Application of vitreoretinal surgery to inflammatory and infectious disease of the posterior segment.
Application of vitreoretinal surgery to inflammatory and infectious disease of the posterior segment.
复制标题
玻璃体视网膜手术在后段炎症和感染性疾病中的应用。
DOI：
10.1097/00004397-199203220-00004
复制
发表时间：
1992
影响因子：
--
通讯作者：
Freeman,WR
中科院分区：
文献类型：
--
作者：
Freeman,WR
Relatively safe access to the posterior segment for diagnostic and therapeutic procedures can be had with modern vitreoretinal surgical techniques. Modern vitreous surgery is performed through 20-gauge incisions in the pars plana, 3 to 4 mm behind the limbus. Entry at this site avoids the vascularized ciliary processes yet is anterior to the ora serrata. Entry through the pars plana involves passage of instruments through the vitreous base, and retinal traction associated with such manipulation of the vitreous base presents a risk of peripheral retinal break formation and retinal detachment. It is largely for this reason that most modern vitreous surgeons prefer 20-gauge instrumentation and no longer utilize so-called full-function probes. Modern vitrectomy instrumentation is designed to minimize the possibility of causing retinal breaks or dialysis formation in relationship to the entry site. If the sclerotomies are carefully inspected with indirect ophthalmoscopy and scleral depression at the end of the diagnostic or therapeutic procedure, prophylactic scleral buckling often is unnecessary if no pathological process is detected. Because 20-gauge instrumentation is preferred, any procedure involving more than minimal vitreous cavity manipulation requires three sclerotomies: one for a vitrectomy probe, one for a 20-gauge fiberoptic light pipe, and a third for a 20-gauge infusion cannula. It is possible, however, to perform some procedures with the indirect ophthalmoscope using only two sclerotomies; one for the infusion cannula and one for the vitrectomy instrument. Prior to diagnostic or therapeutic vitrectomy in a patient with uveitis, thorough examination of the peripheral retina is mandatory. In the majority of cases, the peripheral retina may be examined with scleral depression despite significant media opacity. The indirect ophthalmoscope, preferably one with halogen illumination, must be used in inflamed eyes. The periph-
