TAILIEUCHUNG - Intraocular Drug DelIvery - part 4

Tùy thuộc vào nguyên nhân cụ thể của các đội và các yếu tố khác (chẳng hạn như khả năng của bệnh nhân để thực hiện theo các nhu cầu của phẫu thuật theo), thời gian để đạt được reattachment võng mạc thường có một hoặc hai ngày, nhưng nhân dịp có thể mất nhiều hơn một tuần. Khi võng mạc là đủ phẳng chống lại RPE, phá vỡ võng mạc | Pharmacologic Retinal Reattachment with Denufosol Tetrasodium 99 and 95 following repeat operations 8 9 . Depending on specific causes of the detachment and other factors such as the ability of the patient to comply with the demands of surgical follow-up the time to achieve retinal reattachment usually takes one or two days but can on occasion take more than a week. When the retina is sufficiently flattened against the RPE the retinal breaks are closed and repaired using cryotherapy or laser photocoagulation. Reattachment can be facilitated by additional procedures such as mechanically draining the subretinal fluid or injecting gas such as sulfur hexafluoride SF6 into the vitreous 10 11 . For example a common adjunctive procedure used in scleral buckle surgery comprises posterior insertion of a small needle through the sclera choroid and RPE directly into the subretinal space to drain most of the extraneous fluid. In pneumatic retinopexy and pneumatic buckle surgeries expanding gas is injected into the vitreous and the patient positions himself or herself postoperatively such that the surface tension of the gas acts as a tamponade to block vitreal fluid entry through the retinal break and the gas buoyancy acts to flatten the retina against the RPE. Sometimes this effect is enhanced by having the patient perform specific head movements to help facilitate the gas bubble forcing fluid out from around the tear in a technique referred to as the steam roller. These mechanical procedures have proven very useful to aid in the reattachment process but are associated with significant surgical risk patient morbidity and protracted periods of convalescence. For example serious complications such as subretinal hemorrhage and retinal perforation are associated with the drainage procedure 9 12 . Successful pneumatic retinopexy requires that the patient is able to comply with a rigorous postoperative period of precise head positioning that can last for a few days and the gas .

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