综述
ENGLISH ABSTRACT
内界膜的组织病理学研究进展
冯姝颖
解正高 [综述]
作者及单位信息
·
DOI: 10.3760/cma.j.cn115989-20190620-00270
Advance in the histopathological research of internal limiting membrane
Feng Shuying
Xie Zhenggao
Authors Info & Affiliations
Feng Shuying
Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou 225001, China
Feng Shuying is now working at Department of Ophthalmology, the People's Hospital Affiliated to Jiangsu University
Xie Zhenggao
Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
·
DOI: 10.3760/cma.j.cn115989-20190620-00270
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摘要

内界膜位于视网膜-玻璃体交界面,由Müller细胞的基底膜组成。近年来,玻璃体切除术联合内界膜剥除术广泛应用于多种累及黄斑部的手术中,虽然其临床有效性和安全性得到了证实,但缺少必要的组织学依据,同时,大量研究显示,在各不同疾病的发展过程中,内界膜造成的影响也不尽相同。目前的研究发现,炎症细胞、胶质细胞、玻璃体细胞的增生使视网膜玻璃体界面出现生理功能紊乱,而内界膜本身也可成为肌成纤维细胞增生的支架,这些都将导致黄斑疾病的发生。本文从糖尿病视网膜病变、特发性黄斑裂孔和特发性黄斑前膜这3种疾病中的内界膜组织学研究作一综述,以帮助更好地认识病理状态下的内界膜,从超微结构方面证实内界膜剥除的安全性及必要性。

视网膜疾病;内界膜;超微结构;组织病理学
ABSTRACT

The internal limiting membrane located at vitreoretinal interface is formed by the contiguous basement membranes of Müller cells.Nowadays, vitrectomy combined with internal limiting membrane peeling has been widely used in many operations involving macular area.Although its clinical efficacy and safety have been demonstrated, it lacks the necessary histological support.At the same time, many studies have shown that the internal limiting membrane plays different roles in the occurrence of different diseases.Current studies have found that the proliferation of inflammatory cells, glial cells and vitreous cells leads to the physiological dysfunction of the vitreoretinal interface, and the internal limiting membrane can also become a scaffold for the proliferation of myofibroblasts, which will lead to the occurrence of macular diseases.This article reviewed the histological research of internal limiting membrane in terms of diabetic retinopathy, idiopathic macular hole and idiopathic macular epiretinal membrane, hoping to better understand the internal limiting membrane under pathological conditions and to confirm the safety and necessity of internal limiting membrane peeling from ultrastructure.

Retinal disease;Internal limiting membrane;Ultrastructure;Histopathology
Xie Zhenggao, Email: mocdef.3ab6178eixgz
引用本文

冯姝颖,解正高. 内界膜的组织病理学研究进展[J]. 中华实验眼科杂志,2023,41(01):84-87.

DOI:10.3760/cma.j.cn115989-20190620-00270

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内界膜位于视网膜-玻璃体交界面,由Müller细胞的基底膜组成,它的玻璃体面往往是光滑的,而视网膜面是不规则的,填补了视网膜胶质细胞产生的不规则空隙[ 1 ]。人类内界膜的厚度在10岁之后开始趋于稳定,并在接下来的几十年内保持不变,其中以黄斑区最厚[ 2 ]。经睫状体平坦部玻璃体切除术(pars plana vitrectomy,PPV)联合内界膜剥除术广泛应用于糖尿病黄斑水肿(diabetic macular edema,DME)、黄斑裂孔(macular hole,MH)、黄斑前膜(macular epiretinal membrane,MEM)等多种黄斑部病变的手术中[ 3 , 4 , 5 , 6 , 7 , 8 ]。多个临床研究证实,PPV联合内界膜剥除术可以显著提高患者术后视力、减轻顽固性DME、预防DME、MH和MEM的复发、恢复黄斑部正常的解剖结构及功能[ 9 , 10 , 11 , 12 ]。与此同时,有研究者认为,剥除内界膜时所使用染料的毒性及手术造成的Müller细胞结构改变,均可能影响术后视功能[ 13 , 14 , 15 , 16 ]。有研究者认为,剥除内界膜并未对患者预后产生特别有益的影响,不应作为常规术式,而应谨慎选择[ 17 , 18 ]。总之,内界膜剥除的安全性及必要性仍需要进一步的探究。
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解正高,Email:mocdef.3ab6178eixgz
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所有作者均声明不存在利益冲突
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江苏省研究生科研与实践创新计划项目 (XSJCX19_115)
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