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中华眼科医学杂志(电子版) ›› 2020, Vol. 10 ›› Issue (03) : 129 -134. doi: 10.3877/cma.j.issn.2095-2007.2020.03.001

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重视特发性黄斑裂孔的临床研究
郁艳萍1, 刘武2,†()   
  1. 1. 100730　首都医科大学附属北京同仁医院2017级博士研究生
    2. 100730　首都医科大学附属北京同仁医院　北京同仁眼科中心　北京市眼科研究所　北京市眼视光与视觉科学重点实验室
  • 收稿日期:2020-05-08 出版日期:2020-06-28
  • 通信作者: 刘武
  • 基金资助:
    国家自然科学基金面上项目(81070735); 北京市高层次卫生技术人才培养专项(2013-2-022)

Pay attention to clinical researches of idiopathic macular holes

Yanping Yu1, Wu Liu2,†()   

  1. 1. Doctor′s degree 2017, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
    2. Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
  • Received:2020-05-08 Published:2020-06-28
  • Corresponding author: Wu Liu
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郁艳萍, 刘武. 重视特发性黄斑裂孔的临床研究[J]. 中华眼科医学杂志(电子版), 2020, 10(03): 129-134.

Yanping Yu, Wu Liu. Pay attention to clinical researches of idiopathic macular holes[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2020, 10(03): 129-134.

特发性黄斑裂孔(IMH)是中老年人群的常见病。近年来，随着相干光断层扫描等影像学技术和玻璃体手术技术的普及，业内对该病的临床认识和治疗方法也不断丰富，手术后裂孔的闭合率也明显提高。然而，该病在临床方面还存在许多问题尚未明确。例如全身因素在IMH发病中的作用、性别因素如何影响IMH的临床表现、3期和4期IMH的本质区别、传统的内界膜剥除联合消毒空气填充手术预后的影响因素；相对于对解剖预后的重视程度，目前对该病所致的视物变形、手术区的视网膜敏感度、视觉相关生活质量的评价等除视力以外功能预后的研究；微切口手术条件下视网膜医源性裂孔的发生情况；近年来内界膜瓣技术的兴起，引出了新技术的解剖预后与功能预后是否俱佳的新话题，等等。笔者就IMH的上述相关问题进行评述。

关键词: 特发性黄斑裂孔, 玻璃体切除, 内界膜, 闭合, 视功能

Idiopathic macular hole (IMH) is a common eye disease of middle-aged and elderly people. With the popularization of imaging technologies like optical coherence tomography and vitreous surgery technology, people′s perception and treatment methods of this disease are also constantly enriched, and the surgical closure rate of the hole is also significantly improved. However, there are still many problems to be clarified in the clinical aspect of this disease. For example, the role of systemic factors in the pathogenesis of macular hole is unknown. How do gender-related factors affect the clinical manifestations of macular hole? What are the essential differences between stage 3 and stage 4 holes? What are the prognostic factors of traditional internal limiting membrane peeling and air filling surgery? In addition, in contrast to the emphasis on the anatomical outcomes, the research on the functional prognosis of the disease other than vision is still insufficient, such as metamorphopsia, retinal sensitivity in the operation area, evaluation of visual related quality of life, etc. Moreover, the occurrence of iatrogenic retinal breaks under the condition of micro-incision surgery is also one of the concerns in regard of surgical prognosis. Finally, in recent years, the development of internal limiting membrane flap technology leads to a new topic whether both the anatomical and functional prognosis of this technology are satisfactory. Therefore, the above issues of IMH are reviewed and commented.

Key words: Idiopathic macular hole, Vitrectomy, Internal limiting membrane, Closure, Visual function
图3 左眼特发性黄斑裂孔患者(图1患者)左眼行玻璃体切除术前后不同时间的左眼微视野检查图　图3A示术前，可见裂孔周围视网膜敏感度显著降低；图3B示术后1个月，可见黄斑裂孔闭合，相应区域视网膜敏感度提高；图3C示术后4个月，可见相应区域视网膜敏感度进一步提高
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