眼底老化相关沉积物的病理、多模态影像及临床意义  

Pathology,multimodal imaging and clinical significance of age-related fundus deposits

作　　者：蔡金玉(综述) 蒋燕梅 陈玲(审校)[1] CAI Jinyu;JIANG Yanmei;CHEN Ling(Department of Ophthalmology,Chongqing Key Laboratory for the Prevention and Treatment of Major Blinding Eye Diseases,Chongqing Eye Institute,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院眼科,重大致盲眼病防治重庆市重点实验室,重庆市眼科研究所,重庆400016

出　　处：《眼科学报》2025年第2期155-170,共16页Eye Science

基　　金：国家自然科学基金面上项目(82171083)。

摘　　要：眼底老化是年龄相关性黄斑变性(age-related macular degeneration, AMD)发生和进展的关键因素及病理基础,在组织病理学上主要表现为脉络膜毛细血管萎缩、布鲁赫膜(Bruch?s membrane, Br M)增厚以及视网膜色素上皮(retinal pigment epithelium, RPE)异常。Br M增厚可由多种眼底老化沉积物聚集引起,在AMD的病理机制中具有重要作用。其中,基底薄层沉积物(basal laminar deposit, BLam D)代表了RPE基底膜的弥漫性增厚,通常作为一种正常眼底老化改变。而以酯化和未酯化胆固醇等中性脂质为主的RPE基底膜下沉积物,即基底线性沉积物(basal linear deposits, BLin D)和软性玻璃膜疣,均可参与破坏脉络膜与外层视网膜间物质交换稳态,造成外层视网膜缺血、缺氧及氧化应激,是AMD早期重要病理改变。硬性玻璃膜疣主要分布于周边视网膜,多见于正常老化眼底;表皮玻璃膜疣是RPE基底膜局灶性结节状增厚的结果,眼底表现与硬性玻璃膜疣相似,但其主要分布于后极部,数量更多且密度更高。近年来逐渐加深了对视网膜下玻璃膜疣样沉积物(subretinal drusenoid deposit, SDD)的认识和研究,其是位于RPE上方的沉积物,在AMD发病机制中亦具有深刻意义。文章就几种眼底老化相关沉积物(包括硬性玻璃膜及表皮玻璃膜疣)的病理特征和多模态影像学表现进行综述,旨在帮助认识和理解这些沉积物的眼底表现、病理特征和形成机制,以及在AMD发生及进展中的临床意义。Fundus aging is a key factor and pathological basis for the development and progression of age-related macular degeneration(AMD),which is histopathologically characterized by choroidal capillary atrophy,Bruch’s membrane(BrM)thickening,and abnormalities of retinal pigment epithelium(RPE).BrM thickening can be induced by the aggregation of age-related fundus deposits and plays an essential role in the pathogenesis of AMD.Basal laminar deposits(BLamD)represent diffuse thickening of the basement membrane of RPE,usually considered to be a normal fundus aging.Basal linear deposits(BLinD)and soft drusen,mainly composed of neutral lipids such as esterified and unesterified cholesterol,can disrupt the homeostasis of material exchange between the choroid and the outer retina,resulting in ischemia,hypoxia,and oxidative stress in the outer retina,which are important pathological changes in the early AMD.Hard drusen is mainly distributed in the peripheral retina and is very common in aging fundus;Cuticular drusen are resulted from focal nodular thickening of the basement membrane of RPE,with similar appearance as hard drusen,but mainly distributed in the posterior pole and more numerous and denser.Recently,our understanding of subretinal drusenoid deposits(SDD),deposits above the RPE,has been gradually deepened and it also has profound significance in the pathogenesis of AMD.In this review,we presented the pathologic features and multimodal imaging of age-related fundus deposits(including hard drusen and cuticular drusen),aiming to help recognize and understand the manifestations,pathologic features,and formation mechanisms of these deposits,as well as their clinical significance in the development and progression of AMD.

关 键 词：眼底老化 年龄相关性黄斑变性 脂质沉积 玻璃膜疣 病理 多模态影像学 

分 类 号：R774.5[医药卫生—眼科] R772.5[医药卫生—临床医学]