病理性近视眼后巩膜葡萄肿形态与视网膜劈裂关系探讨

Relation between ultrasonographic characteristics of pathologic myopia posterior staphyloma and retinoschisis

目的：探讨病理性近视眼后巩膜葡萄肿的声像学检查的诊断价值。方法回顾性病例系列研究。分析2010年8月至2012年4月在河南省眼科研究所临床诊断为高度近视眼的患者66例（87只眼）的后巩膜葡萄肿的声像学表现。采用B超测量眼球前后径并探查后巩膜葡萄肿形态。并用OCT观察视网膜劈裂情况。采用ANOVA检验比较不同形态后巩膜葡萄肿眼球前后径，采用卡方检验分析探讨不同后巩膜葡萄肿形态中视网膜劈裂的分布，相关性分析采用列联系数表示。结果 B超探查发现弧形（9例，10.35%）、锥形（20例，22.99%）、楔形（29例，33.33%）及矩形（29例，33.33%）4种后巩膜葡萄肿形态。OCT检查发现87只眼中有65只眼（74.71%）发生后极部或黄斑区视网膜劈裂，其中56只眼视网膜劈裂（86.15%）可以通过B型超探查到并表现为后部球壁欠光滑或纤细膜状回声带附着。弧形、锥形、楔形、矩形后巩膜葡萄肿患者眼球前后径分别为（26.82±0.83）、（28.20±1.50）、（29.14±2.29）、（29.27±2.46）mm，其中弧形后巩膜葡萄肿患者眼球前后径差异有统计学意义（P〈0.01）。后巩膜葡萄肿的形态与视网膜劈裂的发生及发生位置相关（r=0.385,0.406；P＜0.01）。锥形黄斑区视网膜劈裂患者80.00%后巩膜葡萄肿位于黄斑区。75.00%的楔形后巩膜葡萄肿患者的视网膜劈裂发生在楔形转角处。62.50%矩形后巩膜葡萄肿患者的视网膜劈裂发生在矩形转角处。结论 B超影像学检查可以直观反映高度近视眼后巩膜葡萄肿不同形态及后部眼球壁的特点，为高度近视眼底病变提供诊断依据，对高度近视眼患者诊断视网膜劈裂有重要意义。（中华眼科杂志，2017，53：46-52）

Objective To study the ultrasonographic characteristics of pathologic myopia posterior staphyloma and the relation with retinoschisis. Methods Retrospective case series study. Eighty-seven eyes of 66 pathologic myopia patients with posterior staphyloma were included. Staphyloma morphology and anteroposterior axis of the eyeball were observed by B-scan ultrasonography. Optical coherence tomography was used to explore the retinoschisis. Results Arc-shaped （10.35%）, cone-shaped （22.99%）, wedge-shaped （33.33%） and rectangle-shaped （33.33%） posterior staphylomas were found by B-scan ultrasonography. Posterior pole or macular retinoschisis was found by optical coherence tomography in 65 eyes （74.71%）, 56 of which （86.15% ） were observed to have a rough posterior ocular wall or membranoid attachment by ultrasonography. The anteroposterior axis of arc-shaped posterior staphyloma was shorter than that of staphylomas in the other shapes. Posterior staphyloma morphology was related to retinoschisis（r=0.385, 0.406. P〈0.01）. The retinoschisis was at the macula in 80.00%of cone-shaped posterior staphyloma, at the wedge-shaped corner in 75.00% of wedge-shaped posterior staphyloma and at the rectangle-shaped corner in 62.50% of rectangle-shaped posterior staphyloma. Conclusions It is hard to discover retinoschisis of pathologic myopia posterior staphyloma by ophthalmoscopy. Morphologic characters of posterior staphyloma and conditions of posterior eyewall can be showed directly under ultrasonographic examination. B-scan ultrasonography may provide a diagnostic basis for pathologic myopia retinoschisis.