不同眼底改变的高度近视视网膜脱离患者对侧眼后极部功能形态学改变及相关因素分析

Analysis on the high myopic changes and related factors of functions and fundus appearances in the fellow eye of retinal detachment with different fundus impairs

目的观察不同眼底改变的高度近视视网膜脱离患者对侧眼后极部功能形态学变化,以及与相关因素的关系,寻找不同眼底改变对高度近视眼视力、形态损害的早期客观敏感指标。方法从11方面分组分析:视力、年龄、职业、眼别、性别、病程、近视度数、视网膜脱离眼裂孔位置、眼轴、B超形态及眼底形态。将临床与黄斑形态相关的检查项目筛选,采用OCTOPUS101中的中心低视力程序(LVC)、罗兰RETIscan和RETIport视觉电生理系统中的单次视锥-ERG、30Hz闪烁ERG、P-VEP,多焦视网膜电图中一阶反应1、2环,联合A/B超、Heideldery激光扫描眼底荧光/吲哚青绿造影系统等检测手段对高度近视视网膜脱离患者对侧眼后极部视功能状态22项指标进行定性定量观察。结果高度近视眼在不同眼底形态诸分组中,资料齐全的不同眼底改变组病例共94例。从构成比分析,>-10D、40岁以上以及视力低于0.4的近视眼眼底多为豹纹状改变、混合改变。随眼底形态变化的复杂化和累及范围增加,伴有年龄、视力、近视屈光度、眼轴的相关变化。视野的平均光敏感度下降;视觉电生理中单次视锥细胞和30Hz闪烁b波振幅下降;2环振幅密度下降,2环b波振幅均有下降(P<0.05)。结论高度近视患者眼底的变化是随年龄、度数的增加、视力下降而逐渐形成的,因而定期对高度近视的眼底客观功能检测有助于早发现隐匿性器质性病变。

Objective To observe the posterior segment changes of functions and fundus appearances in the high myopic fellow eye of retinal detachment with different fundus impairs and analyze their related factors, such as visual fields, visual electrophysiolography, and to find out the sensitive and objective methods which can detect the earlier damages to the central visual acuity in the high myopia eyes. Methods The data were divided into 11 groups, included central visual acuity, age, profession, gender, history, myopic severity, macular disturb accompanied, ocular axis, B-scan, and fundus appearances. The objective tests related to macular appearance and functions were chosen, such as LVC in the perimeter, cone-ERG, 30Hz flicker ERG, P-VEP, first order kernel in 1,2 ring of multi-focal ERG, and A/B scan , FFA/ICGA. The collected data were analyzed statistically. Results There were 94 cases with the complete data in the group divided by different fundus impairs in the high myopic fellow eye of retinal detachment. From the different constitution of the data, , the diffuse fundus impair was accompanied with myopic diopter over- 10D, the age over 40 years old, and the visual acuities are lower than 0.4 ; the mean light sensitivity of 30°visual field was （ 24.94 ± 5.52）dB, lower significantly; the b wave amplitudes of 30Hz flicker response （52.03 ± 31.46） （μV） and cone response （41.43 ± 25.65 ） （ μV）, and M - ERG＇ response density ofl ring （76.14 ±50.04） （nv/deg2） and 2 ring （36.68 ±23.51） （nv/deg2） are significant changed, the same as b wave amplitudes of 1 ring （0.72 ± 0.5 ） （μV） and 2 ring （0.51 ± 0.31 ） （μV） ; the multiple step regression analysis, the groups of aging, visual acuity, myopic severity are positive related with the diffuse fundus damage （ R =0. 793 ）. Conclusions The fundus impairs in the high myopic fellow eye of retinal detachment were being deteriorate with the aging, myopia developing, central visual acuities decreasing. We may find out the earlier, mild fundus pathologic changes according to the objective visual functional tests to prevent the blindness of high myopia.