近视:组织学、临床特征和轴伸病因的潜在意义。

IF 18.6 1区 医学 Q1 OPHTHALMOLOGY Progress in Retinal and Eye Research Pub Date : 2023-09-01 DOI:10.1016/j.preteyeres.2022.101156
Jost B. Jonas , Rahul A. Jonas , Mukharram M. Bikbov , Ya Xing Wang , Songhomitra Panda-Jonas
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引用次数: 16

摘要

近视轴伸长与各种非病理性变化有关。这些包括光感受器细胞和视网膜色素上皮(RPE)细胞密度和视网膜层厚度的降低,主要发生在赤道后至赤道区域;脉络膜和巩膜变薄,在后极明显,在锯齿口最不明显;以及布鲁赫膜开口(BMO)发生在中度近视眼中并且通常在颞下方向上的偏移。BMO移位导致Bruch膜(BM)突出进入鼻腔乳头内隔室,颞区(即乳头旁伽玛区)没有BM,由于检眼镜可见的水平视盘直径缩短导致视盘卵圆形化,中央凹视盘距离延长,kappa角减小,以及矫正/拉伸乳头状黄斑视网膜血管和视网膜神经纤维。高度近视眼还显示视神经管各层增大,筛状层、乳头状巩膜周围缘(即乳头状旁三角区)和乳头状脉络膜周围边界组织伸长和变薄,圆形乳头状旁β、γ和三角区发育。高度近视的病理特征包括黄斑线性RPE缺陷(漆裂纹)的发展,该缺陷扩展为圆形RPE缺陷,伴有中央BM缺陷、黄斑新生血管形成、近视性黄斑视网膜分裂以及青光眼/青光眼样和非青光眼性视神经病变。BM厚度与轴向长度无关。包括眼睛形状从正视眼的球体到近视眼的长(旋转)椭球体的变化,这些特征可以通过赤道后/赤道区的原发性BM增大导致轴向伸长来解释。
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Myopia: Histology, clinical features, and potential implications for the etiology of axial elongation

Myopic axial elongation is associated with various non-pathological changes. These include a decrease in photoreceptor cell and retinal pigment epithelium (RPE) cell density and retinal layer thickness, mainly in the retro-equatorial to equatorial regions; choroidal and scleral thinning pronounced at the posterior pole and least marked at the ora serrata; and a shift in Bruch's membrane opening (BMO) occurring in moderately myopic eyes and typically in the temporal/inferior direction. The BMO shift leads to an overhang of Bruch's membrane (BM) into the nasal intrapapillary compartment and BM absence in the temporal region (i.e., parapapillary gamma zone), optic disc ovalization due to shortening of the ophthalmoscopically visible horizontal disc diameter, fovea–optic disc distance elongation, reduction in angle kappa, and straightening/stretching of the papillomacular retinal blood vessels and retinal nerve fibers. Highly myopic eyes additionally show an enlargement of all layers of the optic nerve canal, elongation and thinning of the lamina cribrosa, peripapillary scleral flange (i.e., parapapillary delta zone) and peripapillary choroidal border tissue, and development of circular parapapillary beta, gamma, and delta zone. Pathological features of high myopia include development of macular linear RPE defects (lacquer cracks), which widen to round RPE defects (patchy atrophies) with central BM defects, macular neovascularization, myopic macular retinoschisis, and glaucomatous/glaucoma-like and non-glaucomatous optic neuropathy. BM thickness is unrelated to axial length. Including the change in eye shape from a sphere in emmetropia to a prolate (rotational) ellipsoid in myopia, the features may be explained by a primary BM enlargement in the retro-equatorial/equatorial region leading to axial elongation.

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来源期刊
CiteScore
34.10
自引率
5.10%
发文量
78
期刊介绍: Progress in Retinal and Eye Research is a Reviews-only journal. By invitation, leading experts write on basic and clinical aspects of the eye in a style appealing to molecular biologists, neuroscientists and physiologists, as well as to vision researchers and ophthalmologists. The journal covers all aspects of eye research, including topics pertaining to the retina and pigment epithelial layer, cornea, tears, lacrimal glands, aqueous humour, iris, ciliary body, trabeculum, lens, vitreous humour and diseases such as dry-eye, inflammation, keratoconus, corneal dystrophy, glaucoma and cataract.
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