Reappraisal of biomicroscopic classification of stages of development of a macular hole.
Reappraisal of biomicroscopic classification of stages of development of a macular hole.
复制标题
黄斑裂孔发展阶段的生物显微镜分类的重新评估。
DOI：
10.1016/s0002-9394(14)72743-6
复制
发表时间：
1995
影响因子：
4.2
通讯作者：
G. Kokame
中科院分区：
文献类型：
--
作者：
G. Kokame
PurposeTo更新年龄相关性黄斑裂孔发展阶段的生物显微镜分类和解剖学解释，并为玻璃体手术后某些患者视力的显著恢复提供解释。MethodsRecent biomicroscopic observations of various stages of macular holes are used to suppose new anatomical explanations for these stages.ResultsBiomicroscopic observations include following：（1）从黄色斑点的变化（阶段1-A）至黄色环（2）黄斑裂孔前混浊伴小的2期裂孔可能大于裂孔直径;（3）黄斑裂孔周围的黄斑膜样混浊与对侧正常眼的假性黄斑膜难以区分。（阶段1-A）到黄环（阶段1-B）的变化主要是由脐部裂开后视网膜感受器的离心移位引起的。半透明收缩的前凹玻璃体皮质桥接黄环（1期-B隐匿性裂孔）可隐藏裂孔。1期-B隐匿性裂孔在收缩的小凹前玻璃体皮质与小孔周围的视网膜早期分离后变得明显（2期裂孔），或者在收缩的小凹前玻璃体皮质中在较大的2期裂孔边缘处作为偏心的开罐器样撕裂。大多数前孔混浊可能不含视网膜感受器（假盖）。手术复位孔周围的视网膜和向心运动的小凹视网膜神经胶质增生诱导可恢复中央凹的解剖和功能接近正常。
PurposeTo update the biomicroscopic classification and anatomic interpretations of the stages of development of age-related macular hole and provide explanations for the remarkable recovery of visual acuity that occurs in some patients after vitreous surgery.MethodsRecent biomicroscopic observations of various stages of macular holes are used to postulate new anatomic explanations for these stages.ResultsBiomicroscopic observations include the following: (1) the change from a yellow spot (stage 1-A) to a yellow ring (stage 1-B) during the early stages of foveal detachment is unique to patients at risk of macular hole; (2) the prehole opacity with a small stage 2 hole may be larger than the hole diameter; and (3) the opacity resembling an operculum that accompanies macular holes is indistinguishable from a pseudo-operculum found in otherwise normal fellow eyes.ConclusionsThe change from a yellow spot (stage 1-A) to a yellow ring (stage 1-B) is caused primarily by centrifugal displacement of retinal receptors after a dehiscence at the umbo. The hole may be hidden by semiopaque contracted prefoveolar vitreous cortex bridging the yellow ring (stage 1-B occult hole). Stage 1-B occult holes become manifest (stage 2 holes) either after early separation of the contracted prefoveolar vitreous cortex from the retina surrounding a small hole or as an eccentric can-opener-like tear in the contracted prefoveolar vitreous cortex, at the edge of larger stage 2 holes. Most prehole opacities probably contain no retinal receptors (pseudo-opercula). Surgical reattachment of the retina surrounding the hole and centripetal movement of the foveolar retina induced by gliosis may restore foveal anatomy and function to near normal.