PPV术后玻璃体后界膜残留与PVR

Posterior vitreoschisis in vitreo-retinopathy

目的:描述玻璃体切割术后玻璃体后界膜残留的一些临床特征,探讨其在复发性PVR的作用。方法:玻璃体切割术后复发性PVR和视网膜脱离接受再次玻璃体切割36眼,术中发现玻璃体后界膜残留28眼:有硅油充填21眼,充填时间2～26mo;无充填7眼。首次病变:RRD合并CD、巨大裂孔、黄斑裂孔11眼、早期外伤玻璃体积血10眼、视网膜血管病变玻璃体积血7眼、特发性玻璃体病变2眼。追踪观察6～34mo。结果:B超发现玻璃体内有一层较为完整的膜状结构6眼。玻璃体后界膜残留所致的复发性PVR和视网膜脱离,多发生在术后4～12wk。PPV术中发现较为完整膜结构23眼,部分膜结构5眼,组织学和免疫组化证实为后界膜。再次手术后7眼PVR再生,5眼再次手术,2眼经历3次手术,最终21眼(75%)视网膜获得功能复位,2眼获解剖复位,2眼拒绝再手术,3眼眼球萎缩。结论:玻璃体后界膜残留是PPV手术常见并发症,易发生于PDR、无明显PVR的RRD和早期外伤性玻璃体积血患者;玻璃体后界膜残留是PPV术后产生PVR和视网膜脱离的重要原因之一。

· AIM: To identify the clinical features of vitreoschisis in patients with posterior vitreoretinopathy (PVR) after vitrectomy, and to investigate its functionin relapsed PVR.· METHODS: Vitrectomy was performed again in 36 eyes with relapsed PVR and retinal detachment after vitrectomy. Remained posterior hyaloid membrane was foundin 28 eyes, including 21 with oil tamponade and 7 without oil tamponade. The follow-up was 6-34mo.· RESULTS: Complete membrane was found in 6 eyes by B ultrasonogrouphy. The relapsed PVR and retinal detachment caused by remained posterior hyaloid membrane occurred at postoperative 4-12wk. Relative complete membrane was found during PPVsurgery in 23 eyes, and partial membrane was found in 5 eyes. The membrane wasproved to be posterior hyaloid membrane by immunohistology. After the secondaryvitrectomy, PVR relapsed in 7 eyes; third surgery was done in 5 eyes, and fourthsurgery in 2 eyes. Finally, retina was functionally reattached in 21 eyes (75%)and anatomically reattached in 2 eyes. Re-operation was refused in 2 cases andthe eyeball atrophy occurred in 3 eyes.· CONCLUSION: Remained posterior hyaloid membrane is a common complication of PPV surgery, and it usually occurs in patients with PDR, RRD without obvious PVR,and early traumatic vitreous hemorrhage. It also is one of the main causes of PVR and retinal detachment after vitrectomy.·