难治性黄斑裂孔治疗研究进展  

Progress in the treatment of refractory macular hole

作　　者：时昀宏(综述) 张少冲(审校)[1] Shi Yunhong;Zhang Shaochong(Zhongshan Ophthalmic Center,Sun Yat-sen University,State Key Laboratory of Ophthalmology,Guangzhou 510060,China)

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：《中华实验眼科杂志》2021年第1期84-88,共5页Chinese Journal Of Experimental Ophthalmology

基　　金：眼科学国家重点实验室专项(30306020240020128);中山大学教育发展基金项目(83000-3050057)。

摘　　要：难治性黄斑裂孔是指玻璃体切割、内界膜剥除、眼内填充和术后俯卧位等方法难以使裂孔闭合且视力预后较差的黄斑裂孔,主要包括大直径、长病程、外伤性、继发性、高度近视性,初次手术后未闭合的黄斑裂孔。目前手术治疗方法主要包括扩大内界膜剥除术、黄斑裂孔充填术(内界膜翻转覆盖术,内界膜填塞术,晶状体前、后囊膜填塞术,自体视网膜神经上皮层移植术)、自体骨髓间充质干细胞或外泌体移植术和玻璃体腔填充术。而干细胞或外泌体移植术、新型长效内填充物术的应用及其手术技巧的改进可促进黄斑裂孔的原位愈合,是未来较有前景的治疗手段。目前所有手术方式的目标均为促使黄斑裂孔内的胶质增生以最大程度地闭合裂孔。依照循证医学证据进行更具有针对性的个体化治疗是未来发展趋势。本文就近年来难治性黄斑裂孔治疗研究进行综述,以期提高临床医师对难治性黄斑裂孔的认知并为优化和规范其治疗方案提供参考。Refractory macular hole(MH)includes large MH,traumatic MH,secondary MH,high myopic MH,unclosed MH and reopening MH.Refractory macular hole(MH)still has low anatomical closure rate and poor recovery of visual acuity after treatment of the current gold standard of pars plana vitrectomy(PPV),induction of posterior vitreous detachment,internal limiting membrane peeling and gas tamponade.Current surgical treatments include extended internal limiting membrane peeling,inverted internal limiting membrane flap,autologous internal limiting membrane transplantation,lens capsular transplantation,autologous neurosensory retinal transplantation,mesenchymal stem cells or exocrine transplantation and vitreous replacement.Stem cells or exocrine transplantation,the application of new long-acting vitreous replacement and the improvement of surgical techniques can promote the in situ healing of macular hole,which is a promising future.At present,the goal of all surgical methods is to induce or help stimulate glial tissue proliferation to enhance MH contraction and repair.Targeted individualized treatment according to the existing evidence-based medical evidence is a future trend.This article reviewed the researches on the treatment of refractory MH in recent years,in order to improve clinician'understanding of refractory MH and provide reference for optimizing and standardizing the treatment scheme.

关 键 词：难治性黄斑裂孔 玻璃体切除 干细胞 玻璃体腔填充 

分 类 号：R779.6[医药卫生—眼科]