| BackgroundsHigh myopia macular hole with retinal detachment(MHRD)refers to retinal detachment caused by macular hole in high myopia.It is the final stage of the development of myopic traction maculopathy(MTT).Foreign reports,MHRD accounts for 0.6%～4.0%of rhegmatogenous retinal detachment.In China,MHRD accounts for 5.4%～14.4%of rhegmatogenous retinal detachment,of which 50%～67%suffer high myopia.Once it occurs,it will cause great harm to vision and even blindness.After surgical treatment of MHRD patients with high myopia,the recurrence rate is high,and the improvement of visual function is not obvious,which causes great trouble to the patient’s life.Early diagnosis and treatment can significantly improve vision and reduce complications.Therefore,when MHRD occurs in one eye due to high myopia,it is important to timely evaluate the fundus condition of the fellow eye.The fundus changes of high myopia are complex and diverse,the evaluation methods are also diverse,and there are multiple classification methods,but it is difficult to analyze them in a unified way.In order to communicate and compare the results of clinical trials and international multi-center studies,and combined with multi-mode imaging,Ruiz-Medrano et al combined with fundus photography,OCT and other image changes,and proposed an ATN grading method.In this study,multimode images were used to evaluate the severity of myopia in the fellow eye of high myopia MHRD,and combined with ATN classification to comprehensively evaluate the severity of fundus changes in order to detect early clinical lesions and guide clinical treatment.Objective and Methods1.Objective To understand the severity of the fellow eye in patients with high myopia MHRD,and compare with fundus photography,OCT and B-ultrasound to evaluate the quality of fundus lesions,and combine the latest fundus lesion grading standards to assess the severity of maculopathy.2.Methods Retrospective case study.2.1 Collecting medical datas of 145 fellow eyes(atrophy of 5 eyes)of 150 People underwent surgery due to high myopia MHRD in Henan Provincial people’s Hospital from September 2017 to December 2019,including name,age,gender,equivalent spherical lens,eye axis length,vision,fundus photography,OCT and B-ultrasound examination of fellow eye which were used to judge the degree of maculopathy of the fellow eye.The degree of macular degeneration of the fellow eye was evaluated by the length of the eye axis,the equivalent spherical degree and the degree of vision loss,and the incidence of various maculopathy in the posterior pole.Compare the advantages of various tests in disease diagnosis.2.2 Simplifing the latest ATN classification method.According to the ATN classification,myopic maculopathy were classified into atrophiy(A),traction(T),and neovascular(N).The severity of each type of maculopathy was graded according to the degree of influence on vision,maculopathy was divided into mild and severe.Among them,maculopathy of grade 2 and above in category A were classified as severe,grade 3 and above in category T were classified as severe,and grade 2 and category N were classified as severe.As long as there was a serious change in a classification,it was classified as severe maculopathy,and on this basis,the degree of maculopathy of the fundus was re-evaluated.2.3 Statistical analysis was performed using SPSS 22.0 statistical software.The qualitative data was analyzed using a paired four-table chi-square test.P<0.05 is statistically significant.Results1.A total of 150 cases of MHRD fellow eyes in high myopia were collected,including 5 fellow eyes(3.3%)with atrophy,19 fellow eyes(12.7%)without high myopia,and 126 fellow eyes(84.0%)with high myopia.2.Among the patients with high myopia in the fellow eye,7 eyes(5.6%)had undergone surgical treatment for retinal detachment due to high myopia,and the best corrected visual acuity(BCVA)was<0.3;In the other 119 eyes(94.4%),both the length of the axis and the spherical equivalent showed a serious degree of myopia,accompanied by severe decline in vision,including 68.9%of patients with BVCA<0.3 and 15.9%of patients with BCVA≤0.05.3.A total of 86 cases underwent fundus photography,65 cases underwent OCT,and 88 cases underwent B-ultrasound examination.The detection rates of PS in B-ultrasound,OCT and fundus photography were 93.2%,52.3%and 60.5%.The detection rates of MH(including with MHRD,full-layer MH and lamellar MH)in OCT and fundus photography were 18.5%and 2.3%,respectively.4.There are 44 patients who underwent three examinations of fundus photography,OCT and B-ultrasound simultaneously,Among them the detection rates of PS in fundus photography,OCT and B-ultrasound were 61.4%,52.3%and 91.0%,respectively.Compared with OCT and fundus photography,B ultrasound has obvious advantages in the diagnosis rate of PS,and the difference was statistically significant(P=0.044,0.018<0.05).The difference between the detection rates of OCT and fundus photography in PS has no statistically significant(P=0.758>0.05).The detection rates of MH in fundus photography and OCT were 4.5%and 22.7%,respectively.OCT was more advantageous in the diagnosis of MHRD,and the difference was statistically significant(P=0.04<0.05).5.The use of ATN simplified grading combined with fundus photography and OCT examination found that severe macular lesions accounted for 63.6%,while the use of fundus photography and OCT alone found severe macular lesion diagnosis rates were 59.1%and 20.5%,combined with OCT and fudus photography for ATN classification Compared with the use of fundus photography and OCT examination alone in the diagnosis rate of severe macular degeneration,the difference is statistically significant(P=0.016,0.000<0.05).The difference in the diagnosis rate of severe macular degeneration between the use of fundus photography alone and OCT No statistical significance(P=0.459>0.05).Conclusions1.MHRD occurs in one eye due to high myopia,the fellow eye is also often high myopia,and the degree of myopia is severe,with severe pathological changes in the posterior pole.2.A single imaging examination only show advantageous in diagnosing certain types of high myopia fundus changes.3.The use of multi-mode images combined with simplified ATN grading can more comprehensively and accurately assess the degree of lesions in the posterior pole of high myopia and guide clinical diagnosis and treatment. |
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