摘要
外伤性黄斑裂孔(traumatic macular hole,TMH)主要是指眼球在受到直接或间接、闭合或开放的外力创伤下立即或延迟发生的黄斑中心凹区的视网膜裂孔,在组织学上是从内界膜到感光细胞层的部分或全部组织缺损。目前的主要非手术治疗包括:定期随访观察,口服血塞通、地塞米松等药物,手术治疗方式为玻璃体切除联合气体或硅油填充术,术中内界膜(inner limiting membrane,ILM)剥除等,术中辅助使用转化生长因子-β2、自体浓缩血小板、血清填充裂孔等。治疗进展主要包括局部非甾体类抗炎药物促进裂孔自愈,玻璃体切除手术系统进步、手术治疗方式增加(ILM移植术、ILM翻瓣术、自体晶状体囊膜移植术等)、术中辅助药物更新(基因重组纤溶酶等)。各种治疗干预方式中,松解黄斑裂孔周围牵拉、提供Muller细胞增生支架和促进光感受器功能恢复是需要关注研究的重点,更安全的生物黏合剂、生物填充材料、干细胞移植、组织工程视网膜移植等可能是未来值得期待的治疗手段。本文就TMH治疗及研究进展进行综述。
Traumatic macular hole(TMH) mainly refers to the retinal tear in the fovea of the macula that occurs immediately or after a direct or indirect,closed,or open external trauma to the eyeball,and is histologically defined by the inner limiting membrane,defective part or all of the tissue in the photoreceptor layer.Current major non-surgical treatments include:regular follow-up observations,oral medications such as Xuesaitong and dexamethasone,surgical treatment with vitrectomy combined with gas or silicone oil filling,and intra-operative internal limiting membrane(ILM) stripping.Intraoperative assistance includes the use of transcription factor-β2,autologous platelet concentrates,and serum-filled holes.Progress of treatment includes local NSAID drugs to promote self-healing of the hiatus,advancement of vitrectomy system,increased surgical treatment(ILM transplantation,ILM flap surgery,autologous lens capsule transplantation,etc.),and intraoperative adjuvant drug renewal(ocriplasmin,etc.) In various therapeutic interventions,mobilization around the macular hole,provision of Müller cell hyperplasia scaffolds,and promotion of photoreceptor function recovery are the focus of attention,safer bio-adhesives,bio-filled materials,stem cell transplantation,and tissue engineered retina Transplantation,etc.may be a worthwhile treatment in the future.This article reviews the treatment and research progress of traumatic macular hole.
作者
王星
彭惠
WANG Xing;PENG Hui(the Department of Ophthalmology,the First Affiliated Hospital of Chongqing Medical University,Chongqing Key Laboratory of Ophthalmology,Chongqing Eye Institute,Chongqing 400016,China)
出处
《眼科新进展》
CAS
北大核心
2019年第6期583-588,共6页
Recent Advances in Ophthalmology
基金
国家自然科学基金资助(编号:81670881)~~
