What is the optimal timing for rhegmatogenous retinal detachment repair?
What is the optimal timing for rhegmatogenous retinal detachment repair?
复制标题
孔源性视网膜脱离修复的最佳时机是什么？
DOI：
10.1001/jamaophthalmol.2013.4505
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发表时间：
2013
影响因子：
8.1
通讯作者：
I. Scott
中科院分区：
文献类型：
--
作者：
C. Wykoff;H. Flynn;I. Scott
孔源性视网膜脱离（RRD）是一种常见的眼部疾病，一生中约有1/170的眼睛发生，通常需要紧急手术干预。孔源性视网膜脱离可分为保留中心凹的视网膜脱离和累及中心凹的视网膜脱离。在某些情况下，这种区分可能具有挑战性，在这些情况下，中央视觉功能，症状和眼相干断层扫描（OCT）是中心凹状态的有用指标。术前视力（VA）是术后视力结果最强的预后指标。当中央视觉功能得以保留并且视网膜下液没有延伸通过中央凹时，视力恢复的预后通常相当好，大约80%的眼睛最终实现20/40或更好的VA。相比之下，当中心视力受到影响时，表明涉及中央凹光感受器，预后不太乐观，并且更易变，大约30%的患者最终达到20/40或更好的VA。1当患者出现涉及中央凹的RRD时，他们通常期望成功的解剖和视觉结果。从解剖学的角度来看，技术的进步已经产生了一系列优秀的修复技术，包括巩膜扣带术，睫状体平坦部玻璃体切除术，冷冻疗法，充气视网膜固定术，以及很少的临床观察。手术技术的选择可能会受到社会问题的影响，例如在不久的将来需要航空旅行，患者的依从性和可靠性，以及医疗条件，如镰状细胞病。相比之下，从视觉恢复的角度来看，
Rhegmatogenous retinal detachment (RRD) is a common ocular disorder that occurs in approximately 1 of 170 eyes over a lifetime, often indicating urgent surgical intervention. Rhegmatogenous retinal detachments can be divided into fovea-sparing and fovea-involving detachments. In some cases, this distinction can be challenging and in these instances, central visual function, symptoms, and ocular coherence tomography (OCT) are helpful indicators of foveal status. Preoperative visual acuity (VA) is the strongest prognostic indicator of postoperative visual outcome. When central visual function is preserved and subretinal fluid has not extended through the fovea, prognosis for visual recovery is often quite good, with approximately 80% of eyes ultimately achieving a VA of 20/40 or better. In comparison, when central vision is affected, indicating involvement of the foveal photoreceptors, prognosis is less optimistic and more variable with approximately 30% of patients ultimately achieving a VA of 20/40 or better. 1 When patients present with a fovea-involving RRD, they often expect successful anatomic and visual outcomes. From an anatomic perspective, technologic advances have yielded a host of excellent repair techniques including scleral buckling, pars plana vitrectomy, cryotherapy, pneumatic retinopexy, and, rarely, clinical observation. Choice of surgical technique may be influenced by social issues, such as need for air travel in the near future, patient compliance and reliability, and medical conditions, such as sickle-cell disease. In comparison, from a visual recovery perspective, therapies for neural regeneration in