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ENGLISH ABSTRACT
高度近视眼球后壁形态分类及其与近视相关并发症关系研究进展
张宇
严宏 [综述]
作者及单位信息
·
DOI： 10.3760/cma.j.cn115989-20200512-00336
Research progress in classification of posterior wall morphology of eyeball and its relationship with myopia related complications in high myopic eyes
Zhang Yu
Yan Hong
Authors Info & Affiliations
Zhang Yu
Department of Ophthalmology, the First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing 400016, China
Yan Hong
Department of Ophthalmology, the First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing 400016, China; Xi'an People's Hospital (Xi'an Fourth Hospital), Shaanxi Eye Hospital, Affiliated Guangren Hospital School of Medicine, Xi'an Jiaotong University, Xi'an 710004, China
·
DOI： 10.3760/cma.j.cn115989-20200512-00336
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摘要

眼球后壁形态分类对高度近视眼底病变的诊断和治疗起关键作用。目前眼球后壁的主要检查手段有检眼镜、B型超声、磁共振成像(MRI)和光相干断层扫描成像(OCT)。检眼镜对眼球后壁形态分类评估的参考客观性较差且较困难，B型超声检查的显示范围局限且不准确，3D-MRI可全方位且清晰地显示眼球后壁形态，OCT可观察巩膜曲率变化，可用于近视性眼底病变的研究，但扫描范围有限。广角OCT(WF-OCT)联合高分辨率3D-MRI用于眼球形态分类具有较高的价值。本文对检眼镜、B型超声、MRI以及OCT用于高度近视患者眼球后壁形态的分类方法进行分析，并评估不同类型的眼球后壁形态对视力和近视性黄斑病变的影响，为临床客观评价高度近视眼底病变和预后的评估提供依据。

高度近视;后巩膜葡萄肿;眼球形态;分类
ABSTRACT

The classification of the fundus shape is crucial to the diagnosis and treatment of high myopic fundus lesions.There are four main clinical examination methods for the detection of posterior wall morphology, including ophthalmoscope, B mode ultrasonography, magnetic resonance imaging (MRI) and optical coherence tomography (OCT). Ophthalmoscopy is subjective and difficult in classification.B mode ultrasonography is limited by the scan range and the accuracy is not good enough.The 3D MRI has been found to be a well-suited way for the identification of eye shape over a wide area and any angle.OCT also is used to observe myopic fundus lesions because of a good resolving power for fundus structure.It is valuable to combine high resolution 3D-MRI and OCT.Recent advanced studies on classification posterior wall morphology of eyeball and the influences of these different classifications to the visual acuity and myopic maculopathy were reviewed.

High myopia;Posterior staphyloma;Ocular morphology;Classifications
Yan Hong, Email: mocdef.labiamtohst8212nay
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引用本文

张宇,严宏. 高度近视眼球后壁形态分类及其与近视相关并发症关系研究进展[J]. 中华实验眼科杂志,2020,38(11)：997-1000.

DOI:10.3760/cma.j.cn115989-20200512-00336

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近50年来，东亚及东南亚地区近视人数大幅度增长，近视已成为全球性的公共健康问题 [ 1 ]。人群调查和眼盲登记数据均提示病理性近视是严重的致盲原因之一 [ 2 ]。近视程度的持续加深可引起一系列相互关联的退行性病变，最终导致视力严重下降，甚至致盲。高度近视患者眼球后壁形态随着近视程度的加深而发生改变，当眼球变形到一定程度时称之为后巩膜葡萄肿。后巩膜葡萄肿是病理性近视的特征性基础病变 [ 3 ]。研究表明，高度近视眼球形态的改变，尤其是发展至后巩膜葡萄肿时，眼球后极部受到牵拉，可能会导致各种近视性病变，如脉络膜视网膜萎缩、脉络膜新生血管、近视性牵拉性黄斑病变(myopic traction maculopathy，MTM)、近视性黄斑劈裂(myopic macular retinoschisis，MRS)、黄斑裂孔等，且伴有后巩膜葡萄肿的高度近视更易发生视力损害 [ 4 , 5 ]。并且，MTM主要与眼球内层及外层的机械性牵拉有关，虽然机制不明，但通常情况下，眼球形态是高度近视眼底病变进行性加重的危险因素 [ 6 ]，而MRS的位置与后巩膜葡萄肿相互联系 [ 7 ]。
目前，高度近视眼球形态的影像学检查手段主要包括检眼镜、B型超声、光相干断层扫描成像(optical coherence tomography，OCT)。近年来，随着核磁共振成像(magnetic resonance imaging，MRI)在眼科临床中应用的不断增加，关于高度近视眼球的三维形态学特征的研究也日益增多。现就临床上常用的4种高度近视眼球形态的活体无创影像学检查手段以及高度近视眼球形态与视力及近视性黄斑病变的关系进行综述。
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严宏，Email： mocdef.labiamtohst8212nay
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