黄斑裂孔手术中边缘碎片组织的研究进展

Advances in the study of residual fragments in macular hole surgery

特发性黄斑裂孔患眼手术中剥除内界膜(ILM)后,手术中光相干断层扫描可观察到裂孔边缘存在突向玻璃体腔内的碎片组织(RF)。目前认为RF可能来源于视网膜前增生以及与玻璃体牵拉,但存在争议,对手术后疗效的影响也不明确。但现有的研究仍有其共同点,即结果提示手术后视网膜解剖结构和视功能恢复较差的研究,手术中剥除ILM后再次染色,RF组织上残留ILM碎片;而结果提示RF有助于手术后结构和功能恢复的研究,RF组织上ILM碎片被清除干净。说明RF组织上ILM是否剥除干净对手术后疗效存在一定影响。但目前针对RF研究尚少,需从本质上认识RF,通过组织学分析以辅助判断。

Idiopathic macular hole after the internal limiting membrane(ILM)is removed during surgery,the intraoperative optical coherence tomography can be used to observe the presence of debris tissue(RF)protruding into the vitreous cavity at the edge of the hole.Current studies suggest that RF may be caused by epiretinal proliferation and vitreomacular traction,but it is still controversial,and the influence of postoperative anatomical and functional recovery is not clear.Common points can still be found,some of the studies suggest that RF is not conducive to postoperative anatomical and functional recovery during the operation,ILM fragments remain on RF tissues after ILM peeling and re-staining.However,in some studies suggest that RF is beneficial to postoperative anatomical and functional recovery,and ILM fragments on RF are removed.This suggests that whether ILM is removed on RF lead to a certain influence on the postoperative efficacy.There are few researches on RF at present,so it is necessary to understand RF from its essence and assist judgment through histological analysis.