高度近视眼黄斑裂孔伴或不伴视网膜脱离的临床观察

Wang Fei, Xu Ge-zhi, Wang Wen-ji, Jiang Chun-hui

Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China.

Zhonghua Yan Ke Za Zhi. 2010 Jun;46(6):508-12.

OBJECTIVE

To study the clinical features and the pathogenesis of macular hole with and without retina detachment (RD) in high myopic eyes.

METHODS

It was a retrospective series case study. The charts of high myopic patients with macular hole at our hospital from June 2006 to February 2007 were retrospectively reviewed and analyzed. Patients were divided into two groups (the RD group and non-RD group) depending on the presence of RD or not. Their clinical data and optic coherence tomography (OCT) results were further analyzed. SPSS 13.0 was used for the statistic analysis. When comparing the quantitative aspects like age, axial length and refraction, t-test was used. Categorical data, such as sex ratio, occurrence of vitreous traction, posterior staphyloma and retinoschisis were compared by using χ(2) test. Fisher's test was used in comparing eye laterality, incidence of white hole, visual acuity and posterior vitreous detachment (PVD).

RESULTS

During this period, there were 43 patients fitting the including criteria. Among them, 36 patents (37 eyes) were in the RD group and 7 patients (7 eyes) in the no-RD group. In the RD group, the average age was 56.1, 24.3% of them (9/37) were male; percentage of left and right eyes was (11/37) and 70.3% (26/37), respectively; average refraction was (-8.9 ± 2.2) D; average axial length was (28.7 ± 2.0) mm. Visual acuity was ≤ 0.05 (72.2%) in 26 eyes and 0.05 - 0.2 (27.8%) in 10 patients. The incidence of complete and non-complete PVD was 89.2% (33/37) and 10.8% (4/37), respectively. White hole presented in 35.1% (3/37) patients. Vitreous traction and retinoschisis presented in 27.0% (10/37) and 35.1% (13/37) patients, respectively. In the non-RD group, the average age was 47.6; 16.7% of them (1/7) were male; left and right eyes were involved in 42.9% (3/7) and 57.1% (4/7), respectively. Average refraction was (-9.0 ± 1.9) D; average axial length was (28.9 ± 1.5) mm. Vision acuity was ≤ 0.05 in 3 patients (42.9%); between 0.05 - 0.2 in 3 eyes (42.9%) and ≥ 0.2 in 1 eye (14.3%). Incidence of complete and non-complete PVD was 85.7% (6/7) and 14.3% (1/7), respectively. White hole was observed in 14.3% (1/7) patients; 42.9% (3/7) patients were accompanied with vitreous traction and 71.4% (5/7) with retinoschisis. B-scan ultrasonography showed posterior staphyloma in all 44 eyes. The results of statistical analysis showed that the gender (χ(2) = 0.008) and eye laterality (χ(2) = 0.449) as well as refraction (t = 0.193), axial length (t = -0.25) and visual acuity (χ(2) = 4.509) of these two groups were similar (P > 0.05). The incidences of vitreous traction (χ(2) = 0.709), white hole (χ(2) = 1.179), PVD (χ(2) = 0.071) and retinoschisis (χ(2) = 3.207) were also similar (P > 0.05). But the age of the non-RD group is significantly younger than the RD group (t = 1.66, P < 0.05).

CONCLUSIONS

Various pathogenesis may involved in the occurrence of retinal detachment in highly myopic eyes with macular hole. Further study is required to improve our understanding of this entity.

目的

研究高度近视眼黄斑裂孔伴或不伴视网膜脱离（RD）的临床特征及发病机制。

方法

这是一项回顾性系列病例研究。回顾性分析我院2006年6月至2007年2月高度近视黄斑裂孔患者的病历。根据是否存在视网膜脱离将患者分为两组（视网膜脱离组和非视网膜脱离组）。进一步分析他们的临床资料和光学相干断层扫描（OCT）结果。采用SPSS 13.0进行统计分析。比较年龄、眼轴长度和屈光度等定量指标时，采用t检验。对性别比例、玻璃体牵拉、后巩膜葡萄肿和视网膜劈裂等分类数据，采用χ²检验进行比较。比较眼别、白孔发生率、视力和玻璃体后脱离（PVD）时，采用Fisher检验。

结果

在此期间，有43例患者符合纳入标准。其中，视网膜脱离组36例（37只眼），非视网膜脱离组7例（7只眼）。视网膜脱离组平均年龄56.1岁，男性占24.3%（9/37）；左眼和右眼分别占（11/37）和70.3%（26/37）；平均屈光度为（-8.9±2.2）D；平均眼轴长度为（28.7±2.0）mm。26只眼视力≤0.05（72.2%），10只眼视力为0.05 - 0.2（27.8%）。完全性和非完全性PVD发生率分别为89.2%（33/37）和10.8%（4/37）。35.1%（3/37）的患者出现白孔。27.0%（10/37）的患者有玻璃体牵拉，35.1%（13/37）的患者有视网膜劈裂。非视网膜脱离组平均年龄47.6岁，男性占16.7%（1/7）；左眼和右眼分别占42.9%（3/7）和57.1%（4/7）。平均屈光度为（-9.0±1.9）D；平均眼轴长度为（28.9±1.5）mm。3例患者视力≤0.05（42.9%）；3只眼视力在0.05 - 0.2之间（42.9%），1只眼视力≥0.2（14.3%）。完全性和非完全性PVD发生率分别为85.7%（6/7）和14.3%（1/7）。14.3%（1/7）的患者观察到白孔；42.9%（3/7）的患者伴有玻璃体牵拉，71.4%（5/7）的患者伴有视网膜劈裂。B超显示44只眼均有后巩膜葡萄肿。统计分析结果显示，两组的性别（χ²=0.008）、眼别（χ²=0.449）、屈光度（t=0.193）、眼轴长度（t=-0.25）和视力（χ²=4.509）相似（P>0.05）。玻璃体牵拉（χ²=0.709）、白孔（χ²=1.179）、PVD（χ²=0.071）和视网膜劈裂（χ²=3.207）的发生率也相似（P>0.05）。但非视网膜脱离组的年龄明显低于视网膜脱离组（t=1.66，P<0.05）。