病理性近视继发脉络膜新生血管诊疗现状与进展  

Choroidal neovascularization secondary to pathologic myopia： a recent update on diagnosis and treatment

作　　者：占宗议 李梓敬[1] 丁小燕[1] 

机构地区：[1]中山大学中山眼科中心眼科学国家重点实验室,广州510060

出　　处：《中华眼底病杂志》2016年第1期104-107,共4页Chinese Journal of Ocular Fundus Diseases

摘　　要：病理性近视继发脉络膜新生血管（PM—CNV）的危险因素包括老龄、眼轴长、中心凹下脉络膜厚度薄、患眼有萎缩斑或漆裂纹，其发病机制可能与这些因素引起的视网膜色素上皮萎缩或缺氧导致外层视网膜分泌血管内皮生长因子（VEGF）有关。荧光素眼底血管造影检查可提示PM—CNV病灶类型、位置和活动性。光相干断层扫描检查可见活动期PM—CNV表现为紧临视网膜色素上皮的强反射区域伴极少量视网膜下积液；瘢痕期表现为病灶表面强反射，伴下方信号快速衰减；萎缩期则表现为平坦退化病灶和脉络膜视网膜萎缩。光动力疗法与抗VEGF药物玻璃体腔注射是目前治疗PM—CNV的主要方法。其中，抗VEGF药物玻璃体腔注射为目前更多推崇关注的治疗方法。但其治疗频率、再治疗及终止治疗标准等具体用药方案以及治疗效果的影响因素均需更多大样本随机对照研究进一步观察探讨。Pathological myopia can induce choroidal neovascularization （PM-CNV）. The potential risk factors include ageing, long axial length of the eyeball, thinning of suhfoveal choroidal thickness, fundus atrophy spot and lacquer crack. These factors may induce atrophy of retinal pigment epithelial cells （RPE） and hypoxia, resulting in vascular endothelial growth factors （VEGF） secretion by outer retina. The lesion type, location and activity of PM CNV can be determined by fundus fluorescein angiography. The features of PM- CNV on optical coherence tomography include strong reflective area close to RPE with very small amount of subretinal fluid （active stage）, surface strong reflection with signal attenuation area （scar stage） and flat lesion and chorioretinal atrophy （atrophy stage）. Photodynamic therapy and intravitreal injection of anti-VEGF drugs are major treatments for PM-CNV, the latter is more commonly used now. However, more large randomized controlled studies are required to explore the treatment regimen （such as frequency, indications for repeated or termination of treatment） and the efficacy factors further.

关 键 词：脉络膜新生血管化/诊断 脉络膜新生血管化/治疗 近视 退行性/并发症 综述 

分 类 号：R778.11[医药卫生—眼科] R773.4[医药卫生—临床医学]