近视性黄斑劈裂治疗的现状及挑战

Current management strategies and challenges of myopic foveoschisis

近视性黄斑劈裂(myopic foveoschisis,MF)是高度近视患者最常引起视力损害的视网膜病变,可继发黄斑裂孔、黄斑裂孔性视网膜脱离等多种严重眼底病变。目前MF的手术方法多样,以玻璃体切除术为主,近年来后巩膜加固术的报道不断增加。MF的发病大多呈慢性进行性。患者分散、就诊少、长期未关注等问题是开展临床试验研究的难点。MF的临床表现及其评价方法多种多样,包括累及范围、劈裂高度、是否合并玻璃体后脱离、玻璃体后皮质粘连及视网膜前膜的牵拉等。对于各种情况相应处理的研究证据尚不足。除开展随机对照试验外,在大数据时代开展基于真实世界的临床研究是开展治疗MF研究的新希望。

Myopic foveoschisis(MF) is the most common macular disease that causes visual impairment in patients with high myopia,and can be followed by a variety of serious fundus diseases,such as macular hole,macular hole retinal detachment and so on.At present,the management strategies of MF are various.Although vitrectomy is standard treatment for MF,the reports of posterior scleral reinforcement are increasing in recent years.The pathogenesis of MF is mostly chronic and progressive.The difficulty of clinical trial is that patients are often scattered and lack of consultation and treatment.The clinical manifestations of MF are various,including the range of MF involvement,the height of retinal schisis,whether combined with epiretinal membrane and posterior vitreous detachment,the degree of adhesion of posterior vitreous cortex etc.To deal with various manifestations,we need corresponding research evidence,which is still relatively superficial at present.In addition to carrying out randomized controlled trials,it is a new hope to carry out real world study in the era of big data for the treatment of MF.