高度近视眼黄斑劈裂光学相干断层扫描临床观察

目的分析光学相干断层扫描（optical coherence tomography,OCT）对高度近视眼黄斑劈裂诊断和预后评估的作用。方法回顾性分析2009年8月-2011年6月在我院就诊经最佳矫正视力、屈光度、A/B型超声和OCT检查确诊的42例78眼高度近视患者的临床资料。对黄斑劈裂组和非黄斑劈裂组的年龄、视力、屈光度、眼轴长度进行比较。观察黄斑劈裂视网膜厚度与屈光度的关系。结果 OCT扫描发现黄斑劈裂17例25眼（32.1%）,其中黄斑劈裂合并黄斑前膜2眼,合并玻璃体牵拉2眼。有视物变形、暗影、视力下降等症状26例51眼高度近视发现黄斑劈裂14例22眼,无症状16例27眼发现黄斑劈裂3例3眼。年龄、视力、眼轴长度和屈光度对黄斑劈裂发生的影响无统计学意义（P〉0.05）。25眼黄斑劈裂多发生在黄斑中心凹,以外层劈裂多见,均累及2~4个象限不等。外层劈裂15眼,混合性劈裂10眼。外层劈裂可单独存在,中、外层劈裂及内、中、外层劈裂可共存于同一患眼。近视屈光度对黄斑劈裂视网膜厚度的影响无统计学意义（P〉0.05）。25眼黄斑劈裂随访12~20个月,出现黄斑前膜2例2眼,2眼有玻璃体牵拉的黄斑劈裂发生视网膜脱离1眼,黄斑裂孔1眼。结论高度近视眼患者定期OCT检查有助于黄斑劈裂的早期诊断和监测,能明确黄斑劈裂发生的层次和清晰显示黄斑劈裂的形态。

Role of optical coherence tomography in diagnosis of high myopia with macular retinoschisis

Objective To analyze the role of optical coherence tomography（OCT） in diagnosis of high myopia with macular retinoschisis and its prognostic assessment.Methods Clinical data about 42 patients（78 eyes） with high myopia admitted to our hospital from August 2009 to June 2011 with their visual acuity（VA） and refraction corrected were retrospectively analyzed.Their diagnosis was established by A/B ultrasonography and OCT scanning.The patients were divided into retinoschisis group and nonretinoschisis group.Their age,VA,diopter and ocular axial length were compared.The relation between retinal thickness and diopter was analyzed.Results OCT showed high myopia with macular retinoschisis in 25 eyes of 17 patients（32.1%）.Of these eyes,2 were diagnosed with macular retinoschisis accompanying macular membrane and 2 were diagnosed with macular retinoschisis accompanying vitrous traction.Of the 51 eyes of 26 patients with symptoms of metamorphopsia,shadow and reduced VA,22 eyes of 14 patients were diagnosed with high myopia with macular retinoschisis.Of the 27 eyes of 16 patients with no such symptoms,3 eyes of 3 patients were diagnosed with macular retinoschisis.No significant difference was found in the effect of age,VA,diopter and ocular axial length on macular retinoschisis（P 0.05）.Retinoschisis usually occurred in the fovea of 25 eyes involving 2-4 quadrants.Outer kinds of retinoschisis occurred in 15 eyes and mixed schisis in 10 eyes.Outer retinoschisis could exist independently and two or more types of retinoschisis could coexist in the same affected eye.No significant difference was found in the retinal thickness of retinoschisis and diopter（P 0.05）.The 25 eyes with macular retinoschisis were followed up for 12-20 months,during which macular membrane occurred in 2 eyes of 2 patients,retinal detachment in 1 patient due to vitrous traction and macular hole in 1 patient.Conclusion Regular OCT contribute to the early diagnosis and monitoring of high myopia with macular retinoschisis and can display it involved layers and morphology.