中国眼底病手术治疗的研究热点与挑战_Chinese Journal of Ocular Fundus Diseases

Authors：

徐琼 ,  赵明威 , 黎晓新

100044 北京大学人民医院眼科教育部视觉损伤与修复重点实验室;

Corresponding author：

赵明威, Email: zhaomingwei@medmail.com.cn

Keywords：

视网膜脱离/外科学; 近视,退行性/并发症; 视网膜穿孔/外科学; 玻璃体积血/外科学; 早产儿视网膜病/外科学; 玻璃体视网膜手术; 综述

DOI：

10.3760/cma.j.issn.1005-1015.2015.04.025

Video：

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Abstract Full text Figures/Tables Video References Cited by

我国眼底病手术治疗研究较为关注的热点问题包括高度近视黄斑裂孔视网膜脱离(MHRD)、玻璃体积血、小儿视网膜病变的手术治疗方式和手术时机选择。玻璃体切割、内界膜(ILM)剥除联合眼内填充手术是治疗MHRD的常用方法。但对于ILM剥除的必要性、ILM剥除范围以及眼内填充物的选择对预后的影响等还需探讨。玻璃体切割手术是治疗玻璃体积血的有效办法,尽早明确病因并进行针对性治疗才能尽可能挽救患者视力。早产儿视网膜病变、Coats病等小儿视网膜病变因疾病主体、眼部结构的特殊性,其治疗方案的选择是临床工作的难点。玻璃体切割手术是其有效治疗手段,但有关手术时机以及如何根据病情联合其他治疗方法值得进一步探索。

Citation： 徐琼, 赵明威, 黎晓新. 中国眼底病手术治疗的研究热点与挑战. Chinese Journal of Ocular Fundus Diseases, 2015, 31(4): 399-402. doi: 10.3760/cma.j.issn.1005-1015.2015.04.025 Copy

1.	Li X, Wang W, Tang S, et al. Gas injection versus vitrectomy with gas for treating retinal detachment owing to macular hole in high myopes[J]. Ophthalmology, 2009,116(6):1182-1187.
2.	魏勇,王润生,朱忠桥,等. 内界膜剥除对适度高度近视黄斑裂孔性视网膜脱离视网膜复位及裂孔闭合的影响[J].中华眼底病杂志,2013,29(2):151-154.
3.	Zheng B, Chen Y, Zhao Z, et al. Vitrectomy and internal limiting membrane peeling with perfluoropropane tamponade or balanced saline solution for myopic foveoschisis[J]. Retina,2011, 31(4):692-701.
4.	Nakamura Y, Kondo M, Asami T, et al. Comparison of macular hole surgery without internal limiting membrane peeling to eyes with internal limiting membrane peeling with and without indocyanine green staining: three-year follow-up[J]. Ophthalmic Res,2009,41(3): 136-141.
5.	Ho TC, Yang CM, Huang JS, et al. Long-term outcome of foveolar internal limiting membrane nonpeeling for myopic traction maculopathy[J]. Retina,2014,34(9):1833-1840.
6.	陈楠,董晓光,原松强,等. 高度近视黄斑裂孔性视网膜脱离裂孔闭合意义及影响因素[J].中国实用眼科杂志, 2012,30(2):120-122.
7.	吴鹏,黄旭东,孙先勇,等. 内界膜剥除及其联合内界膜移植治疗特发性黄斑裂孔的疗效对比观察[J].中华眼底病杂志,2014,30(3):253-257.
8.	魏勇,王润生,朱忠桥,等. 不同程度高度近视黄斑裂孔性视网膜脱离玻璃体切割手术后疗效比较[J].中华眼底病杂志,2013,29(2):142-146.
9.	Chen YP, Chen TL, Yang KR, et al. Treatment of retinal detachment resulting from posterior staphyloma-associated macular hole in highly myopic eyes[J]. Retina,2006,26(1): 25-31.
10.	于文贞, 孙摇遥, 李娟, 等. 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[J]. 中华实验眼科杂志,2012,30(11):1036-1039.
11.	Zhang R, Wang T, Xie C, et al. Evaluation of supporting role of a foldable capsular vitreous body with magnetic resonance imaging in the treatment of severe retinal detachment in human eyes[J]. Eye,2011,25(6): 794-802.
12.	Tao Y, Tong X, Zhang Y, et al. Evaluation of an in situ chemically crosslinked hydrogel as a long-term vitreous substitute material[J]. Acta Biomaterialia,2013,9(2):5022-5030.
13.	Shi L, Huang YF. Postvitrectomy diabetic vitreous hemorrhage in proliferative diabetic retinopathy[J]. J Res Med Sci,2012,17(9):865-871.
14.	Yan H, Cui J, Lu Y, et al. Reasons for and management of postvitrectomy vitreous hemorrhage in proliferative diabetic retinopathy[J]. Curr Eye Res,2010,35(4):308-313.
15.	Khuthaila MK, Hsu J, Chiang A, et al. Postoperative vitreous hemorrhage after diabetic 23-gauge pars plana vitrectomy[J]. Am J Ophthalmol,2013,155(4):757-763.
16.	Duarte DA, Silva KC, Rosales MA, et al. The concomitance of hypertension and diabetes exacerbating retinopathy: the role of inflammation and oxidative stress[J]. Curr Clin Pharmacol,2013,8(4):266-277.
17.	Gunduz K, Bakri SJ. Management of proliferative diabetic retinopathy[J]. Compr Ophthalmol Update,2007,8(5):245-256.
18.	王颖,江枫,颜华,等. 玻璃体腔硅油或C₃F₈填充对增生型糖尿病视网膜病变并发单纯玻璃体积血玻璃体切割手术疗效的影响[J].中华眼底病杂志,2014,30(2):148-151.
19.	Pokroy R, Desai UR, Du E, et al. Bevacizumab prior to vitrectomy for diabetic traction retinal detachment[J]. Eye, 2011, 25(8): 989-997.
20.	Oshima Y, Shima C, Wakabayashi T, et al. Microincision vitrectomy surgery and intravitreal bevacizumab as a surgical adjunct to treat diabetic traction retinal detachment[J]. Ophthalmology,2009,116(5):927-938.
21.	陶勇,侯婧,黎晓新. 254例息肉样脉络膜血管病变的临床特征分析[J].中华眼底病杂志,2012,28(5):441-444.
22.	El-Sabagh HA, Abdelghaffar W, Labib AM, et al. Preoperative intravitreal bevacizumab use as an adjuvant to diabetic vitrectomy: histopathologic findings and clinical implications[J]. Ophthalmology,2011,118(4):636-641.
23.	Shiraga F, Matsuo T, Yokoe S, et al. Surgical treatment of submacular hemorrhage associated with idiopathic polypoidal choroidal vasculopathy[J]. Am J Ophthalmol,1999,128(2):147-154.
24.	Oshima Y, Ohji M, Tano Y. Pars plana vitrectomy with peripheral retinotomy after injection of preoperative intravitreal tissue plasminogen activator: a modified procedure to drain massive subretinal haemorrhage[J]. Br J Ophthalmol,2007,91(2):193-198.
25.	王雨生,田超伟,苏晓娜,等. 玻璃体切割手术治疗息肉状脉络膜血管病变引起的玻璃体积血的疗效观察[J].中华眼底病杂志,2013,29(2):159-161.
26.	Kang HM, Koh HJ, Lee CS, et al. Combined photodynamic therapy with intravitreal bevacizumab injections for polypoidal choroidal vasculopathy: long-term visual outcome[J]. Am J Ophthalmol,2014,157(3):598-606.
27.	Ma Z, Han L, Wang C, et al. Autologous transplantation of retinal pigment epithelium-Bruch's membrane complex for hemorrhagic age-related macular degeneration[J]. Invest Ophthalmol Vis Sci,2009,50(6):2975-2981.
28.	Xu Y, Zhou X, Zhang Q, et al. Screening for retinopathy of prematurity in China: a neonatal units-based prospective study[J]. Invest Ophthalmol Vis Sci,2013,54(13):8229-8236.
29.	Ertzbischoff LM. A systematic review of anatomical and visual function outcomes in preterm infants after scleral buckle and vitrectomy for retinal detachment[J]. Adv Neonatal Care,2004,4(1):10-19.
30.	Hartnett ME, Maguluri S, Thompson HW, et al. Comparison of retinal outcomes after scleral buckle or lens-sparing vitrectomy for stage 4 retinopathy of prematurity[J]. Retina,2004,24(5):753-757.
31.	赵晨,张琦,张勤,等.激光光凝治疗进展期先天性视网膜劈裂症的疗效观察[J].中华眼底病杂志,2014,30(1):38-41.
32.	Yu H, Li T, Luo Y, et al. Long-term outcomes of vitrectomy for progressive X-linked retinoschisis[J]. Am J Ophthalmol,2012,154(2):394-402.
33.	Nudleman E, Robinson J, Rao P, et al. Long-term outcomes on lens clarity after lens-sparing vitrectomy for retinopathy of prematurity[J]. Ophthalmology,2015,122(4):755-759.
34.	Sears JE, Sonnie C. Anatomic success of lens-sparing vitrectomy with and without scleral buckle for stage 4 retinopathy of prematurity[J]. Am J Ophthalmol,2007,143(5):810-813.
35.	尹虹,黎晓新,梁建宏. 4期早产儿视网膜病变巩膜扣带手术与玻璃体视网膜手术治疗疗效评价[J].中华眼底病杂志,2012,28(1):26-28.
36.	尹虹,黎晓新. 早产儿视网膜病变全视网膜脱离的玻璃体视网膜手术治疗预后[J].中华眼底病杂志,2008,24(1):5-8.
37.	赵培泉,费萍.早产儿视网膜病变诊断治疗研究现状、问题及展望[J].中华眼底病杂志,2012,28(1):3-8.
38.	Wu WC, Drenser KA, Lai M, et al. Plasmin enzyme-assisted vitrectomy for primary and reoperated eyes with stage 5 retinopathy of prematurity[J]. Retina,2008,28(Suppl 3):S75-80.
39.	于伟泓,董方田,戴荣平. Coats病的手术治疗[J].中华眼底病杂志,2005,21(3):145-147.
40.	杨琼,魏文斌,刘月明,等. 单纯玻璃体腔注射雷珠单抗及其联合其他方法治疗3期以上Coats病的疗效观察[J].中华眼底病杂志,2014,30(5):462-465.
41.	Arevalo JF, Espinoza JV, Arevalo FA. Ocular toxocariasis[J]. J Pediatr Ophthalmol Strabismus,2013,50(2):76-86.
42.	Cortez RT, Ramirez G, Collet L, et al. Ocular parasitic diseases: a review on toxocariasis and diffuse unilateral subacute neuroretinitis[J]. J Pediatr Ophthalmol Strabismus,2011,48(4):204-212.
43.	Othman AA. Therapeutic battle against larval toxocariasis: are we still far behind?[J]. Acta Trop,2012,124(3):171-178.

1. Li X, Wang W, Tang S, et al. Gas injection versus vitrectomy with gas for treating retinal detachment owing to macular hole in high myopes[J]. Ophthalmology, 2009,116(6):1182-1187.
2. 魏勇,王润生,朱忠桥,等. 内界膜剥除对适度高度近视黄斑裂孔性视网膜脱离视网膜复位及裂孔闭合的影响[J].中华眼底病杂志,2013,29(2):151-154.
3. Zheng B, Chen Y, Zhao Z, et al. Vitrectomy and internal limiting membrane peeling with perfluoropropane tamponade or balanced saline solution for myopic foveoschisis[J]. Retina,2011, 31(4):692-701.
4. Nakamura Y, Kondo M, Asami T, et al. Comparison of macular hole surgery without internal limiting membrane peeling to eyes with internal limiting membrane peeling with and without indocyanine green staining: three-year follow-up[J]. Ophthalmic Res,2009,41(3): 136-141.
5. Ho TC, Yang CM, Huang JS, et al. Long-term outcome of foveolar internal limiting membrane nonpeeling for myopic traction maculopathy[J]. Retina,2014,34(9):1833-1840.
6. 陈楠,董晓光,原松强,等. 高度近视黄斑裂孔性视网膜脱离裂孔闭合意义及影响因素[J].中国实用眼科杂志, 2012,30(2):120-122.
7. 吴鹏,黄旭东,孙先勇,等. 内界膜剥除及其联合内界膜移植治疗特发性黄斑裂孔的疗效对比观察[J].中华眼底病杂志,2014,30(3):253-257.
8. 魏勇,王润生,朱忠桥,等. 不同程度高度近视黄斑裂孔性视网膜脱离玻璃体切割手术后疗效比较[J].中华眼底病杂志,2013,29(2):142-146.
9. Chen YP, Chen TL, Yang KR, et al. Treatment of retinal detachment resulting from posterior staphyloma-associated macular hole in highly myopic eyes[J]. Retina,2006,26(1): 25-31.
10. 于文贞, 孙摇遥, 李娟, 等. 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[J]. 中华实验眼科杂志,2012,30(11):1036-1039.
11. Zhang R, Wang T, Xie C, et al. Evaluation of supporting role of a foldable capsular vitreous body with magnetic resonance imaging in the treatment of severe retinal detachment in human eyes[J]. Eye,2011,25(6): 794-802.
12. Tao Y, Tong X, Zhang Y, et al. Evaluation of an in situ chemically crosslinked hydrogel as a long-term vitreous substitute material[J]. Acta Biomaterialia,2013,9(2):5022-5030.
13. Shi L, Huang YF. Postvitrectomy diabetic vitreous hemorrhage in proliferative diabetic retinopathy[J]. J Res Med Sci,2012,17(9):865-871.
14. Yan H, Cui J, Lu Y, et al. Reasons for and management of postvitrectomy vitreous hemorrhage in proliferative diabetic retinopathy[J]. Curr Eye Res,2010,35(4):308-313.
15. Khuthaila MK, Hsu J, Chiang A, et al. Postoperative vitreous hemorrhage after diabetic 23-gauge pars plana vitrectomy[J]. Am J Ophthalmol,2013,155(4):757-763.
16. Duarte DA, Silva KC, Rosales MA, et al. The concomitance of hypertension and diabetes exacerbating retinopathy: the role of inflammation and oxidative stress[J]. Curr Clin Pharmacol,2013,8(4):266-277.
17. Gunduz K, Bakri SJ. Management of proliferative diabetic retinopathy[J]. Compr Ophthalmol Update,2007,8(5):245-256.
18. 王颖,江枫,颜华,等. 玻璃体腔硅油或C₃F₈填充对增生型糖尿病视网膜病变并发单纯玻璃体积血玻璃体切割手术疗效的影响[J].中华眼底病杂志,2014,30(2):148-151.
19. Pokroy R, Desai UR, Du E, et al. Bevacizumab prior to vitrectomy for diabetic traction retinal detachment[J]. Eye, 2011, 25(8): 989-997.
20. Oshima Y, Shima C, Wakabayashi T, et al. Microincision vitrectomy surgery and intravitreal bevacizumab as a surgical adjunct to treat diabetic traction retinal detachment[J]. Ophthalmology,2009,116(5):927-938.
21. 陶勇,侯婧,黎晓新. 254例息肉样脉络膜血管病变的临床特征分析[J].中华眼底病杂志,2012,28(5):441-444.
22. El-Sabagh HA, Abdelghaffar W, Labib AM, et al. Preoperative intravitreal bevacizumab use as an adjuvant to diabetic vitrectomy: histopathologic findings and clinical implications[J]. Ophthalmology,2011,118(4):636-641.
23. Shiraga F, Matsuo T, Yokoe S, et al. Surgical treatment of submacular hemorrhage associated with idiopathic polypoidal choroidal vasculopathy[J]. Am J Ophthalmol,1999,128(2):147-154.
24. Oshima Y, Ohji M, Tano Y. Pars plana vitrectomy with peripheral retinotomy after injection of preoperative intravitreal tissue plasminogen activator: a modified procedure to drain massive subretinal haemorrhage[J]. Br J Ophthalmol,2007,91(2):193-198.
25. 王雨生,田超伟,苏晓娜,等. 玻璃体切割手术治疗息肉状脉络膜血管病变引起的玻璃体积血的疗效观察[J].中华眼底病杂志,2013,29(2):159-161.
26. Kang HM, Koh HJ, Lee CS, et al. Combined photodynamic therapy with intravitreal bevacizumab injections for polypoidal choroidal vasculopathy: long-term visual outcome[J]. Am J Ophthalmol,2014,157(3):598-606.
27. Ma Z, Han L, Wang C, et al. Autologous transplantation of retinal pigment epithelium-Bruch's membrane complex for hemorrhagic age-related macular degeneration[J]. Invest Ophthalmol Vis Sci,2009,50(6):2975-2981.
28. Xu Y, Zhou X, Zhang Q, et al. Screening for retinopathy of prematurity in China: a neonatal units-based prospective study[J]. Invest Ophthalmol Vis Sci,2013,54(13):8229-8236.
29. Ertzbischoff LM. A systematic review of anatomical and visual function outcomes in preterm infants after scleral buckle and vitrectomy for retinal detachment[J]. Adv Neonatal Care,2004,4(1):10-19.
30. Hartnett ME, Maguluri S, Thompson HW, et al. Comparison of retinal outcomes after scleral buckle or lens-sparing vitrectomy for stage 4 retinopathy of prematurity[J]. Retina,2004,24(5):753-757.
31. 赵晨,张琦,张勤,等.激光光凝治疗进展期先天性视网膜劈裂症的疗效观察[J].中华眼底病杂志,2014,30(1):38-41.
32. Yu H, Li T, Luo Y, et al. Long-term outcomes of vitrectomy for progressive X-linked retinoschisis[J]. Am J Ophthalmol,2012,154(2):394-402.
33. Nudleman E, Robinson J, Rao P, et al. Long-term outcomes on lens clarity after lens-sparing vitrectomy for retinopathy of prematurity[J]. Ophthalmology,2015,122(4):755-759.
34. Sears JE, Sonnie C. Anatomic success of lens-sparing vitrectomy with and without scleral buckle for stage 4 retinopathy of prematurity[J]. Am J Ophthalmol,2007,143(5):810-813.
35. 尹虹,黎晓新,梁建宏. 4期早产儿视网膜病变巩膜扣带手术与玻璃体视网膜手术治疗疗效评价[J].中华眼底病杂志,2012,28(1):26-28.
36. 尹虹,黎晓新. 早产儿视网膜病变全视网膜脱离的玻璃体视网膜手术治疗预后[J].中华眼底病杂志,2008,24(1):5-8.
37. 赵培泉,费萍.早产儿视网膜病变诊断治疗研究现状、问题及展望[J].中华眼底病杂志,2012,28(1):3-8.
38. Wu WC, Drenser KA, Lai M, et al. Plasmin enzyme-assisted vitrectomy for primary and reoperated eyes with stage 5 retinopathy of prematurity[J]. Retina,2008,28(Suppl 3):S75-80.
39. 于伟泓,董方田,戴荣平. Coats病的手术治疗[J].中华眼底病杂志,2005,21(3):145-147.
40. 杨琼,魏文斌,刘月明,等. 单纯玻璃体腔注射雷珠单抗及其联合其他方法治疗3期以上Coats病的疗效观察[J].中华眼底病杂志,2014,30(5):462-465.
41. Arevalo JF, Espinoza JV, Arevalo FA. Ocular toxocariasis[J]. J Pediatr Ophthalmol Strabismus,2013,50(2):76-86.
42. Cortez RT, Ramirez G, Collet L, et al. Ocular parasitic diseases: a review on toxocariasis and diffuse unilateral subacute neuroretinitis[J]. J Pediatr Ophthalmol Strabismus,2011,48(4):204-212.
43. Othman AA. Therapeutic battle against larval toxocariasis: are we still far behind?[J]. Acta Trop,2012,124(3):171-178.

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中国眼底病手术治疗的研究热点与挑战

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