高度近视黄斑劈裂治疗研究进展_Chinese Journal of Ocular Fundus Diseases

Authors：

李楚 , 郑文斌 , 黄浩 ,  朱晓波

510060 广州, 中山大学中山眼科中心眼科学国家重点实验室;

Corresponding author：

朱晓波, Email: zhuxbo@mail.sysu.edu.cn

Keywords：

近视,退行性/并发症; 近视,退行性/外科学; 视网膜穿孔/外科学; 玻璃体视网膜手术; 综述

DOI：

10.3760/cma.j.issn.1005-1015.2015.04.026

Video：

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高度近视黄斑劈裂(MF)治疗主要针对中心视力明显下降和(或)伴有黄斑裂孔、黄斑脱离等并发症的患者。治疗方式主要有玻璃体切割手术(PPV)、后巩膜加固手术、后巩膜加固联合PPV、脉络膜上腔加压的黄斑加固手术、单纯玻璃体注气或联合后极部视网膜激光光凝等。PPV可获得较高的视网膜复位率及视力的改善效果,但在是否联合内界膜剥除及眼内填充物的选择上存在争议。后巩膜加固手术操作相对简单,可降低内眼手术的风险,但其安全性及有效性有待大样本临床研究证实。新型脉络膜上腔加压的黄斑加固手术对PPV治疗失败的患眼有较好效果,但远期疗效需进一步追踪观察。玻璃体腔注气或联合后极部视网膜激光光凝较其他手术治疗方案风险更小,操作简单且可重复,为临床提供了一种新的选择与治疗思路。

Citation： 李楚, 郑文斌, 黄浩, 朱晓波. 高度近视黄斑劈裂治疗研究进展. Chinese Journal of Ocular Fundus Diseases, 2015, 31(4): 402-405. doi: 10.3760/cma.j.issn.1005-1015.2015.04.026 Copy

1.	Ichibe M,Baba E,Funaki S,et al. Retinoschisis in a highly myopic eye without vision impairment[J]. Retina,2004,24(2): 331-333.
2.	Gaucher D,Haouchine B,Tadayoni R,et al. Long-term follow-up of high myopic foveoschisis: natural course and surgical outcome[J]. Am J Ophthalmol,2007,143(3): 455-462.
3.	Shimada N,Tanaka Y,Tokoro T,et al. Natural course of myopic traction maculopathy and factors associated with progression or resolution[J]. Am J Ophthalmol,2013,156(5):948-957.
4.	Ripandelli G,Rossi T,Scassa C,et al. Macular vitreoretinal interface abnormalities in highly myopic eyes with posterior staphyloma: 5-year follow-up[J]. Retina,2012,32(8): 1531-1538.
5.	Fujimoto M,Hangai M,Suda K,et al. Features associated with foveal retinal detachment in myopic macular retinoschisis[J]. Am J Ophthalmol,2010,150(6): 863-870.
6.	Shimada N,Ohno-Matsui K,Yoshida T,et al. Progression from macular retinoschisis to retinal detachment in highly myopic eyes is associated with outer lamellar hole formation[J]. Br J Ophthalmol,2008,92(6): 762-764.
7.	Gao X,Ikuno Y,Fujimoto S,et al. Risk factors for development of full-thickness macular holes after pars plana vitrectomy for myopic foveoschisis[J]. Am J Ophthalmol,2013,155(6):1021-1027.
8.	Shimada N,Ohno-Mastsui K,Baba T,et al. Natural course of macular retinoschisis in highly myopic eyes without macular hole or retinal detachment[J]. Am J Ophthalmol,2006,142(3): 497-500.
9.	Hwang JU,Joe SG,Lee JY,et al. Microincision vitrectomy surgery for myopic foveoschisis[J]. Br J Ophthalmol,2013,97(7):879-884.
10.	Shin JY,Yu HG. Visual prognosis and spectral-domain optical coherence tomography findings of myopic foveoschisis surgery using 25-gauge transconjunctival sutureless vitrectomy[J]. Retina,2012,32(3): 486-492.
11.	Bando H,Ikuno Y,Choi JS,et al. Ultrastructure of internal limiting membrane in myopic foveoschisis[J]. Am J Ophthalmol,2005,139(1): 197-199.
12.	Sayanagi K,Ikuno Y,Tano Y. Reoperation for persistent myopic foveoschisis after primary vitrectomy[J]. Am J Ophthalmol,2006,141(2): 414-417.
13.	Yeh SI,Chang WC,Chen LJ. Vitrectomy without internal limiting membrane peeling for macular retinoschisis and foveal detachment in highly myopic eyes[J]. Acta Ophthalmol,2008,86(2): 219-224.
14.	Taniuchi S,Hirakata A,Itoh Y,et al. Vitrectomy with or without internal limiting membrane peeling of reach stage of myopic traction maculopathy[J]. Retina,2013,33(10):2018-2025.
15.	Ho TC,Chen MS,Huang JS,et al. Foveola nonpeeling technique in internal limiting membrane peeling of myopic foveoschisis surgery[J]. Retina,2012,32(3): 631-634.
16.	Lim SJ,Kwon YH,Kim SH,et al. Vitrectomy and internal limiting membrane peeling without gas tamponade for myopic foveoschisis[J]. Graefe's Arch Clin Exp Ophthalmol,2012,250(11): 1573-1577.
17.	张娅萍,薛安全,王毓琴,等.非内界膜剥离的玻璃体切除术联合长效气体填充治疗病理性近视继发黄斑劈裂[J].中华眼科杂志,2011,47(6):497-503.
18.	Kim KS,Lee SB,Lee WK. Vitrectomy and internal limiting membrane peeling with and without gas tamponade for myopic foveoschisis[J]. Am J Ophthalmol,2012,153(2): 320-326.
19.	Zheng B,Chen Y,Chen Y,et al. Vitrectomy and internal limiting membrane peeling with perfluoropropane tamponade or balanced saline solution for myopic foveoschisis[J]. Retina,2011,31(4): 692-701.
20.	Ward B,Tarutta EP,Mayer MY. The efficacy and safety of posterior pole buckles in the control of progressive high myopia[J]. Eye (Lond),2009,23(12): 2169-2174.
21.	Ward B. Degenerative myopia:myopic macular schisis and the posterior pole buckle[J]. Retina,2013,33(1): 224-231.
22.	Zhu Z,Ji X,Zhang J,et al. Posterior scleral reinforcement in the treatment of macular retinoschisis in highly myopic patients[J]. Clin Experiment Ophthalmol,2009,37(7): 660-663.
23.	Baba T,Tanaka S,Maesawa A,et al. Scleral buckling with macular plombe for eyes with myopic macular retinoschisis and retinal detachment without macular hole[J]. Am J Ophthalmol,2006,142(3): 483-487.
24.	Mateo C,Bures-Jelstrup A,Navarro R,et al. Macular buckling for eyes with myopic foveoschisis secondary to posterior staphyloma[J]. Retina,2012,32(6): 1121-1128.
25.	El Rayes EN. Supra choroidal buckling in managing myopic vitreoretinal interface disorders: 1-year data[J]. Retina,2013,34(1): 1-7.
26.	Gili P,Yanguela J,Martin JC. Intraocular gas treatment for myopic foveoschisis[J]. Eur J Ophthalmol,2010,20(2): 473-475.
27.	Wu TY,Yang CH,Yang CM. Gas tamponade for myopic foveoschisis with foveal detachment[J]. Graefe's Arch Clin Exp Ophthalmol,2013,251(5): 1319-1324.
28.	Rodrigues IA,Stangos AN,McHugh DA,et al. Intravitreal injection of expansile perfluoropropane C₃F₈ for the treatment of vitreomacular traction[J]. Am J Ophthalmol,2013,155(2): 270-276.
29.	Shimada N,Tanaka Y,Tokoro T,et al. Natural course of myopic traction maculopathy and factors associated with progression or resolution[J]. Am J Ophthalmol,2013,136(5):948-957.
30.	Wu PC,Chen YJ,Chen YH,et al. Factors associated with foveoschisis and foveal detachment without macular hole in high myopia[J]. Eye (Lond),2009,23(2): 356-361.
31.	Sayanagi K,Ikuno Y,Tano Y. Tractional internal limiting membrane detachment in highly myopic eyes[J]. Am J Ophthalmol,2006,142(5): 850-852.
32.	Johnson MW. Myopic traction maculopathy: pathogenic mechanisms and surgical treatment[J]. Retina,2012,32(2): 205-210.
33.	Ikuno Y,Gomi F,Tano Y. Potent retinal arteriolar traction as a possible cause of myopic foveoschisis[J]. Am J Ophthalmol,2005,139(3): 462-467.
34.	Shimada N,Ohno-Matsui K,Nishimuta A,et al. Detection of paravascular lamellar holes and other paravascular abnormalities by optical coherence tomography in eyes with high myopia[J]. Ophthalmology,2008,115(4): 708-717.
35.	Sayanagi K,Ikuno Y,Soga K,et al. Photoreceptor inner and outer segment defects in myopic foveoschisis[J]. Am J Ophthalmol,2008,145(5): 902-908.
36.	Fujimoto S,Ikuno Y,Nishida K. Postoperative optical coherence tomographic appearance and relation to visual acuity after vitrectomy for myopic foveoschisis[J]. Am J Ophthalmol,2013,156(5):968-973.

1. Ichibe M,Baba E,Funaki S,et al. Retinoschisis in a highly myopic eye without vision impairment[J]. Retina,2004,24(2): 331-333.
2. Gaucher D,Haouchine B,Tadayoni R,et al. Long-term follow-up of high myopic foveoschisis: natural course and surgical outcome[J]. Am J Ophthalmol,2007,143(3): 455-462.
3. Shimada N,Tanaka Y,Tokoro T,et al. Natural course of myopic traction maculopathy and factors associated with progression or resolution[J]. Am J Ophthalmol,2013,156(5):948-957.
4. Ripandelli G,Rossi T,Scassa C,et al. Macular vitreoretinal interface abnormalities in highly myopic eyes with posterior staphyloma: 5-year follow-up[J]. Retina,2012,32(8): 1531-1538.
5. Fujimoto M,Hangai M,Suda K,et al. Features associated with foveal retinal detachment in myopic macular retinoschisis[J]. Am J Ophthalmol,2010,150(6): 863-870.
6. Shimada N,Ohno-Matsui K,Yoshida T,et al. Progression from macular retinoschisis to retinal detachment in highly myopic eyes is associated with outer lamellar hole formation[J]. Br J Ophthalmol,2008,92(6): 762-764.
7. Gao X,Ikuno Y,Fujimoto S,et al. Risk factors for development of full-thickness macular holes after pars plana vitrectomy for myopic foveoschisis[J]. Am J Ophthalmol,2013,155(6):1021-1027.
8. Shimada N,Ohno-Mastsui K,Baba T,et al. Natural course of macular retinoschisis in highly myopic eyes without macular hole or retinal detachment[J]. Am J Ophthalmol,2006,142(3): 497-500.
9. Hwang JU,Joe SG,Lee JY,et al. Microincision vitrectomy surgery for myopic foveoschisis[J]. Br J Ophthalmol,2013,97(7):879-884.
10. Shin JY,Yu HG. Visual prognosis and spectral-domain optical coherence tomography findings of myopic foveoschisis surgery using 25-gauge transconjunctival sutureless vitrectomy[J]. Retina,2012,32(3): 486-492.
11. Bando H,Ikuno Y,Choi JS,et al. Ultrastructure of internal limiting membrane in myopic foveoschisis[J]. Am J Ophthalmol,2005,139(1): 197-199.
12. Sayanagi K,Ikuno Y,Tano Y. Reoperation for persistent myopic foveoschisis after primary vitrectomy[J]. Am J Ophthalmol,2006,141(2): 414-417.
13. Yeh SI,Chang WC,Chen LJ. Vitrectomy without internal limiting membrane peeling for macular retinoschisis and foveal detachment in highly myopic eyes[J]. Acta Ophthalmol,2008,86(2): 219-224.
14. Taniuchi S,Hirakata A,Itoh Y,et al. Vitrectomy with or without internal limiting membrane peeling of reach stage of myopic traction maculopathy[J]. Retina,2013,33(10):2018-2025.
15. Ho TC,Chen MS,Huang JS,et al. Foveola nonpeeling technique in internal limiting membrane peeling of myopic foveoschisis surgery[J]. Retina,2012,32(3): 631-634.
16. Lim SJ,Kwon YH,Kim SH,et al. Vitrectomy and internal limiting membrane peeling without gas tamponade for myopic foveoschisis[J]. Graefe's Arch Clin Exp Ophthalmol,2012,250(11): 1573-1577.
17. 张娅萍,薛安全,王毓琴,等.非内界膜剥离的玻璃体切除术联合长效气体填充治疗病理性近视继发黄斑劈裂[J].中华眼科杂志,2011,47(6):497-503.
18. Kim KS,Lee SB,Lee WK. Vitrectomy and internal limiting membrane peeling with and without gas tamponade for myopic foveoschisis[J]. Am J Ophthalmol,2012,153(2): 320-326.
19. Zheng B,Chen Y,Chen Y,et al. Vitrectomy and internal limiting membrane peeling with perfluoropropane tamponade or balanced saline solution for myopic foveoschisis[J]. Retina,2011,31(4): 692-701.
20. Ward B,Tarutta EP,Mayer MY. The efficacy and safety of posterior pole buckles in the control of progressive high myopia[J]. Eye (Lond),2009,23(12): 2169-2174.
21. Ward B. Degenerative myopia:myopic macular schisis and the posterior pole buckle[J]. Retina,2013,33(1): 224-231.
22. Zhu Z,Ji X,Zhang J,et al. Posterior scleral reinforcement in the treatment of macular retinoschisis in highly myopic patients[J]. Clin Experiment Ophthalmol,2009,37(7): 660-663.
23. Baba T,Tanaka S,Maesawa A,et al. Scleral buckling with macular plombe for eyes with myopic macular retinoschisis and retinal detachment without macular hole[J]. Am J Ophthalmol,2006,142(3): 483-487.
24. Mateo C,Bures-Jelstrup A,Navarro R,et al. Macular buckling for eyes with myopic foveoschisis secondary to posterior staphyloma[J]. Retina,2012,32(6): 1121-1128.
25. El Rayes EN. Supra choroidal buckling in managing myopic vitreoretinal interface disorders: 1-year data[J]. Retina,2013,34(1): 1-7.
26. Gili P,Yanguela J,Martin JC. Intraocular gas treatment for myopic foveoschisis[J]. Eur J Ophthalmol,2010,20(2): 473-475.
27. Wu TY,Yang CH,Yang CM. Gas tamponade for myopic foveoschisis with foveal detachment[J]. Graefe's Arch Clin Exp Ophthalmol,2013,251(5): 1319-1324.
28. Rodrigues IA,Stangos AN,McHugh DA,et al. Intravitreal injection of expansile perfluoropropane C₃F₈ for the treatment of vitreomacular traction[J]. Am J Ophthalmol,2013,155(2): 270-276.
29. Shimada N,Tanaka Y,Tokoro T,et al. Natural course of myopic traction maculopathy and factors associated with progression or resolution[J]. Am J Ophthalmol,2013,136(5):948-957.
30. Wu PC,Chen YJ,Chen YH,et al. Factors associated with foveoschisis and foveal detachment without macular hole in high myopia[J]. Eye (Lond),2009,23(2): 356-361.
31. Sayanagi K,Ikuno Y,Tano Y. Tractional internal limiting membrane detachment in highly myopic eyes[J]. Am J Ophthalmol,2006,142(5): 850-852.
32. Johnson MW. Myopic traction maculopathy: pathogenic mechanisms and surgical treatment[J]. Retina,2012,32(2): 205-210.
33. Ikuno Y,Gomi F,Tano Y. Potent retinal arteriolar traction as a possible cause of myopic foveoschisis[J]. Am J Ophthalmol,2005,139(3): 462-467.
34. Shimada N,Ohno-Matsui K,Nishimuta A,et al. Detection of paravascular lamellar holes and other paravascular abnormalities by optical coherence tomography in eyes with high myopia[J]. Ophthalmology,2008,115(4): 708-717.
35. Sayanagi K,Ikuno Y,Soga K,et al. Photoreceptor inner and outer segment defects in myopic foveoschisis[J]. Am J Ophthalmol,2008,145(5): 902-908.
36. Fujimoto S,Ikuno Y,Nishida K. Postoperative optical coherence tomographic appearance and relation to visual acuity after vitrectomy for myopic foveoschisis[J]. Am J Ophthalmol,2013,156(5):968-973.

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