摘要
目的 观察病理性近视内界膜表面结构的组织学变化与黄斑裂孔发生发展的关系。方法回顾分析行玻璃体切割手术的病理性近视黄斑裂孔患者34例34只眼的临床资料。患眼屈光度均超过-6．00D，眼轴26．00～33．12mm，平均眼轴长度27．74mm。5只眼为黄斑裂孔无视网膜脱离（黄斑裂孔组），29只眼为黄斑裂孔合并后极部视网膜浅脱离（视网膜脱离组）。对入选患眼行睫状体平坦部三切口的玻璃体切割手术，手术中观察Weiss环以判断玻璃体后脱离程度，获取34只眼的视网膜前膜及19只眼的内界膜组织标本，行苏木精伊红（HE）及醋酸铀枸橼酸铅双染色，采用光学及透射电子显微镜观察。结果玻璃体切割手术中，5只眼出现Weiss环，24只眼的视网膜表面有多层玻璃体组织残留。光学显微镜观察发现，内界膜表面的视网膜前膜主要由玻璃体胶原纤维，星形胶质细胞及细胞外基质组成。透射电子显微镜观察发现，19只眼的内界膜标本中，5只眼可见内界膜-玻璃体胶原纤维细胞的“三明治”样结构，1只眼可见内界膜损伤、表面组织牵引和星形胶质细胞移行。结论病理性近视玻璃体后界面劈裂、内界膜表面组织结构的变化是黄斑裂孔发生发展直至视网膜脱离的重要原冈。
Objective To investigate the histological changes of the internal limiting membrane （ILM） in pathological myopic eyes, and the relationships between those changes and the formation of macular hole. Methods The clinical data of 34 patients （34 eyes）with pathological myopia and macular hole, who had undergone vitrectomy were retrospectively analyzed. All the patients had a diopter over -6.00 D, their ocular axial length raaged from 26.00 to 33. 12 mm with an average of 27.74 mm. There were 5 eyes without retinal detachment （macular hole group）while the other 29 eyes all had posterior retinal detachment （RD group）. A standard three-port pars plana vitrectomy was performed in all eyes. The existence of Weiss ring was considered as the sign of posterior vitreous detachment. The epiretinal membranes from 34 eyes and ILM specimens from 19 eyes were stained by hematoxylin-eosin （HE） and acetate uranyl acetate-lead citrate, and then investigated under optical microscope and transmission electron microscope. Results The Weiss ring was observed in 5 eyes during the surgery, muhilayer of vitreous tissue resides on the retinal surface in 24 eyes. The results of optical microscope showed that the epiretinal membranes were composed of vitreous collagen, astrocytes and extracellular matrixes. The results from transmission electron microscope showed a sandwich structure （ILM-vitreous collagen-cells） in 5 eyes, and ILM damage, surface traction and astrocytes migration in 1 eye. Conclusions Splitting of posterior surface of vitreous and surface structure change of ILM are the major mechanisms for the formation and progression of macular holes, and even retinal detachment in high myopic eyes.
出处
《中华眼底病杂志》
CAS
CSCD
北大核心
2009年第5期333-336,共4页
Chinese Journal of Ocular Fundus Diseases
基金
上海市科委项目（054119627）
