CAJ | 학술논문

目的观察病理性近视内界膜表面结构的组织学变化与黄斑裂孔发生发展的关系.方法同顾分析行玻璃体切割手术的病理性近视黄斑裂孔患者34例34只眼的临床资料.患眼屈光度均超过-6.00 D,眼轴26.00～33.12 mm,平均眼轴长度27.74 mm.5只眼为黄斑裂孔无视网膜脱离(黄斑裂孔组),29只眼为黄斑裂孔合并后极部视网膜浅脱离(视网膜脱离组).对入选患眼行睫状体平坦部三切口的玻璃体切割手术,手术中观察Weiss环以判断玻璃体后脱离程度,获取34只眼的视网膜前膜及19只眼的内界膜组织标本,行苏木精-伊红(HE)及醋酸铀-枸橼酸铅双染色,采用光学及透射电子显微镜观察.结果玻璃体切割手术中,5只眼出现Weiss环,24只眼的视网膜表面有多层玻璃体组织残留.光学显微镜观察发现,内界膜表面的视网膜前膜主要由玻璃体胶原纤维.星形胶质细胞及细胞外基质组成.透射电子显微镜观察发现,19只眼的内界膜标本中,5只眼可她内界膜一玻璃体胶原纤维-细胞的"三明治"样结构,1只眼可见内界膜损伤、表面组织牵引和星形胶质细胞移行.结论病理性近视玻璃体后界面劈裂、内界膜表面组织结构的变化是黄斑裂孔发生发展直至视网膜脱离的重要原因.
목적 관찰병이성근시내계막표면결구적조직학변화여황반렬공발생발전적관계.방법 동고분석행파리체절할수술적병이성근시황반렬공환자34례34지안적림상자료.환안굴광도균초과-6.00 D,안축26.00～33.12 mm,평균안축장도27.74 mm.5지안위황반렬공무시망막탈리(황반렬공조),29지안위황반렬공합병후겁부시망막천탈리(시망막탈리조).대입선환안행첩상체평탄부삼절구적파리체절할수술,수술중관찰Weiss배이판단파리체후탈리정도,획취34지안적시망막전막급19지안적내계막조직표본,행소목정-이홍(HE)급작산유-구연산연쌍염색,채용광학급투사전자현미경관찰.결과 파리체절할수술중,5지안출현Weiss배,24지안적시망막표면유다층파리체조직잔류.광학현미경관찰발현,내계막표면적시망막전막주요유파리체효원섬유.성형효질세포급세포외기질조성.투사전자현미경관찰발현,19지안적내계막표본중,5지안가저내계막일파리체효원섬유-세포적"삼명치"양결구,1지안가견내계막손상、표면조직견인화성형효질세포이행.결론병이성근시파리체후계면벽렬、내계막표면조직결구적변화시황반렬공발생발전직지시망막탈리적중요원인.
Objective To investigate the histological changes of the internal limiting membrane (ILM) in pathological myopic eyes, and the relationships between those changes and the formation of macular hole. Methods The clinical data of 34 patients (34 eyes)with pathological myopia and maeular hole, who had undergone vitrectomy were retrospectively analyzed. All the patients had a diopter over--6.00 D, their ocular axial length ranged from 26.00 to 33.12 mm with an average of 27.74 mm. There were 5 eyes without retinal detachment (macular hole group)while the other 29 eyes all had posterior retinal detachment (RD group). A standard three-port pars plana vitrectomy was performed in all eyes. The existence of Weiss ring was considered as the sign of posterior vitreous detachment. The epiretinal membranes from 34 eyes and ILM specimens from 19 eyes were stained by hematoxylin-eosin (HE) and acetate urany[ acetate-lead citrate, and then investigated under optical microscope and transmission electron microscope. Results The Weiss ring was observed in 5 eyes during the surgery, multilayer of vitreous tissue resides on the retinal surface in 24 eyes. The results of optical microscope showed that the epiretinal membranes were composed of vitreous collagen, astrocytes and extracellular matrixes. The results from transmission electron microscope showed a sandwich structure (ILM-vitreous collagen-cells) in 5 eyes, and ILM damage, surface traction and astrocytes migration in 1 eye. Conclusions Splitting of posterior surface of vitreous and surface structure change of ILM are the major mechanisms for the formation and progression of macular holes, and even retinal detachment in high myopic eyes.