PROLIFERATIVE DIABETIC RETINOPATHY: Pathophysiology of Extraretinal Complications and Principles of Vitreous Surgery
PROLIFERATIVE DIABETIC RETINOPATHY: Pathophysiology of Extraretinal Complications and Principles of Vitreous Surgery
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增殖性糖尿病视网膜病变：视网膜外并发症的病理生理学和玻璃体手术原理
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发表时间：
1981
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通讯作者：
R. Michels
中科院分区：
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作者：
R. Michels
增殖性糖尿病视网膜病变的视网膜外并发症是由新生血管和/或纤维血管组织生长引起的，包括玻璃体出血、视网膜脱离和损害视网膜和/或视神经的其他作用。纤维血管组织生长和继发并发症的确切特征因病例而异。然而，这种疾病过程的结构发病机制是一致的，因为异常组织几乎总是沿着玻璃体后表面生长。因此，不同的地形特征和继发性并发症取决于：（1）纤维血管增殖的起源和数量，以及（2）任何后玻璃体分离的位置和程度。后者影响纤维血管组织生长的结构并决定对下方和邻近视网膜的影响。增殖性糖尿病视网膜病变的手术治疗基于这一基本结构病理生理学。手术的原则是通过逆转光学和结构并发症并防止类似问题的复发来最大程度地减少损害影响。因此，手术的目的是去除任何玻璃体内混浊物并切除玻璃体后表面。为了实现这些目标，需要各种专门技术，具体取决于每种情况下玻璃体视网膜解剖结构的复杂性。尽管如此，当目标实现时，在大多数人看来，该手术具有类似的近期和长期有益效果。本文讨论和阐述了增殖性糖尿病视网膜病变的结构病理学以及手术治疗的原则和方法，并介绍了所获得的结果和遇到的并发症。
Extraretinal complications of proliferative diabetic retinopathy are caused by neovascular and/or fibrovascular tissue growth and include vitreous hemorrhage, retinal detachment, and other effects damaging the retina and/or optic nerve. Exact features of fibrovascular tissue growth and secondary complications vary widely from case to case. However, the structural pathogenesis of this disease process is consistent because the abnormal tissue nearly always grows along the posterior vitreous surface. Therefore, differing topographic features and secondary complications are dependent on: (1) the places of origin and amount of fibrovascular proliferation, and (2) the location and extent of any posterior vitreous separation. The latter influences the configuration of the fibrovascular tissue growth and determines the effect on the underlying and adjacent retina. Surgical treatment of proliferative diabetic retinopathy is based on this fundamental structural pathophysiology. The principles of surgery are to minimize damaging effects by reversing the optical and structural complications and preventing recurrence of similar problems. Therefore, the objectives of surgery are to remove any intravitreal opacities and to excise the posterior vitreous surface. To achieve these objectives, various specialized techniques are required, depending on the complexity of the vitreoretinal anatomy in each case. Still, when the objectives are achieved, the operation has similar beneficial immediate and long-term effects in most eyes. This paper discusses and illustrates the structural pathology of proliferative diabetic retinopathy and the principles and methods of surgical therapy, and it presents the results obtained and the complications encountered.