Burton T C
Eye Institute, Milwaukee County Medical Complex, Wisconsin.
Trans Am Ophthalmol Soc. 1989;87:143-55; discussion 155-7.
This study indicates the feasibility of stratifying the general population into various risk pools for retinal detachment depending on a person's age, refractive status, and the presence of lattice degeneration. At first impression the risks seem at variance with the fine clinical studies of Byer, who has shown a very low detachment rate in the population with lattice degeneration. In all likelihood the vast majority of his patients were emmetropic or mildly myopic, so that very few would be expected to develop detachments during their entire lifetimes, let along during intervals of only 10 to 20 years. This study shows the futility of following, or treating prophylactically, young emmetropic individuals with lattice degeneration. Assuming that prophylaxis is actually effective, one would have to treat 1000 emmetropic lattice patients in the 30 to 39 year age group to prevent a single detachment over a 10-year period. Lattice patients with low to moderate degrees of myopia tend to develop detachments between 40 and 60 years of age caused by premature posterior vitreous separation and tractional tears. Clearly prophylaxis for this group is not warranted, since only 5% to 10% of these individuals will experience detachments in their lifetimes. On the other hand this study has verified the previous suspicions that persons with myopia exceeding -5.0 D accompanied by lattice degeneration have an extraordinarily high risk of detachment during their lifetimes. Detachments in this group tend to cluster in the second, third, and fourth decades, are typically caused by atrophic holes, are slowly progressive, and are often simultaneously bilateral. Enhanced vigilance is certainly appropriate during this time and perhaps consideration should be given to prophylactically treating this group. This would be no small task, since within a population of 1 million persons there would be about 1150 aged 10 to 39 years with myopia exceeding -5.0 D and lattice degeneration. Only 4 detachments annually and 40 detachments in 10 years would be expected in this highest risk group.
本研究表明，根据一个人的年龄、屈光状态和格子样变性的存在情况，将普通人群分层为不同的视网膜脱离风险组是可行的。乍一看，这些风险似乎与拜尔的精细临床研究结果不一致，拜尔的研究表明，有格子样变性的人群中视网膜脱离率非常低。很可能他的绝大多数患者是正视眼或轻度近视，因此预计在他们的一生中很少有人会发生视网膜脱离，更不用说在仅10至20年的时间段内了。本研究表明，对年轻的正视眼格子样变性患者进行随访或预防性治疗是徒劳的。假设预防实际上是有效的，那么在30至39岁年龄组中，必须治疗1000名正视眼格子样变性患者，才能在10年期间预防一例视网膜脱离。低度至中度近视的格子样变性患者往往在40至60岁之间因过早的玻璃体后脱离和牵拉性裂孔而发生视网膜脱离。显然，对这一组患者进行预防是没有必要的，因为这些人中只有5%至10%的人在一生中会发生视网膜脱离。另一方面，本研究证实了先前的怀疑，即近视超过-5.0 D并伴有格子样变性的人在一生中发生视网膜脱离的风险极高。这一组的视网膜脱离往往集中在第二、第三和第四个十年，通常由萎缩性裂孔引起，进展缓慢，且常常是双侧同时发生。在此期间提高警惕肯定是合适的，也许应该考虑对这一组进行预防性治疗。这可不是一项小任务，因为在100万人口中，大约有1150人年龄在10至39岁之间，近视超过-5.0 D并伴有格子样变性。在这个最高风险组中，预计每年只有4例视网膜脱离，10年内有40例视网膜脱离。
