不同程度近视性黄斑病变高度近视眼的形态学特征和视力

MORPHOLOGICAL CHARACTERISTICS AND VISUAL ACUITY OF HIGHLY MYOPIC EYES WITH DIFFERENT SEVERITIES OF MYOPIC MACULOPATHY.

机构信息

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.

出版信息

Retina. 2020 Mar;40(3):461-467. doi: 10.1097/IAE.0000000000002418.

DOI:10.1097/IAE.0000000000002418

PMID:30576301

Abstract

PURPOSE

To investigate the morphological feature, visual acuity, and prevalence of macular complications in highly myopic eyes with different categories of myopic maculopathy (MM) according to the META-PM classification system.

METHODS

The clinical records of 1,132 consecutive patients (1,841 eyes) with high myopia (refractive error ≤ -6D and axial length ≥26.5 mm), who visited the High Myopia Clinic at the Zhongshan Ophthalmic Center from January 2014 to July 2017, were reviewed. Fundus photograph, optical coherence tomography, axial length, refractive error, and best-corrected visual acuity were measured in each patient. Myopic maculopathy was graded from fundus photographs according to the META-PM classification, including tessellated fundus (C1), diffuse chorioretinal atrophy (C2), patchy atrophy (C3), and macular atrophy (C4). Other macular complications, including foveoschisis, extrafoveal schisis, full-thickness macular hole, epiretinal membrane, lacquer cracks, Fuchs spot, choroidal neovascularization, macular hemorrhage, and dome-shaped macula, were also investigated.

RESULTS

Among the 1,841 eyes, 58 (3.15%) had no MM (C0), 779 (42.31%) had tessellated fundus only (C1), 524 (28.46%) had diffuse chorioretinal atrophy (C2), 352 (19.12%) had patchy chorioretinal atrophy (C3), and 128 (6.95%) had macular atrophy (C4). Age increased and best-corrected visual acuity became worse with the severity of MM (P < 0.01). Axial length was significantly longer with the severity of MM from C0 to C3 (P < 0.01), and spherical equivalent was greater with the severity of MM from C0 to C3 (P < 0.01) but was not different between C3 and C4 (P > 0.05). Subfoveal and parafoveal choroidal thicknesses were significantly thinner from C0 to C3 (P < 0.01). However, no significant difference was found between C3 and C4 in parafoveal choroidal thickness (P > 0.05). The complications were different among C0 to C4 correlated with MM (P < 0.01). The complications of foveoschisis, choroidal neovascularization, hemorrhage, lacquer cracks, Fuchs spot, dome-shaped macula, and epiretinal membrane were different between C1 and C2 (P < 0.01), but none of the complications were different between C3 and C4 (P > 0.05) except Fuchs spot (P = 0.009).

CONCLUSION

The morphological and functional characteristics in eyes with high myopia were positively correlated with the severity of C0 to C3 MM. However, no morphological difference was found between C3 and C4. The absence of the progressive relationship between C3 and C4 might be determined.

摘要

目的

根据 META-PM 分类系统，研究不同类别近视性黄斑病变（MM）的高度近视眼中的形态特征、视力和黄斑并发症的患病率。

方法

回顾 2014 年 1 月至 2017 年 7 月在中山眼科中心高度近视门诊就诊的 1132 例连续患者（1841 只眼）的临床记录。对每位患者进行眼底照相、光学相干断层扫描、眼轴长度、屈光不正和最佳矫正视力检查。根据 META-PM 分类，从眼底照片上对近视性黄斑病变进行分级，包括镶嵌性眼底（C1）、弥漫性脉络膜视网膜萎缩（C2）、斑片状萎缩（C3）和黄斑萎缩（C4）。还研究了其他黄斑并发症，包括黄斑劈裂、黄斑外劈裂、全层黄斑裂孔、视网膜前膜、漆裂纹、Fuchs 斑、脉络膜新生血管、黄斑出血和盘状黄斑。

结果

在 1841 只眼中，58 只（3.15%）无 MM（C0），779 只（42.31%）仅有镶嵌性眼底（C1），524 只（28.46%）弥漫性脉络膜视网膜萎缩（C2），352 只（19.12%）斑片状脉络膜视网膜萎缩（C3），128 只（6.95%）黄斑萎缩（C4）。年龄随 MM 严重程度的增加而增加，最佳矫正视力随之恶化（P<0.01）。从 C0 到 C3，眼轴长度随 MM 严重程度显著增加（P<0.01），从 C0 到 C3，等效球镜度数随 MM 严重程度增加（P<0.01），但 C3 和 C4 之间无差异（P>0.05）。从 C0 到 C3，黄斑下和旁中心脉络膜厚度明显变薄（P<0.01）。然而，旁中心脉络膜厚度在 C3 和 C4 之间无显著差异（P>0.05）。C0 到 C4 之间的并发症与 MM 相关（P<0.01）。黄斑劈裂、脉络膜新生血管、出血、漆裂纹、Fuchs 斑、盘状黄斑和视网膜前膜的并发症在 C1 和 C2 之间不同（P<0.01），但 C3 和 C4 之间除 Fuchs 斑（P=0.009）外，其他并发症均无差异（P>0.05）。