Abstract：
OBJECTIVE: To observe the morphological characteristics of posterior scleral staphyloma (PSS) with or without macular retinoschisis (MRS) using optical coherence tomography (OCT). Additionally, the incidence and severity of other pathologic myopic maculopathy associated with posterior scleral staphyloma was also evaluated.
METHODS: General information and OCT imaging data from 440 patients with posterior scleral staphyloma (PSS) and the PSS curvature > 20×10-3 μm-1 were collected. These patients visited the Department of Ophthalmology at the First Affiliated Hospital of Harbin Medical University from January 2013 to June 2021. The obtained OCT images of PSS were analyzed using the Image J software to measure the curvature along the Bruch\'s membrane. The measured curvature was divided into four levels using the quartile method. The classification of macular retinoschisis (MRS) was based on the anatomical structure of the retina and the location of macular retinoschisis. Patients with PSS accompanied by MRS were assigned to the MRS group, while PSS patients without MRS were assigned to the non-MRS group. Additionally, typical OCT changes in other pathologic myopic maculopathy diseases, such as myopic choroidal neovascularization (mCNV), myopic traction maculopathy (MTM), and myopic foveoschisis (MF), were recorded and evaluated.
RESULTS: A total of 615 eyes (328 right eyes, 287 left eyes) from 440 patients (80 males and 360 females) were recruited in this study. The MRS group consisted of 159 patients (36.1%) with 190 eyes (30.9%), while the non-MRS group consisted of 281 patients (63.9%) with 425 eyes (69.1%). Both groups had a significantly higher proportion of female patients compared to male patients, and the right eye was more commonly affected than the left eye. In the MRS group, the prevalence of MRS increased progressively with the severity of PSS. Among the common posterior pole diseases, epiretinal membrane had the highest prevalence (33.2%), while lamellar macular hole had the lowest prevalence (5.3%). In the non-MRS group, the proportion of PSS in each group decreased progressively (except for an equal prevalence in the third and fourth levels) with increasing severity of PSS. Among the common posterior pole diseases, choroidal neovascularization had the highest prevalence (41.4%), while lamellar macular hole had the lowest prevalence (6.5%). When comparing the two groups, there were no significant differences in age, gender, and eye distribution. The MRS group had a higher prevalence of macular schisis, retinal detachment, and dome-shaped macula (17.9%, 14.2%, 14.8%) compared to the non-MRS group (11.3%, 9.2%, 9.6%). The non-MRS group had a significantly higher prevalence of choroidal neovascularization (41.4%) compared to the MRS group (12.6%), while there were no significant differences in the prevalence of epiretinal membrane and lamellar macular hole between the two groups.
CONCLUSIONS: The prevalence of MRS increased progressively with the severity of PSS, and the MRS occurrence was positively correlated with PSS, which indicated that PSS may lead to MRS, while the proportion of PSS in each group decreases gradually with the severity of PSS in the non-MRS group decreased progressively (except for an equal prevalence in the third and fourth levels). In the MRS group, outer macular retinoschisiss were most relevant to posterior scleral staphyloma, and the prevalence of macular holes and retinal detachments was higher in the MRS group compared to the non-MRS group, indicating that MRS may further turn into complications such as macular holes and retinal detachments, which can significantly affect vision or lead to blindness. The prevalence of choroidal neovascularization (CNV) was significantly higher in the non-MRS group compared to the MRS group, suggesting that PSS with lower severity is more prone to develop into CNV. Dome-shaped macula (DSM) seems to play a protective role in the development of pathologic myopia, and abnormal changes in posterior scleral staphyloma curvature may be an important factor affecting the development and shape of DSM.
METHODS: General information and OCT imaging data from 440 patients with posterior scleral staphyloma (PSS) and the PSS curvature > 20×10-3 μm-1 were collected. These patients visited the Department of Ophthalmology at the First Affiliated Hospital of Harbin Medical University from January 2013 to June 2021. The obtained OCT images of PSS were analyzed using the Image J software to measure the curvature along the Bruch\'s membrane. The measured curvature was divided into four levels using the quartile method. The classification of macular retinoschisis (MRS) was based on the anatomical structure of the retina and the location of macular retinoschisis. Patients with PSS accompanied by MRS were assigned to the MRS group, while PSS patients without MRS were assigned to the non-MRS group. Additionally, typical OCT changes in other pathologic myopic maculopathy diseases, such as myopic choroidal neovascularization (mCNV), myopic traction maculopathy (MTM), and myopic foveoschisis (MF), were recorded and evaluated.
RESULTS: A total of 615 eyes (328 right eyes, 287 left eyes) from 440 patients (80 males and 360 females) were recruited in this study. The MRS group consisted of 159 patients (36.1%) with 190 eyes (30.9%), while the non-MRS group consisted of 281 patients (63.9%) with 425 eyes (69.1%). Both groups had a significantly higher proportion of female patients compared to male patients, and the right eye was more commonly affected than the left eye. In the MRS group, the prevalence of MRS increased progressively with the severity of PSS. Among the common posterior pole diseases, epiretinal membrane had the highest prevalence (33.2%), while lamellar macular hole had the lowest prevalence (5.3%). In the non-MRS group, the proportion of PSS in each group decreased progressively (except for an equal prevalence in the third and fourth levels) with increasing severity of PSS. Among the common posterior pole diseases, choroidal neovascularization had the highest prevalence (41.4%), while lamellar macular hole had the lowest prevalence (6.5%). When comparing the two groups, there were no significant differences in age, gender, and eye distribution. The MRS group had a higher prevalence of macular schisis, retinal detachment, and dome-shaped macula (17.9%, 14.2%, 14.8%) compared to the non-MRS group (11.3%, 9.2%, 9.6%). The non-MRS group had a significantly higher prevalence of choroidal neovascularization (41.4%) compared to the MRS group (12.6%), while there were no significant differences in the prevalence of epiretinal membrane and lamellar macular hole between the two groups.
CONCLUSIONS: The prevalence of MRS increased progressively with the severity of PSS, and the MRS occurrence was positively correlated with PSS, which indicated that PSS may lead to MRS, while the proportion of PSS in each group decreases gradually with the severity of PSS in the non-MRS group decreased progressively (except for an equal prevalence in the third and fourth levels). In the MRS group, outer macular retinoschisiss were most relevant to posterior scleral staphyloma, and the prevalence of macular holes and retinal detachments was higher in the MRS group compared to the non-MRS group, indicating that MRS may further turn into complications such as macular holes and retinal detachments, which can significantly affect vision or lead to blindness. The prevalence of choroidal neovascularization (CNV) was significantly higher in the non-MRS group compared to the MRS group, suggesting that PSS with lower severity is more prone to develop into CNV. Dome-shaped macula (DSM) seems to play a protective role in the development of pathologic myopia, and abnormal changes in posterior scleral staphyloma curvature may be an important factor affecting the development and shape of DSM.
摘要：
目的：使用光学相干断层扫描（OCT）观察伴有或不伴有黄斑视网膜裂开（MRS）的后巩膜葡萄肿（PSS）的形态学特征。此外,还评估了与后巩膜葡萄肿相关的其他病理性近视性黄斑病变的发生率和严重程度.
方法：收集440例后巩膜葡萄肿（PSS）和PSS曲率>20×10-3μm-1患者的一般信息和OCT影像学数据。这些患者于2013年1月至2021年6月在哈尔滨医科大学附属第一医院眼科就诊。使用ImageJ软件分析所获得的PSS的OCT图像,以测量沿着布鲁赫膜的曲率。使用四分位数方法将测量的曲率分为四个级别。黄斑视网膜裂孔（MRS）的分类基于视网膜的解剖结构和黄斑视网膜裂孔的位置。伴MRS的PSS患者被分配到MRS组，而无MRS的PSS患者被分配到非MRS组。此外,其他病理性近视黄斑病变的典型OCT变化，如近视脉络膜新生血管（mCNV），近视牵引性黄斑病变（MTM），和近视中央凹（MF），进行记录和评估。
结果：总共615只眼（328只右眼，本研究招募了440名患者（80名男性和360名女性）的287只左眼）。MRS组159例（36.1%），190只眼（30.9%），而非MRS组包括281例患者(63.9%)和425只眼(69.1%)。两组女性患者的比例明显高于男性患者，右眼比左眼更常见。在MRS组中,MRS的患病率随着PSS的严重程度而逐渐增加。在常见的后极疾病中，视网膜前膜患病率最高(33.2%),而层状黄斑裂孔的患病率最低(5.3%)。在非MRS组中，各组中PSS的比例随着PSS严重程度的增加而逐渐降低(第三和第四水平的患病率相同).在常见的后极疾病中，脉络膜新生血管的患病率最高(41.4%),而层状黄斑裂孔的患病率最低(6.5%)。当比较两组时，在年龄上没有显著差异,性别,和眼睛分布。MRS组黄斑裂隙患病率较高，视网膜脱离,和圆顶状黄斑(17.9%，14.2%,14.8%）与非MRS组（11.3%，9.2%，9.6%）。与MRS组（12.6%）相比，非MRS组脉络膜新生血管的患病率（41.4%）明显更高，而视网膜前膜和板层黄斑孔的患病率在两组之间没有显着差异。
结论：随着PSS的严重程度，MRS的患病率逐渐增加，MRS的发生与PSS呈正相关,这表明PSS可能导致MRS，而各组中PSS的比例随着非MRS组PSS严重程度的逐渐降低而逐渐降低(第三和第四水平的患病率相同除外).在MRS组中,外黄斑视网膜病变与后巩膜葡萄肿最相关，MRS组黄斑裂孔和视网膜脱离的患病率高于非MRS组，表明MRS可能进一步转变为黄斑裂孔和视网膜脱离等并发症，这会显著影响视力或导致失明。非MRS组的脉络膜新生血管(CNV)患病率明显高于MRS组,提示严重程度较低的PSS更容易发展为CNV。圆顶状黄斑（DSM）似乎在病理性近视的发展中起保护作用。后巩膜葡萄肿曲率的异常改变可能是影响DSM发育和形态的重要因素。
方法：收集440例后巩膜葡萄肿（PSS）和PSS曲率>20×10-3μm-1患者的一般信息和OCT影像学数据。这些患者于2013年1月至2021年6月在哈尔滨医科大学附属第一医院眼科就诊。使用ImageJ软件分析所获得的PSS的OCT图像,以测量沿着布鲁赫膜的曲率。使用四分位数方法将测量的曲率分为四个级别。黄斑视网膜裂孔（MRS）的分类基于视网膜的解剖结构和黄斑视网膜裂孔的位置。伴MRS的PSS患者被分配到MRS组，而无MRS的PSS患者被分配到非MRS组。此外,其他病理性近视黄斑病变的典型OCT变化，如近视脉络膜新生血管（mCNV），近视牵引性黄斑病变（MTM），和近视中央凹（MF），进行记录和评估。
结果：总共615只眼（328只右眼，本研究招募了440名患者（80名男性和360名女性）的287只左眼）。MRS组159例（36.1%），190只眼（30.9%），而非MRS组包括281例患者(63.9%)和425只眼(69.1%)。两组女性患者的比例明显高于男性患者，右眼比左眼更常见。在MRS组中,MRS的患病率随着PSS的严重程度而逐渐增加。在常见的后极疾病中，视网膜前膜患病率最高(33.2%),而层状黄斑裂孔的患病率最低(5.3%)。在非MRS组中，各组中PSS的比例随着PSS严重程度的增加而逐渐降低(第三和第四水平的患病率相同).在常见的后极疾病中，脉络膜新生血管的患病率最高(41.4%),而层状黄斑裂孔的患病率最低(6.5%)。当比较两组时，在年龄上没有显著差异,性别,和眼睛分布。MRS组黄斑裂隙患病率较高，视网膜脱离,和圆顶状黄斑(17.9%，14.2%,14.8%）与非MRS组（11.3%，9.2%，9.6%）。与MRS组（12.6%）相比，非MRS组脉络膜新生血管的患病率（41.4%）明显更高，而视网膜前膜和板层黄斑孔的患病率在两组之间没有显着差异。
结论：随着PSS的严重程度，MRS的患病率逐渐增加，MRS的发生与PSS呈正相关,这表明PSS可能导致MRS，而各组中PSS的比例随着非MRS组PSS严重程度的逐渐降低而逐渐降低(第三和第四水平的患病率相同除外).在MRS组中,外黄斑视网膜病变与后巩膜葡萄肿最相关，MRS组黄斑裂孔和视网膜脱离的患病率高于非MRS组，表明MRS可能进一步转变为黄斑裂孔和视网膜脱离等并发症，这会显著影响视力或导致失明。非MRS组的脉络膜新生血管(CNV)患病率明显高于MRS组,提示严重程度较低的PSS更容易发展为CNV。圆顶状黄斑（DSM）似乎在病理性近视的发展中起保护作用。后巩膜葡萄肿曲率的异常改变可能是影响DSM发育和形态的重要因素。
