Stevens T S
Int Ophthalmol Clin. 1981 Fall;21(3):11-26. doi: 10.1097/00004397-198102130-00004.
Pathological changes in the diabetic macula are a frequent cause of visual loss. They can be classified as intraretinal or vitreoretinal maculopathies. The intraretinal ones are due to hyperpermeable retinal capillaries or retinal vascular shut-down. They appear clinically as macular edema, exudative maculopathy, fluorescein dye leak maculopathy, or ischemic maculopathy. When edema and exudation cause or threaten to cause significant visual loss they are treated by photocoagulation. The vitreoretinal maculopathies are due to traction resulting from (1) the formation of vitreoretinal adhesions with subsequent vitreous shrinkage, (2) the formation of bands or membranes from one retinal area to another and their subsequent shrinkage, or (3) epiretinal membrane formation and contraction. They appear clinically as epiretinal membranes, retinal wrinkling, macular heterotopia, or traction detachment of the macula. Traction detachment and contracted epiretinal membranes associated with significant visual loss are treated by vitreous surgery; an effective treatment for macular heterotopia has not been demonstrated.
糖尿病性黄斑病变是视力丧失的常见原因。它们可分为视网膜内或玻璃体视网膜黄斑病变。视网膜内病变是由于视网膜毛细血管通透性增加或视网膜血管闭塞所致。临床上表现为黄斑水肿、渗出性黄斑病变、荧光素染料渗漏性黄斑病变或缺血性黄斑病变。当水肿和渗出导致或可能导致严重视力丧失时，可采用光凝治疗。玻璃体视网膜黄斑病变是由于以下原因引起的牵引：（1）玻璃体视网膜粘连形成并随后玻璃体收缩；（2）从一个视网膜区域到另一个视网膜区域形成条索或膜并随后收缩；或（3）视网膜前膜形成和收缩。临床上表现为视网膜前膜、视网膜皱襞、黄斑异位或黄斑牵引性脱离。与严重视力丧失相关的牵引性脱离和收缩性视网膜前膜通过玻璃体手术治疗；黄斑异位的有效治疗方法尚未得到证实。
