近视眼视网膜退行性病变分析

Analysis of Degenerative Lesions in the Retina of Myopia

目的:通过近视眼术前检查分析,探讨近视眼视网膜退行性病变的分布规律,为近视眼手术治疗方案的选择提供依据,减少视网膜并发症的发生,提高视觉质量。方法:选取我院2018年1月~9月近视眼手术患者共882例(1759只眼),男性568例,女性314例;男:女 = 1:0.5528。年龄16~44岁。近视屈光度在−1.25DS~−10.50DS,其中,近视屈光度 ≤ −3.00D 118例(235只眼)占13.38%;−3.25D~−6.00D 478例(953只眼)占54.20%;−6.25D~−9.00D 259例(517只眼)占29.37%;≥−9.25D 27例(54只眼)占3.06%。最佳矫正视力:0.6~1.0。术前均采用直接检眼镜和间接检眼镜,裂隙灯联合三面镜或全视网膜镜详细检查眼底并于有病变眼底进行眼底照相,记录周边视网膜病变的位置、特点、数量,进行统计学分析。结果:本研究中周边视网膜退行性变性在近视眼患病率中高达113例(131只眼),占12.81%。其中,需定期观察的非压迫变白54例(67只眼)占6.12%;实施视网膜激光光凝治疗59例(64只眼)占6.69%;包括单纯周边视网膜变性54例(59只眼)占6.12%;周边视网膜变性伴干性裂孔3例(3只眼)占0.34%;周边视网膜变性伴裂孔、视网膜浅脱离2例(2只眼)占0.23%。发生视网膜退行性病变的病例中,近视屈光度 ≤ -3.00D 12例(13只眼)占1.36%,10.17%,−3.25D~−6.00D 49例(56只眼)占5.56%,10.25%;−6.25D~−9.00D 42例(50只眼)占4.76%,16.22%;≥−9.25D 10例(12只眼)占1.13%,37.04%。中低度近视视网膜退行性病变的几率无明显统计学差异,高度近视患病率明显增高,差异具有统计学意义。视网膜退行性病变以颞侧为主,颞上颞下无明显差异,鼻侧最少,双眼无明显差别。双眼视网膜周边退行性变性以非压迫变白和单纯周边视网膜格子样变性为主,其次为视网膜变性伴视网膜裂孔。结论:重视近视眼的术前眼底检查,无论低中高度数,均要给予详细检查。随近视度数的增加,周边视网膜发生病变的几率增大;不同屈光度的周边视网膜变性也存在显著差异,随近视屈光度增加而风险增高并具有对称性。因此在行近视眼的术前检查时,需对周边视网膜进行逐象限仔细检查,避免漏诊和误诊。对于累及范围广泛的视网膜退行性病变患者,近视手术方式应慎重选择。

Objective: To explore the distribution law of degenerative sexually transmitted diseases of the retina of myopia through preoperative examination and analysis, which provides a basis for the selection of short-sighted eye surgery treatment, reduces the occurrence of retinal complications and improves visual quality. Methods: A total of 882 patients (1759 eyes) were selected for myopia surgery from January to September 2018, 568 cases of men and 314 cases of women, and male:female is 1:0.5528, age 16 to 44 years old. Myopia refractive degrees at −1.25DS to −10.50DS, of which 13.38% of myopia refraction (235 eyes) was 13.38%;259 cases (517 eyes) accounted for 29.37%, and 27 cases (54 eyes) of −9.25D accounted for 3.06%. Best corrective vision: 0.6 to 1.0. Before surgery, direct glasses and indirect eyeglasses, fissure lamp combined three-sided mirror or full retinal mirror detailed examination of the bottom of the eye and in the under-eye photography of the lesions, record the location, characteristics, quantity of peripheral retinal lesions, statistical analysis. Results: In this study, the prevalence of peripheral retinal degenerative degeneration was as high as 113 cases (131 eyes), accounting for 12.81 percent. Of these, 54 cases (67 eyes) were regularly observed for non-oppressive whitening, 6.69% were performed in the treatment of retinal laser photocose, 6.69% were performed, 6.12% were in 54 cases (59 eyes) including simple peripheral retinal degeneration, and 3 cases (3 eyes) were performed with retinal degeneration Peripheral retinal degeneration with a fissure, retinal shallow separation of 2 cases (2 eyes) accounted for 0.23%. In the cases of retinal degenerative venereal disease, myopia refractive degree of 12 cases (13 eyes) accounted for 1.36%, 10.17%, −3.25D to −6.00D 49 cases (56 eyes) accounted for 5.56%, 10.25%;−6.25D - −9.00D 42 cases (50 eyes) accounted for 4.76%, 16.22%, and 10 cases (12 eyes) of −9.25D accounted for 1.13%, 37.04%. There were no significant statistical differences in the incidence of low- and medium-low myopia retinopathy, and the prevalence of high myopia increased significantly, with statistically significant differences. Retinal degenerative lesions were dominated by the side of the tin;there was no significant difference in the lower tint;the nasal side was the least, and there was no significant difference in the eyes. Degenerative degeneration around the retina of the eye is dominated by non-oppressive whitening and simple peripheral retinal lattice-like degeneration, followed by retinal degeneration with retinal fission. Conclusion: Pay attention to the preoperative eye examination of myopia, regardless of the number of low and medium height, should be given a detailed examination. With the increase of myopia, the probability of lesions in the surrounding retina increased, and there were significant differences in the peripheral retinal degeneration of different refractive degrees, with increased nearsightedness and increased risk and symmetry. Therefore, in the preoperative examination of myopia, it is necessary to carry out quadrant-by-quadrant examination of the surrounding retina to avoid misdiagnosis and misdiagnosis. For patients with a wide range of retinal degenerative lesions, the method of myopia surgery should be carefully chosen.