5 黄斑部牵拉引起的黄斑囊样水肿

　　黄斑囊样水肿是黄斑牵拉综合症的一种常见临床表现，该病由于存在不完全的玻璃体后脱离，造成未脱离的玻璃体对黄斑部的牵拉，从而形成黄斑囊样水肿。视网膜前膜也可由于对黄斑部切线方向的牵拉，从而使黄斑部增厚伴或不伴黄斑囊样水肿。由于黄斑部玻璃体牵拉引起的黄斑囊样水肿，在行玻璃体切除解除黄斑部牵拉后，黄斑部视网膜增厚和视力都立即得到改善。

　　6 视网膜脱离

　　短时间的黄斑部渗出性脱离，如中心性浆液性脉络膜视网膜病变，一般不引起黄斑囊样水肿。但长期慢性的黄斑部视网膜脱离可造成外层视网膜的损伤，从而造成液体以及蛋白质渗入视网膜组织造成黄斑囊样水肿。同样，孔源性视网膜脱离可导致视网膜毛细血管渗透性增强，造成黄斑囊样水肿。

　　7 眼内肿瘤

　　脉络膜血管瘤由于瘤体组织的渗漏可以造成黄斑囊样水肿。光动力学疗法可以消除黄斑囊样水肿提高视力[23]。位于视盘或近黄斑部的视网膜毛细血管瘤也可引起黄斑囊样水肿。该病采用局部视网膜光凝，光动力学疗法以及VEGF抑制因子取得了一定疗效[24]。在各个位置的脉络膜黑色素瘤均可引起黄斑囊样水肿，其具体机制不明，可能是由于VEGF因子的产生或肿瘤所引起的炎症反应。

　　8 特发性黄斑囊样水肿

　　特发性囊样水肿非常罕见，可单侧或双侧发生。荧光造影检查可能看不到明显的视网膜毛细血管渗漏。有些病例为自限性，而有些则迁延不愈。对于荧光造影检查看不到渗漏的病例应排除玻璃体黄斑牵拉综合征，烟酸中毒，全视网膜萎缩等疾病。

　　黄斑囊样水肿在临床中有着极高的发病率，并且可造成视功能的严重损害。不同原因引起的黄斑囊样水肿其治疗方法也不尽相同，在临床工作中我们只有正确的认识其发病机制并采用合理的治疗方法才能取得良好的治疗效果。

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