渗出性年龄相关性黄斑变性并发视网膜色素上皮脱离的诊治进展  

Diagnosis and treatment of exudative age-related macular degeneration combined with retinal pigment epithelial detachment

作　　者：徐恩沛 孙先勇 XU Enpei;SUN Xianyong(School of Clinical Medicine,Weifang Medical University,Weifang 261053,Shandong,China;Fundus disease area,Weifang Eye Hospital,Weifang 261041,Shandong,China)

机构地区：[1]潍坊医学院临床学院,山东潍坊261053 [2]潍坊眼科医院眼底病区,山东潍坊261041

出　　处：《山东大学耳鼻喉眼学报》2023年第3期125-142,共18页Journal of Otolaryngology and Ophthalmology of Shandong University

摘　　要：视网膜色素上皮脱离(retinal pigment epithelial detachment,PED)是视网膜色素上皮(retinal pigment epithelium,RPE)层中基底膜和玻璃膜(Bruch膜)内胶原层发生的分离,根据RPE层下积液性质的不同,可分为多种形式,其中以浆液性视网膜色素上皮脱离(serous pigment epithelium detachment,sPED)最为常见。晚期渗出性年龄相关性黄斑变性(exudative age-related macular degeneration,eAMD)是PED最常见的疾病形式。临床上对PED的具体发病机制仍然不是很清楚,目前临床上被广泛认可的PED发病机制是Bruch膜和脉络膜的渗透系数降低,导致RPE层和脉络膜之间液体交换减少,液体积聚于RPE层下方,出现RPE层的脱离。目前临床上对PED的治疗方式主要有眼底视网膜激光光凝术、抗血管内皮生长因子药物玻璃体腔内注射以及光动力疗法等。论文结合国内外研究的最新进展,对eAMD并发PED的流行病学、发病机制、诊断及治疗等进行综述,并对其治疗方式进行讨论和展望。Retinal pigment epithelial detachment(PED)is the separation of the collagen layer in the retinal pigment epithelial(RPE)layer of the base film from the glass membrane(Bruch's membrane),which can be divided into many forms depending on the properties of the fluid substrate of the RPE layer.Among these forms,serous pigment epithelium detachment(sPED)is most commonly used for slurry-liquid retinal pigment epithelial disengagement.Exudative age-related macular degeneration(eAMD)is the most common form of disease in PED.Clinically,the specific pathogenesis of PED is still unclear.The current clinical and widely recognized PED pathogenesis is that the Bruch's membrane and vein membrane permeation coefficient decreases,resulting the reduction of fluid exchange in the RPE layer and vein membrane.This can lead to liquid accumulation under the RPE layer,thus resulting in the separation of the RPE layer.At present,the treatment of PED in clinical practice mainly includes under-eye retina laser photocoagulation,anti-neovascular drug vitreous body injection therapy,and photodynamic therapy.Based on the latest progress of research locally and internationally,this paper summarizes the epidemiology,pathogenesis,diagnosis,and treatment of eAMD with PED,and discusses and prospects of its treatment methods.

关 键 词：渗出性年龄相关性黄斑变性 视网膜色素上皮脱离 息肉样脉络膜血管病变 视网膜血管瘤样增生 血管内皮生长因子 

分 类 号：R774.5[医药卫生—眼科]