expanding gases in 14%. The silicone oil procedure was restricted to the most advanced cases of PVR. The anatomic success rate with silicone was 72%, with gas tamponade 87%. Visual acuity of 0.05 and better achieved 19% of the eyes treated with silicone oil versus 61% of the eyes with gas tamponade. These results confirm the findings of other investigators: despite of the high anatomic success rate with silicone oil, the functional results are poor. Because many complicated cases of retinal detachment can also be treated successfully with gas tamponade, silicone oil should remain the last step in retinal detachment surgery.     

重硅油玻璃体腔充填治疗复杂性视网膜脱离的临床研究

目的 评价重硅油作为眼内填充剂治疗复杂性视网膜脱离的有效性和安全性.方法 采用标准的玻璃体切割联合重硅油Oxane HD充填术治疗复杂性视网膜脱离患者13例13只眼,术中根据病情联合白内障摘除、巩膜环扎、增殖膜剥除、视网膜切开、重水压平视网膜行眼内激光光凝等.观察重硅油充填期及取出后术眼的最佳矫正视力、视网膜解剖复位情况、手术后并发症等.结果 重硅油充填期平均为93d,取出后平均随访170d.13只眼中有12只眼最佳矫正视力提高,1只眼视力无改善.有10只眼在眼内充填重硅油至取出后保持稳定的视网膜复位至随访结束.术后主要并发症包括轻至中度的眼压升高、眼前段炎症反应、晶状体混浊、增殖膜形成和硅油乳化等.结论 重硅油Oxane HD作为眼内填充物可以有效安全地治疗复杂性视网膜脱离,尤其是伴下方或后极部裂孔的视网膜脱离.     

玻璃体切除联合眼内填充治疗复杂性视网膜脱离158例

目的:探讨一期玻璃体切除联合眼内填充术治疗复杂性眼视网膜脱离的临床疗效。方法:158例(158眼)复杂性视网膜脱离施行玻璃体切除联合眼内填充手术治疗。其中,35例行C3F8充填,123例行硅油充填,术后随访2～12mo。结果:视网膜完全复位128眼(81.0%),部分复位23眼(14.5%),未复位7眼(4.5%)。其中,硅油填充123例,103例解剖复位,复位率为83.7%。C3F8填充35例,25例解剖复位,复位率71.4%。术后视力均有不同程度的提高。结论:玻璃体切除术联合眼内填充治疗复杂性视网膜脱离有良好的疗效,解除视网膜牵引及合理选择充填物,及时处理并发症是手术成功的关键。     

Surgical management of retinal detachment with choroidal coloboma

PURPOSE: To verify the functional and anatomical results of retinal detachments related to choroidal coloboma. METHODS: Seven eyes with retinal detachment secondary to retinal breaks at the margin of or within a choroidal coloboma were analysed retrospectively. RESULTS: Scleral buckling was performed in five of the seven eyes; two needed additional pars plana vitrectomy (PPV) with internal tamponade using silicone oil to reattach the retina. In two eyes PPV with internal tamponade using silicone oil or gas was used as a primary procedure. All seven eyes were reattached. Five eyes (71.4%) showed improvement or had visual acuity of 20/400 or better after surgery, but two remained unchanged. CONCLUSIONS: Retinal detachment secondary to choroidal coloboma can be treated successfully by scleral buckling or PPV with internal tamponade.