病理性近视黄斑劈裂光相干断层扫描图像分型及其对临床的指导意义

病理性近视黄斑劈裂光相干断层扫描(OCT)的类组织学分型可以分为单纯外层劈裂、外层和中层劈裂、外层和内层劈裂、多层劈裂4种情况.以彻底清除玻璃体后皮质及后部血管弓内的内界膜为重点的玻璃体视网手术是治疗病理性近视黄斑劈裂的主要选择.其中,单纯外层劈裂合并中心凹脱离者,手术后视功能改善较明显;而多层劈裂者视功能改善有限或不改善.合理剥除后皮质与内界膜起始点,应在未发生内层劈裂处.正确认识和了解病理性近视黄斑劈裂的OCT分型.对于选择玻璃体视网膜手术方式和判断治疗预后有积极意义.     

高度近视眼黄斑视网膜劈裂光相干断层扫描观察

目的 观察高度近视眼黄斑视网膜劈裂的光相干断层扫描(OCT)图像及临床特征.方法 回顾性分析经最佳矫正视力、屈光度、前置镜、A/B型超声和OCT检查确诊的154例高度近视患者158只眼的临床资料.OCT检查主要进行黄斑部水平及垂直线性扫描.根据OCT检查后极部是否存在视网膜劈裂,将其分为劈裂组、非劈裂组.其中,劈裂组53例55只眼,占34.8%;非劈裂组101例103只眼,占65.2%.回顾分析时,对两组患者年龄、性别、屈光度、视力、眼轴长度、后巩膜葡萄肿发生率、玻璃体牵引率、视网膜脱离发生率进行比较.结果 B型超声检查显示,158只眼均有后巩膜葡萄肿.OCT检查显示,视网膜劈裂组55只眼中,内层劈裂15只眼,占27.3%;外层劈裂53只眼,占96.4%;中层劈裂7只眼,占12.7%.内外层劈裂可单独存在,也可共存于同一患眼,中层劈裂都与外层劈裂相伴.存在2种或以上类型的劈裂13只眼,占23.6%;单纯外层劈裂40只眼,占72.7%;仅有内层劈裂2只眼,占3.6%.伴视网膜脱离26只眼,占47.3%;伴黄斑裂孔13只眼,占23.6%;伴玻璃体牵引12只眼,占21.8%.非劈裂组103只眼中,伴玻璃体牵引23只眼,占22.3%;黄斑裂孔19只眼,占18.4%;视网膜脱离21只眼,占20.4%.两组患者年龄(t=0.250)、屈光度(t=1.156)、眼轴(t=0.252)、性别(X2=1.075)构成、黄斑裂孔(X2=0.598)、后巩膜葡萄肿(X2=∞)、玻璃体牵引(X2=0.05)的发生率比较.差异均无统计学意义(P>0.05);但视网膜劈裂组视力明显低于非劈裂组(X2=6.345,P<0.05);视网膜脱离的发生率明显高于非劈裂组(X2=12.400,P<0.05).结论高度近视眼黄斑视网膜劈裂存在于视网膜内中外多个层次,其中外层劈裂最常见;患者往往视力低下且常伴发其他黄斑病变,以视网膜脱离最常见.     

高度近视眼黄斑视网膜劈裂光相干断层扫描观察

目的 观察高度近视眼黄斑视网膜劈裂的光相干断层扫描(OCT)图像及临床特征.方法 回顾性分析经最佳矫正视力、屈光度、前置镜、A/B型超声和OCT检查确诊的154例高度近视患者158只眼的临床资料.OCT检查主要进行黄斑部水平及垂直线性扫描.根据OCT检查后极部是否存在视网膜劈裂,将其分为劈裂组、非劈裂组.其中,劈裂组53例55只眼,占34.8%;非劈裂组101例103只眼,占65.2%.回顾分析时,对两组患者年龄、性别、屈光度、视力、眼轴长度、后巩膜葡萄肿发生率、玻璃体牵引率、视网膜脱离发生率进行比较.结果 B型超声检查显示,158只眼均有后巩膜葡萄肿.OCT检查显示,视网膜劈裂组55只眼中,内层劈裂15只眼,占27.3%;外层劈裂53只眼,占96.4%;中层劈裂7只眼,占12.7%.内外层劈裂可单独存在,也可共存于同一患眼,中层劈裂都与外层劈裂相伴.存在2种或以上类型的劈裂13只眼,占23.6%;单纯外层劈裂40只眼,占72.7%;仅有内层劈裂2只眼,占3.6%.伴视网膜脱离26只眼,占47.3%;伴黄斑裂孔13只眼,占23.6%;伴玻璃体牵引12只眼,占21.8%.非劈裂组103只眼中,伴玻璃体牵引23只眼,占22.3%;黄斑裂孔19只眼,占18.4%;视网膜脱离21只眼,占20.4%.两组患者年龄(t=0.250)、屈光度(t=1.156)、眼轴(t=0.252)、性别(X2=1.075)构成、黄斑裂孔(X2=0.598)、后巩膜葡萄肿(X2=∞)、玻璃体牵引(X2=0.05)的发生率比较.差异均无统计学意义(P>0.05);但视网膜劈裂组视力明显低于非劈裂组(X2=6.345,P<0.05);视网膜脱离的发生率明显高于非劈裂组(X2=12.400,P<0.05).结论高度近视眼黄斑视网膜劈裂存在于视网膜内中外多个层次,其中外层劈裂最常见;患者往往视力低下且常伴发其他黄斑病变,以视网膜脱离最常见.     

高度近视视网膜劈裂患者手术前后谱域光相干断层扫描影像学特征

目的 观察高度近视视网膜劈裂患者行玻璃体切割手术前后谱域光相干断层扫描(SD-OCT)的影像学特征.方法 回顾性分析SD-OCT检查确诊为高度近视视网膜劈裂不伴黄斑裂孔行玻璃体切割手术治疗的8例患者8只眼临床资料.所有患者均行矫正视力、屈光度、前置镜眼底检查、A/B型超声及SD-OCT检查.所有患眼视网膜均存在外层劈裂.其中,合并中层或内层劈裂5只眼,伴中心凹脱离5只眼.前置镜检查结果显示,8只眼中,黄斑中心凹出现局限性浅脱离3只眼;未发现明显异常5只眼.后极部出现巩膜葡萄肿7只眼.SD-OCT检查结果显示,后极部视网膜呈现明显向下凹陷的弧形条带7只眼;未见明显向下凹陷的弧形条带1只眼.所有患眼均接受玻璃体切割加内界膜剥除手术治疗.手术后1、3、6个行时SD-OCT复查,对比观察手术前后视网膜后极部形态结构影像检查特征变化.结果 手术后6个月,后极部劈裂消失视网膜基本贴附原位6只眼;仍存在中心凹脱离1只眼;出现旁中心凹裂孔1只眼.手术后6个月,矫正视力由手术前0.15提高至0.8者1只眼,SD-OCT检查显示,视网膜光感受器内外节(IS/OS)连接光带层连续性大部分恢复.矫正视力由手术前0.01和0.05提高至0.1和0.15者2只眼;保持不变者5只眼.SD-OCT检查结果显示,手术后IS/OS连接光带层均仍有缺失.结论 高度近视视网膜劈裂在SD-OCT中形态表现多样,以外层劈裂居多.

Abstract：

Objective To observe the image features of high myopia with retinoschisis by spectraldomain optical coherence tomography (SD-OCT). Methods The clinical data of eight patients (eight eyes)of high myopia with retinoschisis were retrospective analyzed. All patients were diagnosed by SD-OCT (Topcon 3D OCT-1000), had no macular holes and underwent vitrectomy including internal limiting membrane (ILM) peeling and gas tamponade. All patients also underwent visual acuity, refraction,pre-mirror fundus examination and A/B-mode ultrasound examination. Visual acuity and SD-OCT were followed up at one, three and six months after surgery. Before surgery, pre-mirror fundus examination revealed shallow foveal detachment in 3/8 eyes, posterior scleral staphyloma in 7/8 eyes. SD-OCT showed concave arc stripes in 7/8 eyes, and outer retinoschisis in 8/8 eyes, middle or inner retinoschisis in 5/8 eyes and foveal detachment in 5/8 eyes. Results Six months after surgery, posterior retinoschisis disappeared in six eyes, foveal detachment still presented in one eye and parafoveal hole occurred in one eye. The corrected visual acuity improved from the 0. 15 to 0. 8 in one eye which had a restored continuous inner segment/outer segmen (IS/OS) line by SD-OCT. The corxected visual acuity improved from 0. 01 to 0. 1 in one eye, from 0. 05 to 0. 15 in one eye, not changed in five eyes. There was no continuous IS/OS line in those patients by SD-OCT. Conclusions SD-OCT shows a variety of morphological features of myopic retinoschisis which could be cured anatomically and functionally by vitrectomy combined ILM peeling. The continuity of IS/OS layer from SD-OCT could help to interpret the vision recovery after the operation.     

高度近视视网膜劈裂症光学相干断层扫描检查的临床研究

目的 探讨高度近视视网膜劈裂症患者发生的年龄、眼轴、视力情况,以及其影像学特征和发生机制.方法 回顾性系列病例研究.对611例（992眼）高度近视患者行光学相干断层扫描（OCT）、B超、IOL Master、主觉验光、裂隙灯、眼底（散瞳）等检查,其中经OCT检查存在视网膜劈裂者79例（97眼）.根据视网膜劈裂的位置分为黄斑中心凹劈裂组43例（51眼）与黄斑旁中心局部劈裂组36例（46眼）两组,对两组的年龄、眼轴、视力、后巩膜葡萄肿、玻璃体后脱离、黄斑前膜、玻璃体牵引的发生率进行比较.采用独立样本t检验和卡方检验进行统计学分析.结果 发生视网膜劈裂的患者中：总体年龄≥30岁者占73％;眼轴≥28 mm者占96％;视力≥4.5者占66％.视网膜劈裂大部分为外层劈裂,其中黄斑中心凹劈裂组中有5眼为混合劈裂.黄斑中心凹劈裂组与黄斑旁中心局部劈裂组劈裂发生的年龄差异有统计学意义（t=-2.28,P=0.025）.黄斑前膜和玻璃体牵引的发生率在两组差异有统计学意义（x2=9.387,P=0.002;x2=6.590,P=0.01）.结论 高度近视眼视网膜劈裂与长眼轴密切相关;年龄、黄斑前膜、玻璃体牵引与劈裂的类型相关.     

后巩膜加固术治疗病理性近视黄斑劈裂

目的评价后巩膜加固术治疗病理性近视黄斑劈裂的效果,观察手术前后黄斑劈裂腔与ERG的变化。方法回顾性病例研究,对25例（32眼）病理性近视黄斑劈裂（其中6眼伴视网膜局限性浅脱离）患者行后巩膜加固术,观察手术前与手术后6个月最佳矫正视力、等效球镜度、眼轴、OCT、ERG的变化。最佳矫正视力、等效球镜度、眼轴的比较采用配对样本t检验,黄斑劈裂腔的大小与ERG各参数的比较采用符号秩和检验。结果手术前后等效球镜度与眼轴差异有统计学意义（t=-11.23、13.23,P<0.01）。术后OCT示,14眼黄斑劈裂愈合,劈裂腔消失,此14眼术前劈裂腔高度为277（190～428）μm;17眼（53%）好转,劈裂腔减小,此17眼术前、术后劈裂腔高度分别为447（344～617）μm和194（106～259）μm,差异有统计学意义（Z=-3.724,P<0.01）;1眼未愈。ERG示,黄斑劈裂愈合组ERG最大反应中的a波波幅术前和术后分别为114（63.45～143.00）μV和119（93.75～169.50）μV,差异有统计学意义（Z=-2.232,P<0.05）。黄斑劈裂好转者术前和术后ERG最大反应中的a波波幅分别为104（76.65～130.00）μV和107（83～151）μV,差异有统计学意义（Z=-2.056,P<0.05）。其他检测的各参数指标差异均无统计学意义。无严重并发症发生。结论后巩膜加固术治疗病理性近视黄斑劈裂具有一定的疗效,不仅有助于黄斑劈裂腔的减小,也有助于视网膜光感受器传导功能的改善。     

病理性近视继发中心凹视网膜劈裂的固视特点

目的 观察病理性近视继发中心凹视网膜劈裂的固视特点.方法 屈光度≥-6.00 D、光相干断层扫描(OCT)检查证实有黄斑中心凹视网膜劈裂的患者36例42只眼纳入本研究.其中,合并中心凹处视网膜脱离者11只眼,合并黄斑裂孔者12只眼,无视网膜脱离及黄斑裂孔者19只眼;并以此分为3组.采用MP-1微视野计对3组患者行固视检查,记录受检眼固视点位置和2°视野范围内固视稳定性.结果 合并中心凹处视网膜脱离组及合并黄斑裂孔组患者偏心固视形成在中心凹上方;无视网膜脱离及黄斑裂孔组患者自然形成固视位置位于中心凹处视网膜.合并中心凹处视网膜脱离组、合并黄斑裂孔组、无视网膜脱离及黄斑裂孔组2°视野范围内固视稳定性分别为(23±4)%、(59±6)%、(91±11)%,组间比较差异有统计学意义(F=243.47,P＜0.01).结论 病理性近视继发中心凹视网膜劈裂无视网膜脱离及黄斑裂孔患者固视位置位于中心凹处,未形成偏心同视且同视稳定;合并中心凹处视网膜脱离及黄斑裂孔患者固视位置均位于上方视网膜,形成偏心同视.

Abstract：

Objective To observe the fixation features of foveoschisis in pathological myopia patients.Methods 36 patients(42 eyes)with>-6.00D myopic degree and foveoschisis who diagnosed by optical coherence tomography were included.The patients were divided into foveoschisis with retinal detachment group(11 eyes),foveoschisis with macular hole group(12 eyes)and only foveoschisis group(19 eyes).Micro-perimeter MP-1 was used to identify the fixation location and fixation stability.Results The eccentric fixation were formed above the foyea in the foveoschisis with retinal detachment and foveoschisis with macular hole group,the fixation location was formed on fovea in the only foveoschisis group.The fixation stability of the foveoschisis with retinal detachment,foveoschisis with macular hole and only foveoschisis group were(23±4)0A,(59±6)% ,(91±11)% respectively,the difference was statistically significant(F=243.47,P＜0.01).Conclusions The fixation location is formed on foyea in the patients with foveoschisis in pathological myopia.The eccentric fixation is formed above the fovea in the patients who has foveoschisis with retinal detachment and macular hole in pathological myopia.     

光学相干断层扫描图像对视网膜劈裂症诊断意义

目的 探讨光学相干断层扫描图像（OCT）对视网膜劈裂症（R.S)诊断价值。方法：对临床诊为视网膜劈裂症患者5例（9眼）行OCT，直接检眼镜，眼底彩色照相及多焦ERG检查。结果：视网膜劈裂症的OCT图像表现为典型的黄斑区囊样改变，伴斜形成垂直的桥状组织相连；后极部视网膜视经上皮层之间分离，其间有桥状组织相连。结论：OCT显示视网膜劈裂症具有高度特异性。清晰地显示视网膜神经上皮层间分离。是一种新的客观检测方法。     

病理性近视继发中心凹视网膜劈裂的固视特点

Objective To observe the fixation features of foveoschisis in pathological myopia patients.Methods 36 patients(42 eyes)with>-6.00D myopic degree and foveoschisis who diagnosed by optical coherence tomography were included.The patients were divided into foveoschisis with retinal detachment group(11 eyes),foveoschisis with macular hole group(12 eyes)and only foveoschisis group(19 eyes).Micro-perimeter MP-1 was used to identify the fixation location and fixation stability.Results The eccentric fixation were formed above the foyea in the foveoschisis with retinal detachment and foveoschisis with macular hole group,the fixation location was formed on fovea in the only foveoschisis group.The fixation stability of the foveoschisis with retinal detachment,foveoschisis with macular hole and only foveoschisis group were(23±4)0A,(59±6)% ,(91±11)% respectively,the difference was statistically significant(F=243.47,P＜0.01).Conclusions The fixation location is formed on foyea in the patients with foveoschisis in pathological myopia.The eccentric fixation is formed above the fovea in the patients who has foveoschisis with retinal detachment and macular hole in pathological myopia.     

病理性近视继发中心凹视网膜劈裂的固视特点

Objective To observe the fixation features of foveoschisis in pathological myopia patients.Methods 36 patients(42 eyes)with>-6.00D myopic degree and foveoschisis who diagnosed by optical coherence tomography were included.The patients were divided into foveoschisis with retinal detachment group(11 eyes),foveoschisis with macular hole group(12 eyes)and only foveoschisis group(19 eyes).Micro-perimeter MP-1 was used to identify the fixation location and fixation stability.Results The eccentric fixation were formed above the foyea in the foveoschisis with retinal detachment and foveoschisis with macular hole group,the fixation location was formed on fovea in the only foveoschisis group.The fixation stability of the foveoschisis with retinal detachment,foveoschisis with macular hole and only foveoschisis group were(23±4)0A,(59±6)% ,(91±11)% respectively,the difference was statistically significant(F=243.47,P＜0.01).Conclusions The fixation location is formed on foyea in the patients with foveoschisis in pathological myopia.The eccentric fixation is formed above the fovea in the patients who has foveoschisis with retinal detachment and macular hole in pathological myopia.     

高度近视黄斑部视网膜劈裂和非裂孔性视网膜脱离

目的 观察高度近视黄斑部视网膜劈裂(MRS)和非裂孔性视网膜脱离(MRDH)的临床表现和影像学特征.方法 高度近视患者186例349只眼中合并MRS和MRDH的19例24只眼纳入研究.所有患者均进行了主觉验光、双目间接检眼镜、裂隙灯显微镜联合Goldmann三面镜检查,以及眼底照相、A/B型超声和光相干断层扫描(OCT)检查.结果 349只眼中后极部存在MRS和(或)MRDH 24只眼,占6.9%.眼底检查结果 显示.所有患跟均有后巩膜葡萄肿(PS),占100.0%;玻璃体黄斑牵引条带(VMT)2只眼.占8.3%;黄斑部局限性视网膜浅脱离2只眼,占8.3%;黄斑全层裂孔1只眼,占4.2%.B型超声检查结果 显示,所有患眼均伴有PS,占100.0%;黄斑部局限性视网膜浅脱离7只眼,占29.2%,脱离的视网膜与PS锥顶形成弓样结构;VMT条带2只眼,占8.3%.OCT检查结果 显示,黄斑部外层视网膜劈裂(ORS)22只眼,占91.7%,其中合并黄斑部内层视网膜劈裂(IRS)8只眼,占黄斑部ORS的36.4%.MRDH 5只眼,占20.8%,其中合并ORS 3只眼,占MRDH的60.0%;单纯性MRDH 2只眼,占MRDH的40.0%,其中合并VMT 1只眼.VMT 13只眼,占54.2%;黄斑囊样水肿(CME)3只眼,占12.5%;黄斑板层裂孔4只眼,占16.7%.结论 MRS和MRDH是伴有PS的高度近视眼的常见并发症.与常规眼底检查和B型超声相比,OCT是发现MRS和MRDH的更为有效的检查手段.     

病理性近视黄斑裂孔患者黄斑区视网膜前膜的组织学观察

目的 观察病理性近视内界膜表面结构的组织学变化与黄斑裂孔发生发展的关系.方法 同顾分析行玻璃体切割手术的病理性近视黄斑裂孔患者34例34只眼的临床资料.患眼屈光度均超过-6.00 D,眼轴26.00～33.12 mm,平均眼轴长度27.74 mm.5只眼为黄斑裂孔无视网膜脱离(黄斑裂孔组),29只眼为黄斑裂孔合并后极部视网膜浅脱离(视网膜脱离组).对入选患眼行睫状体平坦部三切口的玻璃体切割手术,手术中观察Weiss环以判断玻璃体后脱离程度,获取34只眼的视网膜前膜及19只眼的内界膜组织标本,行苏木精-伊红(HE)及醋酸铀-枸橼酸铅双染色,采用光学及透射电子显微镜观察.结果 玻璃体切割手术中,5只眼出现Weiss环,24只眼的视网膜表面有多层玻璃体组织残留.光学显微镜观察发现,内界膜表面的视网膜前膜主要由玻璃体胶原纤维.星形胶质细胞及细胞外基质组成.透射电子显微镜观察发现,19只眼的内界膜标本中,5只眼可她内界膜一玻璃体胶原纤维-细胞的"三明治"样结构,1只眼可见内界膜损伤、表面组织牵引和星形胶质细胞移行.结论病理性近视玻璃体后界面劈裂、内界膜表面组织结构的变化是黄斑裂孔发生发展直至视网膜脱离的重要原因.     

高度近视眼黄斑劈裂的OCT影像特征

Objective To improve our understanding of the morphological characteristics of macular retinoschisis in highly myopic eyes by optical coherence tomography and to discuss the probably associated factors of it. Methods In the retrospective study, 268 patients(369 eyes)with high myopia(spherical equivalent 3≥-6.00D)were included, from which a diagnosis of retinoschisis was given by optical coherence tomography, and observed the area and morphological characteristics of the retinoschisis. The factors that were associated with the occurrence and the development of the retinoschisis were investigated. Results OCT showed that 68 patients(93 eyes)had retinoschisis. Outer schisis was present in 78 eyes, mixed schisis in 14 eyes and inner schisis in 1 eye. The retinoschisis in 2 eyes located far from the macular area, and the other 91 eyes located in the macular area, which were involved into one to four quadrants, in which foveoschisis were present in 53 eyes, and parafoveoschisis in 38 eyes. There were several kinds of types in foveoschisis, companied with other pathological changes, such as vitreoretinal traction, preretinal membrane, foveal detachment and lamellar holes.We proceeded the comparison of the axial length, spherical equivalent, posterior staphyloma, vitreoretinal interface factors and posterior polar chorioretinal atrophy in retinoschisis and non-retinoschisis in highly myopic eyes, finding that all the differences were significant(P <0.01), but Logistic regression showed that all the factors above were the risk factors associated with the retinoschisis(P =0.002, 0.027, 0.003, 0.011)except the spherical equivalent(P =0.073). Conclusions OCT can display the area and morphological characteristics of retinoschisis clearly, the retinoschisis is mostly present in the fovea, which is usually involved into the whole macular area, and the outer schisis is common. The occurrence and development of the retinoschisis is associated with the axial length, posterior staphyloma, vitreoretinal interface factors and posterior polar chorioretinal atrophy.     

高度近视眼黄斑劈裂的OCT影像特征

目的 观察高度近视眼黄斑劈裂的OCT形态学特征,分析其发生的相关危险因素.方法 回顾性分析268例(369只眼)屈光度≥-6.00D的高度近视眼患者继发视网膜劈裂的OCT表现以及与眼轴长度、屈光度、后巩膜葡萄肿、后极部脉络膜视网膜萎缩变性等因素的相互关系.结果 OCT显示68例(93只眼)存在视网膜劈裂;其中78只眼为外层劈裂,14只眼为混合性劈裂,1眼为内层劈裂.所有存在劈裂眼中,2只眼劈裂远离黄斑区,91只眼位于黄斑区,累及一至四个象限不等,其中53只眼为中央凹劈裂,38只眼为旁中央凹劈裂,中央凹劈裂的形态多样,并伴有视网膜前膜或玻璃体牵引、局限性视网膜脱离、黄斑板层裂孔等改变.所有高度近视眼患者中,视网膜劈裂眼与未发生视网膜劈裂眼的眼轴长度、屈光度、后巩膜葡萄肿、玻璃体牵引或视网膜前膜以及后极部脉络膜视网膜萎缩变性比较,差异均有统计学意义(P均<0.01),Logistic回归结果示:超长眼轴(≥29mm)是视网膜劈裂发生的危险因素,屈光度并不是其发生的危险因素,后巩膜葡萄肿、玻璃体牵引或视网膜前膜以及后极部脉络膜视网膜萎缩变性均是其发生的危险因素(P=0.002,0.073,0.027,0.003,0.011).结论 OCT能明确视网膜劈裂发生的部位,清晰地显示视网膜劈裂的形态特征,视网膜劈裂多发生在黄斑中央凹.可累及整个黄斑区,以外层劈裂多见.视网膜劈裂的发生与超长眼轴、后巩膜葡萄肿、玻璃体视网膜牵引以及后极部脉络膜视网膜萎缩变性等因素有关.

Abstract：

Objective To improve our understanding of the morphological characteristics of macular retinoschisis in highly myopic eyes by optical coherence tomography and to discuss the probably associated factors of it. Methods In the retrospective study, 268 patients(369 eyes)with high myopia(spherical equivalent 3≥-6.00D)were included, from which a diagnosis of retinoschisis was given by optical coherence tomography, and observed the area and morphological characteristics of the retinoschisis. The factors that were associated with the occurrence and the development of the retinoschisis were investigated. Results OCT showed that 68 patients(93 eyes)had retinoschisis. Outer schisis was present in 78 eyes, mixed schisis in 14 eyes and inner schisis in 1 eye. The retinoschisis in 2 eyes located far from the macular area, and the other 91 eyes located in the macular area, which were involved into one to four quadrants, in which foveoschisis were present in 53 eyes, and parafoveoschisis in 38 eyes. There were several kinds of types in foveoschisis, companied with other pathological changes, such as vitreoretinal traction, preretinal membrane, foveal detachment and lamellar holes.We proceeded the comparison of the axial length, spherical equivalent, posterior staphyloma, vitreoretinal interface factors and posterior polar chorioretinal atrophy in retinoschisis and non-retinoschisis in highly myopic eyes, finding that all the differences were significant(P <0.01), but Logistic regression showed that all the factors above were the risk factors associated with the retinoschisis(P =0.002, 0.027, 0.003, 0.011)except the spherical equivalent(P =0.073). Conclusions OCT can display the area and morphological characteristics of retinoschisis clearly, the retinoschisis is mostly present in the fovea, which is usually involved into the whole macular area, and the outer schisis is common. The occurrence and development of the retinoschisis is associated with the axial length, posterior staphyloma, vitreoretinal interface factors and posterior polar chorioretinal atrophy.     

正确认识和掌握高度近视黄斑病变的诊疗方法,减少高度近视患者视功能损害

以近视眼中心凹劈裂、黄斑裂孔及黄斑裂孔性视网膜脱离、近视性脉络膜新生血管为代表的高度近视黄斑病变是影响高度近视患者视功能的主要原因之一.光相干断层扫描检查有助于提升高度近视黄斑病变的认知水平.选择合适的手术时机,解除玻璃体后皮质和内界膜对视网膜的牵拉,有利于恢复视网膜的弹性,使近视眼中心凹劈裂消失.促进黄斑裂孔的闭合和视网膜复位;而抗新生血管药物与光动力疗法和(或)糖皮质激素联合应用,则是治疗近视性脉络膜新生血管的发展方向.正确认识和掌握高度近视黄斑病变的诊疗方法 和时机,采取针对性的干预措施.使其能够得到合理有效的治疗,是进一步减少高度近视患者视功能损害的关键.     

Retinal detachment and retinoschisis detected by optical coherence tomography in a myopic eye with a macular hole

The authors describe a myopic patient with a full-thickness macular hole that was accompanied by both retinal detachment and retinoschisis. A 51-year-old woman presented with a localized retinal elevation of three disc diameters around the macular hole in a myopic eye. Optical coherence tomography (OCT) showed features of both retinal detachment and retinoschisis. After vitreous surgery and postoperative intraocular gas tamponade, the macular elevation resolved, and separation of the neurosensory retina from the retinal pigment epithelium band disappeared on the OCT images. OCT is a useful tool for examining macular conditions associated with a macular hole in myopic patients.     

高度近视黄斑部视网膜劈裂和非裂孔性视网膜脱离

目的 观察高度近视黄斑部视网膜劈裂(MRS)和非裂孔性视网膜脱离(MRDH)的临床表现和影像学特征.方法 高度近视患者186例349只眼中合并MRS和MRDH的19例24只眼纳入研究.所有患者均进行了主觉验光、双目间接检眼镜、裂隙灯显微镜联合Goldmann三面镜检查,以及眼底照相、A/B型超声和光相干断层扫描(OCT)检查.结果 349只眼中后极部存在MRS和(或)MRDH 24只眼,占6.9%.眼底检查结果 显示.所有患跟均有后巩膜葡萄肿(PS),占100.0%;玻璃体黄斑牵引条带(VMT)2只眼.占8.3%;黄斑部局限性视网膜浅脱离2只眼,占8.3%;黄斑全层裂孔1只眼,占4.2%.B型超声检查结果 显示,所有患眼均伴有PS,占100.0%;黄斑部局限性视网膜浅脱离7只眼,占29.2%,脱离的视网膜与PS锥顶形成弓样结构;VMT条带2只眼,占8.3%.OCT检查结果 显示,黄斑部外层视网膜劈裂(ORS)22只眼,占91.7%,其中合并黄斑部内层视网膜劈裂(IRS)8只眼,占黄斑部ORS的36.4%.MRDH 5只眼,占20.8%,其中合并ORS 3只眼,占MRDH的60.0%;单纯性MRDH 2只眼,占MRDH的40.0%,其中合并VMT 1只眼.VMT 13只眼,占54.2%;黄斑囊样水肿(CME)3只眼,占12.5%;黄斑板层裂孔4只眼,占16.7%.结论 MRS和MRDH是伴有PS的高度近视眼的常见并发症.与常规眼底检查和B型超声相比,OCT是发现MRS和MRDH的更为有效的检查手段.