视网膜脱离复位手术后视功能恢复及其影响因素

临床上,部分患者尽管接受了成功的视网膜复位手术,其视功能的恢复仍很有限。一些临床特征如手术前视力、黄斑部视网膜脱离高度与时间、视网膜改变以及并发症等,被认为是预测手术后视功能的主要因素。近年通过相干光断层扫描技术对残留视网膜下液和视网膜的病理改变有了新的认识。本文从视网膜复位手术后的视功能恢复和视功能恢复的影响因素两方面对相关文献进行综述,以期了解影响术后视功能恢复的因素,为预测孔源性视网膜脱离术后的视功能提供新的参考依据。     

视网膜脱离复位后的视网膜电图研究

目的 研究视网膜脱离（ＲＤ）复位后视网膜电图改变,探讨视功能损害的程度和部位。方法 １０只健康灰兔分为实验组４组８只,正常对照组２只。通过在视网膜下注射０．１％透明质酸钠方法建立ＲＤ模型。在术前和术后１,２,３,４周时分别记录视网膜电图。结果 暗视视杆细胞反应,最大反应ａ,ｂ波,单闪光明视锥细胞反应和闪烁光反应振幅,在视网膜复位后逐渐升高,复位１周时恢复到正常时的６０％～６５％,复位３周时视网膜ＥＲＧ恢复到７０％～９０％。暗视最大反应ａ波潜伏期在视网膜复位后２天,延长１０．９％,复位１周后逐渐恢复。ＯＰｓ和其它各波的潜伏期未见有显著改变（Ｐ〉０．０５）。结论 复位后的视网膜电图虽然逐渐恢复,但ａ,ｂ波的不完全恢复提示了光感受器和Ｍｕｌｌｅｒ细胞功能的改变。     

实验性视网膜脱离复位后的视网膜细胞凋亡

目的研究视网膜脱离(retinaldetachment,RD)复位后的视网膜细胞凋亡的发生情况,探讨RD后视功损害的机制。方法14只成年灰兔,分为正常对照组1只,RD阳性对照组1只,实验组12只分为4组,视网膜下注射透明质酸钠建立RD模型,后分别观察1周、2周、3周、4周,观察期满取眼球进行组织切片。采用TUNEL法和细胞计数的方法进行细胞凋亡观察。结果正常对照组视网膜细胞凋亡标记基本为阴性。脱离的视网膜在内、外核层发现凋亡标记阳性细胞。在复位的视网膜上观察到凋亡标记阳性细胞,主要分布在内、外核层和神经节细胞层,并随着复位时间而变化(P<0.01)(凋亡细胞计数:1周10.50±3.41,2周6.90±2.42,3周5.50±2.07,4周1.78±1.56)。细胞计数显示实验组除观察4周组外,凋亡细胞数与正常视网膜和脱离时的视网膜分别相比,差异均有高度显著性(P<0.01)。结论RD复位后的视网膜细胞有细胞凋亡的发生,是视网膜功能恢复不良的重要原因。     

视网膜脱离复位后视功能研究

目的 研究视网膜脱离（ＲＤ）术后视功能的恢复及其影响因素。方法 选择孔源性ＲＤ痊愈病例２３３例（２３８眼）,采用Ｘ＾２检验进行统计分析。结果 术前３６．７％患者视力≥０．１,而术后为８１．４％（Ｐ〈０．０１）;术前黄斑不脱离和脱离１周内的患者术后视力１００．０％≥０．３,脱离１周后只有２７．１％的患者有相应的视力;术前视力与术后视力明显相关（r＝０．５１７,Ｐ〈０．０１）。结论 ＲＤ术后视力得到不     

视网膜脱离复位后视网膜再脱离的治疗体会

正0引言玻璃体切割术(内路)与巩膜扣带术(外路)已成为治疗视网膜脱离的主要手段,极大的提高了脱离视网膜的复位率,目前许多医院对视网膜脱离手术的开展呈现一种百家争鸣的态势。但由于危险因素的作用,使得这种手术不能尽善尽美,仍有部分眼发生视网膜脱离,甚至二度治疗后再脱的情况,成为眼科医生的棘手问题之一。我院2008-02/2012-01收治的视网膜脱离复位术后视网膜脱离复发的患者34例39眼,     

视网膜脱离手术复位后再脱离的原因分析和预防措施

对视网膜脱离手术后解剖复位的１１２例１１４只眼随访１２个月，发现再脱离１５只眼。其原因主要是增殖性玻璃体视网膜病变，其次为原裂孔封闭后再漏水和新裂孔形成。分析了造成这些原因的因素，提出预防措施。     

不放液视网膜脱离复位手术

在视网膜脱离手术中,Ｇｕｓｔｏｄｉｓ首先创用不放液手术,以后由Ｌｉｃｏｆｆ加以改进并推广应用。此术提高了治愈率,减少了手术中放视网膜下液引起的并发症。我院1993年1月～2000年4月7年间选择性施行了不放液手术,总结如下:临床资料1病人选择:符合下列条件之一者均可不放液:(1)玻璃体无增生,脱离的视网膜活动性良好,经卧床后视网膜复位或大部复位者。(2)裂孔位于上方,视网膜脱离主要位于下方者。(3)任何部位的单个裂孔或相邻多个小裂孔,裂孔周围视网膜脱离较浅者。(4)视网膜未脱离的裂孔,或脱离仅在裂孔周围,范围又小者。(5)即使有视网膜…     

视网膜脱离复位后的视网膜电流图分析

目的 应用视网膜电流图（ERG）了解孔源性视网膜脱离（RD）复位术后的视功能状态。方法 选择孔源性RD患者73例（73只眼），均进行单次巩膜扣带术，术前及术后不同时期分别检测ERG，随访1－5月。结果 视网膜脱离后，ERG各指标振幅明显下降，潜伏期延迟。手术后1月，ERG的a波、b波振幅较术前明显回升，潜伏期在术后均延迟。随复位时间的延长，振幅无明显变化，潜伏期有缩短趋势。视网膜脱离复位后，最大反应振幅b/a比值呈增加趋势。术后1月，暗视视杆细胞反应振幅可恢复至对照组的58.11%，30Hz闪烁光反应的振幅则恢复至对照组的45．89％。结论 视网膜脱离复位后视功能在1－2月内恢复最快且程度较大，视网膜内核层的恢复较光感受器层迅速，视杆系统较视锥系统恢复迅速且较完全，但随复位时间的延长增进缓慢。ERG的不完全的恢复表明视网膜仍存在不可逆的损害。     

孔源性视网膜脱离复位手术后持续性视网膜下液的研究进展

        持续性视网膜下液（PSF）是影响孔源性视网膜脱离(RRD)复位手术后视力恢复的原因之一。光相干断层扫描检查发现,RRD复位手术后部分患者持续存在视网膜下液。PSF发生和存在的机制尚未明了,可能与手术眼血流动力学改变、视网膜色素上皮泵功能降低、炎症渗出等有关。临床观察发现,PSF常见于年轻患者;行巩膜扣带手术患者的PSF发生率较行玻璃体切割手术患者高。大多数PSF数月内可以自行吸收,也可以持续超过1年。玻璃体腔注气、激光光凝、糖皮质激素治疗可促进PSF的吸收。进一步研究PSF发病机制、预防和治疗方法,有助于改善RRD患者手术后视力,提高其治疗效果。     

Rate of Retinal Detachment after Early Prophylactic Vitrectomy for Acute Retinal Necrosis

Purpose: To compare the rate of retinal detachment after acute retinal necrosis in eyes that underwent early vitrectomy versus no early vitrectomy.

Methods: Charts of patients (61 eyes) who presented to Texas Retina Associates between January 1, 2006 and December 30, 2014 for acute retinal necrosis were reviewed. Charts with incomplete documentation or follow­up less than 6 months were excluded. Twenty-nine remaining eyes were divided into two groups: early vitrectomy and no early vitrectomy. Primary outcome measure was rate of retinal detachment.

Results: Out of 29 eyes, 12 underwent early vitrectomy within 30 days of diagnosis and 17 either underwent vitrectomy after 30 days or did not undergo prophylactic vitrectomy at all. Three out of 12 eyes (25%) developed retinal detachment in the early vitrectomy group versus 10 out of 17 eyes (59%) in the no early vitrectomy group (p = 0.076).

Conclusions: Early vitrectomy within 30 days may prevent retinal detachment after acute retinal necrosis.     

视网膜脱离伴脉络膜脱离的临床分析

伴脉络膜脱离的视网膜脱离发病占同期视网膜脱离的４．１５％。分析住院手术１３５眼，总痊愈率为６５．９３％与同期不含脉络脱离的视网膜脱离成功率相比，复位率低且明显差异（Ｐ〈０．０１），将１３５例脉络膜脱离分为花边，半月，球形三型，花边型组手术成功率较高，放视网膜下液有很高的意外率，封闭了裂孔，可以完成环扎术，不放水更有利。对注气要慎重，术前术后要早用、用足激素，同足激素，同时尽早手术以提高成功率。     

Recurrence of Retinal Detachment after Scleral Buckle Removal

PurposeTo investigate the indications for scleral buckle removal and the risk factors for the recurrence of rhegmatogenous retinal detachment after scleral buckle removal.MethodsIn this retrospective study, the medical records of all patients who underwent scleral buckle removal for the treatment of rhegmatogenous retinal detachment were reviewed.ResultsForty eyes (40 patients) were included in this study. The indications for scleral buckle removal included exposure without infection in 23 eyes (57.5%), exposure with infection in seven eyes (17.5%), elevated intraocular pressure in six eyes (15.0%), strabismus or diplopia in three eyes (7.5%), and migration of buckle material in one eye (2.5%). After the removal of the scleral buckle, the recurrence of rhegmatogenous retinal detachment was observed in four eyes (10.0%) during follow-up, and the retina was successfully reattached after pars plana vitrectomy in all the eyes. Most clinical and ocular factors of the eyes with and without the recurrence of retinal detachment during follow-up were not different, but the eyes that underwent encircling removal were more likely to have retinal detachment recurrence during follow-up than those that underwent segmental buckle removal (n = 4 / 16 [25.0%] vs. n = 0 / 24 [0.0%]; p = 0.020).ConclusionsScleral buckle removal can result in the recurrence of retinal detachment. The benefits and risks of scleral buckle removal should be carefully considered before surgery, and extensive monitoring during follow-up after scleral buckle removal is important, especially for patients who underwent encircling removal.     

Cystoid Macular Edema after Retinal Detachment Surgery

One hundred eyes in 98 patients were studied by fluorescein angiography and stereo color photography six weeks after successful scleral buckling surgery. Twenty-five percent of 67 phakic eyes and 40% of 33 aphakic eyes demonstrated cystoid macular edema. Older phakic patients were at significantly greater risk to develop cystoid macular edema than younger phakic patients. Seventeen percent of successfully repaired eyes demonstrated distortion of the macula by preretinal membranes; 16 of these 17 eyes showed leakage of fluorescein dye into the surrounding retina sometimes also causing cystoid edema. Either cystoid macular edema or macular distortion was present in 38% of the phakic eyes and 64% of the phakic eyes after successful retinal detachment surgery.     

Regional Assessment of Cone System Function Following Uncomplicated Retinal Detachment Surgery

Purpose: To evaluate regional cone system function after uncomplicated retinal detachment (RD) surgery, by recording focal electroretinograms (FERGs) from the central and paracentral regions of the posterior pole. Methods: FERGs in response to either a central (eccentricity: 0–2.25 deg) or a paracentral annular (2.25–9 deg) uniform field, presented on a light adapting background and sinusoidally flickered at 41 Hz (95% modulation depth, 93 cd/m² mean luminance) were recorded from 16 eyes (16 patients) 2 weeks to 420 months following uncomplicated RD surgery (encircling procedure with or without scleral buckling). Pre-operatively, 10 out of 16 eyes had a macular RD. Mean time elapsed from onset of symptoms to surgery was 20 days (range: 5–90 days). Post-operatively, visual acuity ranged 0.1 to 1.0. Eight age-matched normal subjects served as controls. Amplitude and phase of the FERG fundamental harmonic were measured. Results: Compared to control eyes, affected eyes’ central and paracentral FERGs were on average reduced in amplitude (by 40% and 28%, respectively, p<0.01) and delayed in phase (by 70 and 100 degrees, respectively, p<0.01). Eyes with a macular RD did not differ in FERG amplitude or phase from eyes that had a peripheral RD. In individual affected eyes, central, but not paracentral FERG amplitudes were negatively correlated (p=0.05) with time elapsed from onset of symptoms to surgery. Conclusions: Central and paracentral cone system dysfunction may be detected even at lengthy time intervals from retinal reattachment, independent of the presence of a pre-operative macular RD. The extent of central loss appears to be inversely related to RD duration, in agreement with previous reflectometric findings on foveal cone photopigment density [Liem et al., 1994; Ophthalmology 10: 1945-51].     

马蹄形裂孔与视网膜脱离

1980～1990年,共收治裂孔源性视网膜脱离1728例,其中马蹄形裂孔757例(760只眼),占43.8%.在757例中,男性518例(占68.5%),女性239例(占31.5%),年龄7～77岁(多在20～80岁之间),平均年龄42岁。在760只眼中,近视及高度近视者占76.32%,有玻璃体机化牵引者占42.5%。760只限均行手术,其中733只眼为巩膜外垫压术。结果662只眼治愈,总治愈率为87.11%(662/760)。本文就马蹄形裂孔引起的视网膜脱离的临床特点及治疗结果进行了讨论。     

实验性视网膜脱离及眼内显微手术研究

首次报道用兔眼复制类似人眼裂孔源性视网膜脱离模型,实验用1%甲基纤维素网膜下注射联合广泛玻璃体切割术优于其它方法。讨论了手术显微镜直视下网膜下积液排除、眼内冷凝和注气术在网膜脱离治疗中所起的作用及应用于临床的前景,结果表明对后极部裂孔源性视网膜脱离的治疗有良好效果.     

萎缩性裂孔与视网膜脱离

对患萎缩性裂孔源性视网膜脱离的577例(595眼)进行了临床观察。其特征为:(1)67.59%的病例发生在年青人,70.25%为近视或高度近视。(2)裂孔小,数目多,且绝大多数分布在颞侧视网膜。(3)74.62%以上与视网膜退行性变性有关,2/3以上的病人有玻璃体液化和色素游离。     

玻璃体视网膜手术治疗复杂性视网膜脱离

目的探讨玻璃体视网膜手术(VitreoretinalsurgeryVR术)治疗复杂性视网膜脱离的效果。方法采用闭合式玻璃体视网膜手术,包括:玻璃体切割,膜剥除,全氟化碳液体,视网膜激光光凝,硅油与全氟化碳液体交换,硅油充填等技术。结果本组病例共计68例,视网膜复位率为97.06%;手术后视力高于0.02的病例为72.06%。结论VR术是治疗复杂性视网膜脱离的重要方法。     

球内铅异物伤时ERG与视网膜形态变化

研究了兔眼球内铅异物伤后的视网膜电图(ERG)和视网膜形态学变化。伤后2个月,ERG a 波降低75%,b 波降低66%;伤后3个月,视网膜各层细胞广泛出现肿胀、变性、甚至坏死。并对实验结果进行了分析和讨论。提出球内铅异物伤后,应在4周内手术取出异物。