Shaimova V A, Shaimov T B, Boiko E V, Shaimov R B, Zarezina A S, Kravchenko T G, Galin A Yu, Kuchkildina S K, Shaimova T A, Aksenfeld G V, Fomin A V
Multidisciplinary center of laser medicine, Chelyabinsk, Russia.
LLP «CENTER» VISION», Chelyabinsk, Russia.
Vestn Oftalmol. 2020;136(3):32-38. doi: 10.17116/oftalma202013603132.
Tractional flap tears are the main cause of the development of regmatogenic retinal detachment (RRD). The main immediate treatment method for it is laser retinal coagulation.
Case monitoring of tractional symptomatic flap tears after laser treatment.
From 2014 to 2019 we observed 119 patients (130 eyes) with peripheral flap (horseshoe) retinal tears in acute posterior vitreous detachment. Laser coagulation of the retina was performed using Navilas 577s (577 nm), OcuLight GL (532 nm). Laser retinotomy of horseshoe tear flap and dissection of overhanging vessels were performed using Nd:YAG-ultra Q Reflex laser (1064 nm) and controlled with RTVue XR Avanti.
At the initial examination before the preventive laser coagulation, the following conditions were found: regmatogenous retinal detachment (RRD) - 8 eyes (6.2%), partial hemophthalmus - 29 (22.3%), preretinal hemorrhage - 15 (11.5%), epiretinal membrane - 9 (6.9%), non-full-thickness macular retinal breaks - 6 (4.6%), peripheral changes: retinal holes - 16 (12.3%), tears with operculum - 5 (3.8%), retinal degenerations - 40 eyes (30.8%). Observation for 5 years after laser retinopexy revealed new pathological changes: flap tears - 13 (10.6%); holes - 9 (7.4%); tears with operculum - 5 (4.1%); vitreoretinal tuft - 6 (4.9%); RRD - 3 cases (2.5%). In 16 patients (16 eyes) with horseshoe tear and pronounced vitreoretinal traction, the flap retinotomy was performed, which eliminated the traction component and prevented the development of RRD.
Follow-up of tractional symptomatic flap tears for 5 years after preventive laser retinopexy revealed the appearance of retinal detachment in 2.5% of cases. Laser retinotomy of horseshoe tear after barrier retinopexy eliminated the traction component and helped prevent the development of RRD.
牵拉性瓣状裂孔是孔源性视网膜脱离（RRD）发生发展的主要原因。其主要的即时治疗方法是视网膜激光光凝。
对激光治疗后有症状的牵拉性瓣状裂孔进行病例监测。
2014年至2019年，我们观察了119例（130只眼）急性玻璃体后脱离伴周边瓣状（马蹄形）视网膜裂孔的患者。使用Navilas 577s（577nm）、OcuLight GL（532nm）进行视网膜激光光凝。使用Nd:YAG-ultra Q Reflex激光（1064nm）进行马蹄形裂孔瓣的视网膜切开术及对悬垂血管进行分离，并通过RTVue XR Avanti进行监测。
在预防性激光光凝前的初次检查中，发现以下情况：孔源性视网膜脱离（RRD）8只眼（6.2%），部分玻璃体积血29只眼（22.3%），视网膜前出血15只眼（11.5%），视网膜前膜9只眼（6.9%），黄斑区视网膜非全层裂孔6只眼（4.6%），周边改变：视网膜裂孔16只眼（12.3%），有盖裂孔5只眼（3.8%），视网膜变性40只眼（30.8%）。激光视网膜光凝术后5年的观察发现了新的病理改变：瓣状裂孔13只眼（10.6%）；裂孔9只眼（7.4%）；有盖裂孔5只眼（4.1%）；玻璃体视网膜束6只眼（4.9%）；RRD 3例（2.5%）。在16例（16只眼）有马蹄形裂孔且玻璃体视网膜牵拉明显的患者中，进行了瓣状视网膜切开术，消除了牵拉因素，预防了RRD的发生。
预防性激光视网膜光凝术后对有症状的牵拉性瓣状裂孔进行5年随访发现，2.5%的病例出现了视网膜脱离。屏障光凝术后对马蹄形裂孔进行视网膜切开术消除了牵拉因素，有助于预防RRD的发生。
