Trese M T, Ferrone P J
Kresge Eye Institute, Wayne State University, Detroit, Michigan, USA.
Graefes Arch Clin Exp Ophthalmol. 1995 Nov;233(11):706-8. doi: 10.1007/BF00164673.
The purpose of this paper is to describe the technique and application of relief of vitreous traction and inner wall retinectomy in the management of juvenile retinoschisis (JRS). In addition, during the course of this study a previously undescribed form of tractional retinal detachment associated with retinal schisis was observed.
Six eyes of four children with visual field and/or central vision loss underwent vitrectomy (in five of the six eyes the lenses were preserved), inner wall retinectomy and photocoagulation for rhegmatogenous/schisis retinal detachment, tractional retinal detachment and reduced central vision secondary to intraschisis hemorrhage overhanging the macula.
The children were followed up for 1 to 4 years. All eyes showed anatomic reattachment. Three of the four eyes that could be tested for vision showed improved visual function postoperatively. One eye showed marked enlargement of visual field and central visual acuity improvement from 20/200 preoperatively to 20/50 postoperatively.
Inner wall retinectomy can be a useful ajunct in the management of the retinal complication of JRS. Appropriate case selection of eyes with associated central traction retinal detachment can result in improved visual field and central visual acuity. The success of this technique suggests that the mechanical and/or pharmacological relief of vitreous traction may be able to alter the clinical course of JRS.
本文旨在描述玻璃体牵引松解术和视网膜内壁切除术在青少年视网膜劈裂症（JRS）治疗中的技术及应用。此外，在本研究过程中，观察到一种与视网膜劈裂相关的、此前未描述过的牵拉性视网膜脱离形式。
对4例患有视野缺损和/或中心视力丧失的儿童的6只眼进行了玻璃体切除术（6只眼中有5只眼保留了晶状体）、视网膜内壁切除术以及光凝治疗，以治疗孔源性/劈裂性视网膜脱离、牵拉性视网膜脱离以及黄斑区上方劈裂内出血导致的中心视力下降。
对这些儿童进行了1至4年的随访。所有眼睛均实现了解剖复位。4只可进行视力测试的眼中，有3只术后视觉功能得到改善。1只眼视野明显扩大，中心视力从术前的20/200提高到术后的20/50。
视网膜内壁切除术在JRS视网膜并发症的治疗中可能是一种有用的辅助方法。对伴有中心性牵拉性视网膜脱离的眼睛进行适当的病例选择，可改善视野和中心视力。该技术的成功表明，玻璃体牵引的机械性和/或药物性松解可能能够改变JRS的临床病程。
