Measurements of the parapapillary atrophy area and other fundus morphological features in high myopia with or without posterior staphyloma and myopic traction maculopathy

AIM:To investigate the affecting factors of parapapillary gamma and delta zones and other fundus morphological features in high myopia.METHODS:Seventy high myopia patients were included in this retrospective observational study and 47 patients were female.Patients were divided into three groups:no posterior staphyloma(no PS),PS with myopic traction maculopathy(PS with MTM),and PS without MTM using 3-dimensional magnetic resonance imaging and optical coherence tomography.MTM patients were fur ther classified into three types[epiretinal membrane,macular hole,and macular retinoschisis(MRS)].Diameters of the gamma and delta zones were measured among other morphometric variables using fundus photographs.RESULTS:Of the 70 individuals(127 eyes),the mean age was 57.46±13.56y.In univariate analysis,morphological features changed most dramatically in PS with MTM patients,who had the largest gamma zone diameters,the largest disk-fovea distance(DFD)and disk-fovea angle,and the smallest angle kappa and vertical distance of temporal arterial arcade.However,their horizontal delta zone diameter was smaller than in the patients with PS yet without MTM.In multivariate analysis,with axial length(AL)and age adjusted,the horizontal diameter in the delta zone of the PS without MTM group was still significantly larger than in the PS with MTM group(P=0.024).Comparing the three subtypes of MTM patients,the diameters of the gamma zone and DFD in MRS group were the largest.CONCLUSION:The characteristics of the gamma and delta zones change inconsistently in different stages of high myopia.These changes may be associated with anatomical changes caused by local traction.Factors such as PS,AL and age play an important role.These findings may provide a hint about the pathogenesis of traction in high myopia.

Clinical observation of vitrectomy combined with endolaser photocoagulation at the edge of posterior scleral staphyloma for macular hole retinal detachment in high myopia

AIM: To observe the clinical effect of pars plana vitrectomy(PPV) and silicone oil filling surgery combined with intraoperative posterior scleral staphyloma(PS) marginal retinal photocoagulation in the treatment of high myopic macular hole retinal detachment(MHRD) with PS.METHODS: This was a retrospective clinical study. From May 2017 to March 2020, 62 MHRD patients with PS(62 eyes) were enrolled in the study. Patients were divided into 23 G PPV combined with PS marginal retina intraoperative photocoagulation group(combined group) and conventional surgery group(conventional group), with 31 eyes in each. Triamcinolone acetonide and indocyanine green were used to remove the epiretinal membrane and the posterior macular inner limiting membrane(ILM). In the combined group, 2 to 3 rows of retinal photocoagulation were performed on the edge of the PS. The patients were followed up for an average of 8.34±3.21 mo. The first retinal reattachment rate, macular hole closure rate, Duration of silicone oil tamponade, best corrected visual acuity(BCVA) and average number of operations were observed and compared between the two groups.RESULTS: The first retinal reattachment rates of the eyes in the combined group and the conventional group were 96.7%(29/31) and 67.7%(21/31), respectively(χ~2=6.613, P=0.010). The macular hole closure rates in the combined group and the conventional group were 74.2%(23/31) and 67.7%(21/31), respectively(χ~2=0.128, P=0.721). The Duration of silicone oil tamponade of the patients in the combined group was lower than that of the routine group(t=-41.962, P≤0.001). Postoperative log MAR BCVA values of patients in the combined group and the conventional group were 1.27±0.12 and 1.26±0.11, compared with the log MAR BCVA before surgery, each group was improved(t=19.947, t=-19.517, P≤0.001, P≤0.001). There was no significant difference in the log MAR BCVA between the eyes of the two groups(t=-0.394, P=0.695). The average numbers of operations on the eyes in the conventional group and the combined group were 2.39±0.62 and 2.06±0.25 times, the combined group had fewer operations on average(t=-2.705, P=0.009). CONCLUSION: Intraoperative PPV treatment of MHRD with PS combined with PS marginal endolaser photocoagulation can effectively increase the rate of retinal reattachment after the first operation, reduce the number of repeated operations, and reduce the postoperative duration of silicone oil tamponade.

Disseminated Tuberculosis Presenting with Scrofuloderma and Anterior Staphyloma in a Child in Sokoto, Nigeria

Introduction: Disseminated tuberculosis (TB) may occur with skin and ocular involvement which are not common manifestations in children and may lead to debilitating complications. Objective: A child with multi-organ TB involving the lungs, chest abdomen, skin and eyes who had been symptomatic for 3 years is reported. Case Report: A 6-year-old girl presented with recurrent fever, abdominal pain and weight loss of 3 years and skin lesions of a year duration. There was history of pain and redness of the eyes associated with discharge. She was not vaccinated at all. She was chronically ill-looking with bilateral conjunctival hyperaemia, purulent eye discharge with corneal opacity of the right eye. She had significant lymphadenopathy, digital clubbing and ulcerated, discharging swellings around her neck and axilla (scrofuloderma). She had reduced breath sounds and coarse crepitations. Hepatosplenomegaly and ascites were present. She later developed bulging of the upper part of the cornea of the right eye which was diagnosed by the ophthalmologist to be cornea ulcer with anterior staphyloma. Results, Treatment and Outcome: Complete blood count (leucocytosis 12,800 cells), erythrocyte sedimentation rate (150 mm/hr) and tuberculin test (7 mm induration) were suggestive of TB. Radiological tests were also supportive. She received anti-Kochs in addition to systemic and ocular antibiotics. Skin lesions healed progressively and stopped discharging. Caregivers were counseled on poor visual prognosis of the right eye. She was discharged but lost to follow up. Conclusion: Multi-organ involvement of TB especially ocular and cutaneous TB is not common but is very debilitating. More preventive efforts with vaccination and expertise are needed at lower levels of health care in the community to aid early diagnosis.

Surgically induced scleral staphyloma

Background: To report the clinical features of surgically induced scleral staphyloma and investigate the management.Methods: Retrospective uncontrolled study.Results: A full ophthalmological evaluation of surgically induced scleral staphyloma in four patients was performed. The first patient was a 3-year-old young girl underwent corneal dermoid resection. The second patient was a 60-year-old man underwent nasal pterygium excision and conjunctival autograft without Mitomycin C(MMC). The other two were respectively a 74-year-old woman and a 69-year-old man underwent cataract surgery. All patients performed allogeneic sclera patch graft. In the at least half a year follow-up, the best corrected visual acuity(BCVA) of all the four patients were no worse than that of preoperative. Ocular symptoms disappeared, including eye pain, foreign body sensation, and so on. Unfortunately, the fourth patient showed sclera rejection and partial dissolution at postoperative 1 month. Conclusions: Surgically induced scleral staphyloma must be considered in the differential diagnosis of patients with staphyloma following corneal dermoid, pterygium, and cataract surgery. Allogeneic sclera patch graft is one of the methods for treating scleral staphyloma. However sclera rejection and dissolution should be considered postoperatively.

后巩膜葡萄肿对高度近视白内障患者术后人工晶状体稳定性的影响

目的探究后巩膜葡萄肿对高度近视白内障患者术后人工晶状体稳定性的影响。方法57例(63眼)行白内障超声乳化联合人工晶状体植入术的白内障伴高度近视患者根据是否存在后巩膜葡萄肿分研究组(26例共28眼,合并后巩膜葡萄肿)和对照组(31例共35眼,单纯白内障伴高度近视)。对比两组术前眼轴,术后3个月眼轴、中轴区晶状体后囊膜至视网膜距离、前房深度、角膜曲率、最佳矫正视力(BCAV)、平均绝对屈光误差(MAE)、人工晶状体囊袋偏心量及倾斜角。结果研究组术前及术后3个月眼轴长度、术后3个月BCAV、裸眼视力数值(logMAR)、MAE、水平及垂直方向的倾斜角、前房深度均高于对照组(P<0.01或0.05)。结论高度近视合并巩膜葡萄肿患者行白内障手术时应关注人工晶状体的稳定性。

3D CT眼球重建技术用于评估高度近视白内障眼球形态和人工晶状体度数预测精确度的研究

目的探索3D CT眼球重建技术在评估高度近视白内障眼球形态和人工晶状体(IOL)度数预测精确度的应用。方法收集2021年8—12月行白内障超声乳化吸除联合IOL植入术的高度近视患者,眼轴长度(AL)≥26.5 mm,共计52例(52眼),随访1个月。完善眼眶薄层CT(扫描层厚0.3 mm),记录眼底黄斑萎缩、牵引、新生血管病变(ATN)分级,比较术后最佳矫正视力(BCVA)和屈光度平均绝对误差(MAE),分析不同类型后巩膜葡萄肿的眼球形态之间的差异。利用SPSS 20.0对数据进行统计分析,P<0.05为差异有统计学意义。结果高度近视眼3D CT眼球形态分类如下:球形8眼(15.4%)、椭球形4眼(7.7%)、锥形13眼(25%)、鼻侧扭曲形12眼(23.1%)、颞侧扭曲形7眼(13.5%)、桶形8眼(15.4%)。在年龄<60岁患者组中,球形8眼(25.0%)、锥形8眼(25.0%),比例最高,椭球形1眼(3.1%)、颞侧扭曲形4眼(10.5%),比例最低;在年龄≥60岁患者组中,没有球形眼球,而锥形5眼(25%)和鼻侧扭曲形7眼(35%),比例最高,提示随着年龄增加,后巩膜葡萄肿出现比例增加,差异有统计学意义(P<0.001)。同时,当AL<28 mm时,球形眼球7眼(38.9%),比例最高;而当AL≥30 mm时,没有球形眼球,锥形6眼(26.1%)、颞侧扭曲形5眼(21.7%)和桶形5眼(21.7%),比例增加,提示随着AL增加,后巩膜葡萄肿发生率增加,并且容易出现黄斑区的葡萄肿,差异有统计学意义(P<0.001)。无后巩膜葡萄肿的球形眼球患者白内障术后有87.5%的患者BCVA达到20/40及以上,而伴有后巩膜葡萄肿者视力预后不佳,尤其锥形有6眼(46.2%)和颞侧扭曲有3眼(42.9%)的BCVA<20/40,差异有统计学意义(χ^(2)=46.755,P<0.001)。高度近视黄斑ATN分级提示,锥形、颞侧扭曲和桶形眼球的眼底病变更加明显,分级更高。高度近视眼中有30眼(57.7%)白内障术后MAE<0.5 D,其中椭球形、锥形和颞侧扭曲形眼球IOL度数预测准确性最差,仅有25%、53.9%和37.5%眼MAE<0.5 D;球形和鼻侧扭曲形眼球预测性最好,有75%眼MAE<0.5 D,差异有统计学意义(χ^(2)=80.035,P<0.001)。结论高度近视眼轴越长,越容易出现眼球畸形。其中,锥形、颞侧扭曲和桶形等眼球往往伴有严重的近视黄斑病变,白内障术后的视力预后也不佳。球形和鼻侧扭曲形眼球,白内障术中IOL度数预测性更佳,可能与后巩膜葡萄肿位置远离黄斑区域,从而生物测量更加准确有关。

Peripapillary intrachoroidal cavitation at the crossroads of peripapillary myopic changes

AIM:To analyze the prevalence of peripapillary intrachoroidal cavitation(PICC)in eyes with gamma peripapillary atrophy(γPPA),in eyes with peripapillary staphyloma(PPS)and in those combiningγPPA and PPS and to analyze border tissue discontinuity in PICC.METHODS:This prospective cross-sectional non interventional study included highly myopic eyes.Non-highly myopic eyes were used as control.Radial and linear scans centered on the optic nerve head were performed using spectral-domain optical coherence tomography.Variables were analyzed along the twelve hourly optical coherence tomography sections in both eyes of each subject.RESULTS:A total of 667 eyes of 334 subjects were included:229(34.3%)highly myopic eyes and 438(65.7%)non highly myopic eyes.The mean age of the highly myopic group was 48.99±17.81y.PICC was found in a total of 40 eyes and in 13.2%(29/220)of highly myopic eyes.PICC was found in 10.4%(40/386)of eyes withγPPA,in 20.5%(40/195)of eyes with PPS and in 22.7%(40/176)of those combiningγPPA and PPS.All the eyes with PICC showed the co-existence ofγPPA and PPS whereas none of the eyes presenting only one of these entities exhibited PICC.A border tissue discontinuity in theγPPA area was found in all eyes with PICC.CONCLUSION:We confirm the presence of a border tissue discontinuity in theγPPA area of all eyes with PICC.These findings suggest the involvement of mechanical factors in the pathogenesis of PICC which may contribute to PICC-related visual field defects.

Resolving Myopic Foveoretinal Detachment by Fovea-Saving Internal Limiting Membrane Peeling: A Case-Series Report

Background: In highly myopic eyes, myopic foveoschisis (MF), the earliest stage of myopic traction maculopathy (MTM), is present in up to 34% of patients with pathologic myopia and slowly progresses to form foveoretinal detachment (FRD) or macular hole (MH) with or without macular hole retinal detachment (MHRD) as a part of its natural history. Aim: To describe the microstructural and functional results in three highly myopic eyes that underwent macular surgery for early-stage MTM. The last postoperative structural findings were correlated with the final vision and macular automated microperimetry evaluation. Methods: We retrospectively reviewed three highly myopic eyes that underwent successful fovea-saving internal limiting membrane (FS-ILM) macular surgery for chronic FRD at Oftalmologia Integral ABC, Mexico City, Mexico. We performed postoperative multimodal microstructural and functional evaluations, including SD-OCT, SS-OCT, and microperimetric macular examinations. Results: There was a substantial difference between best-corrected visual acuity (BCVA) preoperatively and postoperatively in all three cases. Postoperative surgery was associated with significant improvement in visual acuity confirmed using a paired-sample permutation test. The mean presurgical BCVA value (LogMAR;mean ± SE) was ~0.83 ± 0.15, and the postsurgical value was ~0.43 ± 0.52 (P = 0.00065). The myopic foveoretinal detachment evaluation was ~7.3 ± 3.5 months, with a mean postoperative follow-up time of ~14 ± 4.08 months. Furthermore, postoperative multimodal imaging tests demonstrated an abnormal microstructural foveal SS-OCT pattern without evidence of macular hole (MH) development at the postoperative follow-up. Macular microperimetry confirmed a subclinical reduced macula threshold sensitivity with an anomalous retinal sensitivity analysis map and a stable central foveal fixation site. Conclusions: Even with the successful microstructural disappearance of myopic macular detachment, the last multidisciplinary functional and structural assessments demonstrated different subclinical macular alterations.

高度近视合并白内障患者后巩膜葡萄肿类型对白内障术后屈光误差的影响

目的 研究不同类型后巩膜葡萄肿(PS)对高度近视合并白内障患者术后屈光误差的影响,从而选择合适的计算方法减少因PS带来的术后屈光误差。方法 回顾性分析自2019年12月至2021年12月于同济大学附属第十人民医院行白内障摘除联合人工晶状体(IOL)植入术的高度近视合并白内障患者97例97眼,依据PS类型不同分为宽黄斑型PS组(A组)、窄黄斑型PS组(B组)和其他类型PS组(C组)。采用IOLMaster700系统中的5种IOL屈光度计算公式(Haigis、Holladay1、SRK/T、Holladay2和Barrett UniversalⅡ)预测各组患者的术后理论屈光度,并与术后3个月得到的实际屈光度进行比较,计算平均绝对屈光误差(MAE)。采用Bland-Altman法分析5种IOL屈光度计算公式对应的术后理论屈光度与术后3个月实际屈光度的一致性。结果 依据Haigis、Holladay1、SRK/T、Holladay2等4种IOL屈光度计算公式对术后3个月MAE进行预测,A组MAE最大,与B组和C组相比差异均有统计学意义(均为P<0.05),而依据Barrett UniversalⅡ公式在三组患者IOL屈光度计算中MAE差异无统计学意义(P>0.05);在A组患者中,依据Haigis、Holladay1、SRK/T、Holladay2和Barrett UniversalⅡ公式计算的术后3个月MAE分别为(0.61±0.38)D、(1.00±0.52)D、(0.62±0.53)D、(0.83±0.55)D、(0.32±0.30)D,其中Barrett UniversalⅡ公式偏差最小,Holladay1公式偏差最大,差异均有统计学意义(均为P<0.05);在B组和C组患者中,依据Holladay1公式计算的术后3个月MAE出现较大偏差,B组、C组患者MAE分别为(0.67±0.46)D、(0.58±0.40)D,并与依据Haigis、SRK/T、Holladay2、Barrett UniversalⅡ公式计算的术后3个月MAE相比差异均有统计学意义(均为P<0.05)。Bland-Altman分析结果表明,术后3个月实际屈光度与Barrett UniversalⅡ公式对应的术后理论屈光度一致性最好。结论 在窄黄斑型PS以及其他型PS患者中,术后MAE相对较小,但使用Holladay1公式会产生相对较大的MAE;而在宽黄斑型PS患者中,术后MAE相对较大,Barrett UniversalⅡ公式术后预测准确性最佳。

伴发后巩膜葡萄肿的高度近视性白内障人工晶状体度数测算准确性研究

目的探讨伴发后巩膜葡萄肿的高度近视性白内障人工晶状体(IOL)度数测算的准确性。方法将2021年8—12月新疆维吾尔自治区人民医院高度近视性(眼轴≥26.5 mm)白内障患者75例(75眼)根据眼部B超是否伴有后巩膜葡萄肿分为2组。术前使用IOL Master 700系统自备的6种公式(Holladay 2、SRK/T、Hoffer Q、Holladay 1、Haigis及Barrett UniversalⅡ)测算IOL度数。利用眼B超测量后巩膜葡萄肿宽度及深度。术中植入IOL类型:HOYA 251(22眼)、Zeiss 601(24眼)和爱博诺德ALD(29眼)。随访3个月,记录屈光度平均误差(MNE)和平均绝对误差(MAE)。结果所有手术均顺利完成,无特殊并发症。6种公式测算的MNE和MAE差异有统计学意义(F=6.058,P=0.001;F=3.768,P=0.003);其中SRK/T和Barrett UniversalⅡ测算的MNE最小(依次为0.45 D和0.37 D),Barrett UniversalⅡ测算的MAE最小,为0.54 D。在高度近视患者中,眼轴越长,屈光度误差越大,眼轴长度与Holladay 2、SRK/T、Hoffer Q及Holladay 1这4种公式测算的MNE呈正相关(r=0.482,0.459,0.529,0.530;P=0.002,0.004,0.001,0.001);与MAE亦呈正相关(r=0.490,0.443,0.533,0.533;P=0.002,0.005,0.001,0.001)。3款IOL利用6种公式测算的MNE和MAE差异无统计学意义(P均>0.05)。所有患者中伴发后巩膜葡萄肿者56眼(74.7%),有后巩膜葡萄肿者的MNE和MAE均比无葡萄肿者高。其中Holladay 2、SRK/T、Hoffer Q及Holladay 1这4种公式计算的MNE和MAE,在有、无葡萄肿者之间差异有统计学意义(P均<0.05)。利用Barrett UniversalⅡ公式计算的MAE分布结果显示,在有后巩膜葡萄肿的56眼中,32眼(57.1%)MAE<0.5 D,11眼(19.6%)MAE为0.5~1.0 D,13眼(23.3%)MAE≥1.0 D;在无后巩膜葡萄肿的19眼中,11眼(57.9%)MAE<0.5 D,8眼(42.1%)MAE为0.5~1.0 D,没有患者MAE≥1.0 D;两亚组患者MAE分布确切概率法显示,有后巩膜葡萄肿者MAE变异度更大(P=0.027)。结论伴发后巩膜葡萄肿的高度近视性白内障患者在IOL测算时变异度更大,并且容易出现远视漂移。高度近视患者推荐使用SRK/T和Barrett UniversalⅡ公式进行IOL度数测算。

高度近视后巩膜葡萄肿患者中医证型分布及相关因素分析

【目的】分析高度近视后巩膜葡萄肿患者中医证型分布特点,探究高度近视后巩膜葡萄肿发生的影响因素。【方法】选取2020年2月至2022年1月在广州中医药大学第一附属医院眼科门诊就诊的137例(137眼)高度近视患者为研究对象,根据是否合并后巩膜葡萄肿分为观察组(合并)60例和对照组(未合并)77例。分析2组高度近视患者的中医证型分布特点;并通过单因素分析,比较2组患者视力、眼压、眼轴长度、前房深度及角膜中央厚度、视网膜形态、黄斑区血流密度等眼部参数差异,通过多因素Logistic回归分析探讨影响高度近视发生后巩膜葡萄肿的危险因素。【结果】(1)中医证型分布方面,观察组以肝肾亏虚证的占比最高,为51.67%(31/60),其他从高到低依次为肝血不足证、脾虚气弱证、心阳不足证、气滞血瘀证;对照组以气滞血瘀证和肝肾亏虚证占比最高,均为27.27%(21/77),其他从高到低依次为肝血不足证、心阳不足证、脾虚气弱证;组间比较,观察组的肝肾亏虚证占比明显高于对照组(P<0.01),气滞血瘀证占比明显低于对照组(P<0.01)。(2)视力方面,观察组气滞血瘀证患者的视力较对照组明显下降(P<0.05),而2组其他证型患者的视力比较,差异均无统计学意义(P>0.05);观察组中,与气滞血瘀证相比,肝肾亏虚证患者的视力较好(P<0.05),而其他证型两两比较,差异均无统计学意义(P>0.05)。(3)单因素分析结果显示:观察组患者的眼轴长度、角膜中央厚度、血流密度、血流灌注密度及视网膜劈裂、周围性视网膜病变占比与对照组比较,差异均有统计学意义(P<0.05或P<0.01)。(4)多因素Logistic回归分析结果显示:眼轴长度、角膜中央厚度及视网膜劈裂是高度近视发生后巩膜葡萄肿的独立危险因素(P<0.05或P<0.01)。【结论】高度近视后巩膜葡萄肿患者中医证型多表现为肝肾亏虚证,其中以气滞血瘀证患者视力损害最为严重;此外,眼轴长度、角膜中央厚度及有无视网膜劈裂是导致后巩膜葡萄肿形成的独立危险因素,及早识别相关危险因素对防治后巩膜葡萄肿具有重要意义。

高度近视眼后巩膜葡萄肿与眼底结构和微循环的关系

后巩膜葡萄肿(PS)指眼球后壁局部的异常膨出,是高度近视眼常见的病理性改变之一。PS常伴随着眼底微结构如巩膜、脉络膜、Bruch膜的改变。这些异常改变致使眼底微结构对眼轴扩张的抵抗力下降,或可造成相应区域组织结构的重塑,引发微血管结构的变化,进而导致后极部血流循环异常,而微循环的改变又可能继发眼底微结构的变化,严重影响患眼视力。国际上对PS的发病机制仍无明确定论,且尚无良好的预防措施和治疗方法。本文对高度近视眼PS与眼底结构及微循环的相互关系研究进行总结分析,为探究PS的发病机制、预防和治疗方法以及改善高度近视眼的视功能提供理论依据。

巩膜葡萄肿1例

61岁男性,因“左眼发现巩膜肿物8年”就诊。患者8年前因左眼颞侧巩膜肿物于外院行左眼巩膜肿物切除术,术后病理提示“左眼巩膜肉芽肿”,术后1年患者发现左眼再次出现巩膜肿物伴异物感,药物治疗无效。查体:左眼裸眼视力1.0,结膜颞侧隆起,局部充血,颞侧葡萄肿,约10 mm×7 mm,表面不平整,球壁菲薄,局部呈肉红色,透见色素膜,角膜透明,前房深浅可,虹膜纹理清,未见新生血管,瞳孔欠圆,直径约3 mm,稍向颞侧偏位,对光反应存在,晶状体轻混,玻璃体少量絮状混浊,视盘色淡红,界清,杯盘比(C/D)0.3,视网膜颞侧及颞上见葡萄肿边界,余中周部色素改变,黄斑未见明显异常。于我院行“左眼巩膜肿物活检+异体巩膜移植术”,病理诊断:平滑肌瘤。患者术后视力1.0,定期门诊随访。讨论体会:平滑肌瘤是一种罕见的良性肿瘤,需要与脉络膜黑色素瘤鉴别。该肿瘤可引起巩膜变薄、扩张及巩膜外生长,有效的体格检查及影像学检查,可辅助诊断,明确诊断后,可观察或局部切除。

伴后巩膜葡萄肿的高度近视白内障患者人工晶状体屈光度测算

背景白内障术前人工晶状体（IOL）屈光度的准确测算是术后恢复良好视功能的关键，尤其是对伴后巩膜葡萄肿的高度近视白内障患者。目的对比分析IOLMaster和接触式A型超声两种生物测量方法测算的伴后巩膜葡萄肿的高度近视白内障患者IOL屈光度结果，并对比不同IOL屈光度计算公式的准确性。方法收集2008年8月至2009年2月在天津医科大学眼科医院行白内障超声乳化联合IOL植入术伴后巩膜葡萄肿的高度近视患者28例41眼，术前分别用IOLMaster和接触式A型超声联合手动角膜曲率计测量患眼的生物参数，并根据SRK-Ⅱ、SRK—T、Haigis、HofferQ、Holladay1公式分别计算IOLMaster和接触式A型超声联合手动角膜曲率计测量的IOL屈光度的结果，术后3个月检查患者的屈光状态，评价预测的精确性。结果IOLMaster和接触式A型超声测得的眼轴长度分别为（28．9±2．4）mm和（28．7±2．4）mm，前房深度分别为（3．3±O．4）mm和（2．9±0．6）mm，差异均有统计学意义（P=0．005、0．000），而IOLMaster与手动角膜曲率计测得的角膜曲率分别为（44．7±1．7）D和（44．7±1．6）D，差异无统计学意义（P=0．398）。应用IOLMaster生物测量方法时，SRK／T、Haigis公式较准确；应用接触式A型超声联合手动角膜曲率计生物测量方法时，Holladay1、HofferQ、Haigis公式较准确，平均绝对屈光误差（MAE）较为接近。结论对于伴后巩膜葡萄肿的高度近视白内障患者，应用IOLMaster生物测量方法推荐使用SRK／T、Haigis公式；应用接触式A型超声联合手动角膜曲率计生物测量方法推荐使用Holladay1、HofierQ、Haigis公式。

高度近视眼伴后巩膜葡萄肿黄斑裂孔性视网膜脱离治疗的临床研究

目的:研究高度近视眼伴后巩膜葡萄肿黄斑裂孔性视网膜脱离的临床治疗效果及不同手术方式的有效性。方法:回顾性分析2003-05/2008-05诊断治疗的高度近视眼伴后巩膜葡萄肿黄斑裂孔性视网膜脱离91眼,分析视网膜复位情况及最佳矫正视力。结果:在这些视网膜脱离的治疗中,有6种手术方式:单纯黄斑区巩膜外垫压12眼,5眼(42%)首次术后视网膜回贴;单纯玻璃体腔气体充填15眼,6眼(40%)首次术后视网膜回贴;平坦部玻璃体切除联合球内气体充填20眼,14眼(70%)首次术后视网膜回贴;平坦部玻璃体切除、视网膜前膜剥离联合球内气体充填16眼,11眼(69%)首次术后视网膜回贴;巩膜环扎、玻璃体切除、视网膜前膜剥离联合球内气体充填25眼,18眼(72%)首次术后视网膜回贴;巩膜环扎、玻璃体切除联合硅油填充13眼,10眼(77%)首次术后视网膜回贴。64眼(70%)首次手术治疗后视网膜回贴,85眼(93%)视网膜回贴。结论:玻璃体切除联合球内惰性气体或硅油填充是治疗高度近视眼伴后巩膜葡萄肿黄斑裂孔性视网膜脱离的最有效方法。

后巩膜葡萄肿深度与高度近视合并白内障患者术后屈光误差的关系

目的研究后巩膜葡萄肿深度与高度近视合并白内障患者术后屈光误差的关系。方法选取在我院行白内障超声乳化摘出联合人工晶状体植入术的高度近视合并白内障伴后巩膜葡萄肿的患者共56例(70眼)。术前B超测量后巩膜葡萄肿深度。术后2个月时测量患者屈光状态,计算平均绝对屈光误差值(mean absolute refractive error,MAE),并将后巩膜葡萄肿深度与MAE进行Pearson相关分析。结果预期屈光度为(-2. 91±0.85) D,术后实际屈光度为(-2.63±1. 15) D,MAE为(-0.74±0.56) D,实际屈光度与预期屈光度差异有统计学意义(t=-2. 723,P=0.008)、。本组患者后巩膜葡萄肿深度为0～6.27 (2. 13±1.45)mm,其中64眼能测出后巩膜葡萄肿深度;6眼无法测量其后巩膜葡萄肿深度。后巩膜葡萄肿深度与眼轴长度呈正相关关系(r=0. 776,P=0.00);后巩膜葡萄肿深度与MAE呈正相关关系(r=0.522,P=0.00);MAE与眼轴长度呈正相关关系(r=0.540,P=0.00)。结论随着高度近视后巩膜葡萄肿深度增加,术后屈光误差增大。

高度近视伴后巩膜葡萄肿超声乳化术后视觉质量分析(英文)

目的: 评价高度近视伴后巩膜葡萄肿的白内障患者行白内障超声乳化摘除联合人工晶状体(intraocular lens,IOL)植入术后的视觉质量,并分析其原因。方法: 本研究根据患者术前屈光状态以及有无后巩膜葡萄肿分为三组:A组为高度近视伴有后巩膜葡萄肿的白内障患者;B组为高度近视无后巩膜葡萄肿的白内障患者;C组为正视眼的白内障患者。于手术后3d观察A、B、C三组裸眼远视力(uncorrected distance visual acuity,UCDVA)和最佳矫正远视力(best-corrected distance visual acuity,BCDVA),术后6mo观察A组视力与眼轴的关系、A、B、C三组UCDVA和BCDVA、对比敏感度、眼底检查及患者术后满意度调查。结果:在本实验收集的472例患者(545眼)中,A组患者74例(91眼);B、C组各199例(227眼)。术后3d及6mo,B、C组的UCDVA及BCDVA均优于A组,差异有统计学意义(均P<0.05);术后3d,C组的裸眼远视力及最佳矫正远视力优于B组,差异有统计学意义(P<0.05);术后6mo患者UCDVA及BCDVA在B、C两组间的差异无统计学意义。A组和B组在4种状态5种空间频率下的对比敏感度的差异均有统计学意义(均P<0.05),C组的对比敏感度高于A、B组,B组的对比敏感度要高于A组,差异有统计学意义(均P<0.05)。经统计学检验,高度近视伴后巩膜葡萄肿白内障患者超声乳化术后视力与眼轴长短之间呈负相关性。A、B组患者术后视觉质量满意度高于C组,差异有统计学意义(均P<0.05),但A、B组间患者术后质量满意度无明显差异。结论:高度近视伴后巩膜葡萄肿的白内障患者行白内障超声乳化摘除联合IOL植入术后的视觉质量较高度近视不伴有后巩膜葡萄肿的白内障及正视眼的白内障患者差,这与高度近视眼底病变有直接关系。

病理性近视眼继发视盘周围视网膜脱离的临床分析(英文)

目的:描述病理性高度近视眼视盘周围局限性视网膜脱离,分析这一新认识的眼底病变发生的原因。方法:2002-12/2004-01 间,7 例 10 眼被确认存在视盘周围局限性视网膜脱离,本文评价了其 O C T、FA/IC G A 和m fER G 的临床特征。结果:视盘周围视网膜脱离不是任何患者就诊检查的原因,视力减退或矫正视力低的原因是相对严重的近视性视网膜脉络膜萎缩、C N V 、黄斑前膜形成和弱视。5 只患眼表现为 1 型后巩膜葡萄肿,其视盘周围视网膜脱离均位于视盘的鼻侧半,而另 5 只患眼表现为 3 型或 2 型葡萄肿,其视盘周围视网膜脱离均位于视盘的非鼻侧半,统计学上存在差异 (P =0.01)。所有患眼的视盘周围视网膜脱离区域均为后巩膜葡萄肿累及。结论:病理性近视眼的视盘周围视网膜脱离很可能是后巩膜葡萄肿的一个良性并发症。

伴后巩膜葡萄肿的高度近视眼黄斑区视网膜劈裂和脱离的临床研究

目的:运用光学相干断层扫描(OCT)研究伴后巩膜葡萄肿的高度近视患者黄斑区视网膜劈裂和(或)脱离的发生情况。方法:对301例(575眼)经B超确诊伴后巩膜葡萄肿的高度近视患者行完整的眼科检查和OCT检查。结果:伴后巩膜葡萄肿的高度近视的575眼中67眼(53例)发生黄斑区视网膜劈裂和(或)脱离,均有严重的眼底改变,仅5例患者主诉近来视力进展性损伤。结论:伴有后巩膜葡萄肿的高度近视患者的黄斑区视网膜劈裂和(或)脱离通过OCT检查容易检出,对于有严重眼底病变和伴有后巩膜葡萄肿的高度近视患者建议定期行OCT检查。

高度近视眼底改变与年龄和近视度数变化相关性分析

目的探讨高度近视眼的豹纹状眼底改变及其与近视度数和年龄相关因素的关系。方法对近10年354例不同年龄、不同近视度数的高度近视眼患者按年龄、近视度数、超声及眼底形态进行观察,并分组记录。结果①眼底变化:13.6%无眼底变化,8.8%局部改变,33.3%和44.4%分别为豹纹改变和弥漫性病理改变;不同年龄组分析,20岁组眼底无改变占44.8%,20～40岁组豹纹状眼底占46.1%,40岁以上的弥漫性病理改变超出50%;不同近视度数组分析,-6～-10D组眼底改变呈多样化,阴性改变占28.1%,弥漫性病理改变占33.3%,-10～-15D组眼底主要为豹纹状眼底39.1%和弥漫性病理改变48.3%,-15D以上组混合改变占70.8%。②从A超结果分析,眼轴在25mm时眼底无改变40.5%和豹纹状眼底18.9%,弥漫性病理改变27%,27mm时豹纹状眼底占51.9%,>27mm时弥漫性病理改变比例逐渐增加从53.4%到73.9%;从B超结果分析,阴性改变(61.10%)与25mm组基本相同,均匀扩张改变(58.90%)与25～27mm组对应,葡萄肿改变(70.20%)与27mm以上眼轴组对应。结论高度近视视网膜退行性病变早期(20岁后青春期、眼球扩张初期、豹纹状眼底改变)阶段介入医源性干预可能作为高度近视黄斑病变的预防策略。