中华眼底病杂志

中华眼底病杂志

认识特发性黄斑裂孔分类及治疗新趋势 提升特发性黄斑裂孔诊断治疗水平

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特发性黄斑裂孔(IMH)分期分类是IMH诊断治疗的基础。根据光相干断层扫描(OCT)检查所见的玻璃体视网膜形态特征,将IMH分为原发性或继发性;有玻璃体附着或无玻璃体附着;根据玻璃体附着情况分为玻璃体黄斑附着和玻璃体黄斑牵引;依据水平方向测量的黄斑裂孔直径大小,分为大中小黄斑裂孔。IMH新的分类体系及具体分类指标丰富完善了传统IMH4期分期理论,更好地描述了IMH的发生发展过程,应作为当今IMH诊断分型和玻璃体视网膜手术治疗指征判断、具体手术方式选择以及手术疗效评估的基本准则。内界膜(ILM)剥除对神经节细胞的损害是IMH玻璃体视网膜手术关注的重点。对于复杂、大的IMH,采用ILM瓣翻转技术进行治疗有助于提高其黄斑裂孔的闭合率;对于小于250 μm的IMH,玻璃体视网膜手术时不需要剥除ILM,手术后也不需要面向下的头低位。根据每个患者IMH新的分类信息等眼部及全身特点,依照现有的循证医学证据进行个体化的手术治疗是IMH玻璃体视网膜手术的发展趋势。

Appropriate classification and staging is the basis for the diagnosis and treatment of idiopathic macular hole (IMH). According to the appearance of vitreous and retina determined by optical coherence tomography, IMH can be classified as primary or secondary IMH, and IMH with or without vitreous attachment; Vitreous attachment can be further classified as vitreomacular adhesion or vitreomacular traction. According to the measured horizontal diameter, IMH can be classified as large, middle and small IMH. This new classification system and comprehensive parameters improve the traditional Ⅳ-stage theory, with a better description of the occurrence and development of IMH process. It should be used as the general principal to guide IMH classification, evaluation of surgical indications, selection of operative method, and estimation of surgical outcome. Ganglion cell damage caused by internal limiting membranes (ILM) peeling is the major concern in the IMH vitreoretinal surgery. For complicated and large IMH, inverted ILM flapping can improve the closure rate; ILM peeling and postoperative face-down posture are not necessary for IMH less than 250um in diameter. The current vitreoretinal surgery trend to treat IMH is personalized surgical treatment, following the existing evidence-based medical evidence, and based on the new classification information, ocular and systemic features of each patient.

关键词: 视网膜穿孔/诊断; 视网膜穿孔/治疗; 述评

Key words: Macular hole/ diagnosis; Macular hole/ therapy; Editorial

引用本文: 吕林. 认识特发性黄斑裂孔分类及治疗新趋势 提升特发性黄斑裂孔诊断治疗水平. 中华眼底病杂志, 2017, 33(4): 333-335. doi: 10.3760/cma.j.issn.1005-1015.2017.04.002 复制

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