本文選題：病理性近視 + 黃斑病變��； 參考：《山西醫(yī)科大學(xué)》2010年碩士論文

【摘要】： 目的：觀察病理性近視黃斑病變光學(xué)相干斷層掃描圖像特征,明確其黃斑病變類型；分析不同類型黃斑病變之間年齡、屈光度、最佳矯正視力的關(guān)系,分析病理性近視黃斑部的病理變化,尋找早期防治的最佳時(shí)期和方法。 方法：收集病理性近視黃斑病變、僅包含本研究中一種黃斑病變的患者204人210只眼,散瞳后行光學(xué)相干斷層掃描檢查。記錄患者年齡、屈光度及最佳矯正視力。觀察其黃斑部眼底改變及光學(xué)相干斷層掃描圖像特點(diǎn),依據(jù)其光學(xué)相干斷層掃描圖像特點(diǎn)將病理性近視黃斑病變分為7組,每組30只眼：1組為單純性黃斑出血組；2組為視網(wǎng)膜劈裂組；3組為黃斑脈絡(luò)膜新生血管膜組；4組為黃斑裂孔組；5組為視網(wǎng)膜脫離組；6組為視網(wǎng)膜前膜組；7組為黃斑萎縮組。分析各組黃斑病變與年齡、屈光度、矯正視力的關(guān)系。 結(jié)果： 1、病理性近視黃斑病變各組的光學(xué)相干斷層掃描圖像特征：?jiǎn)渭冃渣S斑出血：視網(wǎng)膜神經(jīng)上皮層下中度強(qiáng)反射團(tuán),其下反射衰減；視網(wǎng)膜劈裂：視網(wǎng)膜神經(jīng)上皮層間暗腔,其間可見(jiàn)橋狀或柱狀連接；黃斑脈絡(luò)膜新生血管膜：神經(jīng)上皮層下色素上皮層光帶水平不規(guī)則強(qiáng)反射團(tuán)；黃斑裂孔：視網(wǎng)膜神經(jīng)上皮層連續(xù)性中斷；視網(wǎng)膜脫離：視網(wǎng)膜神經(jīng)上皮層與色素上皮層間無(wú)光反射的暗區(qū),色素上皮層表面光滑；視網(wǎng)膜前膜：視網(wǎng)膜表面膜樣反射；黃斑萎縮：視網(wǎng)膜神經(jīng)上皮層明顯變薄,視網(wǎng)膜色素上皮層及脈絡(luò)膜呈帶狀高度強(qiáng)反射。 2、病理性近視黃斑病變各組間年齡的關(guān)系：1組-7組患者的平均年齡分別為(30.10±7.76)歲、(45.97±11.63)歲、(47.47±12.53)歲、(53.83±11.31)歲、(54.10±10.41)歲、(59.30±12.65)歲、(60.43±11.44)歲。單純性黃斑出血組平均年齡最小,與各組間均有統(tǒng)計(jì)學(xué)意義(P0.05)。視網(wǎng)膜劈裂組、黃斑脈絡(luò)膜新生血管膜組兩組間無(wú)統(tǒng)計(jì)學(xué)意義,該兩組與其余各組均有統(tǒng)計(jì)學(xué)意義(P0.05)。黃斑裂孔組、視網(wǎng)膜脫離組與黃斑萎縮組之間有統(tǒng)計(jì)學(xué)意義(P0.05)。其余各組間無(wú)統(tǒng)計(jì)學(xué)意義。 3、病理性近視黃斑病變各組間屈光度的關(guān)系：1組-7組患者的平均屈光度分別為(14.70±3.31)D、(13.04±4.27)D、(13.77±4.75)D、(14.18±4.06)D、(14.50±3.89)D、(14.14±4.67)D、(17.25±3.36)D。黃斑萎縮組屈光度最高,與各組均有統(tǒng)計(jì)學(xué)意義(P0.05),其余各組之間無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。 4、病理性近視黃斑病變各組間最佳矯正視力的關(guān)系：1組-7組患者的平均最佳矯正視力分別為0.24±0.07、0.32±0.09、0.22±0.09、0.14±0.09、0.07±0.04、0.31±0.09、0.13±0.08。視網(wǎng)膜脫離組平均最佳矯正視力最差,與各組間均有統(tǒng)計(jì)學(xué)意義(P0.05)。視網(wǎng)膜劈裂和視網(wǎng)膜前膜組平均最佳矯正視力大于0.3,兩組間無(wú)統(tǒng)計(jì)學(xué)意義,兩組與其余各組均有統(tǒng)計(jì)學(xué)意義(P0.05)。黃斑出血組、黃斑脈絡(luò)膜新生血管膜組兩組間無(wú)統(tǒng)計(jì)學(xué)意義,與其余各組均有統(tǒng)計(jì)學(xué)意義(P0.05)。黃斑裂孔組與黃斑萎縮組兩組間無(wú)統(tǒng)計(jì)學(xué)意義,與其余各組間均有統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論：病理性近視黃斑病變依據(jù)光學(xué)相干斷層掃描圖像特征分為七種類型：?jiǎn)渭冃渣S斑出血、視網(wǎng)膜劈裂、黃斑脈絡(luò)膜新生血管膜、黃斑裂孔、視網(wǎng)膜脫離、視網(wǎng)膜前膜、黃斑萎縮。各組患者的平均年齡都大于30歲,高度近視患者30歲以后應(yīng)定期行眼底檢查,及早發(fā)現(xiàn)眼底病變,隨著年齡增加,病變類型不同,單純性黃斑出血患者平均年齡最小,應(yīng)早期防治；屈光度越高,病變?cè)絿?yán)重,各組患者的平均屈光度均大于-13.00D,以黃斑萎縮組最高,因此應(yīng)早期控制其屈光度,阻止或減輕嚴(yán)重眼底損害出現(xiàn)；黃斑病變?cè)綇V泛,受損程度越嚴(yán)重,最佳矯正視力越差,對(duì)高度近視患者出現(xiàn)不明原因視力下降,應(yīng)及時(shí)進(jìn)行眼底檢查,防止發(fā)生更嚴(yán)重黃斑病變。病理性近視黃斑病變根據(jù)其光學(xué)相干斷層掃描圖像分類有助于明確病變性質(zhì)、判斷預(yù)后及指導(dǎo)治療。
[Abstract]:Objective : To observe the characteristics of optical coherence tomography ( OCT ) in pathological myopia and to identify the type of macular degeneration .
The relationship between age , power and the best corrected visual acuity between different types of macular degeneration was analyzed , the pathological changes of the yellow spot of pathological myopia were analyzed , and the best time and method for early prevention and treatment were found .


Methods : The pathological myopia macular degeneration was collected . Only 204 patients with macular degeneration in the study were examined by OCT . The age , power and best corrected visual acuity were recorded . The pathological myopia macular degeneration was divided into 7 groups according to their optical coherence tomography image characteristics .
Group 2 was the retinal cleavage group .
Group 3 was a new group of choroidal neovascularization ;
group 4 was macular hole group ;
Group 5 was the retinal detachment group .
Group 6 was the anterior retinal membrane group .
The relationship between macular degeneration and age , diopter and corrected visual acuity was analyzed .


Results :


1 . Optical coherence tomography image characteristics of pathological myopia macular degeneration group : simple macular hemorrhage : moderate intense reflection mass under the subcortical layer of the retina , and its lower reflection attenuation ;
retinoschisis : the dark cavity between the subcortical layers of the retina , with a visible bridge or column connection therebetween ;
macular choroidal neovascularization : irregular intense reflection of the cortical light band in the subcortical subcortical pigment ;
macular hole : continuous disruption of the retinal nerve ;
Retinal detachment : there is no light - reflecting dark area between the retinal nerve epithelial layer and the pigment epithelium layer , and the surface of the pigment epithelial layer is smooth ;
Anterior retinal membrane : retinal surface membrane - like reflex ;
Macular atrophy : The retinal nerve epithelial layer is significantly thinner , and the retinal pigment epithelial layer and the suprachoroidal layer are highly reflective .


There was no significant difference between the two groups ( P 0.05 ) . There was no statistical difference between the two groups ( P 0.05 ) .


3 . The relationship between the diopter among the patients with pathological myopia was ( 14.70 鹵 3.31 ) D , ( 13.04 鹵 4.27 ) D , ( 13.77 鹵 4.75 ) D , ( 14.18 鹵 4.06 ) D , ( 14.50 鹵 3.89 ) D , ( 14.14 鹵 4.67 ) D , ( 17.25 鹵 3.36 ) D .


The best corrected visual acuity was 0.24 鹵 0.07 , 0.32 鹵 0.09 , 0.22 鹵 0.09 , 0.14 鹵 0.09 , 0.07 鹵 0.04 , 0.31 鹵 0.09 , 0.13 鹵 0.08 in group 1 - 7 . There was no significant difference between the two groups .


Conclusion : The pathological myopia macular degeneration is divided into seven types according to the characteristics of OCT image : simple macular hemorrhage , retinal detachment , macular choroidal neovascularization , macular hole , retinal detachment , anterior retinal membrane and macular degeneration . The average age of patients in each group is greater than 30 years .
The higher the diopter , the more serious the lesion was , the average power of each group was greater than - 13.00D , the highest in the macular atrophy group , so the diopter should be controlled in the early stage , and the occurrence of severe ocular fundus damage should be prevented or alleviated ;
The more extensive the macular degeneration , the more severe the degree of damage , the worse the best corrected vision , the worse visual acuity in the patients with high myopia , and should be examined in a timely manner to prevent more severe macular degeneration . The pathological myopia macular degeneration can help clarify the nature of the lesion , judge the prognosis and guide the treatment according to its optical coherence tomography image classification .

【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R774.5

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 王志立;董應(yīng)麗;孔眾;郭希讓;;OCT對(duì)高度近視眼繼發(fā)黃斑劈裂的診斷價(jià)值[J];醫(yī)藥論壇雜志;2007年11期

2 閔祥榮;趙秉水;韓泉洪;;高度近視黃斑劈裂研究進(jìn)展[J];臨床眼科雜志;2007年03期

3 杜冰;古洵清;黃麗娜;翁宏;余寶花;;OCT對(duì)高度近視眼黃斑部視網(wǎng)膜劈裂的診斷意義[J];眼科新進(jìn)展;2006年03期

4 王文吉;;病理性近視黃斑病變的診治[J];眼科;2006年04期

5 熊潔;鄧應(yīng)平;;影響近視眼患者近視屈光度的相關(guān)因素分析[J];眼科;2006年05期

6 王舜杏,關(guān)國(guó)華,詹宇堅(jiān);兒童和青少年高度近視眼底損害與屈光度的關(guān)系[J];中國(guó)中醫(yī)眼科雜志;2001年01期

7 陳雪梅,吳善宏,廖瑞端,林先軒,馬翠萍;高度近視黃斑出血相關(guān)因素分析[J];中國(guó)航天醫(yī)藥雜志;2003年02期

8 褚仁遠(yuǎn),倪鵬生,倪敏健,沈福民;病理性近視眼的遺傳流行病學(xué)研究[J];中華醫(yī)學(xué)遺傳學(xué)雜志;2000年03期

9 唐仕波,李加青,黃素英,劉文,劉杏;黃斑部病變手術(shù)后解剖結(jié)構(gòu)變化的客觀評(píng)價(jià)[J];中華眼底病雜志;2001年01期

10 汪芳潤(rùn);近視眼研究的現(xiàn)狀與存在問(wèn)題[J];中華眼科雜志;2003年06期

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