方法：收集南京医科大学眼科医院2016-06/2020-12确诊为病理性近视黄斑出血患者100例108眼的临床资料进行回顾性分析。所有患眼均行验光、眼轴、彩色眼底照相、频域光学相干断层扫描(SD-OCT)、荧光素眼底血管造影(FFA)、吲哚菁绿血管造影(ICGA)及OCTA检查。根据检查结果分为漆样裂纹性黄斑出血和脉络膜新生血管(CNV)性黄斑出血，所有患者OCTA检查随访3mo以上。

结果：漆样裂纹性黄斑出血40例42眼，OCTA检查可见出血处脉络膜毛细血管反射被遮挡； 出血吸收后，脉络膜毛细血管层血流图暴露出完整的漆样裂纹形态，呈线状或星状，联合B-scan图像可见色素上皮层(RPE)反射不连续、脉络膜变薄及后方声影。在所有漆样裂纹性黄斑出血吸收后，OCTA随访模式发现原出血下方仅2眼(4.8%)未见漆样裂纹，漆样裂纹呈线状有28眼(66.7%)，呈星状有12眼(28.6%)。随访过程中还发现有8例8眼(19.0%)再次复发漆样裂纹性黄斑出血，4例4眼(9.5%)患者继发CNV性黄斑出血。CNV性黄斑出血60例66眼，OCTA检查可见出血处脉络膜毛细血管反射被遮挡，外层视网膜及脉络膜毛细血管层血流图可见出血周围CNV形态，联合B-scan图像可见CNV突破RPE层，内部血流信号丰富； 行玻璃体内注射抗血管内皮生长因子(VEGF)治疗后，CNV病灶面积减小。在所有CNV性黄斑出血灶周围，OCTA发现48眼(72.7%)周围可见漆样裂纹，其中漆样裂纹呈线状有28眼(42.4%)，漆样裂纹呈星状有20眼(30.3%)。

结论：OCTA在病理性近视黄斑出血的诊断中有重要意义，快捷无创是其最大优势，脉络膜毛细血管层血流图可清晰观察到出血灶、漆样裂纹及CNV的形态及位置，随访模式能够帮助直观了解病情变化，在一定程度上可以替代眼底血管造影直接判断分型，及时帮助临床选择正确治疗方式。

METHODS:Designing a retrospective analysis collected clinical data of 100 patients(108 eyes)diagnosed as macular hemorrhage of pathological myopic in Nanjing Medical University Affiliated Eye Hospital from June 2016 to December 2020. All patients underwent refraction, eye axis,fundus photography, spectral-domain optical coherence tomography(SD-OCT), fundus fluorescein angiography(FFA), indocyanine green angiography(ICGA)and OCTA examination. All patients were divided into macular hemorrhage only with lacquer cracks and macular hemorrhage with choroidal neovascularization(CNV). All patients followed-up for more than 3mo by OCTA.

RESULTS:There were 40 patients(42 eyes)diagnosed as macular hemorrhage only with lacquer cracks, OCTA showed bleed obscured by choroidal capillaries. After hemorrhage was being absorbed, lacquer cracks showed linear or stellate reflection completely in the choroidal capillary layer. B-scan image showed discontinuous retinal pigment epithelium(RPE), thinner choroid and an increased light. Penetrance into deeper tissues. After all macular hemorrhage only with lacquer cracks were absorbed, follow-up mode of OCTA found that 2 eyes(4.8%)without lacquer cracks, 28 eyes(66.7%)were linear and 12 eyes(28.6%)were stellate under the original hemorrhage. Follow-up mode also showed that 8 eyes of 8 patients(19.0%)relapsed macular hemorrhage only with lacquer cracks, and 4 eyes of 4 patients(9.5%)suffered secondary macular hemorrhage with CNV. There were 60 patients(66 eyes)diagnosed as macular hemorrhage with CNV,OCTA showed bleed obscured choroidal capillaries, the outer retinal and choroidal capillary layer also showed the shape of CNV around hemorrhage. B-scan showed CNV breaked through the RPE layer and blood flow signal in it. The area of CNV decreased after anti-vascular endothelial growth factor(VEGF)intravitreal injection treatment. Around all macular hemorrhage with CNV, OCTA found that 48 eyes(72.7%)had lacquer cracks, 28 eyes(42.4%)were linear and 20 eyes(30.3%)were stellate.

CONCLUSION:OCTA has a great significance in the diagnosis of macular hemorrhage of pathological myopia, fast and non-invasive is the biggest advantage. Choroidal capillary layer can clearly observe the shape and location of hemorrhage,lacquer cracks and CNV. The follow-up mode can intuitively comprehend the changes of disease. To some extent, it can replace fundus angiography to directly judge the classification, and time to treat in the clinic.