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目的观察高度近视眼中心凹脱离伴视网膜劈裂的形态学特征,并探讨高度近视眼玻璃体、黄斑及后巩膜葡萄肿三者间的关系。设计回顾性病例系列。研究对象29例(38眼)高度近视眼中心凹脱离伴视网膜劈裂的患者。方法所有患者均进行裂隙灯前置镜、三面镜、直接或间接检眼镜、B超及相干光断层扫描(OCT)检查,观察黄斑中心凹脱离及视网膜劈裂的形态及其与玻璃体以及后巩膜葡萄肿的关系。其中10眼行玻璃体手术。主要指标形态学特征。结果裂隙灯前置镜、三面镜检查见视网膜成微囊样改变并浅脱离,未见黄斑裂孔。B超显示后极部视网膜水肿或浅脱离0.5~2.0mm。所有38眼的OCT扫描均显示黄斑区神经上皮脱离;未显示黄斑裂孔;神经上皮层劈裂,表现为内层劈裂、外层劈裂和双层劈裂,劈裂的内外层视网膜之间可见桥柱样连接;3眼黄斑区未见劈裂,扫描至后巩膜葡萄肿边缘附近见视网膜劈裂;视网膜前存在低反射细光带(玻璃体后皮质),且与视网膜间存在点、线及片状粘连,相应粘连处视网膜被牵引。10眼玻璃体手术中见玻璃体液化、不完全后脱离,后极部玻璃体后皮质与视网膜粘连紧密,尽量剥除后皮质,术后视网膜均复位。结论OCT可清晰显示高度近视眼中心凹脱离伴视网膜劈裂的形态特征,来自玻璃体皮质的牵引及后巩膜葡萄肿因素是导致视网膜劈裂的主要原因。
Objective To observe the morphological characteristics of the high myopia with retinal detachment and retinal detachment and to explore the relationship between the vitreous, macular and posterior scleral grafts in high myopia. Design retrospective case series. The study included 29 patients (38 eyes) with high degree of myopia with retinal detachment and retinal detachment. Methods All patients were examined by slit lamp pre-mirror, three-mirror, direct or indirect ophthalmoscope, B-mode ultrasonography and coherence tomography (OCT) to observe the morphology of foveal foveal detachment and retinal rupture and its relationship with vitreous and posterior scleral Grape swelling of the relationship. Among them, 10 eyes underwent vitrectomy. The main indicators of morphological characteristics. Results Slit lamp pre-mirror, three-mirror examination of the retina into a microcapsule-like change and shallow detachment, no macular hole. Post B-subretinal retinal edema or shallow detachment 0.5 ~ 2.0mm. OCT scans of all 38 eyes revealed macular denervation of the neural epithelium; no macular holes were seen; the neuroepithelial cortex was split, showing an inner splitting, an outer splitting and a double splitting, and a cleft between the inner and outer retina Visible bridge-like connection; 3 macular no splitting, scleral staphyloma scan to the edge of the retinal detachment seen near the splint; retina before the presence of low reflex ribbon (vitreous cortex), and the presence of dots between the retina, line And sheet adhesion, the corresponding adhesions retinal traction. Vitreous surgery in 10 vitreous see liquefaction, incomplete detachment, posterior vitreous posterior cortex and retinal adhesions close, try to remove the posterior cortex, postoperative retina were reset. Conclusions OCT can clearly show the morphological features of the high myopia with retinal detachment and retinal detachment. Traction from the vitreous cortex and posterior staphyloma are the main causes of retinal detachment.