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4.2存在的问题
朱剑峰等[40]对188例RRDChD的术式按照PVR选择手术适应证，是一项较有价值的回顾性研究，其中C13 69例，D13 42例，认为C13和D级均较适合于玻璃体手术。对于早期病例与我们的临床观察相符[9,10]。如果就治疗而言，按照PVR的分级进行手术选择无可非议。但是，就疾病的发生与预防角度去考虑就存在一些问题，因为RRD和ChD的“伴发”或“合并”有早期的和晚期的两种情况，前者就是我们定义的RRDChD，而后者就较为复杂，如果按照前述脉络膜脱离发生的不可预测的特性，怎样确认ChD和增生（PVR）的因果关系？也就是说，是ChD 导致了增生? 还是增生导致了ChD？可能，两者因素均存在；任何一种RD，无论是孔源性，还是牵拉性的，到了晚期，都会发生ChD，那么，何者为渗漏引起的呢？根据RRDChD的发现[1]和对此病的观察[210]，RRDChD不是RRD和ChD的“伴发”或“合并”简单的组合，有其联系和发生的关系，怎样的联系和关系才构成一个疾病实体（病种）。最有说服力的应该是追踪随访，在RRD早期某个时段发生了ChD，经过自然过程到PVRD，这是不现实的。如果PVR D级RRD和ChD的组合不能说明其来源，PVR D级即使有ChD，也不能称其为RRDChD的PVR D级，反之，如果RRDChD以PVR分型不妥，那么，也就失去了其PVR分型的意义，只好将它作为一种特殊类型。如果将ChD作为RRD发生后视网膜外屏障破坏的严重表现，就应作为一种并发症，也就勿谈特殊类型了。在此一点体会，只提出问题和一些假设，离下结论还为时过早，RRDChD是集神经和血管等多系统异常于一疾病的复杂临床表现，很多未知有待于进一步研究和证实。
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