高度近视偏心注视优势位置的研究

目的 探讨高度近视眼因黄斑病理损害形成中心暗点以及丧失中心视力后偏心固视的形成规律,确定偏心注视点的优势位置.方法 应用微视野计(MP-1)对因黄斑病变形成偏心固视的40例高度近视患者的54只眼作固视检查.利用正常成人中心固视的90%置信椭圆,确定偏心固视相对于中心凹的位置.根据观察到的偏心固视的位置,将所有患眼分为preferred retinal locucs(PRL)优势组和PRL非优势组;并将两组视力作统计学比较.结果 54只高度近视眼中,中心视力丧失后偏心固视点形成在暗点下方视野者24只眼,占本组患眼的44.44%;左侧19只眼,占35.19%;上方6只眼,占11.11%;右侧5只眼,占9.26%.双眼均形成偏心固视者14例,其中13例双眼偏心固视模式一致,均为下方者7例,占双眼偏心固视者的50.00%;均为左侧者5例,占35.71%;均为上方者1例,占7.14%.偏心固视位于下方、左侧视野组与偏心位置位于右侧和上方的非优势组之间比较.其视力差异无统计学意义(F=0.144,P>0.05).结论高度近视患者偏心固视会形成在尽量靠近中心凹有功能的视网膜.下方视野是形成偏心固视的优势位置.     

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.     

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.     

正常成年人中心固视点的微视野检测

目的 观察正常成年人中心固视点相对于眼底视盘的位置关系，以及固视稳定性的特点。方法 应用MP-1微视野计对60位正常成年人的120只眼作固视检查，测量中心固视点相对于视盘的坐标位置，并对中心固视点与年龄和屈光度作相关分析，对双眼的差距作t检验。 结果 正常成年人中心固视点距离视盘颞侧边中点的水平距离为14.48°±1.85°，垂直距离为－2.14°±1.26°，90%分布在一个二维正态椭圆内；固视目标时，眼位处于一种不断的微动状态，水平和垂直方向活动度的中位数分别是0.4°和0.3°。 结论 正常成年人中心固视点的分布特征为一个二维正态椭圆，固视目标时眼位在水平方向的移动大于垂直方向的移动幅度。     

高度近视患者后极部视网膜血管曲折度及分叉角变异

目的 观察高度近视患者后极部各个象限视网膜动静脉曲折度及分叉角的变异.方法 对比分析高度近视患者32例52只眼以及正常人22例30只眼后极部不同象限视网膜血管曲折度及分叉角大小,并比较高度近视后极部视网膜血管与正常眼的差异.多变量方差分析对结果 进行分析,P<0.05为差异有统计学意义.结果 高度近视眼由视盘发出平行走向黄斑的血管,动脉曲折度分别为(1.29±1.10)×10-4、(5.39±1.93)×10-5;正常眼分别为(4.15±2.38)×10-4、(9.75±4.99)×10-5,两组差异均有统计学意义(t=1.99,2.00;P<0.05).高度近视眼视网膜动脉鼻上鼻下分叉角分别为(66.17±14.04)°、(61.20±11.02)°,正常眼分别为(77.66±14.12)°、(85.86±16.45)°,两组差异均有统计学意义(F=0.77,0.83;P<0.05).高度近视眼视网膜静脉颞上颞下分叉角分别为(92.39±20.36)°、(83.56± 23.50)°,正常眼分别为(79.45±15.94)°、(70.59±17.27)°,两组比较差异均有统计学意义(F=2.34,1.83;P<0.05).结论高度近视眼视网膜动脉及从视盘发出平行走向黄斑的血管曲折度变小,与动脉相应静脉曲折度变化不明显;高度近视眼底血管动脉鼻上鼻下分叉角较正常眼较小,高度近视眼底静脉颞上颞下分叉角较正常眼增大.     

特发性黄斑裂孔眼的注视性质分析

目的 探讨特发性黄斑裂孔眼的注视性质,评价黄斑区视网膜平均光敏感度及固视稳定性与裂孔孔径的相关性.方法 横断面研究.38例（40眼）经光学相干断层扫描（OCT）检查确诊为全层特发性黄斑裂孔的患者纳入研究,患者均行MP-1微视野检查,测量黄斑区视网膜光敏感度,注视位置和固视稳定性.对黄斑区视网膜光敏感度和稳定性分别与裂孔孔径之间的关系作线性相关分析.结果 40只患眼均形成偏心注视.其中偏心注视点在裂孔上方边缘者28眼（70％）,位于裂孔右侧边缘者10眼（25％）,位于裂孔左侧和下方边缘者各1眼（2％）.黄斑区视网膜平均光敏感度、固视稳定性与裂孔孔径之间呈较弱的负相关关系（r=-0.15、-0.08,P＜0.01）.结论 全层特发性黄斑裂孔眼往往会形成偏心注视,其裂孔孔径的大小可能会影响视功能.     

高度近视患者后极部视网膜血管曲折度及分叉角变异

Objective To observe the changes of tortuosity and bifurcation angle of retinal arteries and veins in each quadrant of the posterior pole in eyes with high myopia. Methods The tortuosity and bifurcation angle of retinal vessels in each quadrant of the posterior pole in 32 patients (52 eyes) with high myopia and 22 healthy people (30 eyes) were observed and compared. The outcomes were analyzed by multivariate analysis of variance. Results The tortuosity of macular vessels and the artery from optic disc in eyes with high myopia was (1.29±1.10)×10-4 and (5.39±1.93)×10-5 respectively, and in the normal eyes was (4.15±2.38)×10-4 and (9.75±4.99)×10-5 respectively; there was significant difference between the two groups (t=1.99, 2.00; P<0.05). The bifurcation angle of superior nasal and inferior nasal retinal arteries in eyes with high myopia was(66.17±14.04)° and (61.20±11.02)° respectively, and in the normal eyes was (77.66±14.12)° and (85.86±16.45)° respectively; there was significant difference between the two groups (F=0.77, 0.83; P<0.05). The bifurcation angle of superior temporal and inferior temporal retinal veins in eyes with high myopia was (92.39±20. 36)° and (83.56±23.50)° respectively, and in the normal eyes was (79.45±15.94)° and (70.59±17.27)°; there was significant difference between the two groups (F=2.34, 1.83; P<0.05). Conclusions The vessel tortuosity of retinal arteries and the vessels extending from the optic disc to macula is smaller in eyes with high myopia, while the venous tortuosity has no change. The bifurcation angle of retinal arteries in the superior nasal and inferior nasal field was smaller in eyes with high myopia, while the venous tortuosity has no change. The bifurcation angle of retinal veins in the superior temporal and inferior temporal field was larger in eyes with high myopia.     

高度近视黄斑区玻璃体视网膜界面异常手术治疗中值得探讨的几个问题

高度近视黄斑劈裂、黄斑裂孔等黄斑区玻璃体视网膜界面异常严重影响高度近视患者的视功能,其自然病程各异,手术治疗的关键是如何去除玻璃体后皮质对黄斑区视网膜的牵引,恢复黄斑中心凹原有的解剖结构,保持和(或)提高中心视功能.但玻璃体腔注气、后巩膜兜带和(或)加固、玻璃体切割手术等具体干预方式的选择和应用仍存在许多争议并值得探讨.如何正确理解和评价现有这些风格迥异的手术方式及其疗效,根据疾病的不同特点制定治疗方案是目前急需解决的现实问题.     

转甲状腺素蛋白作为高度近视血清潜在分子标记物的研究

目的 观察转甲状腺素蛋白(TTR)在高度近视患者血清及玻璃体中的异常表达.方法 经检影验光、裂隙灯显微镜和间接检眼镜眼底检查,Iol-Master测量眼轴后确诊的116例高度近视患者(患者组)纳入研究.其中,男性50例,女性66例;平均年龄(49.7±12.3)岁,平均屈光度(-10±4.4.2)D.选取同期健康检查者86名为正常对照组.其中,男性42名,女性44名;平均年龄(48.5±10.5)岁.根据间接检眼镜及光相干断层扫描(OCT)检察结果,将眼底病变分为黄斑中心凹脱离、黄斑裂孔、脉络膜新生血管、黄斑表面膜、瘢痕萎缩、眼底未见明显病理改变等情况.所有受试者抽取外周静脉血2 ml,制备血清样本.另外选择合并黄斑中心凹脱离、黄斑裂孔的高度近视患者20例20只眼,行玻璃体切割手术前采集玻璃体样本.患者组、正常对照组各选取16份血清样本进行线性离子阱质谱(LTQ-MASS)分析.并采用蛋白免疫印迹(Western blot)及酶联接免疫吸附测定(ELISA)方法对患者组100份血清和正常组80份血清中TTR含量进行测定.再对玻璃体样本20份和对应血清样本进行ELISA检测,同时观察手术后视力与玻璃体中TTR含量之间的关系.结果 患者组和正常对照组血清样本LTQ-MASS检测出4种差异蛋白.其中,患者组TTR含量较正常对照组TTR含量明显升高.Western blot检测结果显示,患者组血清中TTR表达较正常对照组血清TTR表达明显增高,差异有统计学意义(t=3.68,P＜0.05).ELISA检测结果显示,患者组中伴黄斑脱离及黄斑裂孔者血清和玻璃体中TTR含量明显高于正常对照组,差异有统计学意义(F=9.28,P＜0.01).手术后视力恢复较好者玻璃体中TTR含量较高.结论 TTR在高度近视患者血清及玻璃体中表达较正常组明显增高,且与高度近视眼底表现相关.

Abstract：

Objective To observe the abnormal expression of transthyretin in serum and vitreous of high myopia patients.Methods 116 patients(50 males and 66 females)with high myopia,diagnosed by retinoscopic reflex,slit-lamp microscope,indirect ophthalmoscope and Iol-Master,were enrolled.The patients had an average age of(49.7±12.3)years and average diopter of(-10±4.2)D.The control group had 86 healthy individuals(42 males and 44 females)with an average age of(48.5±10.5)years.According to the findings of indirect ophthalmoscope and optical coherence tomography(OCT)examination,the patients were classified as foveal detachment,macular hole,choroidal neovascularization,epimacular membrane.retinal scar and no significant pathological changes.2 ml peripheral blood samples were taken from all the subjects.The vitreous samples of high myopia patients with foveal detachment and macular hole (20 patients.20 eyes)were collected before pars plana vitrectomy.LTQ-MASS was performed on 16 serum samples of patients and 16 control serum samples.Western blot and enzyme linked immunosorbent assay (ELISA)were used to detect serum transthyretin expression in high myopia groups(n=100)and control group(n=80).Vitreous samples(n=20)and corresponding serum samples were further analyzed by ELlSA.Meanwhile,the relationship between visual acuity after surgery and transthyretin expression level in vitreous were analyzed.Results LTQ-MASS detected 4 proteins differentially expressed in the serum of patients and control group,transthyretin was the most significantly increased protein in high myopia patients.Western blot validated that serum transthyretin of high myopia group was much higher than that of the control group(t=3.68,P＜0.05).High myopia patients with macular hole and macular detachment had much higher serum and vitreous transthyretin than that of control group(F=9.28,P＜0.01).Patients with higher vitreous transthyretin had better postoperative visual acuity.Conclusions The transthyretin level increases significantly in serum and vitreous of high myopia patients,and it correlated with ocular pathologies and visual outcomes.     

转甲状腺素蛋白作为高度近视血清潜在分子标记物的研究

Objective To observe the abnormal expression of transthyretin in serum and vitreous of high myopia patients.Methods 116 patients(50 males and 66 females)with high myopia,diagnosed by retinoscopic reflex,slit-lamp microscope,indirect ophthalmoscope and Iol-Master,were enrolled.The patients had an average age of(49.7±12.3)years and average diopter of(-10±4.2)D.The control group had 86 healthy individuals(42 males and 44 females)with an average age of(48.5±10.5)years.According to the findings of indirect ophthalmoscope and optical coherence tomography(OCT)examination,the patients were classified as foveal detachment,macular hole,choroidal neovascularization,epimacular membrane.retinal scar and no significant pathological changes.2 ml peripheral blood samples were taken from all the subjects.The vitreous samples of high myopia patients with foveal detachment and macular hole (20 patients.20 eyes)were collected before pars plana vitrectomy.LTQ-MASS was performed on 16 serum samples of patients and 16 control serum samples.Western blot and enzyme linked immunosorbent assay (ELISA)were used to detect serum transthyretin expression in high myopia groups(n=100)and control group(n=80).Vitreous samples(n=20)and corresponding serum samples were further analyzed by ELlSA.Meanwhile,the relationship between visual acuity after surgery and transthyretin expression level in vitreous were analyzed.Results LTQ-MASS detected 4 proteins differentially expressed in the serum of patients and control group,transthyretin was the most significantly increased protein in high myopia patients.Western blot validated that serum transthyretin of high myopia group was much higher than that of the control group(t=3.68,P＜0.05).High myopia patients with macular hole and macular detachment had much higher serum and vitreous transthyretin than that of control group(F=9.28,P＜0.01).Patients with higher vitreous transthyretin had better postoperative visual acuity.Conclusions The transthyretin level increases significantly in serum and vitreous of high myopia patients,and it correlated with ocular pathologies and visual outcomes.     

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.     

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.     

前后段联合手术及硅油填充治疗高度近视黄斑孔视网膜脱离的疗效观察

目的 观察前后段联合手术及硅油充填治疗高度近视黄斑孔视网膜脱离临床疗效.方法 回顾分析前后段联合手术及硅油充填治疗高度近视黄斑孔视网膜脱离患者48例48只眼的临床资料.患者均有高度近视史,视网膜脱离以后极部为主.裂隙灯前置镜和(或)光相干断层扫描(OCT)检查均发现黄斑裂孔.均行白内障超声乳化或抽吸联合玻璃体切割硅油充填,41例行内界膜(ILM)剥离,23例植入人工晶状体(10L).硅油取出的时间距第一次手术时间为3.5～48.0个月.取硅油前均行OCT检查.取硅油后随访观察均1年以上.结果 除5例外,其他患者手术后1周,前置镜检查均不能看到黄斑孔边缘;视力均有不同程度的提高.48例患者全部已取硅油.取硅油前OCT检查,黄斑孔愈合呈U型8例,V型为6例,W型为23例;未闭合11例.未闭合的11例经取硅油与膨胀气体充填后全部复位,其中,U型2例,W型9例.32例W型愈合者中2例患者在取油后13、38个月后出现视网膜脱离复发.最终黄斑裂孔U型和V型愈合者16例,占33.3%;W型愈合者32例,占66.7%.视网膜复位率为100.0%.结论前后段联合手术及硅油充填是治疗高度近视黄斑孔视网膜脱离的有效方法 ;OCT检查是确定黄斑孔是否封闭的客观标准.     

上海市北新泾街道老年人高度近视眼的流行病学调查

Objective To investigate the prevalence of high myopia,the prevalence and risk factors of high myopia associated with chorioretinopathy in residents aged 60 years or over in Beixinjing community, Shanghai, China. Methods A cluster stratified random sampling method was used to screen 4153 people aged 60 and over in Beixinjing community. There were 3851participants in total with a 92.73% response rate. Participants were invited to complete a questionnaire and received a comprehensive eye examination including visual acuity, refraction, slit-lamp microscopic examination, direct ophthalmoscopy and fundus photography and so on. Spherical equivalent (SE) was used to determine the degree of refractive errors. The diagnosis of high myopic chorioretinopathy was made if SE>-6.00 D and myopic ehorioretinal atrophy lesions were presented such as posterior seleral staphyloma, lacquer cracks, Fuchs spot and myopic arc spots. The degree of visual acuity impairment was determined according to the World Health Organization (WHO) classification as low vision (the best corrected visual acuity≥0. 05, but <0.3) or blindness (the best corrected visual acuity < 0. 05). Results There were 207/3851 (5.37 %) high myopia patients, in which 183/207 (88.40%) patients were associated with myopic chorioretinopathy. The prevalence of myopic chorioretinopathy decreased while age increased (X2= 19.21, P<0.01), but statistically there was no gender difference (X2= 1.83, P>0.05). Logistic regression analysis showed that there were significant differences in the prevalence of high myopia between people with different age, educational levels and family history (X2= 19.21,32. 08,960. 68; P<0.01). There were 29 cases of bilateral blindness, 96 cases of unilateral blindness, 104 cases of bilateral low vision and 562 cases of unilateral low vision in those participants. In 183 cases of high myopic chorioretinopathy patients, 111(60.65 %)cases had an obvious visual impairment, including 34.48% (10 cases) of bilateral blindness, 11.46% (11 cases) of unilateral blindness, 29.81% (31 cases)of bilateral low vision and 10.50% (59 cases) of unilateral low vision. Conclusions The prevalence of high myopia of residents aged ≥ 60 years in Beixinjing community, Shanghai, China is relatively high. Age, education level and family history are the most important factors affecting the occurrence of chorioretinopathy in high myopia patients.     

高度近视黄斑劈裂视网膜内界膜剥离手术联合全氟丙烷眼内填充疗效评价

Objective To evaluate the efficacy of vitrectomy with internal limiting membrane(ILM) peeling and perfluoropropane tamponade (C3F8) to treat macular retinoschisis in high myopic eyes. Methods 33 eyes of 31 consecutive high myopia patients with macular retinoschisis were selected randomly; all had posterior staphyloma without retinal detachment. The preoperative refractive errors ranged from -9.5 D to -21.0 D with the mean of -(13.1±3.6) D. The preoperative axial lengths ranged form 26 mm to 32 mm with the mean of (28.3±2.1 mm. Conventional 20-G vitrectomy was performed with ILM peeling and 10 % C3 F8 infusion, ILM was labeled by Triamcinolone (TA). The best corrected visual acuity (BCVA) and macular structural changes were observed before the surgery, and at 1, 2, 3, 4, 8 months after the surgery. Results Beginning from 1 month after surgery all patients had significant improvement of the macular retinoschisis and BCVA. The macular structure changed very slightly along with the time. The foveal thickness were (327.62±51.7), (165.2±22. 6), (159.3±28.7), (167.7±17.1), (142.7±13.8) and (169.1±19.6) μm respectively before surgery and 1, 2, 3, 4, 8 months after surgery. The mean foveal thickness was reduced significantly at 1-8 months follow-up compared with the preoperational result (t = 9.21,9.23,9.21,10. 67,9.21; P<0.05). The foveal thickness had no significant change at each time-point after surgery. From 4 months after surgery, recurrence of macular retionoscbisis was found in 3 eyes (9.1%). Conclusion Vitrectomy with ILM peeling and C3F8 tamponade is useful to treat macular retinoschisis in high myopic eyes.     

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.     

Preferred retinal locus profile during prolonged fixation attempts

ObjectiveThe retinal area or location used during any fixation attempt defines the preferred retinal locus (PRL). It is presumed that during prolonged fixation attempts there may be various representative reference points within the PRL area. This study aims to clarify this presumption.DesignProspective, nonrandomized, observational case series.ParticipantsSixty-five eyes of 41 patients from the University of Nottingham, Queen’s Medical Centre Retina and Low Vision Clinics.MethodsA total of 65 eyes of 41 patients from the University of Nottingham, Queen’s Medical Centre Retina and Low Vision Clinics were assessed for PRL using the Macular Integrity Assessment (MAIA) microperimetry equipment (CenterVue, Padova, Italy). The MAIA allows automatic calculation for 2 points named PRL_initial (PRLi), which is calculated after the first 10 seconds of fixation, and PRL_final (PRLf), which is calculated after the completion of all fixation attempts during the microperimetry test.ResultsEstimates of PRLi and PRLf were produced for all patients. Forty-six (71%) eyes were classified as having stable fixation; 40 of the 46 eyes (87%) had both PRLs location over the fovea centralis. Nineteen of 65 eyes (29%) were classified as having unstable or relatively unstable fixation; different PRLi and PRLf locations were found in 18 (95%) of the 19 eyes, including 13 (68%) with central geographic atrophy secondary to dry age-related macular degeneration. The mean rate of change was 5.3 units in fixation per unit change in distance in both PRLi and PRLf.ConclusionsThe representative points during prolonged fixation attempts may vary at different stages of fixation. This is reflected in the characteristics of fixation stability of the patients and presents a possible association with main pathology responsible for low vision.     

高度近视眼黄斑部不同区域神经上皮厚度的定量测定及其意义

目的研究高度近视眼黄斑部不同区域的神经上皮层厚度的变化,并分析其与屈光度之间的相关性。方法选取高度近视眼患者78例,按屈光度不同分为A(-6.0~-9.0 D)、B(-9.1~-15.0 D)、C(>-15.0 D)三组。采用Huphery-3000光学相干断层扫描(optical coherence tomogra-phy,OCT)测量黄斑部9个不同分区的视网膜神经上皮层厚度,比较它们之间的差别,并分析各区域神经上皮层厚度与屈光度之间的相关性。结果C组A2~A6区视网膜神经上皮厚度分别为(244.31±24.46)mm、(224.73±27.45)mm、(236.08±27.71)mm、(236.15±34.10)mm与(219.88±20.42)mm,与A、B组比较差别有显著性(P<0.001),其余各区组间差别不明显;A2~A6区视网膜神经上皮厚度与近视屈光度明显相关,r分别为0.387、0.462、0.315、0.403、0.326,经统计学检验发现,差异有显著性(P<0.05)。结论高度近视眼黄斑部神经上皮损害随近视屈光度不断增高而呈区域选择性萎缩变薄,OCT将为追踪观察此种损害提供理想方法。