Helbig Horst
Klinik für Augenkrankheiten, Kantonsspital St. Gallen, Germany.
Klin Monbl Augenheilkd. 2002 Apr;219(4):186-90. doi: 10.1055/s-2002-30664.
Diabetic tractional retinal detachment is a severe complication in diabetic retinopathy. The decision for a surgical intervention has to consider the spontaneous course of the disease, intraoperative and postoperative complications and the expected functional results. An extramacular tractional detachment can remain stable for a long time and can be observed as long as the centre of the macula is not threatened. Traction to the macula can cause oedema and reduced vision, even if the macula itself is not detached. In these cases vitreous surgery can improve vision. Retinal breaks due to tractional membranes can cause a traction-rhegmatogenous retinal detachment which is usually rapidly progressive and requires early surgery. For cases with tractional detachment of the macula there is no alternative to surgery. In cases with long-standing and complete tractional detachment with severe retinal ischaemia the functional prognosis even after anatomically successful surgery is poor and it may be better not to operate.
糖尿病性牵拉性视网膜脱离是糖尿病视网膜病变的一种严重并发症。手术干预的决策必须考虑疾病的自然病程、术中及术后并发症以及预期的功能结果。黄斑外牵拉性脱离可长期保持稳定，只要黄斑中心未受威胁，就可进行观察。即使黄斑本身未脱离，对黄斑的牵拉也可导致水肿和视力下降。在这些情况下，玻璃体手术可改善视力。牵拉性膜导致的视网膜裂孔可引起牵拉性孔源性视网膜脱离，通常进展迅速，需要早期手术。对于黄斑牵拉性脱离的病例，手术是唯一的选择。对于长期完全性牵拉性脱离且伴有严重视网膜缺血的病例，即使手术在解剖学上成功，功能预后也很差，可能不进行手术更好。
