病理性近视眼底病变的光相干断层扫描病理形态学改变

目的：观察病理性近视眼底病变的光相干断层扫描（OCT）病理形态学改变特征。方法：临床检查确诊为病理性近视患者100例（172眼）行OCT检查。用Macular Thickness Map、Fast Macular Thickness及Line程序扫描黄斑区、视乳头、颞侧大血管弓、色素改变及近视弧等部位。结果：将病理性近视眼底病变按部位不同分为4类，其中，玻璃体视网膜界面病变中89眼（51．7％）可见玻璃体后皮质黏附，黄斑全层裂孔15眼（8．7％），黄斑板层孔2眼（1．2％），黄斑前膜（EMR）11眼（6．4％）。视网膜神经上皮层改变中13眼（7．6％）发生无黄斑裂孔的后极部神经上皮层浅脱离，其中5眼（2．9％）可见后极部视网膜脱离周边部网膜外层劈裂，神经上皮层内层劈裂3眼（1．2％）。33眼（20％）发生视乳头颞侧近视弧处视网膜神经上皮层浅脱离。色素上皮厦脉络膜病变中140眼（81．4％）视网膜色素上皮不均匀萎缩，Fuchs斑10眼（5．7％），近视弧165眼（95．9％），后极部脉络膜广泛萎缩117（68．0％）眼。黄斑区脉络膜新生血管25眼（14．5％）。巩膜改变中后巩膜葡萄肿146眼（84．9％）。结论：OCT可活体观察病理性近视的眼底组织病理学改变，对分析其眼底病变特征及病程观察有重要价值。

The Image Futures of Optical Coherence Tomography of the Pathological Changes in Degenerative Myopia

Objective:To observe the pathological changes of degenerative myopia by optical coherence tomography (OCT). Methods: The OCT data of 100 patients (172 eyes)with degenerative myopia were retrospectively analyzed . The scan models of OCT included macular thickness map,fast macular thickness and line. Scans were undertaken at the regions of macular, optic papilla,posterior pole of retina , temporal larger retinal vessels,temporal crescent and pigment distribution abnormality. Results: Four categories were divided according to different parts where pathologic changes developed. At vitreoretinal interface, we found posterior vitreous hyaloid inserting to the retinal surface in 89 eyes (51.7%) ,full-thickness macular hole in 15 eyes (8. 7%), lamellar macular hole in 2 eyes(1.2%),epiretinal memberane (ERM) in 11 eyes(6. 4%). In retina layer,posterior shallow retinal detachment were found in 13 eyes (7. 6%),of which 5 eyes(2. 9%) associated with outer retinal schisis and 2 eyes(1.2%) associated with inner retinal schisis. In RPE and choroidal layer , we found RPE atrophy in 140 eyes(81.4%), Fuchs spots in 10 eyes(5.7%), temporal crescent in 165 eyes (95.9%) ,choroidal atrophy in 117 eyes(68. 0%)and macular choroidal neovascularization in 25 eyes(14. 5%). In sclera layer, posterior staphylomas were observed in 146 eyes (84. 9%). Conclusion :OCT can display the pathological changes of retinal tissues of degenerative myopia in vivo.