近视性黄斑劈裂手术治疗的研究进展

Research progress of surgical treatment of myopic foveoschisis

近视性黄斑劈裂(MF)早期症状较轻,但其病程呈进行性发展,当继发黄斑脱离或黄斑裂孔时会导致严重的视力下降。因此,现普遍认为MF患者应在出现症状后早期进行手术干预,以防止其进一步发展为黄斑裂孔或黄斑裂孔视网膜脱离。现普遍认为玻璃体皮质和后巩膜葡萄肿对视网膜组织的牵拉在MF发生发展中起重要作用,手术方式也主要分为经玻璃体解除视网膜牵拉的玻璃体视网膜手术和经巩膜外路途径复位视网膜的黄斑扣带手术两类。对于玻璃体视网膜手术是否联合内界膜剥除和气体填充目前尚未形成广泛共识,保留中心凹部分的内界膜剥除是当前的研究热点。黄斑扣带手术相比于玻璃体视网膜手术,可以解除后巩膜葡萄肿对视网膜的牵拉,但其无法解除视网膜切线方向上的牵引力。内外路联合手术似乎能够结合两者的优点,弥补两者不足,但其具体的疗效仍需进一步探究。临床工作中对MF患者进行个体化分析,权衡各手术的优缺点,对不同病情的患者选择最合适的手术方式十分必要。未来探索有助于MF复位和手术后视功能改善且并发症相对较少的手术方式依然是我们的重点研究方向。

Myopic foveoschisis(MF)has mild early symptoms,however,its course is progressive.When the secondary macular detachment or macular hole occurs,it can cause severe vision loss.Therefore,it is generally believed that MF patients should undergo surgical intervention early after the onset of symptoms to prevent them from further developing into a macular hole or macular hole retinal detachment.It is generally believed that the traction of the vitreous cortex and posterior scleral staphyloma to the retina plays an important role in the occurrence and development of MF.The operation mode is divided into vitreoretinal surgery and macular buckling,the former release the retinal traction via the vitreous body and the latter reattaches the retina via the extrascleral approach.There is no consensus on whether to perform internal limiting membrane peeling and gas tamponade in vitreoretinal surgery and the fovea-sparing internal limiting membrane peeling has become a hot topic in recent years.Compared with vitreoretinal surgery,macular buckling can release the traction of the retina caused by posterior scleral staphyloma,but it cannot relieve the traction in the tangential direction of the retina.Vitreoretinal surgery and extrascleral surgery seems to make up the shortcomings of both,however,the effect of treatment on patients still needs further verification.In clinical work,it is necessary to conduct individualized analysis of MF patients,weigh the advantages and disadvantages of each operation,and choose the most suitable operation mode for patients with different conditions.In the future,the emphasis of our work is to develop operation mode with great curative effect and less complications.