内界膜剥离术治疗特发性黄斑裂孔的研究进展  

Research progress of internal limiting membrane dissection for idiopathic macular hole

作　　者：王佩 张静琳 秦波 WANG Pei;ZHANG Jinglin;QIN Bo(Aier School of Ophthalmology of Central South University,Changsha,Hunan,410000;Department of Ocular Fundus Disease,Guangzhou Aier Ophthalmology Hospital Affiliated to Jinan University,Guangzhou,Guangdong,510050;Department of Ocular Fundus Disease and Trauma,Shenzhen Aier Ophthalmology Hospital Affiliated to Jinan University,Shenzhen,Guangdong,518000)

机构地区：[1]中南大学爱尔眼科学院,湖南长沙410000 [2]暨南大学附属广州爱尔眼科医院眼底病科,广东广州510050 [3]暨南大学附属深圳爱尔眼科医院眼底病眼外伤科,广东深圳518000

出　　处：《实用临床医药杂志》2023年第13期135-142,共8页Journal of Clinical Medicine in Practice

基　　金：湖南省自然科学基金资助项目(2021JJ30045)。

摘　　要：玻璃体切除联合内界膜(ILM)剥离是特发性黄斑裂孔(IMH)的有效治疗方法。IMH的预后与裂孔大小及病程长短密切相关。直径<400μm的裂孔有自发闭合的可能,>400μm的裂孔很少能够自行闭合,需要玻璃体切除联合ILM剥离解除玻璃体黄斑牵引,才能达到理想的裂孔闭合率。部分直径>400μm、病程长(6~12个月)的IMH,单纯ILM剥除效果欠佳,常在ILM剥离的基础上联合应用气体填充、孔周按摩、自体血填充等手术方式优化治疗效果。但是,有研究者认为ILM剥离会造成视网膜显微结构及视功能损害。近些年ILM剥离技术不断改进,衍生出保留中心凹ILM剥离、向心牵引ILM剥离、根据黄斑裂孔(MH)形状定制ILM剥离、各种类型的ILM瓣等技术,以及ILM磨损、奥克纤溶酶药物治疗等其他方法,在保证治疗效果的基础上尽可能降低对视网膜的损害。本文基于国内外学者的临床经验,对ILM剥离治疗IMH最新进展进行综述,明确不同治疗和手术方式的特点和适用性,为临床上IMH的治疗提供参考。Vitrectomy combined with internal limiting membrane(ILM)dissection is an effective therapeutic method for idiopathic macular hole(IMH).The prognosis of IMH is closely related to size of hole and course of disease.The hole with a diameter <400μm may close spontaneously,while MH with a diameter >400μm can rarely close spontaneously,and vitrectomy combined with ILM dissection is required to relieve the vitreous fovea traction,so as to achieve the ideal closure rate of macular hole.For some IMH patients with diameter >400μm and a long course of disease(6 to 12 months),the ILM dissection alone is not well,and often requires to combined with gas filling,massage around macular hole and autologous blood filling to optimize surgery effect.However,some researchers believe that ILM dissection can cause damage to retinal microstructure and visual function.In recent years,the ILM dissection technology has been continuously improving,technologies are derived such as ILM dissection retaining fovea,centripetal traction ILM dissection,customized ILM dissection according to macular hole(MH)shape,various types of ILM flaps,and other methods such as ILM abrasion and ocriplasmin treatment,so as to reduce retinal damage as far as possible on the basis of ensuring the therapeutic effect.This paper reviewed the latest progresses of ILM dissection in the treatment of IMH based on the clinical experience of domestic and foreign scholars,in order to clarify the characteristics and applicability of different treatment and surgical methods,and provide reference for the clinical treatment of IMH.

关 键 词：特发性黄斑裂孔 内界膜剥离术 染色剂 手术技术 研究进展 

分 类 号：R779.6[医药卫生—眼科] R774.5[医药卫生—临床医学]