病理性近视眼拱形黄斑的临床特征

The clinical characteristics and significance of dome-shaped macula with pathologic myopia

目的回顾性分析病理性近视眼拱形黄斑的临床表现及眼底影像特征，为临床诊治提供客观依据。方法回顾分析2014年6月至2016年1月在上海市第一人民医院眼科就诊的20例（34只眼）病理性近视眼患者合并拱形黄斑的眼底特征。所有患眼进行了屈光及眼底检查、眼底频域OCT扫描及眼B超检查，部分患眼补充眼底荧光造影检查。结果所有患眼均有病理性近视眼的眼底相关表现，屈光度在-500--2 000 D之间，频域OCT表现为黄斑区脉络膜下的隆起，隆起度约（500-1 200）μm。9只眼合并出现浆液性神经上皮下脱离，造影中出现中浆样高荧光渗漏。4只眼合并出现CNV ；8只眼合并出现视网膜劈裂；4只眼合并出现黄斑裂孔。超声波可显示出黄斑区略向内隆起，可呈现＂W＂征。结论病理性近视眼DSM是一种特殊的病理状态，SD-OCT可以直观显现其圆拱形特征，与后巩膜葡萄肿形态不同有关，眼底可合并多种改变，特别是出现中浆样改变。

Objective To retrospectively observe fundus characteristics of dome-shaped macula with pathological myopia and provide evaluation basis for clinical diagnosis. Methods Twenty patho- logical myopic patients （34 eyes） with dome-shaped macular were retrospectively studied. Refraction examination, spectral-domain optical coherence tomography （SD-OCT）, ocular ultrasonic examination were performed in all cases, fimdus fluorescein angiography （FFA） was added in some cases. Re- suits All the cases had the fundus features of pathologic myopia, and the mean refractive error was （-500-2000） diopters, it showed the macular bulge under choroid through SD-OCT, and the bulge height was about （500-1200）urn. Foveal serous retinal detachment was present in 9 eyes, and it had leakage of high fluorescent similar to central serous chorioretinopathy in FFA; 4 eyes presented cho- roidal neovascularization, 8 retinoschisis and 4 macular hole. In ultrasound, the macular area was fiat, slightly inward uplift, and present ＂W＂ shape. Conclusions DSM with pathological myopia is a special kind of pathological morphology. The domed shape can be directly observed by SD-OCT, which is likely related to different forms of the posterior staphyloma. It may merge with variety of pathological changes in the fundus, esoecially in the performance of CSC.