高度近视黄斑部视网膜劈裂和非裂孔性视网膜脱离

Macular retinoschisis and macular retinal detachment without hole in highly myopic eyes

目的 观察高度近视黄斑部视网膜劈裂（MRS）和非裂孔性视网膜脱离（MRDH）的临床表现和影像学特征。方法高度近视患者186例849只眼中合并MRS和MRDH的19例24只眼纳入研究。所有患者均进行了主觉验光、双目间接检眼镜、裂隙灯显微镜联合Goldmann三面镜检查，以及眼底照相、A／B型超声和光相干断层扫描（OCT）检查。结果349只眼中后极部存在MRS和（或）MRDH24只眼，占6．9％。眼底检查结果显示，所有患眼均有后巩膜葡萄肿（PS），占100．0％；玻璃体黄斑牵引条带（VMT）2只眼，占8．3％；黄斑部局限性视网膜浅脱离2只眼，占8．3％；黄斑全层裂孔1只眼，占4．2％。B型超声检查结果显示，所有患眼均伴有PS，占100．0％；黄斑部局限性视网膜浅脱离7只眼，占29．2％，脱离的视网膜与PS锥顶形成弓样结构；VMT条带2只眼，占8．3％。OCT检查结果显示，黄斑部外层视网膜劈裂（ORS）22只眼，占91．7％，其中合并黄斑部内层视网膜劈裂（IRS）8只眼，占黄斑部ORS的36．4％。MRDH5只眼，占20．8％，其中合并0RS3只眼，占MRDH的60．0％；单纯性MRDH2只眼，占MRDH的40．0％，其中合并VMT1只眼。VMT13只眼，占54．2％；黄斑囊样水肿（CME）3只眼，占12．5%；黄斑板层裂孔4只眼，占16．7％。结论MRS和MRDH是伴有PS的高度近视眼的常见并发症。与常规眼底检查和B型超声相比，OCT是发现MRS和MRDH的更为有效的检查手段。

Objective To evaluate the clinical features of macular retinoschisis （MRS） and macular retinal detachment without hole （MRDH） in highly myopic eyes. MetbodsThe clinical data of 19 patients （24 eyes） with MRS and MRDH from 186 patients （349 eyes） with high myopia were retrospectively analyzed. All of the patients had undergone the examinations of subjective refraction, binocular indirect ophthalmoscope, slit lamp microscope combined with Goldmann three-mirror contact lens, fundus images, A/B-scan ultrasonography, and optical coherence tomography （OCT）. Results In 349 eyes, 24 （6.9%） had MRS and （or） MRDH at the posterior pole. The results of ocualr fundus examinations showed that all of the 24 eyes （100%） had posterior scleral staphyloma （PS）, 2 （8.3X） had vitreomacular traction （VMT）, 2 （8.3%） had macular local superficial retinal detachment, and 1 （4.2%） had full-thickness macular hole. The results of B-scan ultrasonography also indicated PS in all 24 eyes （100 %）, macular local superficial retinal detachment in 7 （29.2%） with a bow-like configuration formed by the detached retina and the cone-shaped roof of PS, and VMT in 2 （8.3%）. The results of OCT revealed macular outer-layer retinoschisis （ORS） in 22 eyes （91.7%） in which 8 （36.4%） also had macular inner-layer retinoschisis （IRS）; MRDH in 5 eyes （20.8%） in which ORS was found in 3 （60.0%） and simplex MRDH in 2 （40.0%） including 1 with VMT; VMT in 13 eyes （54.2%）; cystoid maeular edema （CME） in 3 eyes （12.5 %）; and lamellar macular hole in 4 eyes （16.7%） . Conclusions MRS and MRDH are common complications in highly myopic eyes with posterior scleral staphyloma. OCT is more sensitive and accurate in detecting MRS and MRDH than routine ophthalmoscopic examination and B-scan ultrasonography.