Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA.
Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, India.
Nat Rev Dis Primers. 2024 Mar 14;10(1):18. doi: 10.1038/s41572-024-00501-5.
Retinal detachment (RD) occurs when the neurosensory retina, the neurovascular tissue responsible for phototransduction, is separated from the underlying retinal pigment epithelium (RPE). Given the importance of the RPE for optimal retinal function, RD invariably leads to decreased vision. There are three main types of RD: rhegmatogenous, tractional and exudative (also termed serous) RD. In rhegmatogenous RD, one or more retinal breaks enable vitreous fluid to enter the subretinal space and separate the neurosensory retina from the RPE. In tractional RD, preretinal, intraretinal or subretinal membranes contract and exert tangential forces and elevate the retina from the underlying RPE. Finally, in exudative RD, an underlying inflammatory condition, vascular abnormality or the presence of a tumour causes exudative fluid to accumulate in the subretinal space, exceeding the osmotic pump function of the RPE. The surgical management of RD usually involves pars plana vitrectomy, scleral buckling or pneumatic retinopexy. The approach taken often depends on patient characteristics as well as on practitioner experience and clinical judgement. Advances in surgical technology and continued innovation have improved outcomes for many patients. However, even if retinal re-attachment is achieved, some patients still experience decreased vision or other visual symptoms, such as metamorphopsia, that diminish their quality of life. Continued research in the areas of neuroprotection and retinal biology as well as continued surgical innovation are necessary to enhance therapeutic options and outcomes for these patients.
视网膜脱离(RD)是指负责光转导的神经感觉视网膜与位于其下的视网膜色素上皮(RPE)分离。鉴于 RPE 对最佳视网膜功能的重要性,RD 必然导致视力下降。RD 主要有三种类型:孔源性、牵拉性和渗出性(也称为浆液性)RD。在孔源性 RD 中,一个或多个视网膜裂孔使玻璃体液体进入视网膜下空间,将神经感觉视网膜与 RPE 分离。在牵拉性 RD 中,视网膜前膜、视网膜内膜或视网膜下膜收缩并产生切线力,将视网膜从下方的 RPE 抬起。最后,在渗出性 RD 中,潜在的炎症状态、血管异常或肿瘤的存在导致渗出液在视网膜下空间积聚,超过 RPE 的渗透泵功能。RD 的手术治疗通常涉及经睫状体平坦部玻璃体切除术、巩膜扣带术或充气性视网膜固定术。所采用的方法通常取决于患者的特征以及医生的经验和临床判断。手术技术的进步和持续创新改善了许多患者的预后。然而,即使视网膜重新附着,一些患者仍会出现视力下降或其他视觉症状,如视物变形,从而降低他们的生活质量。在神经保护和视网膜生物学领域的持续研究以及持续的手术创新是必要的,以增强这些患者的治疗选择和预后。