内界膜剥除治疗黄斑裂孔中国眼视光网课件

潘建东 2014.4 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 视网膜的最内层 1 2um厚的无结构均质膜 Mu11er 细胞基底膜、少量胶质细胞及玻 璃体纤维组成 内表面光滑, 与玻璃体皮质接触, 外表面呈 波浪形, 与Mu11er 细胞的纤维支架相吻合 。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 黄斑区的ILM 较厚, 与玻璃体皮质牢固粘连 在病理情况下, ILM 可成为色素细胞及纤维 细胞增殖的支架 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. Schepens：生理性或病理性玻璃体视网膜粘 连处的玻璃体纤维前后方向的牵拉。 Gass ：黄斑前玻璃体皮质对黄斑切线方向上 的牵拉是黄斑孔的主要成因。 玻璃体皮质切线牵拉：中心凹ILM产生裂隙 Mu11er 细胞等胶质细胞反应性增殖：黄斑前 膜 牵拉网膜形成裂孔 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. Yoon 对黄斑裂孔手术中剥离的孔周ILM 组 织行超微结构分析 裂孔周围的视网膜前膜在早期多含玻璃体 皮质的非细胞成分 III、IV期( Gass 分期) 则为黏附有分化增殖 的视网膜色素上皮( RPE) 和纤维细胞的ILM 结构 Yoon H- S et al. Am J Ophthalmol, 1996; 122: 67 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 早期裂孔是由黄斑区前玻璃体的机械牵引 所致 RPE 细胞及神经上皮层的胶质细胞迁至孔 周ILM 内表面, 不断增殖, 其切向收缩力就 成为裂孔扩大的主要因素 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 1期：黄斑中心凹脱离 2期：黄斑全层裂孔， 400um 3期： 400um，玻璃体后皮质与黄斑相连 4期：完全玻璃体后脱离 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 1期：视物变形，轻度中心视力丧失。增强 的黄色小环，放射状细沟 2期：中心视力进一步丧失。全层裂孔，环 形视网膜脱离 3期：中心暗点。玻璃体中心凹分离，玻璃 体混浊、视网膜前膜 4期：完全玻璃体后脱离，Weiss环 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 黄斑裂孔的治疗 适应证 3期或4期，引起症状，视力20/60-20/400 2期或3期，引起症状，视力20/40-20/60 视力 20/40，一般不需要手术 视力 20/400，可能有并存的眼病 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 一般手术技术 20G，25G 有晶体眼 无晶体眼、人工晶体眼 玻璃体是否完全后脱离 Weiss环，切中央玻璃体时的表现 软头硅胶吸管 FFA、ICG、台盼兰染色 TA Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 内界膜剥除 内界膜环形剥除 ICG，台盼兰，TA 眼内填充 气体 硅油：术后不能保持正确体位者 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 手术结果 解剖成功指证：神经上皮层脱离复位、裂 孔边缘消失。 OCT显示术后24裂孔闭合。 桥状闭合：视力较差，可能是复发的早期 表现 术后视力：与术前视力相关 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty