联合应用光相干断层扫描和三维磁共振成像对病理性近视视网膜劈裂与后葡萄肿关系的初步研究

A preliminary study on the analysis of myopic retinoschisis and posterior staphyloma in a cohort of patients with pathological myopia by optical coherence tomography and magnetic resonance imaging

目的观察病理性近视(PM)视网膜劈裂(MRS)与后巩膜葡萄肿(PS)的相关性,初步探讨MRS发生的影响因素。方法回顾性病例系列研究。2016年11月至2019年11月于河南省立眼科医院检查确诊的PM伴MRS患者38例60只眼纳入研究。其中,男性10例,女性28例;双眼13例,单眼25例。平均年龄(49±13)岁。均行BCVA、散瞳检影验光、频域OCT、三维磁共振成像(3D-MRI)检查以及眼轴长度(AL)测量。依据频域OCT检查结果将MRS分为内层劈裂、外层劈裂和混合型劈裂;依据3D-MRI扫描结果将PS分为宽黄斑型、窄黄斑型、绕盘型、鼻侧型、盘下型和其他类型。MRS与PS之间相关性行χ^2检验或Fisher精确检验。结果60只眼中,MRS合并PS 58只眼(96.77%)。其中,宽黄斑型、窄黄斑型、绕盘型、鼻侧型、盘下型、其他类型分别为30(51.72%)、19(32.75%)、1(1.72%)、2(3.48%)、2(3.48%)、4(6.85%)只眼;内层劈裂、外层劈裂、混合型劈裂分别为10(17.24%)、24(41.38%)、24(41.38%)只眼。窄黄斑型PS 19只眼中,MRS累及中心凹16只眼;其余形态PS 39只眼中,MRS累及中心凹22只眼。窄黄斑型与其余类型累及中心凹眼数比较,差异有统计学意义(P=0.044)。MRS累及中心凹与窄黄斑型PS相关度中等(Cramer's V=0.275)。内层劈裂、外层劈裂、混合型劈裂患者年龄分别为(44±12)、(56±10)、(44±13)岁。内层劈裂患者较外层劈裂患者年轻,外层劈裂患者较内层劈裂、混合型劈裂患者年龄大,差异均有统计学意义(P=0.010、0.010、0.060)。结论PM伴MRS多发生于PS患眼,且以黄斑型PS(宽黄斑型、窄黄斑型)为主。

Objective To observe the correlation between posterior myopic retinoschisis(MRS)and posterior scleral staphyma(PS)in pathological myopia(PM),and to preliminarily explore the influencing factors of MRS.Methods A retrospective case series study.From November 2016 to November 2019,38 patients with PM with MRS diagnosed in Henan Eye Hospital&Henan Eye Institute from were included in the study.There were 10 males and 28 females;13 patients were binocular and 25 patients were monocular.The average age was(49±13)years old.BCVA,retinoscopy optometry,frequency domain OCT,three-dimensional magnetic resonance imaging(3D-MRI)examination and axial length(AL)measurement were performed.According to the frequency domain OCT inspection results,MRS was divided into inner splitting,outer splitting and mixed splitting;based on the 3D-MRI scan results,PS was divided into broad macula,narrow macula,discoid,nasal,subdisc and other types.The correlation between MRS and PS was tested by χ^2 test or Fisher exact test.Results Among 60 eyes,58 eyes(96.77%)of MRS combined with PS.Among them,the wide macula,narrow macula,discoid,nasal,subdisc,and other types were 30(51.72%),19(32.75%),1(1.72%),2(3.48%),2(3.48%)and 4(6.85%)eyes;inner split,outer split,and mixed split were 10(17.24%),24(41.38%),24(41.38%)eyes.Of the 19 eyes with narrow macular PS,MRS involved the fovea in 16 eyes;of the 39 eyes with PS of other forms,MRS involved the fovea in 22 eyes.There was a statistically significant difference between the narrow macular type and other types involving foveal eyes(P=0.044).The correlation between MRS involving the fovea and narrow macular PS was moderate(Cramer's V=0.275).The ages of patients with inner split,outer split,and mixed split were 44±12,56±10,and 44±13 years,respectively.Patients with inner splitting were younger than those with outer splitting,and those with outer splitting were older than those with inner splitting and mixed splitting.The differences were statistically significant(P=0.010,0.010,0.060).Conclusion PM with MRS mostly occur in PS-affected eyes,and mainly macular PS(wide macula,narrow macula).