Amniotic membrane for covering high myopic macular hole associated with retinal detachment following failed primary surgery

AIM:To evaluate the therapeutic effect of amniotic membrane(AM)for covering high myopic macular hole associated with retinal detachment following failed primary surgery.METHODS:Seventeen eyes of 17 patients whose axial length was more than 29 mm suffered from macular hole(MH)or MH associated with retinal detachment(RD),and had previously surgery of pars plana vitrectomy(PPV)with internal limiting membrane(ILM)peeling and silicone oil(SO)tamponade.Half a year after the surgery,optical coherence tomography(OCT)showed that MH did not heal in all 17 eyes and RD was still maintained in 13 eyes of these 17 eyes.We performed SO removal combined with AM covering on macular area and C3 F8 tamponade,and phacoemulsification combined with intraocular lens implantation simultaneously cataract eyes.We followed up these patients for one year.RESULTS:In all 17 eyes,SO was removed successfully,MHs were healed and RDs were reattached.One eye(5.89%,1/17)had AM shifted half a month after surgery and underwent a second surgery to adjust the position of the AM and supplement C3 F8.After surgery,the visual acuity(VA)improved in 15 eyes(88.24%,15/17),no change in two eyes(11.76%,2/17).No serious complications occurred in all eyes.CONCLUSION:AM covering is helpful to rescue the previous failure surgery of high myopic MH.

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.

Clinical observation of vitrectomy combined with endolaser photocoagulation at the edge of posterior scleral staphyloma for macular hole retinal detachment in high myopia

AIM: To observe the clinical effect of pars plana vitrectomy(PPV) and silicone oil filling surgery combined with intraoperative posterior scleral staphyloma(PS) marginal retinal photocoagulation in the treatment of high myopic macular hole retinal detachment(MHRD) with PS.METHODS: This was a retrospective clinical study. From May 2017 to March 2020, 62 MHRD patients with PS(62 eyes) were enrolled in the study. Patients were divided into 23 G PPV combined with PS marginal retina intraoperative photocoagulation group(combined group) and conventional surgery group(conventional group), with 31 eyes in each. Triamcinolone acetonide and indocyanine green were used to remove the epiretinal membrane and the posterior macular inner limiting membrane(ILM). In the combined group, 2 to 3 rows of retinal photocoagulation were performed on the edge of the PS. The patients were followed up for an average of 8.34±3.21 mo. The first retinal reattachment rate, macular hole closure rate, Duration of silicone oil tamponade, best corrected visual acuity(BCVA) and average number of operations were observed and compared between the two groups.RESULTS: The first retinal reattachment rates of the eyes in the combined group and the conventional group were 96.7%(29/31) and 67.7%(21/31), respectively(χ~2=6.613, P=0.010). The macular hole closure rates in the combined group and the conventional group were 74.2%(23/31) and 67.7%(21/31), respectively(χ~2=0.128, P=0.721). The Duration of silicone oil tamponade of the patients in the combined group was lower than that of the routine group(t=-41.962, P≤0.001). Postoperative log MAR BCVA values of patients in the combined group and the conventional group were 1.27±0.12 and 1.26±0.11, compared with the log MAR BCVA before surgery, each group was improved(t=19.947, t=-19.517, P≤0.001, P≤0.001). There was no significant difference in the log MAR BCVA between the eyes of the two groups(t=-0.394, P=0.695). The average numbers of operations on the eyes in the conventional group and the combined group were 2.39±0.62 and 2.06±0.25 times, the combined group had fewer operations on average(t=-2.705, P=0.009). CONCLUSION: Intraoperative PPV treatment of MHRD with PS combined with PS marginal endolaser photocoagulation can effectively increase the rate of retinal reattachment after the first operation, reduce the number of repeated operations, and reduce the postoperative duration of silicone oil tamponade.

Surgical Management of Retinal Detachment Resulting from Macular Hole in a Setting of High Myopia

Purpose:To evaluate the anatomical and visual outcomes of pars plana vitrectomy (PPV) with internal limiting membrane (ILM).peeling and use of retinal tamponade for retinal detachments resulting from macular hole (MHRD) in highly myopic eyes. Methods:.Twenty-nine highly myopic patients.(29 eyes) underwent PPV with ILM peeling and retinal tamponade for MHRD were enrolled. Demographics and best-corrected visual acuity.(BCVA).were measured preoperatively and at final follow-up. Anatomical success and macular hole closure were analyzed. Results:.Patients' mean age of patients was 58.7±10.6 years, mean follow-up was 11.7±7.4 months. Twenty three eyes (23/26,88.5%)undergoing primary PPV combined with ILM peeling had successful initial retinal reattachment, including 19 eyes (19/19, 100%) with silicone oil tamponade and in 4 eyes (4/7,57.1%).with sulfur hexafluoride.(C3F8).tamponade. Overall anatomical success was achieved in 27 eyes (27/29, 93.1%)..The macular hole closure was observed in 17 eyes (17/26, 65.4%) with final anatomical success. Compared to preoperative BCVA,.the mean postoperative BCVA in the eyes with anatomical success was significantly improved (P = 0.007, Wilcoxon signed rank test). Conclusion:.As a primary or secondary procedure,.PPV combined with ILM peeling and usage of retinal tamponade serves as an effective method for MHRD in highly myopic eyes.

Surgical Treatment for the Proliferative Retinal Detachment Associated with Macular Hole in the Morning Glory Syndrome

Purpose: To evaluate the efficacy of vitrectomy with peripapillary photocoagulation and silicone oil tamponade for the proliferative retinal detachment associated with macular hole in children with morning glory syndrome. Methods: Eight children with morning glory syndrome (mean age 8.0±2.8 years; range 5～13 years) were included; all patients had unilateral eye disease and were initially misdiagnosed as having bilateral squint or amblyopia, with best corrected visual acuity <6/60. Five patients could not cooperate with the fundus examination and one patient had lens opacities.B-ultrasound confirmed that all eight patients had retinal detachment and optic disc dysplasia.All patients underwent standard 3-port pars plana vitrectomy surgery . (20G for three cases and 23G for five cases).At surgery,all patients were confirmed to have morning glory syndrome,macular hole, and proliferative retinal detachment;.two cases had a funnel shaped bulge. All the retinal detachments involved the macular area, and macular hole was detected in the abnormal expansion excavation of the optic disk. The epiretinal membrane and subretinal membrane were completely removed during surgery. Combined photocoagulation in the abnormal expansion excavation of the optic disk, and silicone oil tamponade were also performed. Results:All eyes achieved anatomical resolution of retinal detachment.After follow-ups ranging from eight months to four years,the visual function for all patients was improved by postoperative refractive correction associated with vision training. Best corrected visual acuity was 6/600 to 6/30 at the final follow-up, no retinal detachment recurred, and no silicone oil fluid entered the subretinal space. The silicone oil was successfully removed postoperatively after a mean of 1.5 years. Conclusion:Vitrectomy with peripapillary photocoagulation and silicone oil tamponade is effective in treating the proliferative retinal detachment associated with macular hole in children with morning glory syndrome. (Eye Science 2013;28:7-10)

Risk factors and prognosis of pediatric rhegmatogenous retinal detachment in Egypt:a university hospital based study

AIM:To study and compare the predisposing factors and clinical features of pediatric,adult,and elderly rhegmatogenous retinal detachment(RRD).METHODS:This is an observational analytic crosssectional study in which patients with RRD admitted for surgery during 6mo period were divided into 3 age groups:pediatric(<18y),adult(18-60y),and elderly(>60y).Patients’demographic data,clinical features,RRD predisposing factors/features including myopia(axial length≥26.5 mm),aphakia/pseudophakia,blunt trauma,peripheral retinal degenerations,history of RRD in the fellow eye,and surgical interventions/findings were recorded and analyzed.RESULTS:Totally 142 patients(142 eyes)were studied:26(18.31%)pediatrics,86(60.56%)adults,and 30(21.13%)elderly.Elderly patients had a significantly higher intraocular pressures and cataracts compared to the other 2 groups(P=0.04).The RRD extent was larger in pediatric group(mostly 4 quadrants)compared to adults and elderly(mostly 2 quadrants),but it was not statistically insignificant(P=0.242).There were not statistically significantly differences in proliferative vitreoretinopathy(PVR)rate,posterior vitreous detachment(PVD)rate,number,site,shape,and size of breaks in three groups.All three groups had macular detachment in all eyes.Myopia and peripheral retinal degenerations were found to be more significant in adults(P=0.049,P=0.035,respectively),while blunt trauma was higher but insignificant in pediatric eyes(P=0.052).Pars plana vitrectomy(PPV)with silicone oil as a tamponade was the most used surgery in all groups.CONCLUSION:There are no significant difference in PVR rate in pediatric eyes but a significant higher rate of total RRD.Blunt trauma is more frequent in pediatrics eyes while myopia and/or peripheral retinal degenerations are more frequent in older ages.The rate of PPV as a choice for surgery is similar among all age groups.

Is there a relationship between dopamine and rhegmatogenous retinal detachment?

Dopamine and its receptors have been widely studied in the neurological conditions and in the retina. In this study, we evaluated the possible role of dopamine in rhegmatogenous retinal detachment(RRD) by comparing the amount of 3,4-dihydroxyphenylacetic acid(DOPAC), a surrogate index of retinal dopamin levels, in the vitreous sample of patients affected by RRD with those affected by macular pucker and vitre ous hemorrhage. Our results showed that significantly higher levels of DOPAC were found in the vitreou sample of patients affected by RRD compared with those affected by vitreous hemorrhage and macula pucker(P = 0.002). Specifically, no trace of the substance was found in vitreous hemorrhage and macula pucker samples. A slightly significant positive correlation was found among DOPAC and post-operativ best corrected visual acuity(r = 0.470, P = 0.049). No correlation was found between DOPAC and the day elapsed between diagnosis and surgery(P = 0.317). For the first time our findings suggest that DOPAC i released in RRD, but not in other retinal diseases such as vitreous hemorrhage and macular pucker. More over, we showed a correlation between visual acuity outcome and the amount of DOPAC in the vitreous This might have a potential, although still unknown, implication in the pathogenesis of the disease and/o in the associated photoreceptors loss. This study was approved by the Ethics Committee of Rome Tor Ver gata University Hospital(R.S.92.10) on September 24, 2010.

Posterior vitreous cortex contributes to macular hole in highly myopic eyes with retinal detachment

Background It was well known that tangential vitreoretinal traction and epiretinal membrane play important roles during the formation of macular hole （MH） associated with retinal detachment （RD） in highly myopic eyes. But it was not clear about the correlations between anteroposterior traction, posterior vitreous cortex （PVC） and MH-RD. The vitreous status in highly myopic eyes were analyzed to explore the effect of PVC in the role of MH-RD formation. Methods Sixteen consecutive highly myopic eyes with RD due to MH were retrospectively analyzed from January 2009 to April 2009. The preoperative examinations for detecting posterior vitreous detachment （PVD） and vitreoretinal traction included B-mode ultrasonography and optical coherence tomography （OCT）. The residual PVC and PVD were confirmed intraoperatively during triamcinolone acetonide （TA） assisted vitrectomy. Results Under ultrasonography, the preoperative PVD patterns were stratified as： complete PVD in three （19%） eyes, partial PVD in eight （50%） eyes, and no PVD in five （31%） eyes. OCT confirmed vitreoretinal traction and no complete PVD in 10 （63%） eyes, including anteroposterior traction in four eyes and tangential traction in six eyes. During TA-assisted vitrectomy, it was confirmed that no complete PVD existed in 16 eyes, including six eyes （38%） finally diagnosed of partial PVD, and five （31%） eyes with vitreoschisis. Anteroposterior vitreoretinal traction around MH is always in conjunction with partial PVD （67%）, and high proportion （80%） of vitreoschisis is associated with tangential vitreoretinal traction. Comparing with the precision of TA staining of PVD diagnosis, the coincidence rate of ultrasonography was 69% （P=0.02）, and that of OCT was 63% （P 〈0.01）. Conclusions The residual PVC due to partial PVD or vitreoschisis may cause the anteroposterior or tangential traction of macular area, which contributes to the formation of MH and subsequent RD in highly myopic eyes. And it is necessary to realize the vitreoretinal relationship and assess the status of PVC synthetically for surgery by combined ultrasonography and OCT preoperatively and TA staining intraoperatively.

Surgical treatment for neovascularized retinal pigment epithelial detachment in age -related macular degeneration

Dear Sir, I am Dr. Hui Li, from the Department of Ophthalmology of Shanghai Tenth People’s Hospital Affiliated to Tongji University in Shanghai, China. I write to report a case of neovascularized pigment epithelial detachment (PED) successfully treated with vitrectomy. PED associated occult choroidal neovascular membrane, so called vascularized PED [1] , is a special subtype of neovascular age-related macular degeneration with poor

Relationship between full-thickness macular hole and retinal break/lattice degeneration

Background: The purpose is to investigate the relationship between full-thickness macular hole(MH) and retinal break(RB) and/or lattice degeneration.Methods: Patients diagnosed as full-thickness MH and referred to Dr. Lin Lu from January 2009 to December 2013 were evaluated. All patients underwent general ophthalmologic examinations, fundus examination and optical coherence tomography(OCT). The RB and/or lattice degeneration were recorded.Results: Totally 183 eyes of 167 patients were included. The sex ratio of men to women was 1:2.88. A total of 17 eyes were pseudophakic and 166 eyes were phakic. RB and/or lattice degeneration were found in 62 eyes(33.88%). The prevalence of RB and/or lattice degeneration was similar between men and women(P=0.344>0.05). There was no statistical difference between the pseudophakic eyes and phakic eyes(P=0.138>0.05). All of the RB and/or lattice degeneration were located near or anterior to the equator. The inferior quadrants and the vertical meridian were af ected more often than the superior quadrants and the horizontal meridian.Conclusions: We identified a high incidence of RB/lattice degeneration in cases of full-thickness MH. Carefully examination of the peripheral retina and prophylactic treatment of RB and/or lattice degeneration are critical.

Optical Coherence Tomography’s Contribution to the Diagnosis of the Pathologies of the Vitreoretinal Interface in Lomé

Purpose: To identify the pathologies of the vitreoretinal interface by Optical Coherence Tomography OCT of the retina in Lomé. Methodology: This is a retrospective analytical study, carried out in a specialized liberal center in Lomé. It was based on the analysis of OCT images of the retina, carried out with patients between October 2012 and October 2014. The variables collected were the socio-demographic characteristics, which were the various pathologies of the vitreoretinal interface. Results: 303 eyes of 164 patients were analyzed. The population was predominantly female (sex ratio = 0.95) aged 9 to 84 years with an average of 52.93 years. 121 eyes (39.9%) had posterior vitreous detachment with 66.1% in the 50 - 70 age group. 42 eyes (13.86%) presented vitreomacular traction with 66.6% in the 50 - 70 age group. 31 eyes (10.23%) presented an epi-retinal membrane with 61.2% in the 50 - 70 age group. 33 eyes (10.89%) had a full-thickness macular hole with 69.6% in the 50 - 70 age group. 4 eyes had a lamellar hole and 1 eye had a pseudo hole. Conclusion: OCT is an excellent tool for non-invasive exploration of the vitreoretinal interface. It gives precise information on the various pathologies of this interface. The need to evaluate the functional impact of these abnormalities, calls for other studies, especially prospective studies to assert their reality of those disease.

Long-term outcomes of drusenoid pigment epithelium detachment in intermediate AMD treated with 577 nm subthreshold micropulse laser: a preliminary clinical study

AIM: To evaluate the long-term anatomical and visual outcomes of drusenoid pigment epithelial detachment(D-PED) in intermediate age-related macular degeneration(AMD) eyes treated with 577 nm yellow subthreshold micropulse laser(SML).METHODS: In this retrospective study, 21 eyes of 16 patients with D-PED in intermediate AMD were consecutively included and assessed.All the eyes were treated with 577 nm SML in several sessions according to D-PED growth status.The logarithm of the minimum angle of resolution(logMAR) best-corrected visual acuity(BCVA) were assessed at the initial visit and after treatment.Spectral-domain optical coherence tomography(SD-OCT) was performed to evaluate the D-PED lifecycle by volumetric calculations.Regression analysis was used to determine the breakpoint, growth, and collapse rate of the D-PED lesions.The progression to advanced AMD was also documented.RESULTS: All the eyes were treated with SML for 2.9±1.0 sessions.The mean follow-up period was 25.3±12.6 mo.The BCVA was stable from the baseline to final visit.All the eyes were categorized into two groups according to the anatomical changes of the D-PED lesion: the collapse group(n=6, 28.6%) and non-collapse group(n=15, 71.4%).The change in logMAR BCVA did not differ significantly between the collapse group 0.00(-0.31, 0.85) and non-collapse group 0.00(0.00, 0.00;P=1).Regression analysis showed that the growth rate was significantly higher in the collapse group(0.090±0.095 mm;/mo) than in the non-collapse group(0.025±0.035 mm;/mo;P<0.001).One eye(4.8%) developed macular neovascularization at 11 mo after SML treatment in the non-collapse group.Three eyes(14.3%) developed geographic atrophy(GA) in the collapse group.CONCLUSION: Compared to the natural course of D-PED reported by previous studies, our results preliminarily show that SML can alleviate visual loss and possibility of progression to advanced AMD in eyes with D-PED in intermediate AMD.A controlled clinical trial needs to further verify the benefit of the intervention.

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。

基于血水同治理论探讨渗出性老年性黄斑变性的治疗

渗出性老年性黄斑变性(wet age-related macular degeneration, w AMD)常见于老年人,病情呈进行性发展,对视力造成严重影响,降低患者生活质量。血水同治理论是基于血水同源互化、同病互害的生理病理特点,以活血利水法为基础,辨证施治,广泛应用于临床。根据w AMD的中医病机,可辨证分为肝肾阴虚、肝脾失衡及脏腑失调。本文基于血水同治理论,对w AMD进行分期论治,并对视网膜脱离、玻璃体积血等并发症辨证论治,在临床上疗效确切。

富血小板纤维蛋白膜填塞联合硅油填充治疗高度近视黄斑裂孔伴视网膜脱离的效果评价

目的探讨富血小板纤维蛋白(PRF)膜填塞联合硅油填充在高度近视黄斑裂孔(HMMH)伴视网膜脱离(RD)治疗中的作用。方法采用随机对照研究方法,纳入2021年9月至2023年4月于武汉大学人民医院眼科中心检查确诊的HMMH伴RD患者52例52眼,采用随机数字表法随机分为3个组,均行23G标准三通道平坦部玻璃体切割术。其中内界膜(ILM)剥除组18例18眼,术中剥除ILM;ILM填塞组16例16眼,术中将翻转的ILM填塞裂孔;PRF填塞组18例18眼,使用PRF填塞裂孔。于术前和术后1周、1个月、3个月、6个月行眼压、最佳矫正视力(BCVA)测量,采用光学相干断层扫描测量黄斑中心凹视网膜厚度(CMT);于术前和术后6个月采用光学相干断层扫描血管成像测量浅层视网膜血流密度(SVD)和深层视网膜血流密度(DVD);以术后6个月为疗效判定点,对比3个组裂孔闭合率、视网膜复位率。结果术后6个月,ILM剥除组、ILM填塞组、PRF填塞组的裂孔闭合率分别为83.3%(15/18)、87.5%(14/16)和94.4%(17/18),各组间裂孔闭合率比较,差异无统计学意义(拟合χ^(2)=1.180,P>0.05);各组视网膜全部复位。ILM剥除组、ILM填塞组、PRF填塞组术后BCVA均较术前提升,差异均有统计学意义(均P<0.05)。术后6个月,PRF填塞组CMT较ILM剥除组和ILM填塞组厚,各组术后各时间点CMT较术前均明显下降,差异均有统计学意义(均P<0.05)。各组术后6个月SVD和DVD均高于术前,差异均有统计学意义(均P<0.05)。治疗和随访期间各组均未见眼内炎、玻璃体积血等严重并发症。ILM填塞组观察到4眼Müller细胞过度增殖,ILM剥除组和ILM填塞组未见Müller细胞过度增殖。结论PRF填塞联合硅油填充可促进HMMH伴RD患者的裂孔愈合和视网膜复位,改善视力和血流密度,是一种安全、有效的手术方式。

人羊膜填塞与内界膜翻转填塞对高度近视黄斑裂孔性视网膜脱离疗效比较

目的对比玻璃体切割(PPV)联合人羊膜填塞术或内界膜翻转填塞术治疗高度近视黄斑裂孔性视网膜脱离(MHRD)的疗效。方法采用非随机对照临床研究方法,纳入2020年7月至2021年8月就诊于上海交通大学医学院附属第九人民医院的高度近视MHRD患者15例16眼。所有患者均接受PPV,根据术中黄斑裂孔填塞材料的不同将患者分为人羊膜填塞组7例7眼和内界膜填塞组8例9眼。分别于术前及术后1周、1个月、3个月和6个月测定术眼最佳矫正视力(BCVA)、眼压;采用裂隙灯显微镜联合前置镜、激光扫描检眼镜及光学相干断层扫描(OCT)检查眼底情况并判定黄斑裂孔闭合及视网膜复位情况。结果人羊膜填塞组6眼初次手术后视网膜即复位,内界膜填塞组所有术眼均实现一次手术后视网膜复位。初次手术后,人羊膜填塞组5眼黄斑裂孔闭合,内界膜填塞组8眼黄斑裂孔闭合,2个组间黄斑裂孔闭合率比较差异无统计学意义(P>0.05)。2个组患者手术前后不同时间点间BCVA总体比较差异有统计学意义(F_(时间)=4.420,P<0.05);术后不同时间点BCVA均优于术前值,但差异无统计学意义(均P>0.05)。2个组间BCVA总体比较差异无统计学意义(F_(组别)=0.183,P>0.05)。人羊膜填塞组和内界膜填塞组分别有2眼和4眼出现术后一过性高眼压,给予降眼压治疗1周后均恢复正常。结论PPV联合人羊膜填塞术及内界膜填塞术治疗高度近视MHRD均安全有效,且人羊膜填塞术在伴随复杂的眼底情况时也能保持良好的视网膜解剖学复位及功能恢复。

保留视网膜下液的内界膜瓣填塞治疗高度近视黄斑孔视网膜脱离

目的探讨玻璃体切除(PPV)联合保留视网膜下液(SRF)的内界膜(ILM)瓣填塞治疗高度近视黄斑孔视网膜脱离(MHRD)的疗效。方法回顾性病例研究。纳入华中科技大学同济医学院附属协和医院眼科2020年8月至2023年6月的30例高度近视MHRD(32眼),伴后巩膜葡萄肿及脉络膜视网膜萎缩,眼轴长度为(30.32±1.71)mm。均接受PPV,保留SRF,黄斑孔(MH)鼻上起瓣(借助视盘的力量,固定脱离的视网膜),制作MH边缘带蒂的ILM瓣,反转填塞MH,手术结束时采用硅油填充,观察SRF吸收、视网膜再附着、MH闭合及视力变化。结果术后1周内OCT检查,25眼MH闭合SRF吸收,6眼MH闭合残留SRF,1眼MH未愈合。随访期间,7眼残留的SRF吸收时间分别为术后1年内5例,18月和21月各1例。32眼一次硅油取出后视网膜再附着,视网膜复位率为100%。MHⅠ型闭合者90.62%(29/32),其中U形闭合22眼、V形闭合5眼、W形转变为U形瘢痕闭合2眼;MHⅡ型(W形)闭合者9.38%(3/32)。术后最佳矫正视力(BCVA)有改善,从术前(1.90±0.34)[最小分辨角的对数(logMAR)]提高到(1.14±0.37)(log MAR),差异有统计学意义(t=11.11,P<0.01)。结论在残留SRF的情况下,使用ILM瓣反转填塞技术成功关闭了MH。PPV联合保留SRF、ILM瓣填塞和硅油填充,为长眼轴伴后巩膜葡萄肿的高度近视MHRD提供了一种首选治疗方法。

玻璃体切割联合重硅油眼内填充术治疗高度近视黄斑裂孔视网膜脱离的疗效评估

背景 高度近视黄斑裂孔视网膜脱离较一般孔源性视网膜脱离的手术成功率低,玻璃体切割联合重硅油眼内填充术的治疗效果已有报道,但结果不一. 目的 观察玻璃体切割联合重硅油眼内填充术治疗高度近视黄斑裂孔视网膜脱离的疗效.方法 采用回顾性病例分析的研究方法,对2007年9月至2009年12月于首都医科大学附属北京同仁医院接受玻璃体切割联合重硅油眼内填充术的高度近视黄斑裂孔视网膜脱离患者20例20眼的临床资料进行分析.所有患眼均接受20G玻璃体切割、内界膜剥除联合重硅油填充术治疗.术中根据情况剥除黄斑前膜,必要时联合视网膜切开、眼内激光治疗,晶状体混浊者同时行白内障超声乳化联合人工晶状体植入术.术后患者自由选择体位,经睫状体平坦部行重硅油取出术,以重硅油取出术后视网膜完全复位为手术成功的标准.术眼的主要观察指标包括LogMAR视力、眼压、视网膜复位情况及并发症.结果 患者术前平均等效球镜度为（-14.3±3.0）D,其中7眼为复发性视网膜脱离,占35％,7眼合并脉络膜脱离,占35％.接受玻璃体切割联合重硅油填充术后视网膜复位占95％ （19/20）,一次手术视网膜复位者占90％ （18/20）,二次手术后视网膜复位者占5％ （1/20）,1眼经二次手术后仍有局限性视网膜脱离.术眼LogMAR视力由术前的2.77±0.81增加到术后的1.22±0.46,差异有统计学意义（P=0.000）.术中未行白内障摘出术的术眼术后均出现不同程度的晶状体后囊膜混浊,术后2眼发生非一过性眼压升高. 结论 玻璃体切割联合重硅油眼内填充术后患者视力改善,术后对患者体位无特殊要求,可有效治疗高度近视黄斑裂孔视网膜脱离.

玻璃体切割联合硅油填充与C3F8填充治疗高度近视黄斑裂孔视网膜脱离临床效果比较

背景高度近视黄斑裂孔视网膜脱离（MHRD）可造成严重的视力下降，经睫状体平坦部的玻璃体切割术联合眼内填充术已应用于该病的临床治疗，目前常用的眼内填充物包括硅油及可膨胀性气体C3F8，两种填充物的效果比较仍缺少相关研究证据。目的评价玻璃体切割联合硅油填充与C3F8填充治疗高度近视黄斑裂孔视网膜脱离的手术效果。方法采用回顾性病例对照设计。对采用玻璃体切割联合眼内填充术治疗的51例高度近视MHRD患者，根据术中眼内填充物的不同将患者分为硅油填充组和C3F8填充组，两组患者基线资料一致。对两组术眼术后的最佳矫正视力（BCVA）、视网膜复位率、黄斑裂孔闭合情况及视网膜脱离复发率进行分析和比较。结果两组患者术前视力差异无统计学意义（U=266．000，P=0．286），基线视力一致，术中不同眼内填充物治疗后视力差异亦无统计学意义（U=205．000，P=0．029）；应用硅油填充及C3F8填充患者BCVA术后与术前相比均有显著提高，差异均有统计学意义（Z=-2．729，P=0．006；Z=-3．273，P=0．001），两组患者术后视网膜脱离发生率及黄斑裂孔解剖闭合率差异均无统计学意义（P=0．894、1．000）。患者除自内障外无其他并发症发生。结论应用C3F8填充治疗高度近视MHRD与硅油填充治疗效果相同，且均安全、有效。

氩激光治疗视网膜裂孔的疗效分析

目的 评估氩激光治疗视网膜裂孔的疗效及影响因素。方法 视网膜干性裂孔 2 92例 ,局限性视网膜脱离伴裂孔 113例 ,对接受氩激光治疗的患者进行性别、年龄、近视屈光度及裂孔类型比较 ,以分析不同类型视网膜裂孔患者的氩激光疗效。结果 氩激光视网膜干性裂孔疗效显著 ;对局限性视网膜脱离伴裂孔的疗效取决于视网膜脱离的范围、程度以及裂孔的部位大小形状及近视屈光度 ;性别不影响光凝疗效。结论 视网膜干性裂孔应尽早光凝治疗 ,大于 2