特发性黄斑裂孔的发病机制及治疗进展

Pathogenesis and treatment progress of idiopathic macular hole

特发性黄斑裂孔(IMH)是指无明显病因发生于黄斑区视网膜神经上皮层的全层组织缺损。目前,随着对IMH认识的逐渐深入及其治疗方式的不断创新和改进,其治疗技术也呈现成熟化及多样化。研究表明,早期直径较小的IMH可以进行观察随访;奥克纤溶酶(Ocriplasmin)已被批准用于中小型黄斑裂孔和黄斑粘连(VMA)的患者;内界膜(ILM)剥除可提高解剖闭合率。然而,对于直径<250μm的IMH,尚不确定是否总是需要剥除ILM。本文讨论了IMH的发病机制、分期、分类及当前的治疗方案。基于IMH的特点和患者的差异性,拟提出一种基于循证医学的方法来为个体患者选择最佳和最实际的治疗方案。

Idiopathic macular hole(IMH)refers to a full-thickness tissue defect of the retinal neuroepithelial layer in the macular region without obvious etiology.At present,with the gradual deepening of the understanding of IMH and the continuous innovation and improvement of its treatment methods,its treatment technology has also matured and diversified.Studies have shown that early IMH with small diameter can be observed and followed up.The Ocriplasmin has been approved for use in patients with small to medium sized macular holes and vitreomacular adhesion(VMA);internal limiting membrane(ILM)removal can improve anatomical closure rate.However,for IMH with a diameter of less than 250μm,it is uncertain whether ILM removal is always required.This paper discusses the pathogenesis,stages,classification and current treatment of IMH.Based on the characteristics of IMH and patient differences,an evidence-based medicine method is proposed to select the best and most practical treatment plan for individual patients.