giant hole retinal detachment
Introduction
Introduction to giant hiatus retinal detachment Retinal tears larger than 90° or even 360° are giant retina holes (giantretinaltear), more common in high myopia, ocular trauma and vitrectomy, the incidence of both eyes is high. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: glaucoma cataract
Cause
Causes of massive hiatal retinal detachment
(1) Causes of the disease
Related to retinal degeneration, trauma, genetic factors, etc.
(two) pathogenesis
The pathogenesis of primary disease is not completely clear. It is generally considered to be mainly related to vitreous degeneration. Under physiological conditions, the vitreous body is divided into two parts. Although there is no obvious boundary, the front part is located at 2PD before and after the serrated edge, and is 3~4mm wide. The annular attachment zone, called the basement part, where the collagen fibers of the vitreous body protrude into the inner limiting membrane of the retina, forming a vitreous and retina, a strong adhesion of the ciliary epithelium, which becomes the histological basis for generating huge hiatus, and myopia, especially for patients with high myopia. The vitreous liquefaction, fibrosis and then detachment, the posterior border of the detachment is attached to the posterior edge of the base, the contraction of the vitreous, the retina of the posterior edge of the base is pulled, and a gray-white arc wrinkle appears, and the vitreous further contracts. The retina is torn into a large hole, and there are only a few intermittent small holes at the beginning. Later, it is fused into a large hole, and the ciliary epithelium is easily torn, often with the detachment of the ciliary epithelium.
Prevention
Giant rhegmatogenous retinal detachment prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Complications of massive retinal retinal detachment Complications glaucoma cataract
Can be combined with glaucoma, complicated cataract and eyeball atrophy.
Symptom
Giant retinal detachment symptoms common symptoms plaid degeneration eyeball contusion
1. Non-traumatic retinal giant hole
The patients were mainly young and middle-aged, and the males were significantly more than the females. About 78% of the patients were 21 to 50 years old. The disease was common in myopic patients, and the high myopia (above -8D) accounted for more than 40%. And often have a family genetic predisposition.
The onset of the disease is rapid, the early symptoms are the same as the general rhegmatogenous retinal detachment, that is, there is a sense of flash and floating mosquitoes. At this time, the fundus can be completely normal, from the appearance of symptoms to the formation of a large retinal tear. It can be as short as 1 to 2 weeks, binocular. Indirect ophthalmoscopy and three-sided mirror for detailed fundus examination, peripheral retinal compression whitening and vitreous detachment as early manifestations of large holes.
The large retinal hole of the retina belongs to the torn hole, which occurs at the posterior edge of the base of the vitreous, and is more common in the temporal side, often accompanied by a posterior flap.
The factors affecting the back flap roll are as follows:
(1) The location of the hole: due to the relationship between the subretinal fluid and the retinal gravity of the posterior flap, the posterior flap of the upper hole is easy to roll down, covering the optic disc and the lower part of the fundus. The upper semi-negative pigment epithelium shows a uniform reddish brown It is often mistaken for the retina that is not detached, but the retinal blood vessels are not visible in the pigment epithelial layer. It is easy to distinguish the retina that is rolled down by the binocular indirect ophthalmoscope on the lower retina.
(2) Size of the hole: As the curvature of the hole increases, the activity of the back lobes increases, so it is easy to roll. Generally, the hole is more than 150° and easy to roll.
(3) If there are radial tears at both ends of the huge hole, it increases the mobility of the back flap and is easy to roll.
(4) The heavier the degree of liquefaction of the vitreous, the worse the supporting force of the posterior flap of the huge hole, and the easier the back flap is to be rolled. Generally, the large hole is accompanied by different degrees of vitreous liquefaction and detachment.
(5) The traction of the anterior membrane of the retina can cause the huge posterior flap to be rolled and fixed. In the operation, there is a anterior membrane under the valve.
The large retinal hole has a tendency to continue to expand, and it can expand along the non-compressed whitening part of the retina, and it is more likely to expand along the radial tearing end of the retina, which may be related to the arrangement of nerve fibers.
The incidence of proliferative vitreoretinopathy is high in people with large holes. Due to the exposure of large pigment epithelium, pigment epithelial cells are easy to swim and proliferate, causing hyperplasia around the retina. Due to gravity and body position, cell proliferation occurs in the hole. The lower end and the rolled back flap form an annular and longitudinal retinal fold, which is further contracted to cause the posterior flap to be crimped and folded, resembling a pocket or roller blind, and a post-retinal hyperplasia, forming a ring-shaped proliferative membrane of the napkin, plus tearing along with the tear. Post-crack tissue repair reaction, thickening, stiffness, shortening of the whole layer of the retina, this is a proliferation of the retina, there seems to be no membrane entanglement on the surface, large holes with severe proliferative vitreoretinopathy, surgical treatment is difficult, vision Poor prognosis.
2. Traumatic retinal giant hole
Caused by eyeball contusion, it is the avulsion of the vitreous body from the jagged edge of the attachment point, resulting in the retinal neuroepithelial detachment. It is not the retinal itself. It occurs in the nasal upper quadrant and the temporal side. The disease develops slowly and there are few holes. The tendency to expand, the prognosis of surgery is better.
3. A huge hole secondary to choroidal and retinal degeneration
(1) The large retinal tear of the lattice-like degeneration is the result of vitreoretinal degeneration. The large hole often occurs along the posterior edge of the lattice-like degeneration, which occurs in the equator and the upper and lower parts. The nasal side is rare, and the vitreous in front of the degeneration area is The liquefaction changes, the vitreous at the edge concentrates, fibrosis, and forms a firm adhesion with the retina, and when the vitreous shrinks, a large hole appears at the edge of the denatured zone.
(2) The large holes that are complicated by retinal coagulation treatment are often caused by excessive electrocoagulation, condensation, photocoagulation and local retinal necrosis leading to the formation of huge holes.
Examine
Inspection of giant retinal detachment
B-ultrasound can show the state of retinal detachment, and sometimes the location of the hole can be determined according to the continuity of the retina.
Diagnosis
Diagnosis and diagnosis of giant retinal detachment
According to the fundus performance can be diagnosed.
