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How to treat giant retinal detachment?

Posting time:2022-12-03 09:49:04

How to treat giant retinal detachment?

Editor's note Giant tear retinal detachment (GRT) is a kind of complex retinal detachment. The disease develops rapidly, has a strong destructive force on the visual function of patients, and is difficult to treat. With the advancement of technology and the update of treatment concepts, there are more and more optional surgical treatment methods for GRT, and how to better treat GRT has become a problem that ophthalmologists are very concerned about. Now let's take a look at the exploration results of ophthalmologists at home and abroad in the diagnosis and treatment of GRT. Definition and etiology of GRT GRT refers to retinal breaks that cause retinal detachment in a range of ≥ 3 clock positions (1 quadrant) in the circular direction and with different degrees of reversed posterior edge of the hole. Common causes of GRT include postvitreal detachment, retinal degeneration, as well as ocular trauma, excessive intraoperative scleral condensation or intraocular laser photocoagulation, high myopia, and hereditary eye diseases. Surgical treatment of GRT Pneumatic retinopexy: inject sterile air or inert gas such as SF6, C3F8 into the vitreous body, and make the bubble seal the hole through the specific position of the patient, which is suitable for retinal retinal holes caused by the upper equator and posterior pole. Detachment; scleral buckling (SB): Compression of the sclera with silicone, silicon sponge or allogeneic sclera to relieve vitreous traction and promote retinal hole closure; vitrectomy: currently the most commonly used treatment for GRT is transciliary Flat part vitrectomy (PPV) combined with heavy water, silicone oil, inert gas, etc. GRT treatment options, PPV? Or PPV+SB? There has been controversy about whether the use of PPV in the treatment of GRT needs to be combined with SB. In this year's Ophthalmology Retina, Sally S. Ong et al. published the results of an international multicenter retrospective cohort study, which directly compared the use of PPV alone. Anatomical and visual functional outcomes of GRT patients treated with surgery and PPV combined with SB. CONCLUSIONS: Both PPV and PPV+SB are frequently used regimens by ophthalmologists in the management of GRT and achieve similar anatomical and visual function outcomes in adults with GRT. For the treatment of children with GRT (<18 years old), the success rate of anatomical and visual function repair in the PPV+SB group was significantly better than that in the PPV group at one year after surgery. Based on this result, the investigators hypothesized that in pediatric patients with GRT, combined SB may be beneficial because complete vitrectomy and posterior vitreous detachment and postoperative positioning are difficult. Table 1. Results of surgical anatomy in the two groups Table 2. Summary of postoperative complications in the two groups Although there are still many controversial points in the treatment of GRT, such as whether it is necessary to remove the lens during vitrectomy for GRT, and how to The exchange of heavy water and silicone oil is carried out in different situations. However, domestic and foreign ophthalmologists have not stopped exploring the diagnosis and treatment of GRT, and it is believed that these controversial issues will be answered one by one in the future. References: [1] Ma Chao, Liang Yong. Research status and progress of surgical treatment of retinal detachment with giant tears [J]. New Advances in Ophthalmology, 2017, 37(10): 993-997. [2] Sally S. Ong, Ishrat Ahmed, Anthony Gonzales, et al. Vitrectomy versus Vitrectomy with Scleral Buckling in the Treatment of Giant Retinal Tear Related Retinal Detachments. Ophthalmology Retina Volume 6, Number 7, July 2022.

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