macular hole retinal detachment
Introduction
Introduction to macular hole retinal detachment Macular hole retinal detachment is a special type of rhegmatogenous retinal detachment caused by the formation of a full-thickness macular hole, through which the liquefied vitreous reaches the retinal neuroepithelial layer. In the process of formation of macular hole retinal detachment in high myopia, posterior scleral staphyloma and retinal pigment epithelium and scleral atrophy play more important role than the tangential traction of the macula. In patients with high myopia with posterior scleral staphyloma, posterior sclera The posterior enlargement, the relative extension of the retina is insufficient, resulting in a sagittal force that separates the retinal neuroepithelial layer from the pigment epithelial layer. The atrophy of the posterior scleral grape choroidal retina and the absence of retinal pigment epithelial cells result in neuroepithelial and pigment epithelial layers. The adhesion between them is weakened, resulting in extensive retinal detachment. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: non-infectious Complications: retinal detachment
Cause
Causes of macular hole retinal detachment
(1) Causes of the disease
More related to high myopia and eye injuries.
(two) pathogenesis
The pathogenesis of macular hole retinal detachment caused by high myopia has not been elucidated. It is believed that the cause may be the tangential traction of the posterior vitreous or macular anterior membrane to the macula, posterior scleral staphyloma and retinal pigment epithelium and choroidal atrophy. The tangential traction caused by the contraction of the epiretinal membrane (ERM) in the macular area may be the most important factor causing the disease, and also the main cause of reopening of the macular hole after surgery. Histopathological examination shows that ERM is mainly caused by vitreous cortex. And a variety of cell components, mainly fibrillar glial cells, glial cells through the tight junction and cytoplasmic vesicle exchange metabolites to regulate new collagen to create an active connection between collagen, the newly formed vitreous collagen accumulates in the vitreous The posterior vitreous cortex gradually shrinks and further forms ERM. The contraction of ERM produces one of the important reasons for the macular tangential traction is the incidence of high myopia macular hole retinal detachment. High myopia is often accompanied by posterior scleral staphyloma, posterior pole progressiveness. Stretch, macular area retina, vein The membrane is extremely thin, the choroidal capillaries are reduced or lost, causing retinal tissue atrophy and cystic changes, cystic degeneration and rupture followed by macular hole, anterior and posterior vitreoretinal traction can cause macular degeneration, local contraction of the foveal anterior vitreous It also occurs frequently. This is another factor in the occurrence of hiatus. The contraction of myofibroblasts in ERM around the macular hole is another possible mechanism for producing tangential traction. In addition, vitreous liquefaction and posterior vitreous detachment may also cause anterior-posterior direction of the macula. Traction force, in the process of posterior vitreous detachment, part of the posterior vitreous cortex adheres to the retina around the macular area. As the eyeball rotates, the vitreous cortex of the flutter moves to the macular part in the anteroposterior direction and the tangential direction, and the vitreous cavity of the high myopia expands. The vitreous liquefaction is obvious, and the vitreous body moves in the opposite direction when the eyeball rotates, which causes traction in the macular area.
In the process of formation of macular hole retinal detachment in high myopia, posterior scleral staphyloma and retinal pigment epithelium and scleral atrophy play more important role than the tangential traction of the macula. In patients with high myopia with posterior scleral staphyloma, posterior sclera The posterior enlargement, the relative extension of the retina is insufficient, resulting in a sagittal force that separates the retinal neuroepithelial layer from the pigment epithelial layer. The atrophy of the posterior scleral grape choroidal retina and the absence of retinal pigment epithelial cells result in neuroepithelial and pigment epithelial layers. The adhesion between them is weakened, resulting in extensive retinal detachment.
Prevention
Macular hole retinal detachment prevention
1. Adjust daily life and workload, and regularly carry out activities and exercise to avoid fatigue.
2. Maintain emotional stability and avoid emotional excitement and tension. 3. Keep the stool smooth, avoid using stools, eat more fruits and high-fiber foods. 4. Avoid cold irritation and keep warm.Complication
Macular hole retinal detachment complications Complications
Complicated with total retinal detachment, vitreous liquefaction and traction are important factors for dissociation.
Symptom
Macular hole retinal detachment symptoms common symptoms visual field defect visual impairment macular cystic edema macular avoidance phenomenon
1. Macular hole shape The diameter of the hole is generally less than 0.5PD. The smallest one is the needle tip. It is confirmed by OCT or under the operating microscope. The hole is divided into atrophic hole and tear hole according to the nature. Atrophic hole often occurs in high myopia. Posterior scleral staphyloma or on the basis of cystoid degeneration, generally round or elliptical, often without a perforated membrane, the tearing hole is the result of trauma or posterior vitreous detachment, the shape of the hole is irregular, and the early stage may be fissure Shape, crescent or horseshoe shape, irregularly rounded or elliptical when completely torn off, sometimes a cover film in front of the hole adheres to the detached vitreous posterior membrane. Due to the shrinkage of the membrane, the membrane is smaller than the slit. However, due to turbidity, it is easy to see. It differs from the inner lamellar membrane formed by the tearing of the inner layer of macular degeneration. The latter is a transparent membrane, which forms a small floating object due to shrinkage. It is difficult to find, only in It can be seen under the microscope (Figure 1).
2. Retinal detachment range Retinal detachment caused by macular hole, early confined to the posterior pole, with the prolongation of the disease course, the detachment develops downward and the temporal side, and even completely detached, 3.2% to 11.5% of the cases leave the long time The ground is limited to the vicinity of the macula, and does not extend to the peripheral part. The range of detachment is related to the length of the disease, the size of the hole, the degree of vitreous liquefaction and the presence of vitreoretinal traction. In addition, vitreous liquefaction and traction promote the retina. The important factor of detachment and expansion is that the proliferative changes of the macular hole retinal detachment are generally dominated by the posterior pole, which occurs around the optic disc, around the macula, forming a star-shaped fixed fold, and less developed to the distal periphery.
3. Vitreous changes in non-traumatic macular hole retinal detachment mostly with different degrees of posterior vitreous detachment, sometimes seeing the lamellar cover sheet attached to it, incomplete posterior detachment often exists in the vitreoretinal traction, retinal detachment caused by peripheral hiatus In the case of macular hole, the macular hole is derived from the macular cystic degeneration. It can be called secondary macular hole to distinguish it from the primary macular hole. It is different in surgical treatment.
Examine
Examination of macular hole retinal detachment
If the degree of retinal detachment in the macular area is not high, the OCT examination can clearly show the condition of the hole and vitreous, including the vitreous liquefaction cavity, the residual adhesion between the posterior vitreous cortex and the retina, the neuroepithelial defect in the macular area, and the retinal neuroepithelial layer. A low-reflection zone occurs between the pigment epithelial layer/choroidal capillary layer, and the inner surface of the retina strongly reflects the light band (indicating the presence of the epiretinal membrane).
Clinically, according to the extent of retinal detachment, macular hole retinal detachment is divided into three types: type I, retinal detachment is limited to the peripheral area of the macula; type II, retinal detachment extends to the equator but not to the retinal serrated margin; At least one quadrant of the retinal detachment has reached the serrated edge.
Diagnosis
Diagnosis and diagnosis of macular hole retinal detachment
According to the results of OCT examination and fundus performance, the diagnosis is not difficult, but it needs to be differentiated from some diseases, which is related to the choice of surgical methods and the protection of visual function.
The identification of detachment from the macula has the following points:
1. Since the surrounding tissue is curled when the retina ruptures, the true rupture has a clear boundary, even for very small holes.
2. Tissue defect at the hole, and the slit light band is completely interrupted at the defect (Allen-Wazeke sign).
3. Dark red reflection can be seen through the hole, and the choroid structure can be seen when the separation is low. The small perforation on the basis of cystic degeneration and the hole in the posterior choroidal atrophy in the high myopia are the most difficult to identify.
4. Optical coherence tomography (OCT) examination can be accurately diagnosed (Figures 3-6).
