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玻璃体飞蚊症:病因,诊断和管理

Milston R, Madigan MC, Sebag J

期刊名称:Surv Ophthalmol

卷期:2016年第61卷第2期

关键词:
玻璃体 病因

摘要

玻璃体是一种水合的细胞外基质,其主要成分为水、胶原和透明质酸组成的同质透明凝胶。由于分子改变导致凝胶液化,伴随透明质酸中胶原分离和胶原原纤维形成使光线散射的胶原纤维,有症状的漂浮物因此出现,尤其是在近视中。随着年龄增长,凝胶液化和玻璃体视网膜附着减弱导致后部玻璃体脱离,最常见的原发性有症状的飞蚊症的原因是由后部玻璃体皮质粘稠的胶原基质引起。近期的研究提示有症状的飞蚊症不仅仅是更流行,而且对于生活质量的消极影响比以前意识到的更大。我们回顾了有关有症状的飞蚊症治疗的文献,目前不管是观察、玻璃体切除,还是Nd:YAG激光。已发表的研究证据符合低风险的特点,并且漂浮物玻璃体切除术有极好的成功率,尤其是无缝线的小规格(small gauge)设备和极小核心的、没有玻璃体后脱离(PVD)的玻璃体切除术。漂浮物的Nd:YAG治疗,报道的没有那么多,声称可以解决0%-100%的漂浮物;然而,同行评议刊物和基于网络的非同行评议的激光玻璃体解离术治疗场所所宣称的都还需要证实,并且目前只有玻璃体切除术有经证明的价值。需要使用客观、定量结果测量的前瞻性研究来评估这些治疗措施、以及像药物性玻璃体松解术这样的新疗法的相对有效性和安全性。

Vitreous is a hydrated extracellular matrix comprised primarily of water, collagens, and hyaluronan organized into a homogeneously transparent gel. Gel liquefaction results from molecular alterations with dissociation of collagen from hyaluronan and aggregation of collagen fibrils forming fibers that cause light scattering and hence symptomatic floaters, especially in myopia. With aging, gel liquefaction and weakened vitreoretinal adhesion result in posterior vitreous detachment, the most common cause of primary symptomatic floaters arising from the dense collagen matrix of the posterior vitreous cortex. Recent studies indicate that symptomatic floaters are not only more prevalent, but also have a negative impact on the quality of life that is greater than previously appreciated. We review the literature concerning management of symptomatic vitreous floaters, currently either with observation, vitrectomy, or Nd:YAG laser. Published evidence is consistent with a low-risk profile and excellent success rate for floater vitrectomy, particularly with sutureless small gauge instruments and a limited core vitrectomy without PVD induction. Nd:YAG laser treatment of floaters, reported less commonly, claims resolution of floaters ranging between 0% and 100%; however, both peer-reviewed literature and assertions on web-based nonpeer-reviewed laser vitreolysis sites remain to be substantiated, and at present only vitrectomy has proven value. Prospective studies using objective, quantitative outcome measures are required to assess the relative efficacy and safety of these two procedures as well as new therapies such as pharmacologic vitreolysis.


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