Van Newkirk M R, Johnson M W, Hughes J R, Meyer K A, Byrne S F
Southland Health, Queenstown, New Zealand.
Trans Am Ophthalmol Soc. 2000;98:163-9; discussion 169-71.
To prospectively evaluate the relationship between the posterior hyaloid membrane (PHM) and the retina in eyes with idiopathic macular hole.
Ninety-four eyes of 94 consecutive patients with macular hole underwent complete ophthalmologic examination, contact lens biomicroscopy, and B-scan ultrasonography and/or vitreoretinal surgery.
In 93 of 94 patients (99%), the relationship between the PHM and posterior retina could be visualized during echographic examinations or at surgery. Among these 93 patients, the PHM was detectable biomicroscopically in 36 (39%). Persistent PHM attachment to the foveola with partial separation of the PHM from the perifoveal retina was evident with ultrasonography in 5 of 6 patients (83%) with stage 1 hole and in 12 of 18 patients (67%) with stage 2 hole. When axial views were included, separation of the PHM from the perifoveal retina was evident in 13 of 13 patients (100%) with stage 1 and stage 2 hole. Separation of the PHM from the fovea and perifoveal retina with attachment to the peripapillary retina was evident with ultrasonography in 65 of 65 patients (100%) with stage 3 macular hole and pseudo-operculum and was evident biomicroscopically in 22 of the 65 patients (34%) in this group.
These findings suggest that high-resolution axial and paraxial ultrasonographic examination directly on the surface of the eye is more sensitive in detecting separation of the PHM from the retina than biomicroscopy in idiopathic macular holes. The perifoveal detachment of the PHM may be involved in the pathogenesis of macular holes.
前瞻性评估特发性黄斑裂孔眼的后玻璃体膜（PHM）与视网膜之间的关系。
对94例连续性黄斑裂孔患者的94只眼进行了全面的眼科检查、接触镜生物显微镜检查以及B超超声检查和/或玻璃体视网膜手术。
94例患者中的93例（99%），在超声检查或手术过程中可观察到PHM与视网膜后部的关系。在这93例患者中，36例（39%）可通过生物显微镜检测到PHM。超声检查显示，6例1期裂孔患者中有5例（83%）以及18例2期裂孔患者中有12例（67%）存在PHM持续附着于中央凹且PHM与中央凹周围视网膜部分分离的情况。当纳入轴位视图时，13例1期和2期裂孔患者中有13例（100%）出现PHM与中央凹周围视网膜分离。超声检查显示，65例3期黄斑裂孔伴假性盖膜患者中有65例（100%）出现PHM与中央凹和中央凹周围视网膜分离并附着于视乳头周围视网膜，该组65例患者中有22例（34%）可通过生物显微镜观察到这种情况。
这些发现表明，在特发性黄斑裂孔中，直接在眼球表面进行的高分辨率轴位和旁轴超声检查在检测PHM与视网膜分离方面比生物显微镜检查更敏感。PHM的中央凹周围脱离可能参与了黄斑裂孔的发病机制。
