Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
Surv Ophthalmol. 2024 Jan-Feb;69(1):85-92. doi: 10.1016/j.survophthal.2023.08.001. Epub 2023 Aug 30.
Although there have been numerous innovations in the management of retinal detachment (RD) over the past decades, there is still limited understanding of the pathophysiological processes that take place before and after repair. Summarizing key concepts using animal studies may allow for a better assessment of common pre- and postoperative microstructural abnormalities in RD. We performed a systematic literature review on Ovid MEDLINE, EMBASE, and Cochrane Controlled Register of Trials from January 1968 to January 2022, searching animal or human studies reporting retinal histologic changes following primary or induced RD. Thirty-two studies were included. Main cellular events were summarized: photoceptor apoptosis occurs as early as 12 hours after RD and, although most cells survive, there is extensive remodeling. Outer segments progressively degenerate, while inner segments are reorganized. Rod and cone opsins are redistributed, and rod axons retract while cones undergo changes in shape. Second- and third-order neurons rearrange their dendritic processes, and Müller cells become hypertrophic, growing into the subretinal space. Finally, retinal pigment epithelium cells undergo a change in their morphology. Acknowledging critical morphologic changes following RD is crucial in understanding why anatomical and functional outcomes can vary. Insights from histological studies, together with high-resolution imaging, may be key in identifying novel biomarkers in RD.
尽管在过去几十年中，视网膜脱离（RD）的治疗方法有了很多创新，但人们对修复前后发生的病理生理过程仍知之甚少。通过动物研究总结关键概念，可能有助于更好地评估 RD 常见的术前和术后微观结构异常。我们在 Ovid MEDLINE、EMBASE 和 Cochrane 对照试验注册中心进行了系统的文献综述，检索了 1968 年 1 月至 2022 年 1 月期间报告原发性或诱导性 RD 后视网膜组织学变化的动物或人类研究。共纳入 32 项研究。总结了主要的细胞事件：RD 后 12 小时内就会发生光感受器细胞凋亡，尽管大多数细胞存活，但仍有广泛的重塑。外节逐渐退化，而内节被重新排列。杆状和锥状视蛋白重新分布，杆状轴突回缩，而锥状细胞形状发生变化。二级和三级神经元重新排列其树突过程，Müller 细胞肥大，向视网膜下腔生长。最后，视网膜色素上皮细胞的形态发生变化。承认 RD 后发生的关键形态变化对于理解为什么解剖学和功能结果会有所不同至关重要。组织学研究的见解，加上高分辨率成像，可能是 RD 中识别新生物标志物的关键。
