Vitrectomy combined with silicone oil tamponade in the treatment of severely traumatized eyes with the visual acuity of no light perception

AIM: To evaluate the efficacy of surgical treatment of vitrectomy combined with silicone oil tamponade in the treatment of severely traumatized eyes with the visual acuity of no light perception (NLP).METHODS: This was a retrospective uncontrolled interventional case-series of 19 patients of severely traumatized eyes with NLP who underwent vitrectomy surgery at the Affiliated Hospital of Medical College, Qingdao University (Qingdao, China) during a 3-year period. We recorded perioperative factors with the potential to influence functional outcome including duration from the injury to intervention; causes for ocular trauma; open globe or closed globe injury; grade of vitreous hemorrhage; grade of endophthalmitis; grade of retinal detachment; size and location of intraocular foreign body (IOFB); extent and position of retinal defect; grade of proliferative vitreoretinopathy (PVR); type of surgery; perioperative complications and tamponade agent. The follow-up time was from 3 to 18 months, and the mean time was 12 months.RESULTS: After a mean follow-up period of 12 months (3-18 months) 10.53% (2/19) of eyes had visual acuity of between 20/60 and 20/400, 52.63% (10/19) had visual acuity less than 20/400 but more than NLP, and 36.84% (7/19) remained NLP. Visual acuity was improved from NLP to light perception (LP) or better in 63.16% (12/19) of eyes and the rate of complete retinal reattachment was 73.68% (14/19). Good visual acuity all resulted from those patients of blunt trauma with intact eyewall (closed globe injury). The perioperative factors of poor visual acuity prognosis included delayed intervention; open globe injury; endophthalmitis; severe retinal detachment; large IOFB; macular defect; a wide range of retinal defects andsevere PVR.CONCLUSION: The main reasons of NLP after ocular trauma are severe vitreous hemorrhage opacity; refractive media opacity; retinal detachment; retinal and uveal damages and defects, especially defects of the macula; PVR and endophthalmitis. NLP after ocular trauma in some cases does not mean permanent vision loss. Early intervention of vitrectomy combined with silicone oil tamponade and achieving retinal reattachment of the remaining retina, may make the severely traumatized eyes regain the VA of LP or better.

Anatomical and functional outcomes after Densiron 68 heavy silicone oil tamponade for complicated retinal detachment in Chinese eyes

AIM:To evaluate the safety and efficacy of Densiron 68 heavy silicone oil (HSO) tamponade for complicated retinal detachment(RD)in Chinese eyes.METHODS:Twenty-one eyes of 21 patients with complicated RD were included in this retrospective study.All patients underwent pars plana vitrectomy with an internal tamponade using Densiron 68 HSO.Anatomical and functional results and complications were evaluated,including retinal status,visual acuity(VA),intraocular pressure(IOP),intraocular inflammation,lens opacity,and HSO emulsification.RESULTS:Allthepatients were followed up for 3mo to1y(5.8±1.16mo).Retinal reattachment was achieved in 19of 21 patients(90.5%).VA improved in 18 of 21 patients(85.7%),from 1.93 logMAR(±0.48)to 1.52 logMAR(±0.45)(P=0.001).Postoperative complications included early dispersion of HSO in 7 eyes(38.8%),cataract in 10 of 18phakic eyes(55.5%),moderate postoperative inflammation reaction in 10 eyes(47.6%),and elevated IOP in 5 eyes(23.8%),all of which were controlled by medication or by surgery.CONCLUSION:Highanatomical and functional success rates can be achieved with primary vitrectomy for complicated RD by using Densiron 68 HSO;however,it should not be ignored that Densiron 68 HSO can cause some complications in the eye.

Clinical effect of peripheral capsule preservation in eyes with silicone oil tamponade

BACKGROUND At present,silicone oil has been widely used in vitrectomy to deal with complex fundus diseases.Usually,cataract extraction is combined with vitrectomy.However,reducing the complications of silicone oil tamponade and facilitating the secondary implantation of intraocular lens(IOL)are still an urgent problem.AIM To evaluate the clinical effect of vitrectomy combined with peripheral capsule preservation(PCP)in eyes with silicone oil tamponade.METHODS This single-center retrospective analysis included 70 patients(73 eyes)who underwent vitrectomy and silicone oil tamponade combined with cataract surgery(stage I)between January 2015 and July 2019.All patients underwent selective reoperation for silicone oil extraction and IOL implantation(stage II)more than 3 mo after stage I.These patients were divided into three groups according to the different lens capsule preservation methods:28 patients(31 eyes)in a whole capsule preserved(WCP)group,17(17 eyes)in a capsule absent(CA)group,and 25(25 eyes)in a peripheral capsule preserved(PCP)group.Intraocular pressure(IOP),best-corrected visual acuity,surgery time,and other complications were recorded at each time point(1 d,1 wk,and 1 mo after stages I and II).RESULTS The IOP values were 14.9±8.2 mmHg in the WCP group,20.3±13.0 mmHg in the CA group,and 14.2±9.7 mmHg in the PCP group(P<0.05)at 1 mo after stage I operation.Five eyes had IOP higher than 30 mmHg,and one eye in the WCP group appeared to have silicone oil entering the anterior chamber.There was no significant difference in IOP among the three groups at any other time point(P>0.05).With IOL implantation,visual acuity improved significantly compared to stage I.The incidence rate of posterior capsule opacity was higher in the WCP group than in the other groups(P<0.001).In the CA group,IOL deviation due to suture relaxation occurred in one case.There was no significant difference in the surgery time among the three groups in stage I(P=0.618).In stage II,the surgery time of the PCP group and WCP group was significantly shorter than that of the AC group(P=0.031).CONCLUSION Preservation of the peripheral capsule in vitrectomy combined with lens removal is a better option.This method has significant advantages in reducing intraoperative and postoperative complications.

Episcleral macular buckling for posterior retinal detachment in silicone oil filled eyes associated with myopic macular hole

AIM: To evaluate anatomical and visual outcomes of episcleral macular buckling (EMB) for posterior retinal detachment in silicone oil filled eyes associated with myopic macular hole.METHODS: Five cases of EMB for initial failure of retinal reattachment after internal limiting membrane (ILM) peeling and silicone oil tamponade caused by myopic macular hole were retrospectively reviewed. A silicone sponge sutured directly across the macular region was performed on the silicone oil filled eyes. Silicone oil was removed no sooner than 1 month post- EMB. The duration of follow -up time after removal of silicone oil was more than 3 months.RESULTS: Retinas of five eyes were all reattached at the last follow-up. The postoperative vision ranged from counting fingers to 0.08.CONCLUSION: Anatomical results improved after EBM for posterior retinal detachment in silicone oil filled eyes associated with myopic macular hole, which was not evident for visual outcome.

Outcomes and predictors of vitrectomy and silicone oil tamponade in retinal detachments complicated by proliferative vitreoretinopathy

AIM:To evaluate outcomes and determine factors influencing the outcomes of vitrectomy with silicone oil(SO)endotamponade for the management of rhegmatogenous retinal detachment(RRD)complicated by advanced proliferative vitreoretinopathy(PVR).METHODS:This is a retrospective,interventional case series of eyes with PVR grade C associated RRD with or without prior surgery that underwent vitreoretinal surgery and SO tamponade.Eyes with a minimum follow-up of 6mo after SO extraction were included.Eyes were classified into three PVR subgroups according to severity and extension of proliferation.The influence of several preoperative,intraoperative and postoperative factors upon the functional and anatomical outcomes was assessed using multivariate logistic regression analysis.RESULTS:A hundred and one eyes of 101 patients that met the inclusion criteria were studied.Seventy-five of 101 eyes(74.3%)had successful retinal reattachment after one operation.Increased aqueous cell and flare at the first week exam had a statistically significant association with redetachment,recurrent membrane proliferation and keratopathy.Visual acuity improvement was significantly associated with faint postoperative aqueous inflammation values,primary vitrectomy and PVR outside of the posterior pole.CONCLUSION:Although encouraging anatomical and functional outcomes are achieved after vitrectomy and SO tamponade in eyes with RRD complicated by PVR,an increase in aqueous flare or cells at the first week follow-up is most likely to result in postoperative late complications.Primary vitrectomy,PVR associated with minimal posterior pole extension and absent to mild postoperative aqueous inflammation are associated with improved post-operative final visual acuity.

Final anatomic and visual outcomes appear independent of duration of silicone oil intraocular tamponade in complex retinal detachment surgery

AIM： To report anatomic and visual outcomes following silicone oil removal in a cohort of patients with complex retinal detachment, to determine association between duration of tamponade and outcomes and to compare patients with oil removed and those with oil in situ in terms of demographic, surgical and visual factors. METHODS： We reported a four years retrospective case series of 143 patients with complex retinal detachments who underwent intraocular silicone oil tamponade. Analysis between anatomic and visual outcomes, baseline demographics, duration of tamponade and number of surgical procedures were carried out using Fisher＇s exact test and unpaired two-tailed t-test. RESULTS： One hundred and six patients（76.2%） had undergone silicone oil removal at the time of review with 96 patients（90.6%） showing retinal reattachment following oil removal. Duration of tamponade was not associated with final reattachment rate or with a deterioration in best corrected visual acuity（BCVA）. Patients with oil removed had a significantly better baseline and final BCVA compared to those under oil tamponade（P=0.0001, 〈0.0001 respectively）. CONCLUSION： Anatomic and visual outcomes in this cohort are in keeping with those reported in the literature. Favorable outcomes were seen with oil removal but duration of oil tamponade does not affect final attachment rate with modern surgical techniques and should be managed on a case by case basis.

Silicone oil migrating into the conjunctival space and orbit after surgery for an eye-penetrating injury:A case report

BACKGROUND We report a case of eye-penetrating injury in which a massive silicone oil migration into the patient’s subconjunctival space and orbit occurred after vitrectomy.CASE SUMMARY A 30-year-old male patient sought medical attention at Ganzhou People’s Hospital after experiencing pain and vision loss in his left eye due to a nail wound on December 9,2023.Diagnosis of penetrating injury caused by magnetic foreign body retention in the left eye and hospitalization for treatment.On December 9,2023,pars plana vitrectomy was performed on the left eye for intraocular foreign body removal,abnormal crystal extraction,retinal photocoagulation.Owing to the discovery of retinal detachment at the posterior pole during surgery,silicone oil was injected to fill the vitreous body,following which upper conjunctival bubble-like swelling was observed.Postoperative orbital computed tomography(CT)review indicated migration of silicone oil to the subconjunctival space and orbit through a self-permeable outlet.On December 18,2023,the patient sought treatment at the First Affiliated Hospital of Nanchang University,China.The patient presented with a pronounced foreign body sensation following left eye surgery.On December 20,2023,the foreign body was removed from the left eye frame and an intraocular examination was conducted.The posterior scleral tear had closed,leading to termination of the surgical procedure following supplementary laser treatment around the tear.The patient reported a significant reduction in ocular surface symptoms just one day after surgery.Furthermore,a notable decrease in the migration of silicone oil was observed in orbital CT scans.CONCLUSION The timing of silicone oil injection for an eye-penetrating injury should be carefully evaluated to avoid the possibility of silicone oil migration.

Axial length,vitreoretinal pathology,and anterior chamber depth can predict postoperative refractive outcomes in phacovitrectomy/silicone oil removal

AIM:To evaluate the postoperative refractive prediction error(PE)and determine the factors that af fect the refractive outcomes of combined pars plana vitrectomy(PPV)or silicone oil removal(SOR)with cataract surgery.METHODS:The study is a retrospective,case-series study.Totally 301 eyes of 301 patients undergoing combined PPV/SOR with cataract surgery were enrolled.Eligible individuals were separated into four groups according to their preoperative diagnoses:silicone oil-filled eyes after PPV(group 1),epiretinal membrane(group 2),macular hole(group 3),and primary retinal detachment(RD;group 4).The variables af fecting postoperative refractive outcomes were analyzed,including age,gender,preoperative best-corrected visual acuity(BCVA),axial length(AL),keratometry average,anterior chamber depth(ACD),intraocular tamponade,and vitreoretinal pathology.The outcome measurements include the mean refractive PE and the proportions of eyes with a PE within±0.50 diopter(D)and±1.00 D.RESULTS:For all patients,the mean PE was-0.04±1.17 D,and 50.17%of patients(eyes)had a PE within±0.50 D.There was a significant difference in refractive outcomes among the four groups(P=0.028),with RD(group 4)showing the least favorable refractive outcome.In multivariate regression analysis,only AL,vitreoretinal pathology,and ACD were strongly associated with PE(all P<0.01).Univariate analysis revealed that longer eyes(AL>26 mm)and a deeper ACD were correlated with hyperopic PE,and shorter eyes(AL<26 mm)and a shallower ACD were correlated with myopic PE.CONCLUSION:RD patients have the least favorable refractive outcome.AL,vitreoretinal pathology,and ACD are strongly associated with PE in the combined surgery.These three factors affect refractive outcomes and thus can be used to predict a better postoperative refractive outcome in clinical practice.

Preoperative laser reduces silicone oil use in primary diabetic vitrectomy

AIM: To identify the predictive factors and laser photocoagulation associated with the use of silicone oil as endotamponade during primary diabetic vitrectomy. METHODS: The medical and surgical records of 690 patients(798 eyes) who underwent primary diabetic vitrectomy at a tertiary eye hospital in China from January 2018 to December 2018 were reviewed in this retrospective cohort study. The patients’ baseline characteristics and preoperative treatments were recorded. The binary Logistic regression model was used to evaluate the risk factors for the use of silicone oil as endotamponade agent during primary vitrectomy for proliferative diabetic retinopathy(PDR)-related complications.RESULTS: Among 690 patients with mean age of 52.1±10.5 y(range: 18-85 y), 299/690(43.3%) were female. The 31.6% of the eyes received preoperative laser treatment, and 72.4% of the eyes received preoperative anti-VEGF adjuvant therapy. Non-clearing vitreous haemorrhage(VH) alone or combined with retinal detachment was the main surgical indication(89.5%) for primary vitrectomy. Silicone oil was used as endotamponade in 313(39.2%) eyes. Lack of preoperative laser treatment [odds ratio(OR) 0.66, 95% confidence interval(CI): 0.48-0.92;P=0.015] and older age(OR 0.96, 95%CI: 0.95-0.98;P<0.001) were predictors of silicone oil tamponade during primary vitrectomy for PDR. CONCLUSION: The lack of preoperative laser treatment is a significant predictor of silicone oil tamponade during primary vitrectomy for PDR. However, the severity of PDR relevant to silicone oil use should be further evaluated.

Densiron 68 heavy silicone oil in the management of inferior retinal detachment recurrence: analysis on functional and anatomical outcomes and complications

AIM: To assess the efficacy and safety of a heavy silicone oil(Densiron 68) in the management of inferior retinal detachment recurrence.METHODS: A retrospective non-comparative consecutive case series study. Forty-nine cases of complex inferior retinal detachment were treated using Densiron 68 heavy silicone oil(HSO) as the endotamponade. Our main purpose was anatomic reattachment following Densiron 68 removal. Functional outcomes, rate of recurrences, the presence of inflammatory complications and intraocular pressure alterations were evaluated. RESULTS: Forty-nine patients affected by complex retinal re-detachment were recruited. The mean follow-up was 7.6(±1.5) mo. The mean best corrected visual acuity after Densiron 68 removal was 0.95 log MAR, standard error(SE: 0.068). Retinal reattachment was 61.2% after first surgery and 81.6% after second surgery. Nineteen cases(38.8%) had recurrences when intraocular heavy silicon oil was in situ, 26.3%(5 cases) of which involved the inferior retina. CONCLUSION: Densiron 68 efficiently fills the inferior retinal periphery and might lower the risk of inferior proliferative vitreoretinopathy development, in particular after a standard silicon oil tamponade that reduces the proliferative process in the upper quadrants of the retina.

Retrolaminar migration as a complication of intraocular silicone oil injection detected on unenhanced CT

AIM:To describe the clinical and radiologic features of retrolaminar migration silicone oil(SiO)and observe the dynamic position of ventricular oil accumulation in supine and prone.METHODS:For this retrospective study,29 patients who had a history of SiO injection treatment and underwent unenhanced head computed tomography(CT)were included from January 2019 to October 2022.The patients were divided into migration-positive and negative groups.Clinical history and CT features were compared using Whitney U and Fisher’s exact tests.The dynamic position of SiO was observed within the ventricular system in supine and prone.CT images were visually assessed for SiO migration along the retrolaminar involving pathways for vision(optic nerve,chiasm,and tract)and ventricular system.RESULTS:Intraocular SiO migration was found in 5 of the 29 patients(17.24%),with SiO at the optic nerve head(n=1),optic nerve(n=4),optic chiasm(n=1),optic tract(n=1),and within lateral ventricles(n=1).The time interval between SiO injection and CT examination of migration-positive cases was significantly higher than that of migration-negative patients(22.8±16.5mo vs 13.1±2.6mo,P<0.001).The hyperdense lesion located in the frontal horns of the right lateral ventricle migrated to the fourth ventricle when changing the position from supine to prone.CONCLUSION:Although SiO retrolaminar migration is unusual,the clinician and radiologist should be aware of migration routes.The supine combined with prone examination is the first-choice method to confirm the presence of SiO in the ventricular system.

高度近视黄斑裂孔性视网膜脱离行玻璃体切割术后C_(3)F_(8)与硅油填充的疗效比较

目的:比较高度近视黄斑裂孔性视网膜脱离(MHRD)行玻璃体切割联合内界膜剥离后玻璃体腔内分别行硅油或C_(3)F_(8)填充治疗的疗效观察。方法:回顾性临床研究。2019-01/2022-08就诊于我院的45例45眼高度近视MHRD患者,根据手术方式分为硅油组(23例)及C_(3)F_(8)组(22例),两组患者均常规三切口玻璃体切割手术,内界膜剥离后行内界膜填塞、自体血覆盖,硅油填充组行硅油填充,C_(3)F_(8)组行15%C_(3)F_(8)气体填充。两组患者分别观察最佳矫正视力(BCVA)、多焦视网膜电图(mfERG)、裂孔的闭合及视网膜复位情况,统计两组患者术后并发症情况。结果:C_(3)F_(8)组、硅油组患者裂孔闭合率为77%、83%(P>0.05),视网膜复位率分别为95%、96%(P>0.05)。C_(3)F_(8)组、硅油组术后视力分别为0.99±0.34、1.22±0.37,C_(3)F_(8)组视力优于硅油组(t=-2.156,P=0.037),两组均较术前显著提高。术后12 mo,两组患者mfERG一阶函数1环(C_(3)F_(8)组114.27±26.37 nV/deg2,硅油组98.08±24.36 nV/deg2)及2环(C_(3)F_(8)组80.45±14.94 nV/deg2,硅油组67.73±15.33 nV/deg2)P1波反应密度较术前(1环P1波反应密度:C_(3)F_(8)组58.13±13.96 nV/deg2、硅油组55.30±10.48 nV/deg2;2环P1波反应密度:C_(3)F_(8)组51.18±8.19 nV/deg2、硅油组47.43±11.97 nV/deg2)明显增加(均P<0.05),C_(3)F_(8)组较硅油组增加明显(P<0.05)。硅油组与C_(3)F_(8)组患者术后并发症发生情况无差异(P>0.05)。结论:玻璃体切割联合内界膜剥离后玻璃体腔内分别行硅油或C_(3)F_(8)填充均可促进高度近视MHRD患者视网膜复位及黄斑裂孔闭合,而且在视功能恢复C_(3)F_(8)填充优于硅油填充。

充分硅油填充术治疗复发性视网膜脱离的有效性和安全性研究

目的探讨应用前后段联合手术,后囊切开联合下方周边虹膜造孔、充分硅油填充治疗复发性视网膜脱离的解剖复位率、视力恢复、手术相关并发症情况等临床疗效。方法前瞻性系列病例研究。研究纳入2018年6月至2022年6月,在汕头国际眼科中心诊治的,既往有明确的孔源性视网膜脱离病史并曾行1次或多次视网膜脱离复位术,术后视网膜仍有脱离的患者25例(25只眼)。其中男性14例,女性11例,平均年龄(52.92±13.94)岁,既往平均行(1.44±0.71)次手术(范围1~3次)。本次术前增生性玻璃体视网膜病变(PVR)C_(1)级3只眼,C_(2)级9只眼,C_(3)级11只眼,D_(1)级2只眼;上方裂孔5只眼,下方裂孔18只眼,上下方均有裂孔2只眼;合并脉络膜脱离2只眼。应用晶状体后囊膜切开、下方周边虹膜造孔,充分硅油填充治疗。收集并分析术前、术后3个月、已取油患者取油后2个月及末次随访的最佳矫正视力、眼压、视网膜情况、眼内硅油状态、手术并发症及其处理等。结果所有患者出院时视网膜平伏,硅油完全退回玻璃体腔。术后3个月,所有患者视网膜平伏,平均眼压(14.24±6.28)mmHg。平均随访时长(20.64±12.20)个月,期间所有研究眼玻璃体腔裂隙灯前置镜下及欧堡眼底照相均未观察到油水界面,提示硅油充填相对充分。其中17只眼已取出眼内硅油,平均硅油填充时间(7.26±2.02)个月,在取出眼内硅油前行角膜内皮镜检查,角膜内皮丢失率18.57%。8只眼未取出眼内硅油,平均随访时长(24.38±12.07)个月,其中高度近视黄斑萎缩明显、视力较差3只眼;广泛视网膜及脉络膜疤痕、眼压≤8mmHg3只眼;拒绝再次手术取油2只眼,至末次随访,17只眼已取出眼内硅油均保持视网膜完全贴附,8只眼未取出硅油均保持视网膜复位,未发现硅油乳化迹象。末次随访最佳矫正视力logMAR(1.21±0.60)较术前logMAR(1.66±0.66)提高,差异有统计学意义(P<0.05)。主要并发症为术后早期高眼压(15只眼,60%),10只眼经过单纯降眼压药物处理控制良好,5只眼用药下眼压控制不良,行前房穿刺放出少量房水(2只眼)或硅油(3只眼),所有患者出院时眼压均控制在21 mmHg以下。结论对于复发性视网膜脱离,行玻璃体切除、后囊膜切开联合下方周边虹膜造孔、充分硅油填充的治疗安全有效,操作简单,可以实现硅油在眼内的相对充分填充,对裂孔处于后极部及下方的患者尤为重要。尽管术后早期高眼压发生率较高,但均可控制。该手术方式是复发视网膜脱离复位手术的一种有效的改良和补充。

超声乳化白内障吸除联合玻璃体切割及硅油填充术对糖尿病患者角膜的影响

目的 探究糖尿病视网膜病变患者行超声乳化白内障吸除(Phaco)联合玻璃体切割(PPV)及硅油填充术对角膜的影响。方法 选34例(34眼)视网膜病变患者为研究对象,根据是否合并糖尿病将患者分为糖尿病组与非糖尿病组,各17例(17眼)。所有患者均行Phaco联合PPV及硅油填充术治疗,记录两组并发症发生情况,术前及术后1周、1个月、3个月及6个月测量角膜内皮细胞密度(ECD)、中央角膜厚度(CCT)、角膜前表面曲率、角膜后表面曲率及角膜屈光度,比较两组间的角膜数据。结果 术后1周糖尿病组患者的ECD低于非糖尿病组,术后1周、1个月糖尿病组患者的CCT均厚于非糖尿病组,差异均有统计学意义(均P<0.05)。术后1周糖尿病组患者的角膜前表面曲率K1(平坦轴)的SIA值和角膜前表面曲率K2(陡峭轴)的SIA值均高于非糖尿病组,差异均有统计学意义(均P<0.05);术后1周、1个月、3个月、6个月两组患者术后角膜后表面曲率K1(平坦轴)的SIA值、角膜后表面曲率K2(陡峭轴)的SIA值比较,差异均无统计学意义(均P>0.05)。术后1周糖尿病组患者角膜屈光度的SIA值高于非糖尿病组患者,差异有统计学意义(P<0.05);术后1个月、3个月、6个月两组角膜屈光度的SIA值比较,差异均无统计学意义(均P>0.05)。两组患者均未发生超过24 h持续性高眼压,药物治疗后眼压维持正常,无感染性眼内炎发生。结论 Phaco联合PPV及硅油填充术对糖尿病患者角膜内皮细胞、CCT、角膜前表面曲率及角膜屈光度早期损伤较非糖尿病组更明显,但硅油填充后3—6个月内两组患者角膜内皮细胞、CCT、角膜前后表面曲率及角膜屈光度差异均无统计学意义。因此,Phaco联合PPV及硅油填充术对糖尿病视网膜病变患者是一种相对安全的手术方式。

改良硅油取出联合巩膜扣带术治疗硅油填充术后视网膜脱离

目的:探讨改良硅油取出联合巩膜扣带术治疗硅油填充状态下视网膜脱离的效果。方法:回顾性研究。选取2021-01/2023-02于我院治疗的硅油填充状态下视网膜脱离的患者14例14眼,采用改良硅油取出联合巩膜扣带术进行治疗。硅油取出方法采用自制的23 G抽吸器,即将一次性输血器的针管取出,靠近乳头端剪至2.5-3.0 mm,另一端连接已去除推注手柄的10 mL注射器,注射器另一端连接玻璃体切割器的负压系统,进行硅油取出;巩膜扣带术中外加压块采用外加压复合体;术后未重新注入硅油。随访6 mo,观察术后视网膜复位、最佳矫正视力(BCVA)、眼压和并发症等情况。结果:术后6 mo,视网膜完全复位13眼,视网膜复位率达93%,BCVA(LogMAR)较术前改善(0.95±0.18 vs 1.15±0.21,P=0.002)。术后1 d出现一过性高眼压6眼,药物控制后恢复正常。术中未见视网膜出血、嵌顿、医源性裂孔等并发症,术后未出现眼内炎、脉络膜脱离等并发症。结论:改良硅油取出联合巩膜扣带术可以有效治疗硅油填充状态下视网膜脱离,促使视网膜再复位。

孔源性视网膜脱离硅油填充术对眼部参数的影响

目的探讨硅油填充对孔源性视网膜脱离患者眼部参数的影响。方法对16例孔源性视网膜脱离患者(16眼)用IOL master 700测量玻璃体切割术前、硅油取出术前其眼轴长度(AL)、前房深度(ACD)、晶状体厚度(LT)、角膜曲率(K1、K2)和中央角膜厚度(CCT),并对手术前后眼部参数进行对比分析。结果11例(68.75%)可顺利测出眼轴,患者术后AL较术前增加,术后ACD较术前减少,术后LT较术前增加。术前术后K1、K2、CCT差异均无统计学意义。结论孔源性视网膜脱离患者硅油填充术后,AL有所增加,ACD减小,LT增加,其结果对眼球屈光状态及眼压的影响需进一步的临床研究。

玻璃体切除联合硅油填充术治疗糖尿病视网膜病变的愈后及并发症分析

目的探讨玻璃体切除联合眼内硅油填充术治疗糖尿病视网膜病变的视力改善及并发症分析。方法回顾性分析98眼行玻璃体切除联合眼内硅油填充术治疗的糖尿病视网膜病变患者,观察术后视力恢复情况和术后并发症,分析影响视力预后的因素,探讨术后并发症与并发性疾病等其他因素的关系。结果 98眼患者行玻璃体术后视力提高率为66.33%,术后并发黄斑病变组的视力改善率(55.26%)显著低于无黄斑病变组的视力改善率(73.33%)(P<0.05)。高血压组和糖尿病肾病组的高眼压、新生血管、再出血、黄斑水肿和黄斑前膜的发生率显著高于无高血压组和无糖尿病肾病组(P<0.05)。血糖控制状况良好和较短的糖尿病史可以显著降低高眼压、再出血、黄斑水肿和黄斑前膜的发生率(P<0.05)。高血压组和糖尿病肾病组的高眼压、新生血管、再出血、黄斑水肿和黄斑前膜的发生率显著高于无高血压组和无糖尿病肾病组(P<0.05)。血糖控制状况良好和较短的糖尿病史可以显著降低高眼压、再出血、黄斑水肿和黄斑前膜的发生率(P<0.05)。结论玻璃体切除联合眼内硅油填充术治疗糖尿病视网膜病变可以显著提高患者术后视力,且术后是否并发黄斑病变是影响视力改善的重要因素,术后并发症的发生率与并发性疾病、血糖控制和糖尿病史密切相关。

硅油眼复发性视网膜脱离的特点及临床处理

目的探讨硅油眼复发性视网膜脱离的特点及手术方法的选择。方法回顾性分析本院2012年1月至2015年12月硅油填充术眼复发视网膜脱离者134例(134眼),采用玻璃体切割联合硅油置换术或巩膜外加压术治疗,术后随访6个月,评价手术效果。结果 101眼采用玻璃体切割联合硅油置换治疗,术后79眼视网膜复位,22眼视网膜复位失败者再次行玻璃体切割手术,成功率为78.2%(79/101);视力提高者16眼,不变者56眼,下降者29眼;眼压升高超过25 mmHg(1 kPa=7.5 mmHg)者31眼。33眼采用巩膜外加压治疗,23眼视网膜复位,10眼术后随访中发现视网膜未复位而改行玻璃体切割联合硅油置换术,成功率为69.7%(23/33);视力提高者5眼,不变者16眼,下降者12眼;眼压升高超过25 mmHg者14眼。结论对于下方或较周边的裂孔导致的局限性视网膜脱离,增生性玻璃体视网膜病变处于A或B级,屈光介质不影响眼底检查的病例,可选巩膜外加压术;对于裂孔位于后极部或较大裂孔导致的大范围视网膜脱离,并有较广泛的视网膜增殖或视网膜固定皱襞形成,建议选玻璃体联合硅油置换手术,松解牵拉,填充硅油。

玻璃体切割硅油填塞术后眼压变化分析

目的观察玻璃体切割硅油填塞术后的眼压变化,并探讨其可能原因。方法对45例(45眼)玻璃体切割硅油填塞术后患者的临床资料进行回顾性分析,高眼压标准为术后眼压≥24 mmHg(1 mmHg=0.133 kPa)。结果 22例(48.9%)患者出现高眼压,以术后早期(术后2周内)为多(17/22,77.3%)。所有患者经降眼压药物治疗及调整激素用量或停用激素处理后,眼压均控制在正常范围。高眼压组与非高眼压组性别、年龄、病程、屈光度及硅油填充量比较差异均无统计学意义(P>0.05)。结论高眼压是玻璃体切割硅油填充术后常见的并发症,术后眼内组织水肿、葡萄膜炎反应和频繁使用激素类滴眼液等可能是引起高眼压的主要原因。

后巩膜加固术治疗硅油填充术后复发性超高度近视黄斑裂孔性视网膜脱离

目的探讨后巩膜加固术治疗硅油填充术后复发性超高度近视黄斑裂孔性视网膜脱离(macular hole retinal detachment,MHRD)的可行性及疗效。方法选取2011年6月至2014年6月硅油填充术后的复发性超高度近视性MHRD患者36例(36眼),所有患者均由同一术者行黄斑区改良后巩膜加固术,术后3个月取出硅油。术后随访12个月,观察记录术后并发症、视网膜脱离复位情况、黄斑裂孔闭合情况、术后视力、眼轴长度等指标。结果 36眼视网膜完全复位,视网膜复位率为100%;末次随访SD-OCT示22眼黄斑裂孔完全闭合,占61.1%,11眼黄斑部分闭合,占30.6%,3眼仍未闭合,占8.3%;31眼术后最佳矫正视力(best correct visual acuity,BCVA)较术前提高,占86.1%,5眼BCVA较术前无明显改变,占13.9%;术前患者BCVA为(1.48±0.92)log MAR,术后BCVA为(0.93±0.38)log MAR,差异有统计学意义(P<0.05);术前患者眼轴长度为(30.95±1.16)mm,术后为(28.46±1.34)mm,差异有统计学意义(P<0.001)。所有患眼均未发生眼底出血、眼内炎、涡静脉回流障碍、眼前部缺血综合征等并发症。结论改良后巩膜加固术是治疗硅油填充术后复发性超高度近视MHRD安全有效的手术方法,能提高视网膜解剖复位率、黄斑裂孔闭合率、视力及减少并发症。