高度近视圆顶状黄斑的形态特征及常见并发症治疗

The morphological characteristics and complications treatment of dome-shaped macula in high myopia

高度近视圆顶状黄斑（DSM）是指高度近视后巩膜葡萄肿患眼在光相干断层扫描（OCT）影像上表现为后巩膜葡萄肿凹陷处黄斑部的向内凸起，凸起高度〉50μm。其形态特征主要有圆形凸起、水平方向椭圆形凸起和垂直方向椭圆形凸起。DSM形成机制尚未明确，目前认为与黄斑区局部脉络膜增厚、黄斑区局部巩膜厚度改变、后巩膜葡萄肿进展的适应或代偿、低眼压及玻璃体黄斑牵引有关。DSM及其并发症的出现可能是高度近视后巩膜葡萄肿患眼发生视功能损害的原因。DSM常伴有的并发症主要有浆液性视网膜脱离、脉络膜新生血管、黄斑劈裂及视网膜色素上皮萎缩。临床上对于无临床症状的DSM主要采取定期随访观察；出现浆液性视网膜脱离及明显视功能损害时，采用半剂量光动力疗法、补充激光光凝或口服螺内酯可能有一定疗效。但具体疗效有待进一步大量的临床研究证实。

Dome-shaped macula （DSM） of high myopia has been described as an inward convexity or bulge of the macular within the concavity of the posterior staphyloma in highly myopic eyes, with the bulge height over than 50/2m, which can be observed by optical coherence tomography. There are three patterns DSM, including the typical round dome, the horizontally oriented oval-shaped dome and the vertically oriented oval-shaped dome. The pathogenesis of DSM development remains unclear, several hypotheses have been suggested, such as localized choroidal thickening in the macular area, relatively localized thickness variation of the sclera under the macula, resistance to deformation of sclera staphyloma, ocular hypotony and tangential vitreoretinal traction. Vision-threatening macular complications of DSM including serous retinal detachment, choroidal neovaseularization, foveoschisis and retinal pigment epithelial atrophy. Clinically, asymptomatic patients with DSM mainly take regular follow-up observation. Appears serous retinal detachment and significant visual impairment, treatment with half-dose photodynamic therapy, supplementary of laser photocoagulation or oral spironolactone may have a beneficial effect. However, more large clinical studies are required to confirm the exact efficacy of these treatments.