值得重视的眼底病研究热点与难点：原发性视网膜脱离的治疗和手术后视力恢复  

Appreciable hotspots and problems of research for ocular fundus diseases： treatment and visual recovery after surgery of primary retinal detachment

作　　者：惠延年[1] 

机构地区：[1]第四军医大学西京医院眼科全军眼科研究所,西安710032

出　　处：《中华眼底病杂志》2013年第2期117-120,共4页Chinese Journal of Ocular Fundus Diseases

摘　　要：视网膜裂孔是主要致盲性眼病原发性视网膜脱离的原因，封闭裂孔是其治疗原则。尽管手术疗法已能使现今大多数视网膜脱离成功复位，但视网膜裂孔发生的原因、能否预防视网膜脱离的发生以及怎样才能获得视网膜复位后满意的视力恢复等基本问题，仍然困扰原发性视网膜脱离的防治。近年研究提示，视网膜裂孔的形成与玻璃体液化、后玻璃体脱离过程中异常的玻璃体视网膜附着牵拉有关。完全性后玻璃体脱离可在玻璃体基底部后缘形成裂孔，而部分性后玻璃体脱离则可引起后部裂孔，尤其是表现为视网膜外层缝隙样增厚（中心凹劈裂）和玻璃体黄斑牵拉等特征性的近视牵拉性黄斑病变。已知黄斑的微结构改变、视网膜萎缩、前膜形成等是视网膜复位后视力不良的原因。因此，应加深对玻璃体病变和牵拉机制的认识，探索其临床评估与防治途径，促进视网膜复位后的视力恢复，将原发性视网膜脱离的防治提高到新的水平。Retinal break is the cause of primary retinal detachment, which remains a main cause for visual loss, and closure of the breaks is the principle of treatment. Currently surgical treatment can successfully reattach the retina in most cases. However, some basic questions still beset treatment of the disease, such as the cause responsible for development of retinal breaks and how to prevent it, and how the visual recovery can be satisfactory after reattachment surgery. Recent research indicates that the development of retinal breaks is associated with the process of vitreous liquefaction, posterior vitreous detachment （PVD） and abnormal vitreoretinal adhesion and traction. The retinal breaks can occur in the posterior margin of the vitreous base in the eye with complete PVD. Partial PVD may cause posterior breaks especially in cases of myopic traction maculopathy associated with schisis-like thickening in the outer retina （foveoschisis） and vitreomacular traction. It is known that microstructural changes and atrophy of the macula, and epiretinal membrane formation are the reasons for poor vision after the retina is reattached. Therefore, more attention should be paid to further understand the vitreous pathology and traction mechanism, to research for methods of its clinical evaluation and strategy of prevention and treatment, and to accelerate visual recovery after reattachment surgery, in order to raise the standard of the disease treatment.

关 键 词：视网膜脱离 外科学 视网膜穿孔 外科学 玻璃体切除术 述评 

分 类 号：R77[医药卫生—眼科]