摘要
目的观察高度近视眼中心凹脱离伴视网膜劈裂的形态学特征，并探讨高度近视眼玻璃体、黄斑及后巩膜葡萄肿三者间的关系。设计回顾性病例系列。研究对象29例（38眼）高度近视眼中心凹脱离伴视网膜劈裂的患者。方法所有患者均进行裂隙灯前置镜、三面镜、直接或间接检眼镜、B超及相干光断层扫描（OCT）检查，观察黄斑中心凹脱离及视网膜劈裂的形态及其与玻璃体以及后巩膜葡萄肿的关系。其中10眼行玻璃体手术。主要指标形态学特征。结果裂隙灯前置镜、三面镜检查见视网膜成微囊样改变并浅脱离，未见黄斑裂孔。B超显示后极部视网膜水肿或浅脱离0．5～2．0mm。所有38眼的OCT扫描均显示黄斑区神经上皮脱离；未显示黄斑裂孔；神经上皮层劈裂，表现为内层劈裂、外层劈裂和双层劈裂，劈裂的内外层视网膜之间可见桥柱样连接；3眼黄斑区未见劈裂，扫描至后巩膜葡萄肿边缘附近见视网膜劈裂；视网膜前存在低反射细光带（玻璃体后皮质），且与视网膜间存在点、线及片状粘连，相应粘连处视网膜被牵引。10眼玻璃体手术中见玻璃体液化、不完全后脱离，后极部玻璃体后皮质与视网膜粘连紧密，尽量剥除后皮质，术后视网膜均复位。结论OCT可清晰显示高度近视眼中心凹脱离伴视网膜劈裂的形态特征，来自玻璃体皮质的牵引及后巩膜葡萄肿因素是导致视网膜劈裂的主要原因。（眼科．2006,15：237-239）
Objective To describe the morphological characteristics of foveal retinoschisis and retinal detachment in highly myopic eyes. Design Retrospective observational case series. Participants Twenty-nine patients （38 eyes） of high myopia with foveal retinoschisis and retinal detachment. Methods All patients with foveal retinoschisis and retinal detachment were performed complete ophthalmic examinations, B-scan and studied cross-sectional images of the maculae with optical coherence tomography （OCT）. 10 eyes underwent vitreous surgery. Main Outcome Measures Morphological characteristics. Results On biomicroscopy, the maculae of all 38 eyes had a microcystic appearance and shallow elevation without macular hole. B-scan showed posterior retinal edema or with 0.5 to 2mm detachment. OCT disclosed foveal retinoschisis and retinal detachment in all eyes. The neuroretina splitted into a thick inner layer and a thin outer layer or a thin inner layer and a thick outer layer or a thin inner layer, a thick inter layer and a thin outer layer. A hy- perreflective preretinal structure resembling the posterior hyaloid was stretched over the retinoschisis and drew the retina. Vitreous surgery performed on l0 eyes, including posterior vitreous detachment, removal of the premacular vitreous cortex. In all eyes, foveal detachment and retinoschisis gradually decreased in height, and attained foveal attachment finally. Conclusion Foveal retinoschisis and retinal detachment in highly myopic eyes with staphyloma is better characterized with OCT than with biomicroscopy. Vitreomacular traction forms the posterior hyaloid and the staphyloma maybe the major cause of it. （Ophthalmol CHN, 2006, 15： 237-239）
出处
《眼科》
CAS
2006年第4期237-239,共3页
Ophthalmology in China
