内界膜的组织病理学研究进展

Advance in the histopathological research of internal limiting membrane

内界膜位于视网膜-玻璃体交界面,由Müller细胞的基底膜组成。近年来,玻璃体切除术联合内界膜剥除术广泛应用于多种累及黄斑部的手术中,虽然其临床有效性和安全性得到了证实,但缺少必要的组织学依据,同时,大量研究显示,在各不同疾病的发展过程中,内界膜造成的影响也不尽相同。目前的研究发现,炎症细胞、胶质细胞、玻璃体细胞的增生使视网膜玻璃体界面出现生理功能紊乱,而内界膜本身也可成为肌成纤维细胞增生的支架,这些都将导致黄斑疾病的发生。本文从糖尿病视网膜病变、特发性黄斑裂孔和特发性黄斑前膜这3种疾病中的内界膜组织学研究作一综述,以帮助更好地认识病理状态下的内界膜,从超微结构方面证实内界膜剥除的安全性及必要性。

The internal limiting membrane located at vitreoretinal interface is formed by the contiguous basement membranes of Müller cells.Nowadays,vitrectomy combined with internal limiting membrane peeling has been widely used in many operations involving macular area.Although its clinical efficacy and safety have been demonstrated,it lacks the necessary histological support.At the same time,many studies have shown that the internal limiting membrane plays different roles in the occurrence of different diseases.Current studies have found that the proliferation of inflammatory cells,glial cells and vitreous cells leads to the physiological dysfunction of the vitreoretinal interface,and the internal limiting membrane can also become a scaffold for the proliferation of myofibroblasts,which will lead to the occurrence of macular diseases.This article reviewed the histological research of internal limiting membrane in terms of diabetic retinopathy,idiopathic macular hole and idiopathic macular epiretinal membrane,hoping to better understand the internal limiting membrane under pathological conditions and to confirm the safety and necessity of internal limiting membrane peeling from ultrastructure.