近视牵引性黄斑病变自然病程进展远期观察

Long Term Study of the Natural Course of Myopic Traction Maculopathy

目的:观察近视牵引性黄斑病变(MTM)患者自然病程进展的远期变化及影响因素。方法:回顾性系列病例分析。2015年1-6月在嘉兴市第一医院眼科门诊就诊的MTM患者48例(96眼),于2017年1-6月进行患者回访,间隔时间为2年。患者均行最佳矫正视力(BCVA)、屈光度、眼压、眼轴、B超、眼底彩色照相及光学相干断层扫描(OCT)检查。根据随访初期OCT显示的黄斑病变形态将对象分成黄斑结构正常组(39眼)、黄斑劈裂组(42眼)、无孔性视网膜脱离组(10眼)、全层黄斑裂孔组(5眼),观察回访时黄斑结构变化。组间计量资料比较采用Kruskal-Wallis检验,计数资料比较采用R×C列联表χ2检验。结果:末次随访时,7%眼黄斑区牵引性病变改善或是完全恢复。69%眼情况稳定,24%眼黄斑区病变进行性恶化。随访发现,黄斑劈裂组、无孔性视网膜脱离组、全层黄斑裂孔组3组间病变进展率比较差异具有统计学意义(χ2=11.73,P=0.005)。4组间屈光度(χ2=10.36,P=0.015)、眼轴(χ2=10.96,P=0.016)、后巩膜葡萄肿(χ2=12.13,P=0.004)、脉络膜萎缩(χ2=22.56,P<0.001)、初始视力(χ2=42.14,P<0.001)和现有视力(χ2=36.61,P<0.001)差异均有统计学意义。结论:MTM病程多变,需要长期密切的随访观察。长眼轴、脉络膜萎缩、后巩膜葡萄肿、视网膜前部牵引可加快MTM的进展。

Objective:To observe long term changes in the natural course of myopic traction maculopathy(MTM)and its influence factors.Methods:This was a retrospective case analysis.Forty-eight patients previously diagnosed with MTM were recruited between January 2015 and June 2015.All patients were followed up for 2 years.Patients underwent BCVA,refraction,intraocular pressure,axial length,B-ultrasonography,fundus photography and OCT measurements.According to different macular morphologies detected by OCT,patients were divided into four groups:normal(39 eyes),macular retinoschisis(42 eyes),foveal detachment(10 eyes),and full-thickness macular hole(5 eyes).Data were analyzed using Kruskal-Wallis test andχ2 test.Results:Of the 48 patients included,7%of eyes exhibited partial or complete MTM resolution,69%of eyes stabilized and 24%exhibited MTM progression.The differences in progression rates in the macular retinoschisis,foveal detachment and full-thickness macular hole groups were statistically significant(χ2=11.73,P=0.005).Refraction(χ2=10.36,P=0.015),axial length(χ2=10.96,P=0.016),the frequency of posterior staphyloma(χ2=12.13,P=0.004),chorioretinal atrophy(χ2=22.56,P<0.001),initial BCVA(χ2=42.14,P<0.001)and final BCVA(χ2=36.61,P<0.001)all differed significantly among the four groups.Conclusions:Axial elongation,chorioretinal atrophy,posterior staphyloma,and anterior traction contribute to MTM development.Patients with high myopia require regular OCT monitoring of the eyes to assess progression to pre-MTM.