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ENGLISH ABSTRACT
近视牵引性黄斑病变分级及诊疗研究进展
李世玮
吴强 [综述]
作者及单位信息
·
DOI： 10.3760/cma.j.cn115989-20210818-00466
Research progress in the classification, diagnosis and treatment of myopic traction maculopathy
Li Shiwei
Wu Qiang
Authors Info & Affiliations
Li Shiwei
Department of Ophthalmology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
Wu Qiang
Department of Ophthalmology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
·
DOI： 10.3760/cma.j.cn115989-20210818-00466
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摘要

近视牵引性黄斑病变(MTM)是高度近视眼黄斑部视网膜劈裂(MRS)、黄斑裂孔(MH)及黄斑部视网膜脱离(MD)等多种病理改变的总称。近年来，基于光学相干断层扫描，根据外层MRS累及的部位和范围、MTM与后巩膜葡萄肿的关系以及是否发生MH、MD等提出的新的MTM分级方法，加深了对疾病的认识，可有效评估病情及预后。MTM的发病机制可能与玻璃体视网膜粘连、内界膜牵拉及后巩膜葡萄肿产生的垂直及切线方向的牵引力有关。在MTM的自然病程中，多数MRS的形态和视功能保持稳定，劈裂的进展与劈裂的严重程度以及外层视网膜微结构的损害有关。处于进展期、视力明显受损的MTM可行手术治疗，玻璃体切割术是主要的治疗手段，对于发生MH和/或MD的MTM可选择黄斑扣带术或联合手术，对于合并长眼轴、后巩膜葡萄肿及玻璃体切割术效果不佳的MTM可选择后巩膜加固术，以达到解除内外向牵引力、复位视网膜的目的，手术效果也与多种因素有关。酶促玻璃体溶解、巩膜交联技术等也为治疗MTM提供了新思路。本文就MTM的临床特点和治疗策略进行归类总结，以指导诊疗。

近视;体层摄影术，光学相干;玻璃体视网膜手术;近视牵引性黄斑病变/诊断
ABSTRACT

Myopic traction maculopathy (MTM) is a general term for multiple pathological changes such as myopic retinoschisis (MRS), macular hole (MH), and macular detachment (MD) in highly myopic eyes.The new MTM classification methods based on optical coherence tomography, the size and the location of the outer MRS, the relationship of MTM with posterior staphyloma, occurrence of MH and MD deepen the understanding of the disease and effectively assess the condition and prognosis of the disease.The pathogenesis of MTM may be related to the perpendicular and tangential traction produced by vitreoretinal adhesion, internal limiting membrane, and the posterior staphyloma.In the natural course of MTM, the morphology and visual function of most patients with MRS remain stable, and the progression of MRS is related to the severity of schisis and damage to the outer retinal microstructure.Surgical treatment is effective for advanced MTM with significantly impaired visual function.Vitrectomy is the main treatment method for MTM.Macular buckling or combined surgery can be chosen for MRS with MH and/or MD, and posterior scleral reinforcement is also an option for the treatment of MTM with long axial length, posterior staphyloma and poor results of vitrectomy to achieve the goal of relieving internal and external traction and repositioning the retina.The effectiveness of the surgery is also related to a variety of factors.Enzymatic vitreolysis and scleral cross-linking techniques have also provided new ideas for the treatment of MTM.This article summarized the clinical features and treatment strategies of MTM to guide its diagnosis and treatment.

Myopia;Tomography, optical coherence;Vitreoretinal surgery;Myopic traction maculopathy/diagnosis
Wu Qiang, Email: nc.defudabe.umshsuw.gnaiq
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引用本文

李世玮,吴强. 近视牵引性黄斑病变分级及诊疗研究进展[J]. 中华实验眼科杂志,2023,41(08)：827-832.

DOI:10.3760/cma.j.cn115989-20210818-00466

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病理性近视(pathologic myopia，PM)是指屈光度≥－6.00 D，眼轴长度≥26.5 mm，后极部脉络膜、视网膜组织呈进行性损害的眼病[ 1 ]。PM发病率为0.9%~3.1%[ 2 ]，亚洲国家有0.2%~1.4%的患者因PM黄斑部病变导致视力损害[ 3 ]，严重影响生活质量。在PM眼中，视网膜劈裂(myopic retinoschisis，MRS)、黄斑裂孔(macular hole，MH)及黄斑部视网膜脱离(macular detachment，MD)等病理改变均可由牵引因素导致，其中以MRS最为常见，因此，2004年，Panozzo和Mercanti[ 4 ]将其统称为近视牵引性黄斑病变(myopic traction maculopathy，MTM)，其在屈光度≥－5.00 D的近视眼中的患病率约为7.3%[ 5 ]。随着频域光学相干断层扫描(optical coherence tomography，OCT)技术的快速发展以及对PM眼底黄斑部并发症的重视，临床上对MTM也有了更多的研究和认识。本文就MTM的分级、分期、发病机制、临床表现、自然病程和治疗进行综述。
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吴强，Email：nc.defudabe.umshsuw.gnaiq
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所有作者均声明不存在利益冲突
C
国家自然科学基金面上项目 (81770940)
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