Meng Li-Hui, Yuan Ming-Zhen, Zhao Xin-Yu, Chen You-Xin
Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China.
Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
Int J Ophthalmol. 2022 Mar 18;15(3):466-473. doi: 10.18240/ijo.2022.03.15. eCollection 2022.
To compare the ocular fundus features of highly myopic eyes with and without macular Bruch's membrane (BM) defects and investigate the associations between macular BM defects and other myopic lesions.
This retrospective, observational case series included 262 eyes (139 patients) with high myopia (HM) refractive error ≥-6.0 diopters (D) or axial length ≥26.5 mm from March 2019 to December 2019. The patients underwent a comprehensive ophthalmic examination, including swept-source optical coherence tomography (SS-OCT). The features of macular BM defects and other ocular fundus lesions were examined in OCT images.
Totally 51 eyes (19.5%) were detected with macular BM defects, which were characterized by a lack of BM, retinal pigment epithelium (RPE), and an almost complete loss of photoreceptors or choriocapillaris. Eyes with macular BM defects had worse best-corrected visual acuity (BCVA) than those without (<0.001). Dome-shaped macula (DSM, =0.042), retinal cysts (=0.006), choroidal neovascularization (CNV, <0.001), choroidal defects and abnormality (=0.003), scleral defects (=0.015), scleral deformation (=0.005), posterior staphyloma (=0.011), and perforating vessels (<0.001) occurred more frequently in eyes with macular BM defects. In multivariate analysis, the presence of macular BM defects remained the significant association with presence of DSM (=0.013), scleral defects (=0.015), posterior staphyloma (=0.001), perforating vessels (<0.001) and CNV (=0.004).
Macular BM defects has a prevalence of approximately 20% in HM and it has tight association with other myopic fundus lesions. BM might be crucial in the pathogenesis of myopic fundus lesions due to its biomechanical function. A comprehensive understanding of BM's role is useful for further researches about myopic lesions.
比较有和没有黄斑 Bruch 膜（BM）缺损的高度近视眼的眼底特征，并研究黄斑 BM 缺损与其他近视性病变之间的关联。
本回顾性观察性病例系列纳入了 2019 年 3 月至 2019 年 12 月期间 262 只眼（139 例患者）的高度近视（HM），屈光不正≥-6.0 屈光度（D）或眼轴长度≥26.5 mm。患者接受了全面的眼科检查，包括扫频光学相干断层扫描（SS-OCT）。在 OCT 图像中检查黄斑 BM 缺损和其他眼底病变的特征。
共检测到 51 只眼（19.5%）有黄斑 BM 缺损，其特征为 BM、视网膜色素上皮（RPE）缺失，以及光感受器或脉络膜毛细血管几乎完全丧失。有黄斑 BM 缺损的眼的最佳矫正视力（BCVA）比没有黄斑 BM 缺损的眼更差（<0.001）。黄斑隆起（DSM，=0.042）、视网膜囊肿（=0.006）、脉络膜新生血管（CNV，<0.001）、脉络膜缺损和异常（=0.003）、巩膜缺损（=0.015）、巩膜变形（=0.005）、后巩膜葡萄肿（=0.011）和穿通血管（<0.001）在有黄斑 BM 缺损的眼中更频繁出现。在多变量分析中，黄斑 BM 缺损的存在仍然与 DSM（=0.013）、巩膜缺损（=0.015）、后巩膜葡萄肿（=0.001）、穿通血管（<0.001）和 CNV（=0.004）的存在显著相关。
黄斑 BM 缺损在高度近视中的患病率约为 20%，并且与其他近视性眼底病变密切相关。由于其生物力学功能，BM 可能在近视性眼底病变的发病机制中起关键作用。全面了解 BM 的作用有助于对近视性病变的进一步研究。
