高度近视眼视盘的相干光断层扫描变化

摘要

Objective To investigate the morphologic alterations of the optic disc by optical coherence tomography (OCT) in high myopia. Methods sisty-six eyes(38 patients) with high (6.00 dioptersD) myopia were observed. In addition, 23 emmetropic(1.00 to 1.00 D) eyes and 36 eyes with low(6.00 D) myopia were examined as controls. The participants had ophthalmologic examinations including stereoscopic fundus observations, OCT examinations, and perimetry. For OCT, multiple horizontal and vertical OCT scans were obtained around the optic disc and fovea in each patient. Results A peripapillary detachment in eyes with pathologic myopia (PDPM) was found by OCT in 9 eyes( 14.3% ). Eyes with PDPM had glaucomalike visual field defects more frequently than eyes without PDPM. Pitlike structures within the conus were observed ophthalmoscopically in 4 eyes with high myopia, and OCT examinations revealed the presence of cystic structures with an opening toward the vitreous cavity at the corresponding sites. Microfolds in the retinal vessels were found at the conus edge in 30 of the highly myopic eyes (45.5% ) ,and 16 of these eyes had retinoschisis at the site of the retinal vessels. Eight of these 13 eyes showed an extension of the retinoschisis along the temporal retinal vessels toward the macula , and 3 of these 8 eyes had macular holes. None of these changes (PDPM, pitlike structures, microfolds, and retinoschisis) were found in controls. Conclusions OCT examinations demonstrated different types of abnormalities around the optic disc in highly myopic eyes. These changes might be related to the visually disabling complications, such as visual field defects and myopic foveoschisis, seen in highly myopic eyes.%目的 通过相干光断层扫描(OCT)来检查高度近视眼视盘周围的形态学改变.方法 选择38例(66只限)高度近视(屈光度D≥-6.00)患者进行分析.另外选择23只正视眼(+1.00至-1.00 D)和36只低度近视眼(＜-6.00 D)作为对照.参与者均进行包括立体眼底观察、OCT检查和视野检查在内的眼科检查.进行OCT检查时,对每名患者的视盘和中心凹处进行多次水平和垂直OCT扫描.结果 通过OCT在9只眼(13.6％)内发现有PDPM.PDPM眼比无PDPM眼有更高几率会发生类青光眼样视野缺损.眼底镜检查时有4只高度近视眼发现近视弧内有坑状结构,OCT检查发现相应位置处存在向玻璃体腔开口的囊状结构.30只高度近视眼(45.5％)在近视弧边缘检测到有视网膜血管微皱褶,其中16只眼在视网膜血管处有视网膜劈裂.这16只眼中有8只发现视网膜劈裂沿着颞侧视网膜血管走行向黄斑延伸,其中3只眼存在黄斑裂孔.对照眼中未检测到上述任何改变(PDPM、坑状结构、微皱褶、视网膜劈裂).结论 OCT检查证明高度近视眼中视盘周围存在不同类型的异常.这些改变可能与高度近视眼中发生的视力受损并发症有关,如视野缺损和近视性黄斑裂孔.