巨大裂孔视网膜脱离手术治疗的研究现状与进展

Current status and progress of surgical management of giant retinal tear

巨大裂孔视网膜脱离(giant retinal tear,GRT)是指引起视网膜脱离的裂孔范围在环形方向上≥3个钟位(1个象限)伴有裂孔后缘不同程度翻转的视网膜裂孔。随着科技的发展,GRT的手术成功率大大提高。吊顶灯的应用,可以使术者完成双手操作,23G、25G、27G等显微技术的应用可以方便器械进出,使手术操作范围增加。眼科内镜的应用,可以减少屈光间质对手术的影响。术前眼内药物的应用,可以做好术前准备。但是,是否需要联合巩膜扣带术,是否需要术中摘出晶状体,以及对翻转、僵硬的视网膜的手术方式的选择还存有不同观点。本文从GRT的发病机制、手术方式、术中和术后填充物等方面的现状及进展做一综述。

Giant retinal tear （GRT） refers to a retinal break extending circumferential for ≥ 3 clock hours （≥90°） of the retinal with trailing edge folding.With the development of technology,success rate of surgical for GRT was increased.Chandelier illumination can help surgeons complete the operation by themselves,and 23G,25G,27G microsurgical techniques make it easy for the application of surgical instruments and amplify the scope of operation.Meanwhile,endoscope can reduce the impact of refractive media opacity.Administration of preoperative intraocular medicine is helpful for the operation.However,there is no definite findings of whether adjuvant scleral buckling and lens extraction are necessary in the management of GRT as well as how to deal with retinal stiff and flap of GRT.And this article tries to summarize the pathogenesis,surgical methods and pre- and post-operative stuffing of the GRT.