[关键词]
[摘要]
近视牵引性黄斑病变(MTM)是高度近视患者常见的视力威胁性并发症。随着高度近视全球化发展,MTM患病率在全球范围内呈现逐年攀升的趋势,导致的疾病、经济及社会负担日益加剧。光学相干断层扫描(OCT)技术的出现与发展为MTM的分级提供了有力的技术支持。基于对MTM的病理机制及自然病程理解的深入,研究者提出多种分级方法并应用于临床,为个体化治疗管理MTM患者提供了重要的依据。除此之外,经睫状体平坦部玻璃体切除术(PPV)以及后巩膜加固、黄斑扣带术(MB)等手术方式及手术材料的创新改良也为MTM的治疗提供了更多选择。文章系统综述了MTM的分级体系、治疗策略,重点探讨了基于OCT的分级方法对个体化治疗方案的指导作用,并对现有PPV、MB及其联合手术等新兴术式的有效性与安全性证据进行归纳。文章进一步提出未来研究应聚焦于构建整合多模态数据的手术时机预测模型以明确手术适应证,开展多中心大样本临床随机对照试验探索PPV及MB单一或联合术式选择,实现MTM个性化手术治疗,以期为优化MTM临床诊疗路径、改善患者预后提供理论依据与实践方向。
[Key word]
[Abstract]
Myopic traction maculopathy(MTM)is a common vision-threatening complication in patients with high myopia. With the global increase in high myopia, the prevalence of MTM has been rising worldwide, leading to a growing burden of disease, economic costs,and social impact. The emergence and development of optical coherence tomography(OCT)have provided robust technical support for the staging of MTM. Based on the evolving understanding of its pathological mechanisms and natural course, various staging systems have been proposed and applied in clinical practice, offering crucial guidance for the personalized management of MTM patients. Additionally, innovations and refinements in surgical techniques and materials, such as pars plana vitrectomy(PPV), posterior scleral reinforcement, and macular buckling(MB), have expanded the therapeutic options for MTM. This article systematically reviews the staging systems and treatment strategies for MTM, focusing on the role of OCT-based staging in guiding individualized treatment plans. It also summarizes the current evidence on the efficacy and safety of existing and emerging surgical approaches, including PPV, MB, and their combined procedures. The review further proposes that future research should focus on developing predictive models integrating multimodal data to clarify surgical timing and indications, as well as conducting large-scale, multicenter randomized controlled trials to explore the selection of PPV, MB, or combined surgeries. The review aims to discuss personalized treatment for MTM, providing theoretical foundations and practical directions for optimizing clinical management and improving patient prognosis for MTM patients.
[中图分类号]
[基金项目]
国家重点研发计划(No.2024YFC2510803); 国家自然科学基金项目(No.82471103)