本视频为2025年10月于山西省眼科医院所开展的玻璃体视网膜相关院基培训的手术范例之九。
在本视频中，Hendrick医生与学员为一名右眼黄斑前膜，且有多年糖尿病史的71岁男性患者，施行了右眼玻璃体切除术。
手术地点：山西省眼科医院，太原，山西省，中国
手术医生：Andrew M. Hendrick医生，埃默里大学 (Emory University)，美国
提示：本片为手术全记录，时长较长。
Transcript
0:00 This is an elderly patient with PDR recurrent vitreous hemorrhages despite good PRP and visually significant cataract. Anti-vegf injection given the week prior to surgery improved the vitreous hemorrhage but it was anticipated that tractional forces were contributing to the recurrent episodes. The cataract surgery proceeds uneventfully.
患者为一名老年人，既往有增殖性糖尿病视网膜病变，虽已接受充分的全视网膜光凝治疗，但仍反复发生玻璃体出血，并存在影响视力的白内障。术前一周给予抗VEGF药物注射后，玻璃体出血有所改善，但预计牵拉因素仍是反复发作的主要原因。白内障手术过程顺利，无明显并发症。
17:00 Note the miotic pupil that is not terribly problematic with good hand position. Trocars are placed. Core PPV is begun. The hyaloid is shallowly separated and quite inapparent. I seldom use triamcinolone but found it useful in this case to highlight the residual posterior vitreous.
需注意，尽管患者瞳孔较小，但凭借良好的手术操作并未造成明显困难。已置入套管，核心玻璃体切除术开始进行。玻璃体后界膜分离范围较浅，且不易辨认。我平时很少使用曲安奈德，但在本例中将其用于突出显示残留的后部玻璃体，起到了良好的辅助作用。
29:30 Finally, I get an incision in the hyaloid and I am able to lift this off the macula and near periphery. Evident pegs of neovascularization are unmasked as multifocal hemorrhages that can be treated with photocoagulation. The gel is stripped anteriorly and the case eventually proceeds in a more typical fashion.
最终，我在玻璃体后界膜上切开，并成功将其从黄斑及近周边部剥离。新生血管化的明显突起表现为多灶性出血，可通过激光光凝进行治疗。向前剥离玻璃体后，手术过程转为更为常规的操作模式。
37:05 Endolaser is used to fill in PRP and directly treat the foci of hemorrhage.
应用眼内激光补充周边视网膜光凝，并直接处理出血灶。
43:00 Air fluid exchange will reduce the likelihood of recurrent problematic VH. The preop intravitreal anti-vegf injection also helps.
特定气液交换有助于降低复发性难治性玻璃体积血的发生风险。术前玻璃体腔内注射抗VEGF药物同样具有积极作用。