In Vivo Visualization of Perforating Vessels and Focal Scleral Ectasia in Pathological Myopia
In Vivo Visualization of Perforating Vessels and Focal Scleral Ectasia in Pathological Myopia
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DOI：
10.1167/iovs.13-12981
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发表时间：
2013-11-01
影响因子：
4.4
通讯作者：
Querques, Giuseppe
中科院分区：
文献类型：
--
作者：
Pedinielli, Alexandre;Souied, Eric H.;Querques, Giuseppe
目的。描述继发于病理性近视的黄斑/黄斑周围斑片状绒毛膜视网膜萎缩区域的局灶性巩膜扩张。对39例至少有一只眼睛的病理性近视和绒毛膜视网膜萎缩，伴有或不伴有局灶性巩膜扩张的患者，采用红外反射（IR）和/或多色成像、增强深度成像光学相干断层扫描（EDI-OCT）（39例，78眼）和扫描源(SS)-OCT（39例患者中13例，26眼）横断面扫描进行分析。68只眼中有12只（39例连续患者中有11例，27例女性/12例男性，平均年龄65.7 +/- 11.9岁）出现局灶性巩膜扩张，伴黄斑/黄斑周围斑片状绒毛膜视网膜萎缩，且常见于黄斑下方或颞部（平均1.25 +/- 0.38/眼）。局灶性巩膜扩张，眼底检查表现为深黑色圆形/椭圆形病灶，边界清晰，在EDI-OCT和SS-OCT上表现为巩膜后突弓，边界有不同程度的巩膜裂。所有病变均未见视网膜色素上皮和脉络膜。红外反射和多色成像显示大血管似乎从局灶性巩膜扩张中出现，并穿过斑片状萎缩区域。EDI-OCT和SS-OCT显示球后血管在巩膜突后弓的边缘/底部穿入巩膜（即局灶性巩膜扩张），并穿过巩膜浅层厚度，延伸萎缩区。我们发现病理性近视的穿孔血管位于局灶性巩膜扩张的边缘/底部。
PURPOSE. To describe focal scleral ectasia in areas of macular/perimacular patchy chorioretinal atrophy secondary to pathologic myopia.METHODS. Thirty-nine consecutive patients with pathologic myopia and chorioretinal atrophy in at least one eye, with and without focal scleral ectasia, were analyzed by infrared reflectance (IR) and/or multicolor imaging, enhanced depth imaging optical coherence tomography (EDI-OCT) (39 patients, 78 eyes), and swept source (SS)-OCT (13 out of 39 patients, 26 eyes) cross-sectional scan.RESULTS. Focal scleral ectasia was found in 12 out of 68 eyes (11 out of 39 consecutive patients, 27 females/12 males; mean age 65.7 +/- 11.9 years) with macular/perimacular patchy chorioretinal atrophy, and was always observed inferior or temporal to the macula (mean 1.25 +/- 0.38/eye). Focal scleral ectasia, appearing on fundus examination as a deep dark round/oval lesion with well-defined borders, was characterized on EDI-OCT and SS-OCT by an abrupt posterior bow of the sclera with different degrees of scleral schisis on its borders. The retinal pigment epithelium and the choroid were absent in all lesions. IR reflectance and multicolor imaging showed large vessels that seem to emerge from the focal scleral ectasia, and crossing the area of patchy atrophy. EDI-OCT and SS-OCT revealed retrobulbar vessels perforating the sclera at the borders/bottom of the abrupt posterior bow of the sclera (i.e., focal scleral ectasia) and running through the superficial scleral thickness for the whole extension of the atrophic area.CONCLUSIONS. We showed that perforating vessels are localized at the border/bottom of focal scleral ectasia in pathologic myopia.