白内障术后黄斑水肿的诊治新进展  

New progress of diagnosis and treatment in pseudophakic cystoid macular edema

作　　者：皇甫镜如(综述) 严宏(审校)[1,2] Huangfu Jingru;Yan Hong(Department of Ophthalmology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400042,China;Department of Ophthalmology,Xi'an No.4 Hospital,Shaanxi Eye Hospital,Affiliated Guangren Hospital School of Medicine,Xi'an Jiaotong University,Xi'an 700004,China)

机构地区：[1]重庆医科大学附属第一医院眼科,重庆400042 [2]西安市第四医院眼科,陕西省眼科医院,西安交通大学附属广仁医院,西安700004

出　　处：《中华实验眼科杂志》2019年第4期312-315,共4页Chinese Journal Of Experimental Ophthalmology

基　　金：国家自然科学基金项目(81370997).

摘　　要：白内障术后黄斑水肿(PCME)作为白内障术后常见的并发症,是造成术后视力减退的主要原因,其发病机制尚不明确,炎症反应是黄斑水肿形成的重要原因。糖尿病是常见的独立危险因素,且患病风险与术前糖尿病严重程度密切相关。PCME典型临床症状为术后突然的视力减退,荧光素眼底血管造影(FFA)可呈特征性花瓣状点彩,晚期可见视盘点状染色,黄斑囊样水肿(CME)最早出现在内核层(INL)中,并逐渐向外丛状层(OPL)发展,最后液体积聚于视网膜下腔。光相干断层扫描(OCT)和光相干断层扫描血管成像(OCTA)对PCME与糖尿病黄斑水肿(DME)的鉴别诊断已有新的进展。临床上普遍将局部应用非甾体类抗炎药(NSAIDs)或糖皮质激素作为一线治疗方案,抗血管内皮生长因子(anti-VEGF)作为一种新的治疗方式也受到关注。针对特殊类型PCME需个体化预防和治疗。Pseudophakic cystoid macular edema (PCME) is one of the most common complications of cataract surgery.It is the main cause of postoperative visual loss.PCME pathogenesis is unclear yet,inflammation is supposed to be an important cause.Systemic or local diseases,and complicated surgical operations may increase the risk of PCME.Diabetes is the most common independent risk factor,and the risk of PCME is closely related to severity of preoperative diabetes.Typical clinical symptoms of PCME include acute vision loss after surgery.In PCME eyes,fundus fluorescein angiography (FFA) can show the petal-like spots characteristically,and visual disc dot staining can be seen later.Cystoid macular edema (CME) first appears in the inner nuclear layer (INL) and gradually develops in the outer plexiform layer (OPL).Finally,fluid accumulates in the subretinal space.Besides,optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) have new advances in differential diagnosis between PCME and diabetic macular edema (DME).In practice,topical non-steroid anti-inflammatory drugs (NSAIDs) or glucocorticoids are generally used as first-line treatment medicines.Anti-vascular endothelial growth factor (anti-VEGF) also attracts attention as a new treatment.Individualized prevention and treatment is required for specific types of PCME.It still lacks a common recognized treatment of PCME,and long-term efficacy of the current treatment remains to be observed more rigorous and comprehensive experimental programs are required.

关 键 词：白内障术后黄斑水肿 糖尿病黄斑水肿 光相干断层扫描血管成像 抗血管内皮细胞生长因子 飞秒激光辅助 

分 类 号：R774.5[医药卫生—眼科]