低龄高度近视患者黄斑劈裂的临床观察

Macular retinoschisis in teenagers with high myopia

目的 观察低龄高度近视患者黄斑劈裂的形态改变,探讨高度近视黄斑劈裂的早期临床特点和病因.方法 回顾性分析了2009年7月至2014年3月在温州医科大学眼视光医院就诊的2 155例5～73岁高度近视患者的光相干断层扫描（OCT）检查结果,将其中诊断为高度近视黄斑劈裂的187例患者中低龄的（＜20岁）7例9只眼纳入研究.所有患者均接受了主觉验光、眼底照相,裂隙灯联合Goldmann三面镜、光相干生物测量仪（IOL-Master）、B型超声和OCT检查.结果 低龄（＜20岁）患者在高度近视黄斑劈裂患者中占3.74％ （7/187）.7例患者均有近视度数不断加深史,其中5例（7只眼）患者有较明确的既往主觉验光记录,近视度数平均每年加深0.58～1.57 D.等效球镜度数-12.50～-19.38 D,平均（-15.59±2.48）D;眼轴长度28.29～33.52 mm,平均（29.89±1.50） mm;最佳矫正视力0.3～0.9.B型超声检查发现9只患眼均有后巩膜葡萄肿;OCT检查发现9只患眼均有外层劈裂,其中6只眼外层劈裂累及中心凹;5只眼伴有内层劈裂;未发现非裂孔性黄斑脱离、黄斑裂孔、黄斑前膜或玻璃体黄斑牵引等.结论 黄斑劈裂较少见于低龄高度近视患者,在研究中低龄（＜20岁）患者在高度近视黄斑劈裂患者中占3.74％.低龄患者黄斑劈裂的OCT特征性表现为单纯性黄斑劈裂：外层劈裂,易累及黄斑中心凹,多伴内层劈裂.后巩膜扩张可能是高度近视黄斑劈裂发病和病程演变的主要因素.

Objective To describe the early stage clinical characteristics of myopic macular retinoschisis in young patients with high myopia by observing the macular profile and to investigate the risk factors for myopic macular retinoschisis.Methods Two thousand one hundred and fifty five patients （ageing from 5 to 73 years） were examined by OCT,187 high myopic patients with myopic macular retinoschisis were found,of which 7 patients with age under 20 years.This 7 patients （9 eyes） were recruited in the retrospective clinical study.All patients underwent standard examination,including manifest refraction,fundus photography,fundus examine with Goldmann 3 mirror lens,axial length with IOL-Master,B scan ultrasonography,and OCT.Results In this retrospective clinical study,187 high myopic patients with myopic macular retinoschisis were found,of which 7 patients with age under 20 years,making up 3.74% of all the 187 patients.Seven patients had a history of myopia continues to deepen,5 patients （7 eyes） had relatively clear previous record of refraction,with a mean growth of 0.58～1.57 D each year.Spherical equivalent was from-12.50D to-19.38D,with mean （-15.59±2.48）D,axial length was from 28.29mm to 33.52mm,with mean （29.89±1.50） mm,BCVA was 0.3～0.9.And all the eyes were accompanied with posterior scleral staphyloma.OCT examination revealed outer retinoschisis in all the 9 eyes,6 eyes involved fovea center,and 5 eyes were associated with inner retinoschisis.None of eyes was accompanied macular hole or retina detachment or macular epiretinal membrane or vitreoretinal traction.Conclusions Macular retinoschisis is uncommon in teenagers with high myopia,in this study,the prevalence of teenagers with macular retinoschisis is 3.74%.The clinical characteristics of macular retinoschisis in teenagers is simple macular retinoschisis：outer retinoschisis is easily to involved fovea center,and inner retinoschisis is always accompanied by outer retinoschisis.Posterior scleral expansion may played an important role in occurrence of macular retinoschisis.