近视性黄斑区视网膜劈裂的临床特征及危险因素分析

Clinical characteristics and risk factors of myopic macular retinoschisis

目的:探讨老年高度近视性黄斑区视网膜劈裂(myopic macular retinoschisis, MRS)的临床特征及不同程度MRS的危险因素。方法:选择2016年上海市成年人高度近视流行病学调查项目中的50岁以上高度近视238例238眼纳入横断面研究。按照MRS的程度分为5组:无黄斑劈裂(S0)组、中心凹外劈裂(S1)组、中心凹劈裂(S2)组、中心凹+中心凹外劈裂(S3)组、全黄斑区劈裂(S4)组。S0组设为对照组。研究对象均实施全面的眼科检查,观察近视萎缩性黄斑病变(atrophic myopic maculopathy, AMM)的分级、黄斑前膜(epiretinal membrane, ERM)和玻璃体黄斑牵拉(vitreomacular traction, VMT)的状态,基于SS-OCT测量黄斑区不同方位黄斑巩膜高度(macular scleral height, MSH)。结果:238眼中存在MRS的89眼(37.4%),与对照组间年龄、性别差异无统计学意义。MRS组鼻侧、颞侧及下方MSH显著高于对照组(P<0.05),ERM、VMT和A2以上AMM发生率在MRS组中更高(P<0.05)。在S1~S4各组中,S2组眼轴最短(P<0.001),A1以下轻症AMM比例最大(36.4%,P=0.046),与S0组更为接近。结论:长眼轴、黄斑区后巩膜膨出、VMT和严重AMM是MRS形成的危险因素。中心凹劈裂与中心凹外劈裂形成机制可能存在差异,需要长期队列研究进一步证实。

Objective: To explore the clinical characteristics of myopic macular retinoschisis(MRS) in an elder pathologic myopia population and the risk factors for different grades of MRS. Methods: 238 eyes of 238 patients with high myopia over 50 years old in the 2016 Shanghai Adult High Myopia Epidemiology Survey Project were enrolled in the cross-sectional study. MRS was classified into five groups: no macular retinoschisis(S0) group, extrafoveal retinoschisis(S1) group, foveal retinoschisis(S2) group, both fovea and extrafovea retinoschisis but not the entire macula(S3) group, and entire macula retinoschisis(S4) group. S0 group was set as the control group. Each participant underwent detailed ocular examinations. The grading of atrophic myopic maculopathy(AMM) was assessed. Swept-source optical coherence tomography(SS-OCT) was used to detect the incidence of epiretinal membrane(ERM) and vitreomacular traction(VMT) and to measure the macular scleral height(MSH). Results: MRS group comprised 89 eyes in 238 eyes(37.4%). No significant differences were found in age or sex between the MRS group and the non-MRS group. The nasal, temporal, and inferior MSH in the MRS group were significantly higher than those in the non-MRS group(P<0.05). The incidence of ERM, VMT, and severe AMM above A2 was higher in the MRS group(P<0.05). Among the different grades of MRS, the S2 group displayed a significantly shorter axial length(P<0.001) and a significantly higher proportion of eyes with A0 or A1(36.4%, P=0.046), which was similar to the S0 group. Conclusions: Long axial length, MSH, VMT, and severe AMM are risk factors for MRS. There might be different formation mechanisms of foveal retinoschisis and extrafoveal retinoschisis, which need to be further confirmed by a long-term cohort study.