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高度近视眼穹顶样黄斑形成机制及其与近视性并发症的关系研究进展
李昊儒
魏瑞华 [综述]
作者及单位信息
·
DOI： 10.3760/cma.j.cn115989-20221008-00472
Advances in the formation mechanism of dome-shaped macula in highly myopic eyes and its association with myopic complications
Li Haoru
Wei Ruihua
Authors Info & Affiliations
Li Haoru
Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
Wei Ruihua
Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
·
DOI： 10.3760/cma.j.cn115989-20221008-00472
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摘要

穹顶样黄斑(DSM)多表现为高度近视眼后巩膜葡萄肿区域内黄斑区向内隆起。依据光学相干断层扫描成像检查结果，DSM被分为垂直型、水平型和圆型，但其形成机制仍存在争议。DSM最初被认为与低眼压及玻璃体黄斑牵拉等有关。越来越多的研究支持DSM是为抵抗近视进展而形成的一种适应性保护机制。但最新研究表明，黄斑隆起可能是其周围区域进行性不对称的脉络膜及巩膜变薄所致，而不是黄斑中心区主动向内隆起的结果。高度近视眼DSM中常伴随多种近视性并发症，导致DSM患眼视力下降及视功能损伤，如浆液性视网膜脱离、视网膜劈裂、脉络膜新生血管、黄斑裂孔及Bruch膜缺损等。DSM与近视性并发症的因果关系尚不明确，且针对相关并发症仍无有效预防及治疗方法。本文对高度近视眼DSM形成机制及其与近视性并发症的关系进行总结，为探索高度近视的视觉预后及DSM的发病机制提供理论依据。

高度近视;并发症;光学相干断层扫描成像;穹顶样黄斑;形成机制
ABSTRACT

Dome-shaped macula (DSM) mostly presents as an inward bulging of the macular area within the area of posterior staphyloma in highly myopic eyes.According to the optical coherence tomography results, DSM has been classified as vertical, horizontal and round type, but its formation mechanism is still controversial.The appearance of DSM was initially thought to be associated with low intraocular pressure and vitreous macular traction.There is growing support that DSM is an adaptive protective mechanism developed to resist the progression of myopia.However, recent studies suggest that the macular bulge may be the result of progressive asymmetric choroidal and scleral thinning in the surrounding area, rather than active inward bulging of the central macula.In addition, DSM in highly myopic eyes is often accompanied by a variety of myopic complications that lead to decreased visual acuity and visual impairment in the eye with DSM, such as serous retinal detachment, retinoschisis, choroidal neovascularization, macular hole and Bruch membrane defects.However, the causal relationship between DSM and myopic complications is unclear, and there are still no effective preventive measures or treatments for related complications.This article summarizes the mechanism of DSM formation in highly myopic eyes and its association with myopic complications to provide a theoretical basis for exploring the visual prognosis of patients with high myopia and the pathogenesis of DSM.

High myopia;Complications;Tomography, optical coherence;Dome-shaped macula;Mechanism of formation
Wei Ruihua, Email: nc.defudabe.umtiewr
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引用本文

李昊儒,魏瑞华. 高度近视眼穹顶样黄斑形成机制及其与近视性并发症的关系研究进展[J]. 中华实验眼科杂志,2025,43(02)：164-168.

DOI:10.3760/cma.j.cn115989-20221008-00472

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穹顶样黄斑(dome-shaped macula，DSM)在光学相干断层扫描成像(optical coherence tomography，OCT)技术中被定义为视网膜色素上皮(retinal pigment epithelium，RPE)和Bruch膜的向内凸起，高度高于RPE水平线50 μm [ 1 , 2 ]。DSM在近视眼中比正视眼和远视眼更为常见 [ 3 ]，多表现为高度近视眼后巩膜葡萄肿区域内黄斑区的向内隆起。高度近视眼中DSM的患病率为9.3%～20.1% [ 2 , 4 , 5 ]，这种病理性改变在眼底生物显微镜下很难辨识。眼底照相中，连接视盘和中心凹的水平隆起的出现及黄斑区色素沉着的存在可能是DSM的重要线索 [ 5 ]。随着OCT技术的进步，DSM可以被清晰地辨识并描述。根据Caillaux等 [ 6 ]提出的分类方法将DSM类型分为水平型、垂直型和圆型。另有研究发现了存在于年轻患者中的脊形黄斑 [ 7 , 8 ]。此外，一些无后巩膜葡萄肿的非高度近视患者也发现了DSM的存在 [ 9 , 10 , 11 ]。目前，DSM的形成机制仍存在较大争议，与DSM相关的各类近视性并发症也逐渐被发现。随着眼科医师们对OCT在常规视网膜检查中所起作用认识的不断提升，以及增强深度OCT技术的发展，越来越多的研究试图阐明这种复杂病理改变的发病机制及与近视性并发症，如浆液性视网膜脱离(serous retinal detachment，SRD)和视网膜劈裂等的关系。本文旨在讨论及总结现有的相关文献，对高度近视眼DSM的形成机制及其与近视性并发症之间关系的研究进展进行综述。
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备注信息
A
魏瑞华，Email： nc.defudabe.umtiewr
B
所有作者均声明不存在利益冲突
C
国家自然科学基金 (82070929)
天津市医学重点学科（专科）建设项目 (TJYXZDXK-037A)
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