Combs J L, Welch R B
Trans Am Ophthalmol Soc. 1982;80:64-97.
A group of patients with retinal breaks without detachment were analyzed. They were divided into a treatment and a nontreatment group. The treatment group consisted of cases that the authors felt to be at high risk for the development of retinal detachment. Most of these were cases of horseshoe tears following the onset of an acute posterior vitreous detachment. Although a number of modalities were used in the treatment, a transconjunctival cryotherapy approach with topical anesthetic drops is currently used and was the most frequently employed. It is of note that while no case in this series developed a detachment because of inadequate treatment of the original tear a certain number did develop new tears and detachments. This would speak for a frequent follow-up, especially within the first three months following treatment, to anticipate such an occurrence. In the untreated group there were essentially two types of patients. One was the asymptomatic patient in which a retinal tear was found on routine examination and the other was the symptomatic patient with a round hole with pulled out operculum. New tears and or detachments also occurred in the asymptomatic group (4 of 72 eyes) but none of the round holes with pulled out opercula detached. Complications of treatment were related to the anesthesia and included vasovagal reactions and retrobulbar hemorrhage. One case seen in consultation had evidence of scleral perforation from a bridle suture and illustrates the inherent danger in any ophthalmic ocular procedure. The question of macular pucker (pre-retinal fibrosis) as a high risk of treatment is not shown by this study and in fact was more common in the untreated group than the treated group; however the vision of patients with macular pucker in the treated group was generally less than that of those untreated. Recurrent vitreous hemorrhage from bridging or avulsed vessels represented a significant problem following treatment and led to the only case of total visual loss in this study. The prophylactic treatment of acute horseshoe tears with continuing vitreous traction significantly reduces the incidence of subsequent retinal detachment. Whatever method of treatment is chosen by the surgeon, he must follow the principles laid down many years ago by Jules Gonin and completely close the tear. However, it is important to recognize that a new tear or detachment may occur in some cases and seems related to the continuing evolution of the posterior vitreous detachment or residual vitreo-retinal adherence rather than a cause of the treatment itself.
对一组未发生视网膜脱离的视网膜裂孔患者进行了分析。他们被分为治疗组和非治疗组。治疗组包括作者认为发生视网膜脱离风险较高的病例。其中大多数是急性玻璃体后脱离发生后出现马蹄形裂孔的病例。尽管治疗中使用了多种方法，但目前采用的是联合表面麻醉滴眼液的经结膜冷冻疗法，且该方法使用最为频繁。值得注意的是，虽然该系列中没有病例因对原始裂孔治疗不充分而发生视网膜脱离，但确实有一定数量的病例出现了新的裂孔和视网膜脱离。这表明需要频繁随访，尤其是在治疗后的头三个月内，以预测此类情况的发生。在未治疗组中，基本上有两种类型的患者。一种是在常规检查中发现视网膜裂孔的无症状患者，另一种是有圆形裂孔且有脱离盖膜的有症状患者。无症状组中也出现了新的裂孔和/或视网膜脱离（72只眼中有4只），但所有有脱离盖膜的圆形裂孔均未发生视网膜脱离。治疗的并发症与麻醉有关，包括血管迷走神经反应和球后出血。会诊中见到的1例病例有巩膜被缝线穿孔的证据，这说明了任何眼科手术都存在的固有风险。本研究未显示黄斑皱襞（视网膜前纤维化）作为治疗高风险的问题，事实上在未治疗组中比治疗组更常见；然而，治疗组中有黄斑皱襞的患者视力通常低于未治疗组。治疗后，桥接或撕裂血管引起的反复玻璃体出血是一个重大问题，导致了本研究中唯一一例完全失明的病例。对伴有持续玻璃体牵拉的急性马蹄形裂孔进行预防性治疗可显著降低后续视网膜脱离的发生率。无论外科医生选择何种治疗方法，他都必须遵循朱尔斯·戈南多年前制定的原则，完全封闭裂孔。然而，重要的是要认识到，在某些情况下可能会出现新的裂孔或视网膜脱离，这似乎与玻璃体后脱离的持续演变或玻璃体视网膜残余粘连有关，而不是治疗本身的原因。
