特发性黄斑前膜的研究进展

发布时间：2019-05-17 18:26

【摘要】：视网膜前膜是位于玻璃体与视网膜内界膜之间的一层纤维细胞膜,发生在黄斑区的视网膜前膜称为黄斑前膜。黄斑前膜按照病因可分为特发性黄斑前膜和继发性黄斑前膜。特发性黄斑前膜的确切发病原因和形成机制目前仍然不清,其中最广泛被接受的理论是玻璃体后脱离引起的视网膜内界膜损伤导致来自其下方的视网膜胶质细胞和其他细胞迁移并在内界膜上增殖形成黄斑前膜。黄斑前膜早期为半透明的薄膜,可以完全无症状,随着前膜的发展增厚,膜收缩时引起黄斑结构异常,最终导致患者视物变形和中心视觉功能下降。特发性黄斑前膜多发生在50岁以上人群,其发病率逐渐上升,发病年龄呈现年轻化趋势。按照眼底镜下的表现,黄斑前膜可分为早期玻璃纸样反光型和后期黄斑纤维增生型。黄斑纤维增生型黄斑前膜可引起浅层或全层视网膜皱褶、牵引、血管迂曲或扩张,严重者可引起视网膜出血、渗出、血管异常、水肿和黄斑裂孔,导致进一步的视力损害。光学相干断层扫描、对比敏感度、视野检查、眼底照相、多焦视网膜电图和眼底荧光血管造影等客观检查技术常常被用于对黄斑前膜的诊断以及形态和功能变化的评估。因为光学相干断层扫描检查具有方便、无创、直观和可重复性强等优点,所以在黄斑前膜的诊断、评估预后和术后随访中应用越来越广泛,成为黄斑前膜诊断的金标准。黄斑前膜的治疗目前尚无统一标准,主要的治疗方法包括随访观察、药物和手术治疗。近几年,很多研究者在研究药物治疗黄斑前膜的方法,其中药物溶解玻璃体术较为有前景。但是,手术治疗仍是目前黄斑前膜最主要的治疗方法。本文主要回顾了近年来黄斑前膜发病机制和治疗的相关研究,探讨特发性黄斑前膜的发病机制和治疗的发展方向。
[Abstract]:The anterior retinal membrane is a layer of fiber membrane between vitreous and retinal inner limiting membrane. The anterior retinal membrane, which occurs in macular area, is called macular membrane. According to the etiology, the anterior macular membrane can be divided into Idiopathic macular membrane and secondary macular membrane. The exact cause and formation mechanism of Idiopathic macular membrane are still unclear. Among them, the most widely accepted theory is that the injury of retinal inner limiting membrane caused by posterior vitreous detachment leads to the migration of retinal glial cells and other cells from below it and the proliferation of retinal glial cells and other cells from the inner limiting membrane to form macular membrane. The anterior macular membrane is a translucent film in the early stage, which can be completely asymptomatic. With the development of the anterior membrane, the macular structure is abnormal when the membrane contract, and finally leads to the deformation of the visual object and the decrease of the central visual function of the patients. Most of the Idiopathic macular membrane occurred in the population over 50 years old, the incidence of which increased gradually, and the age of onset showed a younger trend. According to the fundus microscopic findings, the anterior macular membrane can be divided into early glass pattern reflective type and late macular fiber hyperplasia type. Macular fiber hyperplasia macular membrane can cause superficial or full layer retinal wrinkle, traction, vascular detour or dilatation, severe can cause retinal hemorrhage, exudation, vascular abnormalities, edema and macular hole, leading to further visual impairment. Objective techniques such as optical coherence tomography, contrast sensitivity, visual field examination, fundus photography, multifocal electroretinography and fundus fluorescein angiography are often used for the diagnosis of macular membrane and the evaluation of morphological and functional changes. Because optical coherence tomography has the advantages of convenience, noninvasive, intuitionistic and reproducibility, it is more and more widely used in the diagnosis, prognosis evaluation and postoperative follow-up of macular membrane, which has become the gold standard for the diagnosis of macular membrane. There is no unified standard for the treatment of macular membrane. The main treatment methods include follow-up observation, medicine and surgical treatment. In recent years, many researchers have been studying the treatment of macular membrane with drugs, among which drug dissolution vitreous surgery is more promising. However, surgical treatment is still the most important treatment of macular membrane. In this paper, the pathogenesis and treatment of macular membrane in recent years were reviewed, and the pathogenesis and treatment of idiopathic anterior macular membrane were discussed.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R774.5

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