Retinal dialysis

Retinal dialysis is a disinsertion of the sensory retina at the ora serrata. Dialysis may result from ocular trauma or occur as a spontaneous non-traumatic event. Dialyses are often asymptomatic and associated with a slowly progressing secondary retinal detachment. They show a predilection for the inferotemporal retinal quadrant. Retinal dialysis is the major cause of retinal detachment in children and young adults. Two cases of spontaneous retinal dialysis are presented. These cases represent extremes of the age spectrum for this condition.     

全氟癸烷液体在超过180°裂孔性视网膜脱离手术中应用

为评价全氟癸烷液体联合眼内氩激光光凝在超过１８０°巨大裂孔性视网膜脱离手术中的应用效果。采用环扎、玻璃体切除、膜剥离，部份病人联合视网膜切开或切除，术中注入全氟癸烷液体（Ｃ１０Ｆ１８），压平视网膜，展平视网膜瓣，同时应用眼内氩激光封闭视网膜裂孔，眼内充填硅油。共治疗了１０例１０眼巨大裂孔性视网膜脱离，其中裂孔超过１８０°者７眼，超过２７０°者３眼，经９～２３个月随访，９眼完全复位，１眼部份复位。术后最佳视力≥００５者５眼（５／１０）。全氟癸烷在玻璃体手术中的应用，治疗超过１８０°巨大裂孔性视网膜脱离，具有操作简便，并发症少，手术成功率高，平复视网膜后瓣，驱赶视网膜下液，便于进行增殖膜清除，以及直视下眼内氩激光封闭裂孔，不必于后极部做视网膜切开放液等优点。视网膜活动度恢复良好者，全氟癸烷注入量可超过裂孔缘，使其恢复原位。眼内注入全氟癸烷液体后宜采用硅油重水交换方式，充填硅油。     

葡萄膜视网膜炎伴复杂性视网膜脱离的处理

目的 观察葡萄膜视网膜炎所致视网膜脱离的临床特征及玻璃体切除手术效果。方法 回顾性分析11例（11只眼）因葡萄膜视网膜炎所致复杂性视网膜脱离，6只眼为巨大裂孔，2只眼为周边多发网状孔，3只眼无明确裂孔，PVR程度C3－D1级。患者均玻璃体切除术手术，术后充填硅油8只眼，充填长效气体3只眼。结果 一次手术8只眼视网膜获良好复位，2只眼二次手术成功，1只眼拒绝再手术。8只眼视力有增进（72．7％），视力在0.02以上有6只眼（54．5％）。结论 葡萄膜视网膜炎可致复杂性视网膜脱离，玻璃体切除视网膜复位效果肯定，并存在的视网膜脉络膜、视神经、血管病变及黄斑疤痕是限制视功能恢复的主要原因。     

巨大裂孔视网膜脱离手术的探讨

目的探讨玻璃体视网膜手术治疗巨大裂孔视网膜脱离的手术方法和效果。方法巨大裂孔视网膜脱离11例（11眼）。其中10眼行闭合式三通道玻璃体切除联合巩膜扣带术和眼内视网膜光凝,另1眼未做巩膜扣带。6眼手术中采用全氟化碳液（重水）-硅油置换,硅油眼内填充;5眼为气体-液体交换,硅油填充。结果 11眼手术后视网膜均完全复位。随访观察中视网膜复位良好,2眼已取出硅油。但其中1眼取出油后又发生了视网膜脱离,并出现新裂孔,又做了硅油填充术。2眼发生继发性青光眼,2眼发生了并发性白内障,其中1眼已做了白内障手术。未发生全氟化碳液（重水）眼内残留或角膜变性等并发症。结论玻璃体切除术联合巩膜扣带、硅油眼内填充、视网膜激光光凝能有效治疗有巨大裂孔的视网膜脱离。     

玻璃体积血合并视网膜裂孔患者的临床特征分析

目的：研究玻璃体积血合并视网膜裂孔患者的临床特点,为早期干预和改善患者预后提供指导建议。

方法：回顾性分析2016/12-2018/12我院收治的105例105眼玻璃体积血合并视网膜裂孔患者,其中男54例,女51例,分析其临床特征,治疗效果和影响预后的相关因素。

结果：在105眼中共有151个视网膜裂孔,其中82个裂孔位于颞上象限(54.3%),28个位于鼻上象限(18.5%),27个位于颞下象限(17.9%),14个位于鼻下象限(9.3%)。视网膜裂孔的形状以马蹄形为主(77.5%)。裂孔直径1/8～4PD之间,最常见的为1PD大小。76例(72.4%)视力优于或等于术前视力。术后矫正视力与术前比较无差异(P>0.05); 扣带组与玻璃体切除组相比,视力改善无差异(P>0.05)。

结论：视网膜裂孔是玻璃体积血的重要原因。视网膜裂孔多位于颞上象限,以马蹄形为主。全面了解视网膜裂孔相关的玻璃体积血的临床特点,有助于早期发现视网膜裂孔,避免严重并发症的产生。如果术前最佳矫正视力(LogMAR)小于1.6并且光定位小于1m,术后视力则差。如果视网膜脱离累及黄斑,特别是伴增殖性玻璃体视网膜病变的患者预后也较差。     

Prevalence of retinal tears in an optometric population

The prevalence of fresh retinal tears and acute symptomatic posterior vitreous detachment (PVD) was determined for a metropolitan optometric population by retrospectively examining the records of 2,700 consecutively presenting patients. Twenty-eight cases (one per cent) harboured a retinal tear. Fourteen patients manifested operculated tears and a further 14 were found to have flap tears. Significantly more tears lay in the temporal half of the fundus (p < 0.001). A preponderance of tears lay in the superotemporal retinal quadrant. Twenty-six patients (one per cent) presented with an acute symptomatic PVD. Of these four patients (15 per cent) had a retinal tear related to the onset of the PVD.     

眼铁质沉着症导致视网膜脱离的临床观察

目的：观察和分析由眼铁质沉着症（OS）导致的视网膜脱离患者临床特征。方法：回顾性系列病例 研究。收集2016年1月至2019年12月在武汉大学附属爱尔眼科医院收治的由OS导致的视网膜脱离 并接受手术治疗的患者12例（12眼）,分析其临床特征,包括最佳矫正视力、视网膜脱离复位情况以 及异物存留位置。视力的比较应用秩和检验。结果：末次随访时有6例术后视力有改善,5例术后视 力无明显改善,1例术后视力进一步下降。所有患者术前术后最佳矫正视力变化差异有统计学意义 （Z=2.09, P=0.037）。4例合并存在视网膜裂孔的患者出现了视网膜脱离的复发。结论：OS导致的视网 膜脱离患者视力预后较差,存在视网膜裂孔易导致视网膜脱离复发。     

视网膜巨大裂孔47例的超声诊断

目的报告视网膜巨大裂孔的超声声像学特征。方法对47例(47眼)视网膜巨大裂孔伴脱离,应用美国Storz公司产品CompuScanA/B超声波扫描仪(探头频率10MHz)进行直接接触法探查,分析声像学特征,并与临床资料和手术所见相对照。结果除5例眼球萎缩外,其余42例视网膜巨大裂孔的B型超声声像图特征如下:玻璃体腔内脱离的视网膜光带断裂,形成分离明显的2个断端,即裂孔的前、后瓣;裂孔的前瓣较短,后瓣较长;裂孔边缘特别是后瓣多翻卷形成钩状或发夹状。结论在大多数视网膜巨大裂孔眼,依照B型超声图像即可以提示诊断。     

调整头位油液交换法处理外伤性巨大视网膜裂孔

目的:介绍一种玻璃体切割术中处理外伤性巨大视网膜裂孔 (traumaticgiantretinaldetachment ,TGRT)的方法。方法 :适应症为裂孔范围≤ 180° ,PVR较轻的TGRT。将灌注头置于无裂孔的象限 ,行玻璃体切割术后 ,在裂孔所在方向留一睫状体平坦部切口 ,通过头位调整及眼球旋转 ,使此切口逐渐处于眼球最低位置 ,从灌注头注油后先在无裂孔区形成油泡 ,随着油泡扩大将视网膜逐渐展平复位 ,视网膜下液由裂孔中被逐渐压出 ,并从处于下方的睫状体平坦部切口中排出眼外。结果 :共用此法处理TGRT12例 ,术中视网膜全部复位。经 6～ 2 0个月随访 ,已取出硅油 10例 ,未次复诊 11例保持复位。结论 :在适应症范围内通过调整头位和油液交换是一种操练简便、效果确切、经济安全的处理TGRT的方法     

Use of fluorosilicone to unfold a giant retinal tear

We unfolded and attached a giant retinal tear with an inverted edge using fluorosilicone oil while the patient was in the supine position. The advantages of high viscosity (10,000 centistokes) and specific gravity (1.31) fluorosilicone are discussed in this paper.     

The avulsed retinal vessel syndrome and its variants

The course of 18 patients (19 eyes) with the avulsed retinal vessel syndrome and its variants was followed up for an average of 54 months. This syndrome consists of recurrent vitreous hemorrhages from an avulsed retinal vessel caused by retinal tear formation. Even after the retinal tears are closed by various techniques, vitreous hemorrhages may recur until the retinal vessel ruptures. The visual prognosis is generally good.     

联合脉络膜眼内光凝治疗巨大裂孔性视网膜脱离

观察脉络膜眼内光凝联合玻璃体手术治疗巨大裂孔性视网膜脱离的效果。方法对８例巨大裂孔视网膜脱离的患者在施行玻璃手术中,于巨大裂孔区的赤道至周边部脉络膜上联合眼内半导体激光光凝,及视网膜裂孔边缘松解性切开或楔形切除。     

Discriminate characteristics of photopsia in posterior vitreous detachment, retinal tears and retinal detachment

Aims:  To characterize photopsia in posterior vitreous detachment (PVD), retinal tears (RT) and rhegmatogenous retinal detachment (RRD).
Methods:  Seventy seven patients presenting to an eye emergency department and vitreoretinal clinic with photopsia had documentation of their symptoms.
Results:  A total of 27 patients had PVD alone, 7 had RTs and 25 RRD. In patients with isolated PVD, photopsia were temporal (94%), lasting seconds (81%) and vertically orientated (59%) flashes. Patients with photopsia located in quadrants other than temporal were more likely to have RRD ( p  = 0.0003). Patients with an oblique or horizontal orientation of their photopsia were likely to have RRD or RT ( p  = 0.001, specificity 96%, sensitivity 40%).
Conclusions:  Most patients with PVD have a typical presentation of photopsia, with temporal, vertically orientated, momentary flashes. Patients with RTs or RRD may describe subtle differences in their photopsia which may raise the index of suspicion for the presence of a complication from PVD.     

全玻璃体切除术治疗巨大裂孔视网膜脱离的临床效果观察

目的观察全玻璃体切除手术治疗巨大裂孔视网膜脱离的效果。设计回顾性病例系列。研究对象2003年7月至2008年1月连续在中山眼科中心就诊的原发性巨大裂孔视网膜脱离患者17例（17眼）。方法对所有17例（17眼）患者行全玻璃体切除手术治疗,术中做充分的全玻璃体切除,剥离粘连玻璃体皮质,重水压平视网膜后,切除视网膜裂孔后缘翻卷的边,眼内光凝,气饭交换和硅油填充。术中3例切除裂孔前瓣,9例切除合并裂孔前瓣的睫状体非色素上皮脱离。联合环扎1例,行晶状体咬切1例。术后平均随访24．5±8．5个月,观察视力、视网膜平伏情况及并发症,并作相应处理。主要指标视力、视网膜平伏情况及并发症。结果其中1例术后出现新裂孔,另1例术后7个月玻璃体增生牵拉导致视网膜脱离,其余15例患者在术后2～18个月顺利取出硅油,视网膜保持复位。失访1例。最后一次随访最好矫正视力：光感-指数2例,0．02±0．35例,0．5±0．76例,≥1．03例,与术前相比明显好转（χ2=17．01,P〈0．05）。结论平均随访2年的结果显示,全玻璃体切除术、部分视网膜切除、眼内光凝和硅油填充治疗巨大裂孔性视网膜脱离具有较好的手术效果。     

玻璃体手术在后段眼内异物及其外伤性视网膜裂孔中的应用

目的探讨现代显微玻璃体手术在治疗眼后段眼内异物及其外伤性视网膜裂孔中的应用。方法对48例（48眼）眼内异物,包括磁性异物28例,非磁性异物20例,常规行玻璃体切除手术治疗、内路异物摘出、剥除异物床区玻璃体后皮质、眼内光凝及封闭视网膜裂孔。临床随访评估手术效果及并发症。结果48例（48眼）均摘出异物,视力改善或不变者44例（91．67％）,视网膜脱离复位47例（97．92％）。结论眼后段眼内异物及其外伤性视网膜裂孔应选择玻璃体联合手术,尽量去除诱发外伤性增生性玻璃体视网膜病变的危险因素。     

全氟化碳液体短期术后填塞治疗巨大视网膜裂孔

目的:探讨全氟化碳液体短期术后填塞治疗视网膜脱离伴巨大视网膜裂孔的有效性和安全性。方法:检索从1998-01/2010-12在单一的医疗中心治疗患者的病历数据。比较应用和没有应用全氟化碳液体的患者的视网膜复位成功率,视力预后及术后并发症。结果:术后,治疗组22眼(21例),对照组14眼(14例)视网膜均附着。两组的最终附着率分别为81.8%和42.9%(P<0.05)。治疗组4眼(18.2%),对照组7眼(50%)发展为重症增生性玻璃体视网膜病变和持续性视网膜脱离。治疗组73.3%,对照组26.7%患者的视力为6/12或更高(P<0.05)。治疗组50.0%,对照组14.3%患者视力提升;治疗组22.7%,对照组57.1%患者视力下降(P=0.054)。结论:视网膜脱离伴巨大视网膜裂孔使用全氟化碳液体作为短期术后填塞是安全的。全氟化碳液体在预防增生性玻璃体视网膜病变方面有效。     

视网膜静脉阻塞患者血浆和泪液中血管内皮生长因子表达的研究

目的　观察视网膜静脉阻塞（ｒｅｔｉｎａｌｖｅｉｎｏｃｃｌｕｓｉｏｎ,ＲＶＯ）患者血浆和泪液中血管内皮生长因子（ｖａｓｃｕｌａｒｅｎｄｏｔｈｅｌｉａｌｇｒｏｗｔｈｆａｃｔｏｒ,ＶＥＧＦ）的表达情况。方法　选取我院确诊的２８例ＲＶＯ患者,收集血浆和泪液样本,通过酶联免疫吸附试验测定ＶＥＧＦ表达水平,在１ｄ、２周和４周使用光学相干断层扫描检查中央视网膜厚度（ｃｅｎｔｒａｌｒｅｔｉｎａｌｔｈｉｃｋｎｅｓｓ,ＣＲＴ）,另选健康志愿者３０人作为对照组,比较两组血浆和泪液中ＶＥＧＦ、ＣＲＴ表达差异。结果　各时间点,ＲＶＯ组血浆中ＶＥＧＦ表达水平显著高于对照组（均为Ｐ＜０．０５）,１ｄＲＶＯ组泪液ＶＥＧＦ表达水平与对照组差异无统计学意义（Ｐ＞０．０５）。ＲＶＯ组血浆和泪液中ＶＥＧＦ表达水平呈微弱正相关（Ｐ＜０．０５）,而对照组中这种相关性稍强（Ｐ＜０．０５）。两组２周后ＣＲＴ明显增加,１ｄ与２周ＣＲＴ值差异均有统计学意义（均为Ｐ＜０．０５）,２周与４周差异均无统计学意义（均为Ｐ＞０．０５）,各时间段ＲＶＯ组与对照组差异有统计学意义（Ｐ＜０．０５）。结论　ＲＶＯ患者泪液中ＶＥＧＦ表达水平及ＣＲＴ与健康人比较显著升高,血浆与泪液中ＶＥＧＦ表达水平的变化有一致性,泪液检测作为非侵入性的检测方式,对ＲＶＯ的早期诊断有较高的临床应用价值。     

Ultrasound reliability in detection of retinal tear in acute symptomatic posterior vitreous detachment with vitreous hemorrhage

Cross-sectional study of 75 consecutive patients presenting with acute symptomatic posterior vitreous detachment (ASPVD) and vitreous hemorrhage was conducted at University Eye Clinic, University Hospital “Sveti Duh”, Zagreb, Croatia. To check ultrasound reliability in detecting retinal tears in patients with ASPVD, transpalpebral ultrasound of the eye and the orbit was performed followed by fundus examination initially and in 6wk period. In 13 (17%) patients membranous lesion with ultrasound characteristics of retinal tear was detected. Ophthalmoscopy confirmed the diagnosis in 8/13 patients. In 62/75 patients neither ultrasound nor clinical examination revealed retinal tear. Sensitivity of ultrasound examination was 100%, specificity 92%, positive predictive value 62% and negative predictive value 100%. Ultrasound proved to be a reliable and accurate method for detection of retinal tears in ASPVD. Given the high sensitivity and negative predictive value, negative result on B-scan ultrasound excludes the probability of the retinal tear with a high degree of certainty.     

显微外路手术治疗巩膜穿刺孔玻璃体嵌顿引起的巨大裂孔

目的:探讨显微外路视网膜脱离手术在玻璃体切除手术中巩膜穿刺孔玻璃体嵌顿引起的视网膜巨大裂孔的处理疗效。方法:回顾性分析本院2008-06/2010-02在显微镜直视下环扎、硅胶填压、巩膜外冷凝、C3F8眼内填充处理玻璃体切除手术中因巩膜穿刺孔玻璃体嵌顿引起的视网膜巨大裂孔4眼、术后发生的视网膜巨大裂孔8眼的术后效果。结果:术后随访2～15(平均6)mo,11眼视网膜完全复位,1眼术后1mo再脱离,再行显微外路手术复位。术后矫正视力<0.1者4眼(33%);0.1～0.3者5眼(42%);≥0.4者3眼(25%)。结论:巩膜穿刺孔玻璃体嵌顿引起的视网膜裂孔是一种严重的并发症,而且常常裂孔巨大,对这类患者采用显微镜直视下环扎、硅胶填压、巩膜外冷凝、C3F8眼内填充处理是一种安全有效的方法。     

【In Press】Ultrasound reliability in detection of retinal tear in acute symptomatic posterior vitreous detachment with vitreous hemorrhage

AIM: To check ultrasound reliability in detecting retinal tears in patients with acute symptomatic posterior vitreous detachment (ASPVD) with vitreous hemorrhage. METHODS: Cross-sectional study of seventy five consecutive patients presenting with ASPVD symptoms was conducted at University Eye Clinic, University Hospital “Sveti Duh“, Zagreb. In each patient, transpalpebral ultrasound of the eye and the orbit was performed followed by fundus examination initially and in 6 weeks period. RESULTS: In 13 (17%) patients membranous lesion with ultrasound characteristics of retinal tear was detected. Clinical examination of the fundus confirmed the diagnosis in 8/13 patients. In 62/75 patients neither ultrasound nor clinical examination revealed retinal tear. Sensitivity of ultrasound examination was 100% (95% CI 60-100), specificity 92%, positive predictive value 62% (95% CI 32-85) and negative predictive value 100% (95% CI 93-100). CONCLUSION: Ultrasound is a reliable and accurate method for detection of retinal tears in ASPVD. Given the high sensitivity and negative predictive value, negative result on B-scan ultrasound excludes the probability of the retinal tear with a high degree of certainty.