急性视网膜坏死的手术治疗

目的研究玻璃体手术治疗急性视网膜坏死（ａｃｕｔｅｒｅｔｉｎａｌｎｅｃｒｏｓｉｓ,ＡＲＮ）的疗效。方法对１７例（２０只眼）伴有或即将发生视网膜脱离的ＡＲＮ患者进行手术治疗。共有１８只眼行玻璃体手术,其中１５只眼加行巩膜外加压或环扎术;７只眼行晶体摘除术,７只眼行３０°～３６０°视网膜切开,１只眼球内注入Ｃ３Ｆ８,１２只眼注入硅油。９只眼在术后５～７个月取出硅油。２只眼行单纯巩膜外手术,均为３６０°冷凝、环扎、外加压。结果随访期５个月至５年,手术２０只眼中有２只眼因术中脉络膜上腔出血而致眼球萎缩,１只眼在取硅油后因复发视网膜脱离而致眼球萎缩,余均维持有用视力;其中８只眼视力优于００２,３只眼视力优于０２。结论视网膜脱离是急性视网膜坏死的严重并发症,通过适时的玻璃体视网膜手术可以显著改善其预后     

Zoster-related bilateral acute retinal necrosis syndrome as presenting sign in AIDS

The acute retinal necrosis (ARN) syndrome has recently been associated with intraocular infections with one or more members of the herpesvirus family. There have been 14 cases in the literature linking ARN with a preceding or subsequent herpetic dermatitis. We report the development of bilateral ARN (BARN) after unilateral Herpes zoster ophthalmicus as the presenting sign of acquired immunodeficiency syndrome (AIDS) in a previously healthy man. The development of BARN after diffuse Herpes simplex dermatitis in AIDS patients is also discussed. These cases further illustrate the central role of the herpes-virus family in the etiology of ARN and alert the clinician to a new presenting sign for AIDS.     

Decrease in the risk of bilateral acute retinal necrosis by acyclovir therapy

We reviewed the course of 54 patients who had unilateral acute retinal necrosis at initial examination. Thirty-one patients were treated with acyclovir, whereas 23 were not. Of the 31 patients treated with acyclovir, 27 (87.1%) had fellow eyes that remained disease-free throughout a median follow-up of 12 months. Of the 23 patients not treated with acyclovir, seven (30.4%) had fellow eyes that remained disease-free throughout a median follow-up of 11 months. Survival analysis indicated that the fellow eyes of the group of patients treated with acyclovir were more likely to remain disease-free than the fellow eyes of the group not treated with acyclovir (P = .0013). Two years after initial onset, the proportion of fellow eyes that remained disease-free was 75.3% for the group treated with acyclovir and 35.1% for the group not treated with acyclovir. These results suggest that acyclovir treatment reduces the risk of involvement of the fellow eye in patients with acute retinal necrosis.     

Early Avastin management in acute retinal vein occlusion

Purpose

To evaluate the safety, functional and anatomical effects of intravitreal Avastin (bevacizumab) in treatment of recent retinal venous occlusion.

Design

Prospective interventional series non-comparative study.

Setting

Department of Ophthalmology, Faculty of Medicine, El-Minia University, Egypt.

Methods

The study included 30 eyes of 30 patients with recent retinal venous occlusion of less than 3 months duration 12 eyes (40%) of patients with central retinal vein occlusion (CRVO) and 18 eyes (60%) with branch retinal vein occlusion (BRVO) were injected with intravitreal bevacizumab 1.25 mg (0.05 ml) of commercially available bevacizumab [Avastin; Genentech, Inc., San Francisco, CA] at a concentration of 25 mg/ml as a primary treatment. The mean number of injections was 2.7 (range, 1–6 injections) 6–8 weeks intervals and follow-up for 12 months (range, 9–13 months). Patients underwent visual acuity testing (VA) as functional assessment. Anatomically, optical coherence tomography (OCT) is used for measurement of central retinal thickness (CRT) to detect macular edema (ME), fundus photography and fluorescein angiography (FA) to detect venous tortuosity, optic disc edema and surface wrinkling rather than ME. All finding at baseline and each follow-up visit were reported.

Results

The mean age of all patients was 65.3 years ± 8.5 (range, 55–82 years), 20 males and 10 females patients. The mean baseline VA was 20/240 (log MAR 1.08 ± 0.52) and improved to 20/60 (log MAR 0.48 ± 0.32) with statistically significance difference change (P < 0.001). The mean baseline CRT was 455 μm ± 126 (range, 386–510), decreased to 356 μm ± 118 (range, 296–416) after 1 month with statistically significance difference change (P < 0.02) and to 402 μm ± 170 (range, 338–468) after 6 months (P < 0.067) and to 250 μm ± 48 (range, 200–298) at last follow-up with statistically significance difference change from the baseline (P < 0.001). There were great proportional decrease in venous tortuosity, optic disc edema and surface wrinkling after 1 month of injection. Neither systemic nor intraocular adverse events were reported.

Conclusions

Intravitreal Avastin (IVA) is safe well tolerated, effectively improve VA, fundus picture and stabilize anterior segment neo-vascular activity in patients with recent retinal venous occlusion.     

Successful management of acute retinal necrosis with intravenous acyclovir

Two patients (3 eyes) had a history and clinical findings typical of acute retinal necrosis syndrome. Ten-day treatment with intravenous acyclovir and topical cycloplegia resulted in rapid resolution of the vitreoretinal findings and a swift return to near normal vision. All three eyes have maintained normal vision, and there have been no retinal detachments over a year after treatment.     

Surgical management of retinal detachment secondary to acute retinal necrosis: clinical features,surgical techniques,and long-term results

PURPOSE: To describe the clinical features of complicated retinal detachment secondary to acute retinal necrosis (ARN) and to present the long-term results of vitreous surgery in these cases. METHODS: A retrospective study was conducted on 16 immunocompetent patients (18 eyes). The average follow-up period was 60 months. RESULTS: Proliferative vitreoretinopathy (PVR) grade C, with the predominance of anterior PVR, and characteristic changes in the vitreous base area were present in all cases before surgery. All eyes underwent vitrectomy, membrane peeling, endolaser photocoagulation, and intraocular tamponade without scleral buckling. Additional procedures were performed in 13 eyes. Retinal reattachment was achieved in the 18 eyes (100%) in the short term. Variable degrees of reproliferation occurred in all cases after surgery. Other delayed complications included ocular hypotony, macular pucker, peripheral retinal neovascularization, and severe preretinal fibrosis. Improvement of visual acuity occurred in 13 eyes (72.2%). Eleven eyes (61.1%) achieved final ambulatory visual acuity of 5/200 or better. CONCLUSIONS: Rhegmatogenous retinal detachment secondary to ARN has characteristic clinical features. Severe proliferative vitreoretinopathy with the predominance of anterior PVR develops rapidly. Reproliferation is the most important late postvitrectomy complication necessitating multiple surgical procedures in these cases. The visual results remain unfavorable due to the destructive nature of ARN.     

Surgical management of retinal detachment associated with the acute retinal necrosis syndrome.

We operated on nine eyes in eight patients with retinal detachment associated with acute retinal necrosis (ARN) syndrome. The patients were treated with scleral buckling, vitreoretinal surgery, or a combination of these treatments. Vitrectomised eyes underwent combinations of lensectomy, membrane dissection, scleral buckling, air-fluid exchange, endolaser photocoagulation, cryotherapy, and retinal tamponade with C3F8 gas or SF6 gas. Macular attachment was achieved in eight (89%) eyes. Vision improved in seven (78%) eyes, of which five (56%) achieved 20/200 or better vision. Three eyes that had received laser treatment posterior to areas of retinitis suffered retinal detachment despite this prophylactic treatment. Poor visual outcome resulted from viral infection of the optic nerve or macular involvement, macular hole formation, macular pucker, or hypotony.     

Bilateral acute retinal necrosis.

In this paper 4 patients are described who had bilateral symmetrical confluent retinal swelling followed by apparent necrosis and sloughing of the retina into the vitreous. The disease was accompanied by signs of uveitis and the clinical appearance suggested inflammation rather than infarction as the pathogenic mechanism. No systemic abnormalities were found by which the aetiology could be identified.     

玻璃体切除术治疗急性视网膜坏死的疗效分析

目的分析玻璃体切除术治疗急性视网膜坏死的效果。方法急性视网膜坏死施行玻璃体切除术24例（24眼）。其中视网膜脱离者13例,未脱离者11例。均行常规玻璃体切除术,其中3例联合白内障手术,15例行玻璃体切除术＋硅油填充,4例单纯玻璃体切除术,2例联合巩膜外垫压。5例硅油取出后再次出现视网膜脱离,进行二次玻璃体切除＋硅油填充术。结果24例中7例术后视力较术前提高两行,8例视力无明显改善,9例术后视力继续下降。其中有5例硅油取出后出现视网膜脱离复发,再次玻璃体切除＋硅油填充术,术后视力未见明显改善。结论玻璃体切除术在治疗急性视网膜坏死长期效果差,我们期待高效抗病毒药物及有效抑制眼内免疫反应的药物能够早日在临床上应用。     

Therapy for acute retinal necrosis

Acute retinal necrosis is a progressive necrotizing retinopathy caused by herpes simplex virus (HSV) or varicella zoster virus (VZV). The mainstay of its treatment is antiviral therapy against these pathogenic organisms, such as intravenous acyclovir or oral valacyclovir. Systemic and topical corticosteroids together with antiviral therapy are used as an anti-inflammatory treatment to minimize damages to the optic nerve and retinal blood vessels. Because the majority of severe cases of the disease show occlusive retinal vasculitis, a low dosage of aspirin is used as anti-thrombotic treatment. Vitreo-retinal surgery is useful to repair rhegmatogenous retinal detachment, one of the main late-stage complications. Moreover, recent articles have reported some encouraging results of prophylactic vitrectomy before rhegmatogenous retinal detachment occurs. The efficacy of laser photocoagulation to prevent the development or extension of rhegmatogenous retinal detachment is controversial. Despite these treatments, the visual prognosis of acute retinal necrosis is still poor, in particular VZV-induced acute retinal necrosis.     

急性视网膜坏死综合征的治疗

目的:探讨使用抗病毒药物、激光及手术治疗急性视网膜坏死综合征的临床经验。方法:确诊为急性视网膜坏死综合征的患者28例30眼,全身应用抗病毒药物,选择性使用激光治疗,其中15例16眼发生视网膜脱离的病例行玻璃体视网膜手术治疗。结果:患者28例经过治疗后炎症均得到控制、视力有所提高。全身应用抗病毒药物是经典的用药途径,选择性使用激光治疗可以减少和延缓视网膜脱离的发生,玻璃体视网膜手术有利于严重病例视功能的保存和提高。结论:急性视网膜坏死综合征的预后较差,及时准确的诊断及早期积极有效系统治疗可以改善预后。     

Photocoagulation to prevent retinal detachment in acute retinal necrosis

Retinal detachment (RD) occurs in more than 50% of eyes with acute retinal necrosis (ARN) and is the leading cause of visual loss in this syndrome. In order to decrease the incidence of RD in ARN, the authors treated 12 eyes of 10 patients with prophylactic laser photocoagulation. Retinal detachment occurred in two eyes (17%). Over the same time period, seven eyes with ARN did not receive prophylactic laser treatment, most often because of dense vitreous debris, with a 67% rate of RD. Prophylactic photocoagulation treatment should be considered in the management of patients with ARN.     

晚期急性视网膜坏死综合征的手术效果观察

目的评价急性视网膜坏死综合征视网膜脱离行玻璃体切除、硅油填充联合视网膜光凝术的手术效果。方法对10例（10眼）急性视网膜坏死综合征视网膜脱离进行经睫状体平坦部玻璃体切除和增生膜剥离术，术中氩激光光凝视网膜裂孔和残留的正常视网膜边缘，并行硅油填充术，3眼因晶状体浑浊同时行晶状体切除术，术后5～6个月取出硅油，硅油取出之前3周行赤道部的氩激光光凝，观察硅油取出后视网膜复位及视力状况。结果术后短期内（〈1月）视网膜全复位，随访14～26月，8眼视网膜复位良好，复位率80．00％（8／10），2眼因视网膜表面增生膜形成，视网膜再次脱离。术后视力：光感者1眼，手动者1眼，数指者3眼，0．05～0．1者3眼，0．12者2眼。结论现代玻璃体切除、硅油填充联合视网膜光凝术提高了急性视网膜坏死视网膜脱离的视网膜复位率，但因视网膜坏死结构破坏以致视力恢复较差。     

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.