Retinal detachment.

IF 76.9 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Nature Reviews Disease Primers Pub Date : 2024-03-14 DOI:10.1038/s41572-024-00501-5
Jonathan B Lin, Raja Narayanan, Elise Philippakis, Yoshihiro Yonekawa, Rajendra S Apte
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Abstract

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.

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视网膜脱落
当负责光传导的神经血管组织--神经感觉视网膜与底层视网膜色素上皮(RPE)分离时,就会发生视网膜脱离(RD)。鉴于视网膜色素上皮对视网膜最佳功能的重要性,RD 必然会导致视力下降。RD 主要有三种类型:流变性、牵引性和渗出性(也称浆液性)RD。在流变性 RD 中,一个或多个视网膜断裂使玻璃体液进入视网膜下间隙,将神经感觉视网膜与 RPE 分离。在牵引性 RD 中,视网膜前膜、视网膜内膜或视网膜下膜收缩并产生切向力,使视网膜从底层 RPE 上抬起。最后,在渗出性 RD 中,潜在的炎症状况、血管异常或肿瘤的存在导致渗出性液体积聚在视网膜下间隙,超过了 RPE 的渗透泵功能。RD 的手术治疗通常包括玻璃体旁切除术、巩膜扣锁术或气动视网膜整形术。采取哪种方法通常取决于患者的特征以及医生的经验和临床判断。手术技术的进步和不断创新改善了许多患者的治疗效果。然而,即使实现了视网膜再粘连,一些患者仍会出现视力下降或其他视觉症状,如偏盲,从而降低了他们的生活质量。有必要在神经保护和视网膜生物学领域继续开展研究,并不断进行手术创新,以提高这些患者的治疗选择和疗效。
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来源期刊
Nature Reviews Disease Primers
Nature Reviews Disease Primers Medicine-General Medicine
CiteScore
76.70
自引率
0.20%
发文量
75
期刊介绍: Nature Reviews Disease Primers, a part of the Nature Reviews journal portfolio, features sections on epidemiology, mechanisms, diagnosis, management, and patient quality of life. The editorial team commissions top researchers — comprising basic scientists and clinical researchers — to write the Primers, which are designed for use by early career researchers, medical students and principal investigators. Each Primer concludes with an Outlook section, highlighting future research directions. Covered medical specialties include Cardiology, Dermatology, Ear, Nose and Throat, Emergency Medicine, Endocrinology, Gastroenterology, Genetic Conditions, Gynaecology and Obstetrics, Hepatology, Haematology, Infectious Diseases, Maxillofacial and Oral Medicine, Nephrology, Neurology, Nutrition, Oncology, Ophthalmology, Orthopaedics, Psychiatry, Respiratory Medicine, Rheumatology, Sleep Medicine, and Urology.
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