关注视网膜脱离手术后的视功能恢复

摘要

原发性视网膜脱离手术治疗的历史已有90多年.虽然视网膜解剖复位的成功率可以达到90％以上,但视力恢复仍不够令人满意.视网膜脱离复位后究竟发生了什么变化?通过动物疾病模型的研究,已知主要在视网膜色素上皮细胞、光感受器细胞及其界面出现一系列的细胞学反应,其结构和功能重建需要较长时间.近年光学相干断层扫描(OCT)发现,光感受器内节与外节连接(IS/OS连接)断裂、外界膜(ELM)断裂,以及黄斑的微小病变,是视力后果不良的影响因素.关于手术方式等治疗因素对视力恢复的影响,仍有争议.因此,应更多地关注视网膜复位后的视力恢复,进行相关的基础和临床研究.%More than 90 years have elapsed in the history of surgical treatment for primary retinal detachment.Although the anatomical reattachment rate can reach more than 90％ after surgery,visual function is still far from satisfactory.What happens after reattachment following retinal detachment? Animal models have shown that a series of cytological changes occur mainly in the retinal pigment epithelium and photoreceptors and their junctures.And a relatively long period of tine is required for the remodeling of structure and function.The rupture of the inner segment and outer segment junctures (IS/OS junctures) of the photoreceptors and the external limiting membrane (ELM) and micro-pathologic changes in the maculae were recently found with optical coherence tomography (OCT) and these were responsible for poor visual outcomes.There is still a debate on the effects of the surgical modality on visual outcomes.Therefore,more attention should be paid to visual recovery after retinal reattachment surgery and basic and clinical research can be carried out to solve the problem.