病理性近视黄斑劈裂光相干断层扫描图像分型及其对临床的指导意义

Classification of macular retinoschisis in pathological myopic eyes by optical coherence tomography and its clinical applications

病理性近视黄斑劈裂光相干断层扫描（OCT）的类组织学分型可以分为单纯外层劈裂、外层和中层劈裂、外层和内层劈裂、多层劈裂4种情况。以彻底清除玻璃体后皮质及后部血管弓内的内界膜为重点的玻璃体视网手术是治疗病理性近视黄斑劈裂的主要选择。其中，单纯外层劈裂合并中心凹脱离者，手术后视功能改善较明显；而多层劈裂者视功能改善有限或不改善。合理剥除后皮质与内界膜起始点，应在未发生内层劈裂处。正确认识和了解病理性近视黄斑劈裂的OCT分型，对于选择玻璃体视网膜手术方式和判断治疗预后有积极意义。

Pathological myopic macular retinoschisis can be classified into 4 types based on optical coherence tomography （OCT） images： outer layer retinoschisis, outer ＋ middle layer retinoschisis, outer inner layer retinoschisis and multilayer retinoschisis. Currently vitrectomy is the major option to treat this condition as it can remove the posterior vitreous cortex completely and peel the internal limiting membrane （ILM） around the posterior vessels arch. Vitrectomy benefits the visual function significantly for outer layer retinoschisis with foveal detachment, but has no or very little effects on multilayer retinoschisis. The appropriate starting site for removal of posterior cortex and ILM should be the site without inner layer retinoschisis. The knowledge and understanding of the OCT classification of pathological myopic macular retinoschisis is important for us to chose correct operation methods and determine the prognosis after treatment.