Stirpe M, Heimann K
Fondazione G.B. Bietti per I'Oftalmologia, Roma, Italy.
Eur J Ophthalmol. 1996 Jan-Mar;6(1):50-8. doi: 10.1177/112067219600600111.
This report on 496 highly myopic eyes that underwent transcleral or vitreoretinal surgery for retinal detachment (RD) focuses particularly on how changes in the vitreous gel and the resulting modifications of the vitreoretinal interface produce typical characteristics and complications. According to the pattern of vitreous modifications the 496 eyes were divided into five groups: 1) eyes with uniform PVD (108 eyes) 2) eyes with PVD spreading towards the upper quadrants (231 eyes) 3) eyes with extensive vitreous liquefaction (EVL) and condensations of the vitreous base (51 eyes) 4) eyes with posterior vitreous lacuna (PVL, 87 eyes) 5) eyes with very limited PVD (19 eyes). Age, degree of myopia, surgical procedures and final results are reported for each group. A strong correlation was observed between vitreous changes and clinical picture of RD especially in the group of PVL and EVL. In the PVL group a higher degree of myopia was found and more pronounced posterior staphyloma. Frequently the posterior hyaloid, in the form of a thin, extremely smooth membrane, was hard to separate from the inner posterior retina during surgery. Posterior retinal breaks, including macular holes, were found in 56% of eyes. The presence of EVL with condensation of the vitreous base was correlated with giant retinal tear (GRT) in 70% of cases (36 of 51 eyes). Sixteen GRT were also found in the group of uniform PVD, but these were less extensive and located more posteriorly than in the EVL group. In the former group there were better surgical results because of a lower incidence of PVR. In 46% of the eyes of our series (group 2), PVD extended mostly in the upper quadrants with no vitreous detachment inferiorly. In these cases there was a clinical appearance of inferior vitreous collapse. These eyes had 92% of peripheral superior retinal breaks. Relapses of RD in this group almost invariably occurred in the inferior quadrants.
这份关于496只高度近视眼睛的报告，这些眼睛因视网膜脱离（RD）接受了经巩膜或玻璃体视网膜手术，特别关注玻璃体凝胶的变化以及由此产生的玻璃体视网膜界面改变如何产生典型特征和并发症。根据玻璃体改变的模式，将这496只眼睛分为五组：1）均匀性玻璃体后脱离（PVD）的眼睛（108只）；2）PVD向上象限扩展的眼睛（231只）；3）广泛玻璃体液化（EVL）和玻璃体基底部浓缩的眼睛（51只）；4）玻璃体后腔隙（PVL，87只）的眼睛；5）PVD非常有限的眼睛（19只）。报告了每组的年龄、近视程度、手术方式和最终结果。观察到玻璃体变化与RD的临床表现之间存在密切相关性，特别是在PVL和EVL组。在PVL组中，发现近视程度更高，后葡萄肿更明显。在手术过程中，后玻璃体通常呈薄而极其光滑的膜状，很难与视网膜内后部分离。56%的眼睛发现了包括黄斑裂孔在内的视网膜后部裂孔。70%的病例（51只眼中的36只）中，EVL伴玻璃体基底部浓缩与巨大视网膜裂孔（GRT）相关。在均匀性PVD组中也发现了16个GRT，但这些裂孔比EVL组的范围更小，位置更靠后。由于增殖性玻璃体视网膜病变（PVR）发生率较低，前一组的手术效果更好。在我们系列的46%的眼睛（第2组）中，PVD主要向上象限扩展，下方无玻璃体脱离。在这些病例中，有下方玻璃体塌陷的临床表现。这些眼睛周边上视网膜裂孔占92%。该组RD复发几乎总是发生在下象限。
