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.     

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.     

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.     

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.     

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.     

改良型巩膜扣带手术治疗高度近视黄斑部视网膜劈裂临床观察

视网膜劈裂是指视网膜神经上皮层层间裂开[1].随着光相干断层扫描(OCT)技术的应用,证实继发性黄斑视网膜劈裂是高度近视的并发症,在病理性近视眼中并不少见[2,3].尽管多数患者视网膜劈裂长期处于稳定期,但伴随后极部玻璃体牵拉患者则有继发黄斑裂孔的危险.对高度近视继发性黄斑劈裂的治疗,目前多采用玻璃体切割联合注气手术,但视力改善一般低于50％,且有手术后发生黄斑裂孔可能[4,5].     

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.     

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.     

Natural course of macular retinoschisis in highly myopic eyes without macular hole or retinal detachment

PURPOSE: To investigate the natural course of macular retinoschisis in highly myopic patients. DESIGN: A prospective, observational case series. METHODS: Seven consecutive patients (eight eyes) with macular retinoschisis without macular hole or retinal detachment determined by optical coherence tomography (OCT) were followed at least two years without surgical intervention. The changes in the OCT findings and best-corrected visual acuity (BCVA) were analyzed. RESULTS: During follow-up, two eyes that had vitreoretinal adhesions developed a macular hole, one with and one without retinal detachment (RD), and two eyes without detectable vitreoretinal adhesion developed RD without a macular hole. BCVA in these four eyes was significantly reduced. The remaining four eyes did not develop complications, although the thickness of the macula increased significantly. CONCLUSIONS: These findings suggest that macular retinoschisis might be a progressive condition, and that complications appeared to be related to the presence of vitreoretinal tractions.     

高度近视眼发生黄斑裂孔伴与不伴有视网膜脱离的临床观察

目的 探讨高度近视眼发生黄斑裂孔伴与不伴有视网膜脱离的临床特点及其发生机制.方法 回顾性病例对照研究.对2006年6月至2007年2月43例(44只眼)高度近视眼发生黄斑裂孔患者的临床资料进行回顾性分析.根据患者是否伴有视网膜脱离分为脱离组与非脱离组,对两组各项观察指标进行对比分析,同时对非脱离组黄斑裂孔患者的相干光断层扫描(OCT)图像进行分析.采用SPSS 13.0统计软件进行数据处理.对两组患者的计量资料如年龄、眼轴长度、屈光度数进行比较,采用t检验;对两组患者的计数资料如性别构成比,裂孔周围玻璃体牵引、后巩膜葡萄肿及视网膜劈裂的发生率进行比较,采用X2检验;对两组患者左右眼的构成比和白孔、玻璃体后脱离的发生率进行比较,采用Fisher's确切概率法检验.结果 43例(44只眼)患者中,视网膜脱离组37例(37只眼),非脱离组7例(7只眼).视网膜脱离组患者平均年龄56岁;男性9例(24.3%),女性28例(75.7%);11只左眼(29.7%),26只右眼(70.3%);平均屈光度数(-8.9±2.2)D,平均眼轴长度(28.7±2.0)mm;视力≤0.05者26只眼,视力0.05～0.2者11只眼;玻璃体完全后脱离33只眼(89.2%),玻璃体不完全后脱离4只眼(10.8%),白孔13只眼(35.1%),裂孔周围玻璃体牵引10只眼(27.0%),视网膜劈裂13只眼(35.1%).非脱离组患者平均年龄48岁;男性1例(14.3%),女性6例(85.7%);左眼3只眼(14.3%),右眼4只眼(57.1%);平均屈光度数(-9.0±1.9)D,平均眼轴长度(28.9±1.5)mm;视力≤0.05者3只眼,视力0.05～0.2者3只眼,视力≥0.2者1只眼;玻璃体完全后脱离6只眼(85.7%),玻璃体不完全后脱离1只眼(14.3%),白孔1只眼(14.3%),裂孔周围玻璃体牵引3只眼(42.9%),视网膜劈裂5只眼(71.4%).B超检查显示所有患者均有后巩膜葡萄肿.OCT检测结果显示,非脱离组患者的黄斑裂孔周围大多有视网膜水肿、劈裂或脱离晕等与特发性黄斑裂孔相似的改变,但局部后巩膜葡萄肿的膨隆并不明显.统计分析结果显示,视网膜脱离组与非脱离组患者性别比(X2=0.008)、左右眼构成比(X2=0.449)、屈光度数(t=0.193)、眼轴(t=-0.25)、视力(X2=4.509)、玻璃体后脱离(X2=0.071)、白孔(X2=1.179)、孔缘部玻璃体牵引(X2=0.709)及视网膜劈裂发生率(X2=3.207)差异均无统计学意义(P>0.05);但视网膜脱离组患者年龄明显大于非脱离组,差异有统计学意义(t=1.66,P<0.05).结论 高度近视眼发生黄斑裂孔伴有视网膜脱离的原因可能有多种.高度近视眼患者在年龄增长过程中玻璃体和视网膜的改变可能是发生黄斑裂孔继而引起视网膜脱离的重要原因.     

高度近视眼黄斑裂孔性视网膜脱离的治疗

目的:探讨玻璃体手术治疗高度近视眼黄斑裂孔引起的视网膜脱离的疗效。方法:回顾性分析2001-03/2007-02的1组病例31例(32眼)。纳入标准为屈光不正≥-6.00D,黄斑下视网膜脉络膜萎缩的白色黄斑裂孔引起的原发性视网膜脱离,经过玻璃体手术联合硅油填充术治疗的病例,随访时间≥6mo。结果:随访时间6～12(平均8.4)mo。所有病例均行玻璃体切除联合硅油填充术、自体浓缩血小板封黄斑裂孔。8眼进行了内界膜剥除。术后最终视网膜复位29眼(91%),未复位3眼;术后视力提高22眼(69%),不变7眼(22%),下降3眼(9%)。结论:玻璃体切除术,自体浓缩血小板封孔是治疗高度近视眼黄斑裂孔性视网膜脱离的一种有效方法。     

视网膜内界膜剥离手术治疗高度近视黄斑裂孔视网膜脱离的疗效观察

目的 观察视网膜内界膜剥离治疗高度近视黄斑裂孔视网膜脱离的疗效. 方法 回顾分析25例25只眼高度近视黄斑裂孔伴视网膜脱离患者的临床资料.根据治疗方法 分为2组,A组为单纯玻璃体切割手术,13例13只眼;B组为玻璃体切割手术加吲哚青绿染色内界膜剥离,12例12只眼.所有患者行惰性气体填充,手术后保持面朝下体位7～15 d.观察最佳矫正分辨角对数(LogMAR)视力,检查眼底,光相干断层扫描(OCT)、B型超声检查视网膜复位及黄斑裂孔闭合情况,比较两组间疗效差异.手术后随访6～18个月,平均随访时间10个月. 结果 A组13只眼中,7只眼手术后视网膜复位,占53.8%;B组12只眼中,11只眼手术后视网膜复位,占91.7%.B组视网膜复位率明显优于A组(X2=4.427,P=0.046);25只眼中,手术后黄斑裂孔闭合者17只眼,占68.0%.其中,A组13只眼中,6只眼黄斑裂孔闭合,占A组患者的46.2%;B组12只眼中,11只眼黄斑裂孔闭合,占B组患者的91.7%.两组患者手术后黄斑裂孔闭合率比较,差异有统计学意义(X2=5.940,P=0.020).A组手术后最佳矫正LogMAR视力提高平均0.32,与手术前比较,差异有统计学意义(Z=-2.045,P=0.041),B组手术后最佳矫正LogMAR视力提高平均0.53,与手术前比较,差异有统计学意义(Z=-2.481,P=0.012).两组间手术后视力差异无统计学意义(U=51.5,P=0.16). 结论玻璃体切割联合视网膜内界膜剥离手术可能通过完全解除玻璃体黄斑牵引、增加视网膜顺应性而提高高度近视黄斑裂孔视网膜脱离的治疗效果.显著增加视网膜复位率及黄斑裂孔闭合率.     

Vitrectomy with internal limiting membrane peeling for macular retinoschisis and retinal detachment without macular hole in highly myopic eyes

PURPOSE: To report anatomic and visual improvement following vitrectomy with internal limiting membrane (ILM) peeling for two highly myopic patients with retinoschisis and/or retinal detachment without a macular hole. DESIGN: Two interventional case reports. METHODS: Two highly myopic patients who had retinoschisis and/or retinal detachment without a full-thickness macular hole underwent vitrectomy, internal limiting membrane peeling, and long-acting gas injection. Main outcome measures included best-corrected visual acuity, biomicroscopic appearance, and optical coherent tomography finding. RESULTS: Vitrectomy with ILM peeling results in biomicroscopic, functional, and tomographic improvement in both patients, for follow-up periods of 12 months and 8 months, respectively.CONCLUSIONS: Vitrectomy with ILM peeling and gas tamponade is an effective method for retinoschisis and/or retinal detachment without a macular hole in highly myopic patients.     

高度近视眼发生黄斑裂孔伴与不伴有视网膜脱离的临床观察

Objective To study the clinical features and the pathogenesis of macular hole with and without retina detachment(RD)in high myopic eyes.Methods It was a retrospective series case study.The charts of high myopic patients with macular hole at our hospital from June 2006 to February 2007 were retrospectively reviewed and analyzed. Patients were divided into two groups (the RD group and non-RD group) depending on the presence of RD or not. Their clinieal data and optic coherence tomography (OCT)results were further analyzed. SPSS 13.0 was used for the statistic analysis. When comparing the quantitative aspects like age, axial length and refraction, t-test was used. Categorical data, such as sex ratio, occurrence of vitreous traction, posterior staphyloma and retinoschisis were compared by using X2 test. Fisher's test was used in comparing eye laterality, incidence of white hole, visual acuity and posterior vitreous detachment (PVD). Results During this period, there were 43 patients fitting the including criteria. Among them,36 patents (37 eyes) were in the RD group and 7 patients (7 eyes) in the no-RD group. In the RD group,the average age was 56. 1,24. 3% of them (9/37) were male;percentage of left and right eyes was (11/37)and 70. 3% (26/37), respectively; average refraction was ( -8.9 ± 2. 2) D; average axial length was (28.7 ±2. 0) mm. Visual acuity was ≤0. 05 (72. 2% ) in 26 eyes and 0. 05-0. 2 (27. 8%) in 10 patients.The incidence of complete and non-complete PVD was 89. 2% (33/37) and 10. 8% (4/37), respectively.White hole presented in 35.1% (3/37) patients. Vitreous traction and retinoschisis presented in 27. 0%(10/37) and 35. 1% (13/37) patients, respectively. In the non-RD group, the average age was 47. 6;16. 7% of them (1/7) were male; left and right eyes were involved in 42. 9% (3/7) and 57. 1% (4/7),respectively. Average refraction was ( -9. 0 ± 1.9) D; average axial length was ( 28.9 ± 1.5 ) mm. Vision acuity was ≤0.05 in 3 patients (42.9%); between 0.05-0.2 in 3 eyes (42.9%) and ≥0.2 in 1 eye (14. 3% ). Incidence of complete and non-complete PVD was 85.7% (6/7) and 14. 3% (1/7),respectively. White hole was observed in 14. 3% (1/7) patients; 42. 9% (3/7) patients were accompanied with vitreous traction and 71.4% (5/7) with retinoschisis. B-scan ultrasenography showed posterior staphyloma in all 44 eyes. The results of statistical analysis showed that the gender (X2 = 0.008) and eye laterality (X2=0.449) as well as refraction (t=0.193), axial length (t=-0.25) and visual acuity (X2=4.509) of these two groups were similar (P>0.05). The incidences of vitreous traction (X2=0. 709), white hole (X2=1.179 ), PVD (X2=0.071) and retinoschisis (X2=3.207) were also similar (P>0. 05). But the age of the non-RD group is significantly younger than the RD group (t=1.66,P<0. 05). Conclusions Various pathogenesis may involved in the occurrence of retinal detachment in highly myopic eyes with macular hole. Further study is required to improve our understanding of this entity.     

高度近视眼发生黄斑裂孔伴与不伴有视网膜脱离的临床观察

Objective To study the clinical features and the pathogenesis of macular hole with and without retina detachment(RD)in high myopic eyes.Methods It was a retrospective series case study.The charts of high myopic patients with macular hole at our hospital from June 2006 to February 2007 were retrospectively reviewed and analyzed. Patients were divided into two groups (the RD group and non-RD group) depending on the presence of RD or not. Their clinieal data and optic coherence tomography (OCT)results were further analyzed. SPSS 13.0 was used for the statistic analysis. When comparing the quantitative aspects like age, axial length and refraction, t-test was used. Categorical data, such as sex ratio, occurrence of vitreous traction, posterior staphyloma and retinoschisis were compared by using X2 test. Fisher's test was used in comparing eye laterality, incidence of white hole, visual acuity and posterior vitreous detachment (PVD). Results During this period, there were 43 patients fitting the including criteria. Among them,36 patents (37 eyes) were in the RD group and 7 patients (7 eyes) in the no-RD group. In the RD group,the average age was 56. 1,24. 3% of them (9/37) were male;percentage of left and right eyes was (11/37)and 70. 3% (26/37), respectively; average refraction was ( -8.9 ± 2. 2) D; average axial length was (28.7 ±2. 0) mm. Visual acuity was ≤0. 05 (72. 2% ) in 26 eyes and 0. 05-0. 2 (27. 8%) in 10 patients.The incidence of complete and non-complete PVD was 89. 2% (33/37) and 10. 8% (4/37), respectively.White hole presented in 35.1% (3/37) patients. Vitreous traction and retinoschisis presented in 27. 0%(10/37) and 35. 1% (13/37) patients, respectively. In the non-RD group, the average age was 47. 6;16. 7% of them (1/7) were male; left and right eyes were involved in 42. 9% (3/7) and 57. 1% (4/7),respectively. Average refraction was ( -9. 0 ± 1.9) D; average axial length was ( 28.9 ± 1.5 ) mm. Vision acuity was ≤0.05 in 3 patients (42.9%); between 0.05-0.2 in 3 eyes (42.9%) and ≥0.2 in 1 eye (14. 3% ). Incidence of complete and non-complete PVD was 85.7% (6/7) and 14. 3% (1/7),respectively. White hole was observed in 14. 3% (1/7) patients; 42. 9% (3/7) patients were accompanied with vitreous traction and 71.4% (5/7) with retinoschisis. B-scan ultrasenography showed posterior staphyloma in all 44 eyes. The results of statistical analysis showed that the gender (X2 = 0.008) and eye laterality (X2=0.449) as well as refraction (t=0.193), axial length (t=-0.25) and visual acuity (X2=4.509) of these two groups were similar (P>0.05). The incidences of vitreous traction (X2=0. 709), white hole (X2=1.179 ), PVD (X2=0.071) and retinoschisis (X2=3.207) were also similar (P>0. 05). But the age of the non-RD group is significantly younger than the RD group (t=1.66,P<0. 05). Conclusions Various pathogenesis may involved in the occurrence of retinal detachment in highly myopic eyes with macular hole. Further study is required to improve our understanding of this entity.