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.

Clinical observations of macular hole with and without retinal detachment in high myopic eyes

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.