2025年1月21日弄明白玻璃体相关的疾病，玻璃膜疣是玻璃体相关疾病吗？

2024年12月份的某一天，我去东明社区做回访，使用我们单位生产的全自动人工智能OCT的社区医生是一名全科医生，主修五官科。她提问，玻璃膜疣是什么？跟玻璃体有什么关系？为此，我特意写了一篇“弄明白玻璃膜疣是什么”，我们一起学习。

为了方便记忆，今天整理了玻璃体相关疾病主要有几种，如下：

玻璃体混浊（Vitreous Opacity）
– 定义：正常玻璃体是透明的凝胶体，当玻璃体内出现不透明体，导致视线范围内出现黑影飘动等视觉异常的情况就是玻璃体混浊。这些不透明物质可能是变性的胶原纤维、红细胞、炎性细胞等。它可由多种原因引起，如老化、高度近视、眼内炎症（如葡萄膜炎）、玻璃体积血（视网膜血管破裂等导致血液进入玻璃体）等。

玻璃体后脱离（Posterior Vitreous Detachment，PVD）
– 定义：随着年龄增长或某些病理因素，玻璃体的胶原纤维支架结构塌陷或收缩，使玻璃体后皮质与视网膜内表面分离。多数情况下是一种生理现象，但在脱离过程中，玻璃体对视网膜的牵拉可能导致视网膜裂孔、视网膜脱离等严重并发症。

飞蚊症（Floaters）
– 定义：是一种常见的视觉症状，患者自觉眼前有飘动的小黑影，其形状多样，有点状、线状、网状等。主要是由于玻璃体混浊引起，生理性飞蚊症多与玻璃体老化有关，而病理性飞蚊症可因眼内炎、玻璃体积血等疾病导致，这些疾病使得玻璃体内出现异常物质而干扰视线。

遗传性玻璃体视网膜病变（Hereditary Vitreoretinopathy）
– 定义：一组由于遗传因素导致的玻璃体和视网膜同时出现病变的疾病。例如家族性渗出性玻璃体视网膜病变（Familial Exudative Vitreoretinopathy，FEVR），是因基因突变致使视网膜血管和玻璃体发育异常，可出现视网膜脱离、玻璃体视网膜牵拉等病理改变，严重影响视力。

玻璃体寄生虫病（Vitreous Parasitic Disease）
– 定义：较为少见，是寄生虫（如猪囊尾蚴）进入眼内并在玻璃体等部位寄生而引起的疾病。寄生虫在玻璃体中会引发眼内炎症反应，造成玻璃体混浊，患者会出现视力下降、眼前黑影飘动、眼痛等症状。

玻璃体积血（Vitreous Hemorrhage）

– 定义：指眼内血管破裂，血液进入玻璃体腔。可由多种原因引起，如视网膜静脉阻塞、糖尿病视网膜病变导致视网膜新生血管破裂、眼外伤使眼球内血管破裂等。积血会使玻璃体混浊，影响光线的透过，从而导致视力下降，严重程度与出血量有关。

星状玻璃体变性（Asteroid Hyalosis）

– 定义：这是一种以玻璃体内出现含钙的脂质白色小球为特征的疾病。这些小球粘连于玻璃体的纤维上，呈星状分布。通常是一种老年性退行性改变，多发生于50岁以上人群，单眼患病居多。多数情况下患者视力不受影响或仅有轻微下降，只有当这些小球大量聚集时，才可能对视力产生明显干扰。

闪辉性玻璃体液化（Synchysis scintillans）

– 定义：又称眼胆固醇沉着症。是一种少见的玻璃体疾病，主要是由于玻璃体内的胆固醇结晶析出导致。通常发生在眼外伤、长期眼内炎症后，或者继发于一些严重的视网膜疾病。患者会看到眼前有各种形状的金色或彩色的反光体飘动，在眼球运动时更明显。

玻璃体视网膜牵拉综合征（Vitreoretinal Traction Syndrome）

– 定义：由于玻璃体不完全后脱离、视网膜前膜等原因，造成玻璃体对视网膜产生牵拉。这种牵拉可能导致视网膜变形、水肿，甚至引起视网膜裂孔、黄斑水肿等病变，进而出现视力下降、视物变形等症状。

关于玻璃膜疣，它主要和视网膜相关，特别是在年龄相关性黄斑变性疾病中比较重要。玻璃膜疣位于视网膜色素上皮和玻璃膜之间，是视网膜病变过程中的一种产物。虽然它和玻璃体在位置上不同，但在一些复杂的眼部病变过程中，视网膜的病变（如玻璃膜疣大量出现引发视网膜病变后）可能会间接影响到玻璃体，例如引起炎症反应波及玻璃体，或者因为视网膜病变导致眼内环境改变，从而促使玻璃体出现一些继发性的改变。

“玻璃膜疣”英文是“drusen”。

它之所以叫这个名字，是因为在病理检查时，这些沉积物看起来像小的、疣状的结构，并且位于视网膜的玻璃膜（Bruch’s membrane）附近。玻璃膜是视网膜色素上皮和脉络膜之间的一层细胞外基质，主要起分隔和物质交换的作用。

它和玻璃体不在同一空间，玻璃体在晶状体后方，占据眼球的较大部分空间，而玻璃膜疣在视网膜的结构层次内。正常情况下它们不相连，但是在一些病理过程中，如黄斑病变进展导致视网膜结构破坏、炎症介质释放等情况，视网膜的病变可能会引起眼内微环境变化，通过一些炎症因子等的扩散或者眼球内部液体平衡的改变等间接影响到玻璃体。

从形成机制来讲，玻璃膜疣的产生主要是由于视网膜色素上皮细胞的代谢产物在玻璃膜和视网膜色素上皮之间堆积而形成的。它是一种脂褐质和其他物质的沉积物。

在年龄相关性黄斑变性中，玻璃膜疣的数量、大小和分布可以作为评估疾病进展的一个重要指标。如果玻璃膜疣不断增多、融合变大，会增加视网膜色素上皮层和外层视网膜的损伤风险，进而可能导致湿性年龄相关性黄斑变性的发生，出现脉络膜新生血管等严重病变。

虽然它和玻璃体本身没有直接的连接结构，但在眼部是一个整体的系统。例如，当玻璃膜疣导致黄斑区出现病变后，可能会引起眼内液体成分的改变，而玻璃体的营养供应部分来源于眼内液体，这样就可能对玻璃体产生潜在的、间接的影响。

还有多种跟玻璃体相关的罕见的疾病，整理了名称，如果对其种某种疾病感兴趣，请留言，我整理出来，一起学习。

|–先天性与遗传性

|   |–遗传性玻璃体视网膜错构瘤病

|   |–代谢贮积病相关性玻璃体改变

|   |–线粒体病相关性玻璃体视网膜病变

|–全身性疾病继发

|   |–缺氧性玻璃体视网膜病变

|   |–全身代谢紊乱相关性玻璃体病变

|   |–系统性血管炎相关性玻璃体病变

|   |–睡眠呼吸暂停综合征相关的玻璃体病变

|   |–长期素食导致的营养缺乏性玻璃体病变

|–医源性与治疗相关

|   |–医源性玻璃体损伤

|   |–药物洗脱支架术后眼部并发症之玻璃体病变

|   |–基因编辑治疗后迟发性玻璃体病变

|–环境因素影响

|   |–辐射诱发玻璃体病变

|   |–高原性玻璃体病变

|   |–微重力环境下的玻璃体变化

|   |–生物节律紊乱相关性玻璃体病变

|   |–雾霾暴露相关性玻璃体病变

|   |–极端温度环境致玻璃体病变

|   |–职业粉尘暴露相关性玻璃体病变

|   |–海洋环境作业相关性玻璃体病变

|   |–电磁脉冲暴露相关性玻璃体病变

|   |–慢性噪音暴露相关性玻璃体病变

|–眼部局部病变引发

|   |–异物残留致玻璃体慢性病变

|   |–眼部肿瘤侵及玻璃体病变

|   |–晶状体源性玻璃体病变

|   |–脉络膜视网膜营养不良伴玻璃体异常

|   |–牙周炎相关性玻璃体病变

|–生活习惯与用品相关

|   |–长期眼部化妆引发的玻璃体病变

|   |–人工智能视觉显示终端长期使用性玻璃体病变

|   |–虚拟现实设备过度使用性玻璃体病变

|   |–食品添加剂摄入过量引发的玻璃体病变

One day in December 2024, I went to Dongming Community for a follow – up visit. The community doctor who used the fully automatic artificial intelligence OCT produced by our unit is a general practitioner, majoring in otolaryngology and ophthalmology. She asked what drusen were and what the relationship was between drusen and the vitreous. Therefore, I specifically wrote an article titled “Understanding What Drusen Are”, and we studied together. For easy memorization, today I have sorted out several main vitreous – related diseases as follows:

Vitreous Opacity – Definition: The normal vitreous is a transparent gel. When opaque bodies appear in the vitreous, causing visual abnormalities such as black shadows floating within the line of sight, it is called vitreous opacity. These opaque substances may include degenerated collagen fibers, red blood cells, inflammatory cells, etc. It can be caused by various factors, such as aging, high myopia, intraocular inflammation (such as uveitis), vitreous hemorrhage (caused by the rupture of retinal blood vessels, etc., leading to blood entering the vitreous), etc.

Posterior Vitreous Detachment (PVD) – Definition: Due to aging or certain pathological factors, the collagen fiber scaffold structure of the vitreous collapses or contracts, causing the posterior cortex of the vitreous to separate from the inner surface of the retina. In most cases, it is a physiological phenomenon. However, during the detachment process, the traction of the vitreous on the retina may lead to serious complications such as retinal holes and retinal detachment.

Floaters – Definition: It is a common visual symptom. Patients feel that there are small black shadows floating in front of their eyes, and their shapes are diverse, such as dot – shaped, linear, and reticular. It is mainly caused by vitreous opacity. Physiological floaters are mostly related to vitreous aging, while pathological floaters can be caused by diseases such as endophthalmitis and vitreous hemorrhage. These diseases cause abnormal substances to appear in the vitreous, interfering with the line of sight.

Hereditary Vitreoretinopathy – Definition: It is a group of diseases in which both the vitreous and the retina are affected due to genetic factors. For example, Familial Exudative Vitreoretinopathy (FEVR) is caused by gene mutations that lead to abnormal development of retinal blood vessels and the vitreous. Pathological changes such as retinal detachment and vitreoretinal traction can occur, severely affecting vision.

Vitreous Parasitic Disease – Definition: It is relatively rare. It is a disease caused by parasites (such as cysticercus cellulosae) entering the eye and parasitizing in the vitreous and other parts. Parasites in the vitreous can trigger an intraocular inflammatory response, causing vitreous opacity. Patients may experience symptoms such as vision loss, black shadows floating in front of the eyes, and eye pain.

Vitreous Hemorrhage – Definition: It refers to the rupture of blood vessels in the eye, causing blood to enter the vitreous cavity. It can be caused by various reasons, such as retinal vein occlusion, rupture of new blood vessels in the retina due to diabetic retinopathy, and rupture of blood vessels in the eye due to eye trauma. The hemorrhage makes the vitreous opaque, affecting the transmission of light, thus leading to vision loss. The severity is related to the amount of bleeding.

Asteroid Hyalosis – Definition: This is a disease characterized by the presence of white, calcium – containing lipid globules in the vitreous. These globules adhere to the fibers of the vitreous and are distributed in a star – like pattern. It is usually a senile degenerative change, mostly occurring in people over 50 years old, and more often affecting one eye. In most cases, the patient’s vision is not affected or only slightly decreased. Only when these globules accumulate in large numbers may it significantly interfere with vision.

Synchysis scintillans – Definition: Also known as cholesterolosis bulbi. It is a rare vitreous disease mainly caused by the precipitation of cholesterol crystals in the vitreous. It usually occurs after eye trauma, long – term intraocular inflammation, or secondary to some severe retinal diseases. Patients can see various – shaped golden or colored reflectors floating in front of their eyes, which are more obvious when the eyes move.

Vitreoretinal Traction Syndrome – Definition: Due to incomplete posterior vitreous detachment, epiretinal membrane, etc., the vitreous exerts traction on the retina. This traction may cause retinal deformation, edema, and even lead to lesions such as retinal holes and macular edema, resulting in symptoms such as vision loss and distorted vision.

Regarding drusen, it is mainly related to the retina, especially in age – related macular degeneration. Drusen are located between the retinal pigment epithelium and Bruch’s membrane and are a product of the retinal pathological process. Although it is in a different position from the vitreous, in some complex eye diseases, retinal lesions (such as those caused by a large number of drusen leading to retinal diseases) may indirectly affect the vitreous. For example, it may cause an inflammatory reaction that spreads to the vitreous, or due to changes in the intraocular environment caused by retinal lesions, secondary changes may occur in the vitreous. The English for “drusen” is “drusen”. It is named so because during pathological examination, these deposits look like small, wart – like structures and are located near the Bruch’s membrane of the retina. Bruch’s membrane is a layer of extracellular matrix between the retinal pigment epithelium and the choroid, mainly playing a role in separation and substance exchange. It is not in the same space as the vitreous. The vitreous is located behind the lens, occupying a large part of the space in the eyeball, while drusen are within the structural layers of the retina. Under normal circumstances, they are not connected. However, in some pathological processes, such as the progression of macular lesions leading to retinal structure damage and the release of inflammatory mediators, retinal lesions may cause changes in the intraocular micro – environment. These changes may indirectly affect the vitreous through the diffusion of some inflammatory factors or changes in the balance of intraocular fluids. In terms of the formation mechanism, drusen are mainly formed by the accumulation of metabolic products of retinal pigment epithelial cells between Bruch’s membrane and the retinal pigment epithelium. It is a deposit of lipofuscin and other substances. In age – related macular degeneration, the number, size, and distribution of drusen can be an important indicator for evaluating the progression of the disease. If drusen continue to increase, fuse, and become larger, it will increase the risk of damage to the retinal pigment epithelium and the outer retina, and may lead to the occurrence of wet age – related macular degeneration, with serious lesions such as choroidal neovascularization. Although it has no direct connection structure with the vitreous itself, the eye is an integrated system. For example, when drusen cause lesions in the macular area, it may cause changes in the composition of intraocular fluids. Since part of the nutritional supply of the vitreous comes from the intraocular fluids, this may have a potential, indirect impact on the vitreous.

There are also many rare diseases related to the vitreous. I have sorted out their names. If you are interested in a certain disease, please leave a message, and I will organize the information for us to study together.

|I– Congenital and Hereditary
||–Hereditary Vitreoretinal Hamartomatosis
||– Metabolic Storage Disease – Related Vitreous Changes
||– Mitochondrial Disease – Related Vitreoretinal Lesions
||– Secondary to Systemic Diseases
||– Hypoxic Vitreoretinopathy
||– Systemic Metabolic Disorder – Related Vitreous Disease
||– Systemic Vasculitis – Related Vitreous Disease
||– Sleep Apnea Syndrome – Related Vitreous Disease
||– Nutritional Deficiency – Related Vitreous Disease Caused by Long – Term Vegetarian Diet
||– Iatrogenic and Treatment – Related
||– Iatrogenic Vitreous Injury
||– Vitreous Lesions Complicating Drug – Eluting Stent Implantation
||– Delayed Vitreous Lesions after Gene Editing Treatment
||– Influenced by Environmental Factors
||– Radiation – Induced Vitreous Disease
||– High – Altitude – Related Vitreous Disease
||– Vitreous Changes in Microgravity Environment
||– Biological Rhythm Disorder – Related Vitreous Disease
||– Vitreous Disease Related to Haze Exposure
||– Vitreous Disease Caused by Extreme Temperature Environment
||– Vitreous Disease Related to Occupational Dust Exposure
||– Vitreous Disease Related to Marine Environment Operations
||– Vitreous Disease Related to Electromagnetic Pulse Exposure
||– Vitreous Disease Related to Chronic Noise Exposure
||– Caused by Local Ocular Lesions
||– Chronic Vitreous Lesions Caused by Foreign Body Retention
||– Vitreous Lesions Caused by Ocular Tumors Infiltrating
||– Lens – Originated Vitreous Disease
||– Choroidoretinal Dystrophy with Vitreous Abnormalities
||– Vitreous Disease Related to Periodontitis
||– Related to Living Habits and Supplies
||– Vitreous Disease Caused by Long – Term Eye Makeup
||– Vitreous Disease Caused by Long – Term Use of Artificial Intelligence Visual Display Terminals
||– Vitreous Disease Caused by Excessive Use of Virtual Reality Devices
||– Vitreous Disease Caused by Excessive Intake of Food Additives