Chung Hyewon, Byeon Suk Ho
Department of Ophthalmology, Konkuk University School of Medicine, Seoul, Korea.
Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea.
Surv Ophthalmol. 2017 Jul-Aug;62(4):506-521. doi: 10.1016/j.survophthal.2017.03.003. Epub 2017 Mar 11.
Various important findings related to the development and progression of idiopathic macular holes (MHs) have been described using optical coherence tomography since Gass first staged MH development using biomicroscopy in 1988 and 1995. We believe that a system for classifying and staging MHs should reflect the degree of disease status and its progression and have value not only from a practical point of view (by predicting the chance of closure or visual recovery), but also provide researchers and clinicians with insights into the pathogenesis and disease progression of MH. These data pave the way for the development of more effective strategies. In this review, we integrate the morphologic features of MHs observed by optical coherence tomography with Gass's biomicroscopic classification and anatomic interpretations. As a result, we propose a conceptual model of a modified classification system for MHs: (1) there are 2 types of MHs starting from the earliest developmental phases of the condition; (2) differences between the types of MHs result from the peculiar characteristics of Müller cells in the fovea; and (3) this classification system, which is based on the degree of preoperative tissue defects, determines closure patterns as well as visual outcomes after an MH is surgically repaired.
自1988年和1995年加斯首次使用生物显微镜对特发性黄斑裂孔（MH）的发展进行分期以来，利用光学相干断层扫描已经描述了与特发性黄斑裂孔发展和进展相关的各种重要发现。我们认为，一个用于对MH进行分类和分期的系统应该反映疾病状态及其进展程度，不仅从实际角度（通过预测闭合或视力恢复的机会）具有价值，而且还应为研究人员和临床医生提供对MH发病机制和疾病进展的见解。这些数据为开发更有效的策略铺平了道路。在本综述中，我们将光学相干断层扫描观察到的MH形态学特征与加斯的生物显微镜分类及解剖学解释相结合。因此，我们提出了一个针对MH的改良分类系统的概念模型：（1）从病情最早发展阶段开始就有2种类型的MH；（2）MH类型之间的差异源于中央凹处Müller细胞的特殊特征；（3）这个基于术前组织缺损程度的分类系统决定了MH手术修复后的闭合模式以及视力结果。
