中华眼底病杂志

中华眼底病杂志

内界膜翻转手术治疗高度近视黄斑裂孔视网膜脱离

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由于高度近视的长眼轴、后巩膜葡萄肿、黄斑区视网膜脉络膜的萎缩,使得高度近视黄斑裂孔视网膜脱离(MHRD)手术后视网膜复位率、复发率、黄斑裂孔(MH)闭合率、视力提高程度均不甚理想。目前微创玻璃体切割手术结合内界膜翻转覆盖和嵌塞术成为治疗方法上的技术热点,可促进MH闭合的作用,被认为可以显著提高高度近视MHRD的治疗效果,但对于手术后视功能提高的作用仍有争议。内界膜翻转覆盖术治疗的优势在于将松解的内界膜覆盖在MH表面形成类似基底膜的支架结构,可以更有效地刺激Müller细胞的胶质增生,更好地促进MH中组织的填充引起裂孔闭合,促进视网膜复位并减少再次脱离的可能性,未来有望成为该类疾病治疗的标准手术方式。内界膜嵌塞术相对内界膜翻转覆盖术,不容易滑脱,操作相对简单,是该术式的重要补充。未来需要进一步明确不同手术方式的选择适应证和MH愈合方式对于手术成功率和视功能恢复的预测作用,降低手术复发率。

The reattachment rate, macular hole (MH) closure rate, visual acuity improvement and re-detachment rate of MH retinal detachment (MHRD) of high myopia are not satisfactory owing to long axis oculi, posterior scleral staphyloma and macular atrophy. At present, minimally invasive vitrectomy surgery combined with the internal limiting membrane flap technique has become popular in the treatment of MHRD, as it can promote MH closure, and significantly improve the outcome of MHRD. However if this method can improve the postoperative visual function is still controversial. The advantage of this technique is that the loosened internal limiting membrane is applied to cover the MH surface to form a scaffold structure similar to the basement membrane. It can stimulate Müller cell gliosis more effectively, and promote tissue filling in the MH which results in MH closure. It can also promote retinal reattachment and reduce the likelihood of retinal re-detachment. This technique is expected to be a standard surgical method for the treatment of MHRD of high myopia in the future. The inserted internal limiting membrane flap technique is relatively easy to perform, induces stable flaps by simple procedures, and can be an essential complement procedure of the inverted internal limiting membrane flap technique. In order to reduce the recurrence rate in the future, it is necessary to further define the indications of different surgical methods and the predictive effects of MH healing mode on the success rate and visual function recovery.

关键词: 近视, 退行性/并发症; 视网膜穿孔/外科学; 视网膜脱离/外科学; 玻璃体视网膜手术; 视网膜外膜; 述评

Key words: Myopia, degenerative/complications; Retinal perforations/surgery; Retinal detachment/surgery; Vitreoretinal surgery; Epiretinal membrane; Editorial

引用本文: 刘海芸, 孙晓东. 内界膜翻转手术治疗高度近视黄斑裂孔视网膜脱离. 中华眼底病杂志, 2018, 34(2): 107-110. doi: 10.3760/cma.j.issn.1005-1015.2018.02.001 复制

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