A preliminary study on the analysis of myopic retinoschisis and posterior staphyloma in a cohort of patients with pathological myopia by optical coherence tomography and magnetic resonance imaging_Chinese Journal of Ocular Fundus Diseases

Authors：

An Guangqi ¹ , Dai Fangfang ¹ , Jin Xuemin ² ,  Lei Bo ¹

1. Zhengzhou University People’s Hospital, Henan Eye Hospital & Henan Eye Institute, Henan People's Hospital, Zhengzhou 450003, China;
2. The First Affiliated Hospital of Zhengzhou University, Henan Province Ophthalmic Hospital, Zhengzhou 450052, China;

Corresponding author：

Lei Bo, Email: bolei99@126.com

Keywords：

Myopia, degenerative; Scleral diseases; Retinoschisis; Tomography, optical coherence; Magnetic resonance imaging

DOI：

10.3760/cma.j.cn511434-20200304-00093

Video：

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Objective To observe the correlation between posterior myopic retinoschisis(MRS) and posterior scleral staphyma (PS) in pathological myopia (PM), and to preliminarily explore the influencing factors of MRS.Methods A retrospective case series study. From November 2016 to November 2019, 38 patients with PM with MRS diagnosed in Henan Eye Hospital & Henan Eye Institute from were included in the study. There were 10 males and 28 females; 13 patients were binocular and 25 patients were monocular. The average age was (49±13) years old. BCVA, retinoscopy optometry, frequency domain OCT, three-dimensional magnetic resonance imaging (3D-MRI) examination and axial length (AL) measurement were performed. According to the frequency domain OCT inspection results, MRS was divided into inner splitting, outer splitting and mixed splitting; based on the 3D-MRI scan results, PS was divided into broad macula, narrow macula,discoid, nasal, subdisc and other types. The correlation between MRS and PS was tested by χ² test or Fisher exact test.Results Among 60 eyes, 58 eyes (96.77%) of MRS combined with PS. Among them, the wide macula, narrow macula, discoid, nasal, subdisc, and other types were 30 (51.72%), 19 (32.75%), 1 (1.72%), 2 (3.48%), 2 (3.48%) and 4 (6.85%) eyes; inner split, outer split, and mixed split were 10 (17.24%), 24 (41.38%), 24 (41.38%) eyes. Of the 19 eyes with narrow macular PS, MRS involved the fovea in 16 eyes; of the 39 eyes with PS of other forms, MRS involved the fovea in 22 eyes. There was a statistically significant difference between the narrow macular type and other types involving foveal eyes (P=0.044). The correlation between MRS involving the fovea and narrow macular PS was moderate (Cramer's V=0.275). The ages of patients with inner split, outer split, and mixed split were 44±12, 56±10, and 44±13 years, respectively. Patients with inner splitting were younger than those with outer splitting, and those with outer splitting were older than those with inner splitting and mixed splitting. The differences were statistically significant (P=0.010, 0.010, 0.060).Conclusion PM with MRS mostly occur in PS-affected eyes, and mainly macular PS (wide macula, narrow macula).

Citation： An Guangqi, Dai Fangfang, Jin Xuemin, Lei Bo. A preliminary study on the analysis of myopic retinoschisis and posterior staphyloma in a cohort of patients with pathological myopia by optical coherence tomography and magnetic resonance imaging. Chinese Journal of Ocular Fundus Diseases, 2020, 36(10): 777-782. doi: 10.3760/cma.j.cn511434-20200304-00093 Copy

1.	Gaucher D, Haouchine B, Tadayoni R, et al. Long-term follow-up of high myopic foveoschisis: natural course and surgical outcome[J]. Am J Ophthalmol, 2007, 143(3): 455-462. DOI: 10.1016/j.ajo.2006.10.053.
2.	Hayashi K, Ohno-Matsui K, Shimada N, et al. Long-term pattern of progression of myopic maculopathy: a natural history study[J]. Ophthalmology, 2010, 117(8): 1595-1611. DOI: 10.1016/j.ophtha.2009.11.003.
3.	冯竞仰, 樊莹. 高度近视黄斑劈裂的研究进展[J]. 眼科新进展, 2011, 31(4): 384-387.Feng JY, Fan Y. Research advances m high myopic foveschisis[J]. Rec Adv Ophthntmot, 2011, 31(4): 384-387.
4.	Gohil R, Sivaprasad S, Han LT, et al. Myopic foveoschisis: a clinical review[J]. Eye (Lond), 2015, 29(5): 593-601. DOI: 10.1038/eye.2014.311.
5.	Wu PC, Chen YJ, Chen YH, et al. Factors associated with foveoschisis and foveal detachment without macular hole in high myopia[J]. Eye (Lond), 2009, 23(2): 356-361. DOI: 10.1038/sj.eye.6703038.
6.	Ohno-Matsui K, Jonas JB. Posterior staphyloma in pathologic myopia[J]. Prog Retin Eye Res, 2019, 70: 99-109. DOI: 10.1016/j.preteyeres.2018.12.001.
7.	Hsiang HW, Ohno-Matsui K, Shimada N, et al. Clinical characteristics of posterior staphyloma in eyes with pathologic myopia[J]. Am J Ophthalmol, 2008, 146(1): 102-110. DOI: 10.1016/j.ajo.2008.03.010.
8.	Spaide RF, Ohno-Matsui K, Yannuzzi LA. Pathologic myopia[M]. Springer New York Heidelberg Dordrecht London: New York, 2014: 167-176.
9.	李舒茵, 郭希让,李蕴随,等. 超声探测后巩膜葡萄肿位置形态范围与眼轴的长度关系[J]. 中华超声影像学杂志, 1996, 5(3): 134-136.Li SY, Guo XR,Li YS,et al. Ultrasonic scanning of position, shape, scope and relation with axial length in posterior staphyloma[J]. Chin J Ultrasonogr, 1996, 5(3): 134-136.
10.	Singh KD, Logan NS, Gilmartin B. Three-dimensional modeling of the human eye based on magnetic resonance imaging[J]. Invest Ophthalmol Vis Sci, 2006, 47(6): 2272-2279. DOI: 10.1167/iovs.05-0856.
11.	Ohno-Matsui K, Akiba M, Modegi T, et al. Association between shape of sclera and myopic retinochoroidal lesions in patients with pathologic myopia[J]. Invest Ophthalmol Vis Sci, 2012, 53(10): 6046-6061. DOI: 10.1167/iovs.12-10161.
12.	Takano M, Kishi S. Foveal retinoschisis and retinal detachment in severely myopic eyes with posterior staphyloma[J]. Am J Ophthalmol, 1999, 128(4): 472-476. DOI: 10.1016/s0002-9394(99)00186-5.
13.	Baba T, Ohno-Matsui K, Futagami S, et al. Prevalence and characteristics of foveal retinal detachment without macular hole in high myopia[J]. Am J Ophthalmol, 2003, 135(3): 338-342. DOI: 10.1016/s0002-9394(02)01937-2.
14.	肖琛辉, 曾广川, 廖武, 等. 高度近视后巩膜葡萄肿形态与视网膜劈裂参数的关系研究[J]. 中国医学创新, 2019, 16(21): 47-50. DOI: 10.3969/j.issn.1674-4985.2019.21.012.Xiao SH, Zheng GC, Liao W, et al. Study on the relationship between shapes and retinal splitting parameters for posteriorscleral staphyloma with high myopia[J]. Med Innovation Chin, 2019, 16(21): 47-50. DOI: 10.3969/j.issn.1674-4985.2019.21.012.
15.	刘茜, 李舒茵, 陈晓. 病理性近视眼后巩膜葡萄肿形态与视网膜劈裂关系探讨[J]. 中华眼科杂志, 2017, 53(1): 46-52. DOI: 10.3760/cma.j.issn.0412-4081.2017.01.010.Liu Q, Li SY, Chen X. Relation between ultrasonographic characteristics of pathologic myopia posterior staphyloma and retinoschisis[J]. Chin J Ophthalmol, 2017, 53(1): 46-52. DOI: 10.3760/cma.j.issn.0412-4081.2017.01.010.
16.	周黎纹, 吴星伟. 高度近视眼后巩膜葡萄肿患者后极部视网膜劈裂分析[J]. 临床眼科杂志, 2015, 23(5): 18-20. DOI: 10.3969/j.issn.1006-8422.2015.05.005.Zhou LW, Wu XW. Analysis of retinoschisis in the fundus posterior pole of high myopia with posterior staphyloma using OCT[J]. J Clin Ophthalmol, 2015, 23(5): 18-20. DOI: 10.3969/j.issn.1006-8422.2015.05.005.
17.	Ohno-Matsui K. Proposed classification of posterior staphylomas based on analyses of eye shape by three-dimensional magnetic resonance imaging and wide-field fundus imaging[J]. Ophthalmology, 2014, 121(9): 1798-1809. DOI: 10.1016/j.ophtha.2014.03.035.
18.	Phillips CI. Retinal detachment at the posterior pole[J]. Br J Ophthalmol, 1958, 42(12): 749-753. DOI: 10.1136/bjo.42.12.749.
19.	Benhamou N, Massin P, Haouchine B, et al. Macular retinoschisis in highly myopic eyes[J]. Am J Ophthalmol, 2002, 133(6): 794-800. DOI: 10.1016/s0002-9394(02)01394-6.
20.	任若瑾, 李彬, 翁乃清. 视网膜劈裂症的光学相干断层扫描图像特征[J]. 中国实用眼科杂志, 2003, 21(8): 599-602. DOI: 10.3760/cma.j.issn.1006-4443.2003.08.013.Ren RJ, Li B, Weng NQ. Optical coherence tomography of retinoschisis[J]. Chin J Pract Ophthalmol, 2003, 21(8): 599-602. DOI: 10.3760/cma.j.issn.1006-4443.2003.08.013.
21.	Wen B, Yang G, Cheng J, et al. Using high-resolution 3d magnetic resonance imaging to quantitatively analyze the shape of eyeballs with high myopia and provide assistance for posterior scleral reinforcement[J]. Ophthalmologica, 2017, 238(3): 154-162. DOI: 10.1159/000477466.
22.	Ikuno Y, Gomi F, Tano Y. Potent retinal arteriolar traction as a possible cause of myopic foveoschisis[J]. Am J Ophthalmol, 2005, 139(3): 462-467. DOI: 10.1016/j.ajo.2004.09.078.
23.	徐格致, 刘卫. 病理性近视黄斑劈裂光相干断层扫描图像分型及其对临床的指导意义[J]. 中华眼底病杂志, 2009, 25(5): 331-332. DOI: 10.3760/cma.j.issn.1005-1015.2009.05.02.Xu GZ, Liu W. Classification of macular retinoschisis in pathological myopic eyes by optical coherence tomography and its clinical applications[J]. Chin J Ocul Fundus Dis, 2009, 25(5): 331-332. DOI: 10.3760/cma.j.issn.1005-1015.2009.05.02.
24.	陶继伟, 林艳雯, 沈丽君, 等. 玻璃体切割联合保留中心凹内界膜剥除手术治疗高度近视黄斑劈裂的长期疗效观察[J]. 中华眼底病杂志, 2019, 35(5): 441-445. DOI: 10.3760/cma.j.issn.1005-1015.2019.05.004.Tao JW, Lin YW, Shen L J, et al. Long-term efficacy of pars plana vitrectomy with fovea-sparing internal limiting peeling for macular foveoschisis in pathologic myopic[J]. Chin J Ocul Fundus Dis, 2019, 35(5): 441-445. DOI: 10.3760/cma.j.issn.1005-1015.2019.05.004.
25.	刘建君. 改良型巩膜扣带手术治疗高度近视黄斑部视网膜劈裂临床观察[J]. 中华眼底病杂志, 2013, 29(2): 195-197. DOI: 10.3760/cma.j.issn.1005-1015.2013.02.018.Liu JJ. Clinical observation of modified scleral buckle in the treatment of macular retinoschisis in high myopic eyes[J]. Chin J Ocul Fundus Dis, 2013, 29(2): 195-197. DOI: 10.3760/cma.j.issn.1005-1015.2013.02.018.
26.	Mimura R, Mori K, Torii H, et al. Ultra-widefield retinal imaging for analyzing the association between types of pathological myopia and posterior staphyloma[J/OL]. J Clin Med, 2019, 8(10): 1505[2019-09-20]. https://pubmed.ncbi.nlm.nih.gov/31547036/. DOI: 10.3390/jcm8101505.
27.	Curtin BJ. The posterior staphyloma of pathologic myopia[J]. Trans Am Ophthalmol Soc, 1977, 75: 67-86.
28.	Shinohara K, Tanaka N, Jonas JB, et al. Ultrawide-field OCT to investigate relationships between myopic macular retinoschisis and posterior staphyloma[J]. Ophthalmology, 2018, 125(10): 1575-1586. DOI: 10.1016/j.ophtha.2018.03.053.
29.	Spaide RF, Ohno-Matsui K, Yannuzzi LA. Pathologic myopia[M]. Springer New York Heidelberg Dordrecht London: New York, 2014: 231-254.
30.	施靖容, 何玉萍, 赵婷婷, 等. 应用3D-MRI成像技术重建高度近视眼球形态[J]. 中华眼视光学与视觉科学杂志, 2016, 18(5): 269-274. DOI: 10.3760/cma.j.issn.1674-845X.2016.05.004.Shi JR, He YP, Zhao TT, et al. Reconstruct the high myopic eye modules with 3D-MRI imaging technology[J]. Chin J Optom Ophthalmol Vis Sci, 2016, 18(5): 269-274. DOI: 10.3760/cma.j.issn.1674-845X.2016.05.004.

1. Gaucher D, Haouchine B, Tadayoni R, et al. Long-term follow-up of high myopic foveoschisis: natural course and surgical outcome[J]. Am J Ophthalmol, 2007, 143(3): 455-462. DOI: 10.1016/j.ajo.2006.10.053.
2. Hayashi K, Ohno-Matsui K, Shimada N, et al. Long-term pattern of progression of myopic maculopathy: a natural history study[J]. Ophthalmology, 2010, 117(8): 1595-1611. DOI: 10.1016/j.ophtha.2009.11.003.
3. 冯竞仰, 樊莹. 高度近视黄斑劈裂的研究进展[J]. 眼科新进展, 2011, 31(4): 384-387.Feng JY, Fan Y. Research advances m high myopic foveschisis[J]. Rec Adv Ophthntmot, 2011, 31(4): 384-387.
4. Gohil R, Sivaprasad S, Han LT, et al. Myopic foveoschisis: a clinical review[J]. Eye (Lond), 2015, 29(5): 593-601. DOI: 10.1038/eye.2014.311.
5. Wu PC, Chen YJ, Chen YH, et al. Factors associated with foveoschisis and foveal detachment without macular hole in high myopia[J]. Eye (Lond), 2009, 23(2): 356-361. DOI: 10.1038/sj.eye.6703038.
6. Ohno-Matsui K, Jonas JB. Posterior staphyloma in pathologic myopia[J]. Prog Retin Eye Res, 2019, 70: 99-109. DOI: 10.1016/j.preteyeres.2018.12.001.
7. Hsiang HW, Ohno-Matsui K, Shimada N, et al. Clinical characteristics of posterior staphyloma in eyes with pathologic myopia[J]. Am J Ophthalmol, 2008, 146(1): 102-110. DOI: 10.1016/j.ajo.2008.03.010.
8. Spaide RF, Ohno-Matsui K, Yannuzzi LA. Pathologic myopia[M]. Springer New York Heidelberg Dordrecht London: New York, 2014: 167-176.
9. 李舒茵, 郭希让,李蕴随,等. 超声探测后巩膜葡萄肿位置形态范围与眼轴的长度关系[J]. 中华超声影像学杂志, 1996, 5(3): 134-136.Li SY, Guo XR,Li YS,et al. Ultrasonic scanning of position, shape, scope and relation with axial length in posterior staphyloma[J]. Chin J Ultrasonogr, 1996, 5(3): 134-136.
10. Singh KD, Logan NS, Gilmartin B. Three-dimensional modeling of the human eye based on magnetic resonance imaging[J]. Invest Ophthalmol Vis Sci, 2006, 47(6): 2272-2279. DOI: 10.1167/iovs.05-0856.
11. Ohno-Matsui K, Akiba M, Modegi T, et al. Association between shape of sclera and myopic retinochoroidal lesions in patients with pathologic myopia[J]. Invest Ophthalmol Vis Sci, 2012, 53(10): 6046-6061. DOI: 10.1167/iovs.12-10161.
12. Takano M, Kishi S. Foveal retinoschisis and retinal detachment in severely myopic eyes with posterior staphyloma[J]. Am J Ophthalmol, 1999, 128(4): 472-476. DOI: 10.1016/s0002-9394(99)00186-5.
13. Baba T, Ohno-Matsui K, Futagami S, et al. Prevalence and characteristics of foveal retinal detachment without macular hole in high myopia[J]. Am J Ophthalmol, 2003, 135(3): 338-342. DOI: 10.1016/s0002-9394(02)01937-2.
14. 肖琛辉, 曾广川, 廖武, 等. 高度近视后巩膜葡萄肿形态与视网膜劈裂参数的关系研究[J]. 中国医学创新, 2019, 16(21): 47-50. DOI: 10.3969/j.issn.1674-4985.2019.21.012.Xiao SH, Zheng GC, Liao W, et al. Study on the relationship between shapes and retinal splitting parameters for posteriorscleral staphyloma with high myopia[J]. Med Innovation Chin, 2019, 16(21): 47-50. DOI: 10.3969/j.issn.1674-4985.2019.21.012.
15. 刘茜, 李舒茵, 陈晓. 病理性近视眼后巩膜葡萄肿形态与视网膜劈裂关系探讨[J]. 中华眼科杂志, 2017, 53(1): 46-52. DOI: 10.3760/cma.j.issn.0412-4081.2017.01.010.Liu Q, Li SY, Chen X. Relation between ultrasonographic characteristics of pathologic myopia posterior staphyloma and retinoschisis[J]. Chin J Ophthalmol, 2017, 53(1): 46-52. DOI: 10.3760/cma.j.issn.0412-4081.2017.01.010.
16. 周黎纹, 吴星伟. 高度近视眼后巩膜葡萄肿患者后极部视网膜劈裂分析[J]. 临床眼科杂志, 2015, 23(5): 18-20. DOI: 10.3969/j.issn.1006-8422.2015.05.005.Zhou LW, Wu XW. Analysis of retinoschisis in the fundus posterior pole of high myopia with posterior staphyloma using OCT[J]. J Clin Ophthalmol, 2015, 23(5): 18-20. DOI: 10.3969/j.issn.1006-8422.2015.05.005.
17. Ohno-Matsui K. Proposed classification of posterior staphylomas based on analyses of eye shape by three-dimensional magnetic resonance imaging and wide-field fundus imaging[J]. Ophthalmology, 2014, 121(9): 1798-1809. DOI: 10.1016/j.ophtha.2014.03.035.
18. Phillips CI. Retinal detachment at the posterior pole[J]. Br J Ophthalmol, 1958, 42(12): 749-753. DOI: 10.1136/bjo.42.12.749.
19. Benhamou N, Massin P, Haouchine B, et al. Macular retinoschisis in highly myopic eyes[J]. Am J Ophthalmol, 2002, 133(6): 794-800. DOI: 10.1016/s0002-9394(02)01394-6.
20. 任若瑾, 李彬, 翁乃清. 视网膜劈裂症的光学相干断层扫描图像特征[J]. 中国实用眼科杂志, 2003, 21(8): 599-602. DOI: 10.3760/cma.j.issn.1006-4443.2003.08.013.Ren RJ, Li B, Weng NQ. Optical coherence tomography of retinoschisis[J]. Chin J Pract Ophthalmol, 2003, 21(8): 599-602. DOI: 10.3760/cma.j.issn.1006-4443.2003.08.013.
21. Wen B, Yang G, Cheng J, et al. Using high-resolution 3d magnetic resonance imaging to quantitatively analyze the shape of eyeballs with high myopia and provide assistance for posterior scleral reinforcement[J]. Ophthalmologica, 2017, 238(3): 154-162. DOI: 10.1159/000477466.
22. Ikuno Y, Gomi F, Tano Y. Potent retinal arteriolar traction as a possible cause of myopic foveoschisis[J]. Am J Ophthalmol, 2005, 139(3): 462-467. DOI: 10.1016/j.ajo.2004.09.078.
23. 徐格致, 刘卫. 病理性近视黄斑劈裂光相干断层扫描图像分型及其对临床的指导意义[J]. 中华眼底病杂志, 2009, 25(5): 331-332. DOI: 10.3760/cma.j.issn.1005-1015.2009.05.02.Xu GZ, Liu W. Classification of macular retinoschisis in pathological myopic eyes by optical coherence tomography and its clinical applications[J]. Chin J Ocul Fundus Dis, 2009, 25(5): 331-332. DOI: 10.3760/cma.j.issn.1005-1015.2009.05.02.
24. 陶继伟, 林艳雯, 沈丽君, 等. 玻璃体切割联合保留中心凹内界膜剥除手术治疗高度近视黄斑劈裂的长期疗效观察[J]. 中华眼底病杂志, 2019, 35(5): 441-445. DOI: 10.3760/cma.j.issn.1005-1015.2019.05.004.Tao JW, Lin YW, Shen L J, et al. Long-term efficacy of pars plana vitrectomy with fovea-sparing internal limiting peeling for macular foveoschisis in pathologic myopic[J]. Chin J Ocul Fundus Dis, 2019, 35(5): 441-445. DOI: 10.3760/cma.j.issn.1005-1015.2019.05.004.
25. 刘建君. 改良型巩膜扣带手术治疗高度近视黄斑部视网膜劈裂临床观察[J]. 中华眼底病杂志, 2013, 29(2): 195-197. DOI: 10.3760/cma.j.issn.1005-1015.2013.02.018.Liu JJ. Clinical observation of modified scleral buckle in the treatment of macular retinoschisis in high myopic eyes[J]. Chin J Ocul Fundus Dis, 2013, 29(2): 195-197. DOI: 10.3760/cma.j.issn.1005-1015.2013.02.018.
26. Mimura R, Mori K, Torii H, et al. Ultra-widefield retinal imaging for analyzing the association between types of pathological myopia and posterior staphyloma[J/OL]. J Clin Med, 2019, 8(10): 1505[2019-09-20]. https://pubmed.ncbi.nlm.nih.gov/31547036/. DOI: 10.3390/jcm8101505.
27. Curtin BJ. The posterior staphyloma of pathologic myopia[J]. Trans Am Ophthalmol Soc, 1977, 75: 67-86.
28. Shinohara K, Tanaka N, Jonas JB, et al. Ultrawide-field OCT to investigate relationships between myopic macular retinoschisis and posterior staphyloma[J]. Ophthalmology, 2018, 125(10): 1575-1586. DOI: 10.1016/j.ophtha.2018.03.053.
29. Spaide RF, Ohno-Matsui K, Yannuzzi LA. Pathologic myopia[M]. Springer New York Heidelberg Dordrecht London: New York, 2014: 231-254.
30. 施靖容, 何玉萍, 赵婷婷, 等. 应用3D-MRI成像技术重建高度近视眼球形态[J]. 中华眼视光学与视觉科学杂志, 2016, 18(5): 269-274. DOI: 10.3760/cma.j.issn.1674-845X.2016.05.004.Shi JR, He YP, Zhao TT, et al. Reconstruct the high myopic eye modules with 3D-MRI imaging technology[J]. Chin J Optom Ophthalmol Vis Sci, 2016, 18(5): 269-274. DOI: 10.3760/cma.j.issn.1674-845X.2016.05.004.

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A preliminary study on the analysis of myopic retinoschisis and posterior staphyloma in a cohort of patients with pathological myopia by optical coherence tomography and magnetic resonance imaging

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