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Objective:To observe the morphological characteristics of high myopia (HM) paravalvular abnormalities (PVA), and the correlation between different manifestations of PVA and myopic traction maculopathy (MTM) was analyzed.Methods:A cross-sectional clinical study. A total of 42 middle-aged and elderly patients with HM and PVA diagnosed by ophthalmology examination in Department of Ophthalmology, The Second Hospital of Hebei Medical University from June to December 2021 were included in the study. There were 24 eyes in 16 males and 48 eyes in 26 females. Age was (56.71±8.10) years old. Diopter was (-13.05±3.10) D. Axial length (AL) was (28.22±1.04) mm. According to the characteristics of ultra-wide-angle optical coherence tomography images, PVA morphology was divided into paravascular microfolds (PM), paravascular cysts (PC) and paravascular lamellar holes (PLH). MTM was divided into T0-T5 grades, of which MTM≥T3 was defined as severe MTM. The state of vitreoretinal junction was observed and the state of posterior vitreous detachment (PVD) was recorded, which divided into complete PVD and partial PVD. Partial PVD was divided into macular fovea adhesions and paravascular adhesions according to the vitreoretinal adhesions. Posterior scleral staphyloma (PS) was divided into 6 types by ultra-wide-angle fundus photography. Logistic regression model was used to analyze the factors related to MTM.Results:In 72 eyes, PM, PC and PLH were 72 (100.0%, 72/72), 62 (86.1%, 62/72) and 29 (40.3%, 29/72) eyes, respectively. Among them, there were 10 (13.9%, 10/72) eyes with PM alone, 33 (45.8%, 33/72) eyes with PM and PC, and 29 (40.3%, 29/72) eyes with PM, PC and PLH, respectively. There were 42 eyes with partial PVD (58.3%, 42/72), among which the macular fovea and paravascular adhesion were 22 (52.4%, 22/42) and 24 (57.1%, 24/42) eyes, respectively. PS was present in 50 eyes (69.4%, 50/72), among which 27 (54.0%, 27/50), 21 (42.0%, 21/50), 1 (2.0%, 1/50), and 1 (2.0%, 1/50) eyes were types Ⅰ to Ⅳ, respectively. Multivariate logistic regression analysis showed that AL[odds ratio ( OR)=16.139, 95% confidence interval ( CI) 4.062-64.120, P<0.001], PS ( OR=4.212, 95% CI 1.234-14.378, P=0.022), paravascular vitreoretinal adhesion (OR=3.478, 95% CI 11.124, P=0.036) were risk factors for PM, PC and PLH. MTM was present in 58 eyes (80.6%, 58/72), among which T1 was the most common type in 19 eyes (26.4%, 19/72). Univariate logistic regression analysis showed that the occurrence of MTM was significantly correlated to PS ( OR=4.190, 95% CI 1.240-14.157, P=0.021), coexistence of PM, PC and PLH ( OR=11.323, 95% CI 1.389-92.311, P=0.023), and PS were significantly correlated. There was no correlation with PVD ( OR=1.889, 95% CI 0.580-6.150, P=0.291) or PS ( OR=2.778, 1.786; 95% CI 0.700-11.023; 0.445-7.167; P=0.146, 0.413). There was significant difference in the incidence of severe MTM between PM alone, PM combined with PC and coexistence of PM, PC and PLH ( χ2=20.943, P<0.001). Conclusions:PM is the most common and earliest manifestation of PVA in middle-aged and elderly HM patients. AL, PS and paravascular vitreoretinal adhesion are risk factors for PM, PC and PLH. The coexistence of three PVA forms may be a marker of severe MTM.
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@#High myopia complicated with fundus lesions is one of irreversible blinding eye diseases. Posterior seleral staphyloma(PSS)is one of the most basic pathologies in a series of complications of high myopia. This article reviews the pathogenesis, examination methods, classification and treatment of PSS in high myopia by sorting out domestic and foreign literature, providing a better understanding of the prevention and control of PSS.
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Background The accurate calculation of intraocular lens (IOL) power is essential for attaining the desired refractive outcome after cataract surgery,especially for patients with high myopia and posterior scleral staphyloma.Objective This study was to evaluate the clinical feasibility of IOL Master compared with contact A-scan in cataract patients with high myopia and posterior scleral staphyloma,then compare the accuracy of different IOL power calculation formulas.Methods This was a prospective case control clinical research.Fourty-one eyes with age-related cataract of 28 patients underwent phacoemulsification with monofocal foldable IOL implantation in Tianjin Medical University Eye Hospital were involved,who were all high myopia with posterior scleral staphyloma.Preoperative measurement was measured with IOL Master as well as with contact A-scan and manual keratometry.IOL power was calculated according to the SRK-Ⅱ,SRK-T,Haigis,Hoffer Q,Holladay 1 formulas.The refractive outcome was followed-up 3 months after operation.Results The difference was significant between the 2 methods in axial length (AL) and anterior chamber depth (ACD) measurement (P =0.005,0.000) ; In corneal curvature measurement,there was no significant difference between them (P =0.398).When mean absolute refractive error (MAE) was divided by ±1.00 D,The SRK/T and Haigis formula performed better than other formulas measured by IOL Master;The Holladay 1,Hoffer Q and Haigis formula performed better than other formulas measured by contact A-scan combined with manual keratometry,respectively.Conclusions For cataract patients with high myopia and posterior scleral staphyloma,SRK/T and Haigis formula were recommended when employing IOL Master; whereas when using contact A-scan combined with manual keratometry,we prefer Holladay 1,Hoffer Q or Haigis formula.
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ObjectiveTo study the postoperative complications and nursing intervention of high myopia combining posterior scleral staphyloma macular rhegmatogenous retinal detachment. MethodsFrom January 2010 to December 2011,120 cases of patients with high myopia combining posterior scleral staphyloma macular rhegrnatogenous retinal detachment were selected as research objects.All patients were given vitrectomy combined with silicone oil filling operation,then we observed the postoperative complications. ResultsIn 120 patients,14 cases of patients occurred high intraocular pressure ( 11.67％ ),6 cases of patients were found bleeding(5.0％),68 cases of patients had great pain,all the postoperative complications alleviated after nursing intervention,the comparing difference had statistical significance between before and after nursing intervention. 31 cases of patients occurred cataract (25.83％),and 2 cases in intraocular infection (1.67％),the postoperative complications were properly handled. ConclusionsHigh intraocular pressure,internal bleeding of eyes,cataracts,postoperative pain,and intraocular infection are the postoperative complications of high myopia combining posterior scleral staphyloma macular rhegrnatogenous retinal detachment,targeted nursing intervention can effectively treat complications.