近视性黄斑区外视网膜劈裂与血管旁异常的影像学特征及其相关因素分析  

Imaging features and related factors of retinal splits and paravascular abnormalities in myopic macular region

作　　者：路晨雨 安广琪 刘培 李姝 张敏[1,2] 金学民[1] 杜利平[1] Lu Chenyu;An Guangqi;Liu Pei;Li Shu;Zhang Min;Jin Xuemin;Du Liping(Department of Ophthalmology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Ophthalmology,Zhengzhou People's Hospital,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院眼科,郑州450052 [2]郑州人民医院眼科,郑州450000

出　　处：《中华眼底病杂志》2025年第2期106-112,共7页Chinese Journal of Ocular Fundus Diseases

基　　金：国家自然科学基金(81770949)。

摘　　要：目的观察近视患眼黄斑区外视网膜劈裂(EMRS)和视网膜血管旁异常(PVA)的影像学特征,初步分析其在年龄、最佳矫正视力(BCVA)、等效球镜度(SE)、眼轴长度(AL)、黄斑中心凹下脉络膜厚度(SFCT)的差异性。方法横断面临床研究。2023年1月至2024年6月于郑州大学第一附属医院眼科就诊的近视伴E M R S患者60例60只眼纳入研究。其中,男性18例18只眼,女性42例42只眼;年龄(37.57±17.14)岁;SE(−10.76±4.66)D;AL(28.36±1.87)mm。根据超广角扫频源光相干断层扫描图像特征,将PVA形态分为血管旁囊肿(PC)、血管旁微皱褶(PM)、血管旁板层裂孔(PLH);根据劈裂层次将EMRS分为内层、中层、外层。根据SE将患眼分为低度近视组、中度近视组、高度近视组。观察视盘旁以及颞上、颞下、鼻上、鼻下EMRS发生情况,以及不同位置、不同层次EMRS和不同形态PVA患者的临床特征。不同位置、不同层次有无EMRS者年龄、BCVA、SE、AL、SFCT比较采用独立样本t检验。分类变量组间比较采用χ^(2)检验或Fisher确切概率检验。结果60只眼中,EMRS位于颞上、颞下、鼻上、鼻下、视盘旁分别为36、43、15、13、14只眼。内层、外层EMRS分别为59(98.3%,59/60)、35(58.3%,35/60)只眼,无单纯中层EMRS。存在PVA者47只眼(78.3%,47/60)。其中,PC、PM、PLH分别为45、39、18只眼。视盘旁劈裂者年龄较视盘旁无劈裂者更大(t=2.720),颞上有劈裂者BCVA较无劈裂者更差、AL更长(t=2.139、2.119),鼻下有劈裂者BCVA较无劈裂者更差、近视程度更高、AL更长、SFCT更薄,差异均有统计学意义(t=2.926、−2.640、2.635、−3.938,P<0.05)。与其他类型EMRS比较,内层EMRS患者年龄更小、BCVA更好、AL更短、近视程度更低、SFCT更厚(t=−2.383、−4.825、−4.767、4.791、4.791),全层EMRS患者年龄更大、BCVA更差、AL更长、近视程度更高、SFCT更薄(t=2.419、3.656、2.677、−2.755、−3.283),差异均有统计学意义(PObjective To observe the imaging features of extramacular retinoschisis(EMRS)and paravascular abnormalities(PVA)in myopic patients,and preliminary analyze the differences in age,best corrected visual acuity(BCVA),spherical equivalent(SE),axial length(AL),and subfoveal choroidal thickness(SFCT).Methods A cross-sectional clinical study.A total of 60 myopia patients with EMRS who were admitted to Department of Ophthalmology of The First Affiliated Hospital of Zhengzhou University from January 2023 to June 2024 were included in the study.There were 18 male cases with 18 eyes and 42 female cases with 42 eyes.Age was(37.57±17.14)years;SE was(−10.76±4.66)D;AL was(28.36±1.87)mm.According to the characteristics of ultra-wide-angle optical coherence tomography images,PVA was divided into perivascular cysts(PC),perivascular microfolds(PM)and perivascular lamellar holes(PLH).According to the splitting level,EMRS can be divided into inner layer,middle layer and outer layer.According to SE,the affected eyes were divided into low myopia group,moderate myopia group and high myopia group.The occurrence of EMRS near optic disc,supratemporal,suprasal and subnasal,as well as the clinical characteristics of patients with EMRS at different locations,levels and forms of PVA were observed.Age,BCVA,SE,AL and SFCT of EMRS patients at different locations and levels were compared by independent sample t test.χ^(2) test or Fisher exact probability test were used to compare the categorical variables between groups.Results In 60 eyes,EMRS were located in supratemporal,infratemporal,supranasal,subnasal,and paratopic discs in 36,43,15,13,and 14 eyes,respectively.The EMRS in the inner and outer layers were 59(98.3%,59/60)and 35(58.3%,35/60)eyes,respectively.PVA was present in 47 eyes(78.3%,47/60).Among them,PC,PM and PLH were 45,39 and 18 eyes,respectively.The age of those with paratopic splitting was older than those without paratopic splitting(t=2.720).Those with temporal splitting had worse BCVA and longer AL than those without splitting

关 键 词：高度近视 视网膜劈裂症 血管旁病变 光相干断层扫描 

分 类 号：R73[医药卫生—肿瘤]