Zhao Dongsheng's Retinal Detachment Surgery: Including Intraocular Diseases and Vitreous Microsurgery

Author: Zhao Dongsheng
Editor: Fang Tingyuan
Publisher:
Publish Date: 1999-02-01
Features:
Fragment: The development of the retina follows a pattern of thickening followed by flattening. Thickening refers to an increase in cell number, while flattening refers to the expansion from the posterior pole of the eye to the periphery. The order of cell differentiation is also from the inside out. Inner ganglion cells first differentiate from the inner neuroepithelium, and outer neuroepithelial cells later differentiate into photoreceptors. Following this pattern, the evolution of each layer of the retina also develops in the order of the inside out. Thus, a fully developed retina consists of the following nine layers from the inside out: inner limiting membrane, retinal fiber layer, ganglion cell layer, inner plexiform layer, inner nuclear layer, outer plexiform layer, outer nuclear layer, outer limiting membrane, and photoreceptor layer, totaling nine layers. Adding the retinal pigment epithelium, which evolves from the outer layer of the optic cup, gives a total of ten layers. By the time a fetus is born, all ten layers of the retina have fully developed (Figure 1-3). If a particular tissue fails to develop during embryonic development, it is called aplasia. Among these, lens aplasia is relatively common and is also the main one. If the lens fails to develop, the primitive optic vesicle cannot form an optic cup. In such cases, what is left is only a cystic structure called a cystic eye, which is essentially congenital anophthalmia. During embryonic development, if tissue growth is poor or abnormal, it is called dysplasia. Lens dysplasia can lead to the entire eye developing abnormally, particularly when the neural retina fails to adhere to the retinal pigment epithelium, a condition known as congenital retinal nonattachment. While nonattachment between the two layers is normal during embryonic development, it becomes pathological after birth and is often accompanied by other abnormalities, such as microphthalmia, persistent primary vitreous proliferation, congenital lens defects, and cataracts. In such cases, the neural retina is often dysplastic, but it can also be normal (Figure 1-4). Retinal dystrophy (retinal dystrophy) is different from retinal dysplasia. The former is a primary genetic disease with clear clinical symptoms, such as Best disease and Stargardt disease, which will be described in detail in Section 9.3.