新生血管性年龄相关性黄斑变性中视网膜下高反射物质的研究进展

Advances in subretinal hyperreflective material in neovascular age-related macular degeneration

视网膜下高反射物质(SHRM)是光学相干断层扫描中显示的一种高反射性形态学特征,位于神经上皮外层、色素上皮内层。其常见于未经治疗或经抗血管内皮生长因子治疗后的新生血管性年龄相关性黄斑变性(nAMD),也可见于中心性浆液性脉络膜视网膜病变、葡萄膜炎、近视性脉络膜新生血管、近视性黄斑变性、Best病、视网膜营养不良和脂质肉芽肿病等。SHRM与患者眼部椭圆体带缺失、瘢痕形成、外界膜损伤、黄斑萎缩及外层视网膜管型结构等关系密切,并与视力损害显著相关。抗血管内皮生长因子治疗可显著消退部分SHRM,不同成分及特征的SHRM对治疗有不同的预后反应。明确nAMD中SHRM的形态特征及其功能后果,进一步加深临床对SHRM的认识。

Subretinal hyperreflective material(SHRM)is a morphologic feature seen on optical coherence tomography as hyperreflective material outside the retina and within the retinal pigment epithelium.SHRM is common in untreated neovascular age-related macular degeneration(nAMD)and often persists after anti-vascular endothelial growth factor therapy.It is also seen in central serous chorioretinopathy,uveitis,myopic choroidal neovascularization,myopic macular degeneration,Best disease,retinal malnutrition,Erdheim-Chester disease and so on.SHRM is closely associated with loss of the ellipsoid zone,scarring,disruption of outer limiting membrane,macular atrophy and outer retinal tubulations,and is significantly associated with visual impairment.Some SHRM was regression after anti-vascular endothelial growth factor therapy.The prognosis and responses to treatment of SHRM may vary depending on its components and characteristics.Identifying the morphologic characteristics and functional consequences of SHRM in nAMD may deepen the clinical understanding of SHRM.