高度近视圆顶状黄斑合并黄斑裂孔的形态学特点及相关性分析  

Morphological characteristics and correlation of dome-shaped macula with macula hole in high myopia

作　　者：赵可人 郝玉华 张瑞涵 陈鹏飞 刘瑞[1] Zhao Keren;Hao Yuhua;Zhang Ruihan;Chen Pengfei;Liu Rui(Department of Ophthalmology,Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China;Department of Ophthalmology,First Hospital of Hebei Medical University,Shijiazhuang 050023,China)

机构地区：[1]河北医科大学第四医院眼科,石家庄050011 [2]河北医科大学第一医院眼科,石家庄050023

出　　处：《中华眼底病杂志》2025年第2期113-118,共6页Chinese Journal of Ocular Fundus Diseases

基　　金：河北省科学技术厅2023年度省级引智项目。

摘　　要：目的观察高度近视圆顶状黄斑(DSM)合并黄斑裂孔(MH)的形态特征,初步分析DSM与MH的相关性。方法回顾性病例对照研究。2021年4月至2023年12月于河北医科大学第四医院眼科就诊的高度近视(近视屈光度≥6.00 D)患者503例963只眼纳入研究。患者年龄5~89(48.91±16.69)岁;屈光度−6.00~−26.00(−10.49±3.15)D。所有患眼均行光相干断层扫描(OCT)检查。设备自带软件测量DSM宽度、高度以及中心凹下脉络膜厚度(SFCT)、MH内口直径及基底直径。根据OCT图像特征将DSM分为水平、垂直方向椭圆形凸起和对称型圆形凸起。按照有无DSM,将患眼分为DSM组、无DSM组;再将合并MH的患眼分为DSM合并MH组、无DSM合并MH组。观察DSM发生率和DSM组、无DSM组的MH发生率。对比观察DSM合并MH组、无DSM合并MH组的MH内口直径、基底直径、SFCT和黄斑前膜发生情况,以及视网膜劈裂(RS)的发生位置。组间比较采用独立样本t检验或非参数Mann-Whitney U检验。MH内口、基底直径与DSM宽度、高度、高度/宽度比的相关因素采用Pearson相关性分析。结果963只眼中,DSM组、无DSM组分别为266(27.6%,266/963)、697(72.4%,697/963)只眼。与无DSM比较,DSM组患者年龄更大(Z=−11.302),近视屈光度更高(Z=−8.944),SFCT更薄(Z=−16.244),MH发生率(χ^(2)=8.828)更高,差异均有统计学意义(P<0.05)。与无DSM合并MH组比较,DSM合并MH组患者年龄更大(t=2.610),近视屈光度更高(t=3.593),SFCT更薄(t=3.505),差异均有统计学意义(P<0.05);两组黄斑前膜发生眼数比较,差异无统计学意义(χ^(2)=0.119,P=0.730)。DSM合并MH组RS多发生于外层视网膜且范围较大,无DSM合并MH组RS多发生于外层及内层视网膜且范围较小;两组不同位置的RS发生眼数比较,差异有统计学意义(χ^(2)=25.131,P<0.05)。相关性分析结果显示,MH内口、基底直径与DSM宽度、高度、高度/宽度比均无相关性(P>0.05)。结论与高度近视未合并DSM者�Objective To observe the morphological characteristics of dome-shaped macula(DSM)and macular hole(MH)in high myopia by optical coherence tomography(OCT),to further explore the correlation between DSM and MH.Methods A retrospective case-control study.From April 2021 to December 2023,963 eyes of 503 patients with high myopia(myopic diopter≥6.00 D)in Department of Ophthalmology of the Fourth Hospital of Hebei Medical University were enrolled in the study.The age of patients ranged from 5 to 89 years old,with the mean age of(48.91±16.69)years.Diopter was−6.00 to−26.00(−10.49±3.15)D.All eyes were examined by OCT.The width and height of DSM,subfoveal choroidal thickness(SFCT),inner port diameter and base diameter of MH were measured by software on OCT.According to the OCT image features,DSM was divided into horizontal and vertical oval-shaped DSM,and symmetrical round DSM.According to the presence or absence of DSM,the eyes were divided into DSM group and non-DSM group.Then,the affected eyes with MH were divided into DSM with MH group and non-DSM with MH group.The incidence of DSM,the incidence of MH in the DSM group and the non-DSM group,the inner port diameter of MH,the base diameter of MH,SFCT,and the location of retinoschisis(RS)in the DSM with MH group and the non-DSM with MH group were observed.Independent sample t test or non-parametric Mann-Whitney U test was used for comparison between groups.Pearson correlation analysis was used to analyze the related factors of MH inner port diameter,base diameter and DSM width,height,height/width ratio.Results Among the 963 eyes,the DSM group and the non-DSM group were 266(27.6%,266/963)and 697(72.4%,697/963)eyes.Compared with the non-DSM group,patients in the DSM group were older(Z=−11.302),had higher degree of myopia(Z=−8.944),thinner SFCT(Z=−16.244),and higher incidence of MH(χ^(2)=8.828),and the differences were statistically significant(P<0.05).Compared with non-DSM with MH group,the patients in DSM with MH group were older(t=2.610),higher myopia diopt

关 键 词：圆顶状黄斑 黄斑裂孔 高度近视 光相干断层扫描 

分 类 号：R778.11[医药卫生—眼科] R774.5[医药卫生—临床医学]