方法：回顾性筛选2012-06/2015-12我科收治的极重度PVR患者13例13眼，分析对其行玻璃体切割联合重硅油填充术及后期重硅油取出联合C₃F₈填充术的临床疗效。13眼于重硅油填充术后10～17wk行重硅油取出联合C₃F₈填充术。13眼观察随访时间为玻璃体切割联合重硅油填充术后第1～7d、出院后1、2、4～17wk，重硅油取出术后第 1～7d、出院后1、2、4、8、12、24wk复查，取油术后随诊时间不少于24wk。观察指标包括视网膜复位、最佳矫正视力、眼压、人工晶状体及并发症等。

结果：患者13眼于重硅油填充术后随诊期间，下方裂孔均封闭、视网膜均平复； 13眼分别于重硅油填充术后10～17wk行重硅油取出联合C₃F₈填充术，其中第5例患者于取油术后4wk因黄斑裂孔再次视网膜脱离，第8例患者于取油术后8wk因颞上方新的裂孔再次视网膜脱离，余11眼于取油术后随诊24wk，下方视网膜裂孔均封闭、视网膜平复。患者13眼于重硅油填充术前最佳矫正视力为光感～手动，于重硅油取出术后24wk随诊时最佳矫正视力为手动～20/250，其中重硅油取出术后再出现视网膜脱离的第5例及第8例患者于末次随诊时视力为指数和手动。4眼于重硅油填充术后1wk内出现高眼压，经抗炎和降眼压药物治疗后，眼压降至10～21mmHg，后期因重硅油乳化5眼出现药物难以控制的高眼压，对其及时行重硅油取出术，取油术后3眼曾出现一过性高眼压，经降眼压药物治疗后控制在10～21mmHg，后期3眼停用降眼压药物未再出现眼压升高情况。13眼于治疗期间未出现严重前房炎症反应、眼内炎等并发症。

结论：对极重度PVR行玻璃体切割联合重硅油填充及后期重硅油取出联合C₃F₈填充术，可获得满意的视网膜复位率，并最大限度地提高患者的预后视力。

METHODS: Totally 13 severe proliferative vitreous retinopathy(PVR)patients(13 eyes)admitted to our hospital between June 2012 and December 2015 were included. We analyzed the clinical efficacy of vitrectomy combined with heavy silicone oil tamponaded and heavy silicone oil removal combined with C₃F₈ tamponaded at late phase for 13 patients. Heavy silicone oil removal of 13 patients were performed at 10 to 17wk after heavy silicone oil tamponaded. The patients were reviewed at 1-7d after vitrectomy combined with heavy silicone oil tamponaded, 1, 2, 4 and 17wk after hospital discharge, 1-7d after the heavy silicone oil removal, 1, 2, 4, 8, 12 and 24wk after the second hospital discharge. Patients were followed up for at least 24wk after the heavy silicone oil removal. The observed indicators included the rate of retinal reattachment, the best corrected visual acuity, intraocular pressure(IOP), intraocular lens and postoperative complications.

RESULTS: During follow-up,13 eyes showed a stably reattached after heavy silicone oil tamponaded. Heavy Silicone oil of 13 patients were removed combined with C₃F₈ tamponaded for 10 to 17 wk after heavy silicone oil tamponaded. But the fifth case had retinal detachment recurrence for 4wk after heavy silicone oil removed because of macular hole and the eighth case had retinal detachment recurrence for 8wk after heavy silicone oil removed because of new superior temporal retinal hole. Follow up for 24wk, the other 11 eyes showed a stably reattached after heavy oil silicone removed. The best corrected visual acuity range of 13 eyes were in light perception to hand move before heavy oil silicone tamponaded and the best corrected visual acuity range of 13 eyes were in hand move to 20/250 for 24wk after heavy oil silicone removed. The best corrected visual acuity of the fifth case and the eighth case were count finger and hand move for 24wk after heavy oil silicone removed. Four eyes had high intraocular pressure 1wk after heavy oil silicone tamponaded which were reduced to 10-21mmHg after drug treatment. At late phase 5 eyes had drug uncontrollable high intraocular pressure which we took silicone oil removal timely. Three eyes had temporarily high intraocular pressure after heavy oil silicone removed which were reduced to 10-21mmHg after drug treatment. At late phase 3 eyes did not appear high intraocular pressure after stopping anti-glaucoma medication. Thirteen eyes had no serious complications such as anterior chamber inflammation and endophthalmitis during the treatment.

CONCLUSION: Vitrectomy combined with heavy silicone oil tamponaded and heavy oil silicone removed combined with C₃F₈ tamponaded at late phase for 13 severe proliferative vitreous retinopathy patients could achieve a satisfactory rate of retinal reattachment and improve the patients' prognostic visual acuity.