摘要
目的 利用光学相干断层扫描血管造影术(OCTA)测定青少年不同程度近视眼视网膜神经纤维厚度(RNFL)及视乳头周围脉络膜毛细血管的微结构改变.方法 回顾性将2022年1月至2023年1月的惠州市中心人民医院收治的90例5～15岁青少年(共计180只眼睛)作为研究对象,按等效球镜度数(SE)分为正视组(n=30),轻度近视组(n=44),中度近视组(n=56),高度近视组(n=50).用OCTA测定各组的RNFL、视盘旁萎缩弧β区(PPA-β)及视盘旁萎缩弧α区(PPA-α)面积、PPA-β及PPA-α区微血管丢失(MVD)面积、PPA-β及PPA-α区血流密度值,同时收集各组的SE和眼轴长度(AL)进行比较,用Spearman相关性分析PPA-β区MVD面积与SE、AL、RNFL及PPA-β区面积的相关性.结果 4组的SD、AL值比较,差异均有统计学意义(P＜0.05),且随着近视程度越重SD、AL值越高.4组的上方、下方、鼻侧及颞侧RNFLT、平均RNFLT比较,差异均有统计学意义(P＜0.05);轻度近视组与正视组的上方、下方、鼻侧及颞侧RNFLT、平均RNFLT差异均无统计学意义(P＞0.05);高度近视组的上方、下方、颞侧和平均RNFLT均显著低于中度近视组和轻度近视组,差异均有统计学意义(P＜0.05).150只近视眼中有141只(94.00％)的PPA-β区存在MvD.高度近视组PPA-β区的MvD面积、PPA-β面积分别为(0.239±0.106)、(1.104±0.270)mm2,均显著高于中度近视组[(0.095±0.041)、(0.612±0.264)mm2]和轻度近视组[(0.071±0.030)、(0.507±0.241)mm2],而PPA-β区血流密度为198.24±95.89,低于中度近视组(349.07±126.32)和轻度近视组(402.63±132.09),差异均有统计学意义(P＜0.05).高度近视组PPA-α区存在MvD占比为56.00％,显著高于中度近视组(26.79％)和轻度近视组(15.91％),差异有统计学意义(P＜0.05),3组PPA-α区的MvD面积、PPA-α面积及PPA-α区血流密度差异均无统计学意义(P＞0.05).Spearman相关性分析显示,PPA-β区MvD面积与与SE、RNFLT呈负相关(r=-0.492、-0.574,P＜0.05),与 AL、PPA-β 区面积呈正相关(r=0.480、0.798,P＜0.05).结论 PPA-β 区MvD是青少年高度近视患者视乳头周围脉络膜毛细血管的微血管改变的重要指标,且与SE、AL、RNFLT和PPA-β区面积相关.
Abstract
Objective To investigate microvascular alterations of peripapillary choriocapillaris and retinal nerve fiber layer thickness(RN-FL)in adolescents with different degrees of myopia detected by optical coherence tomography angiography(OCTA).Methods A total of 90 ado-lescents with a total of 180 eyes aged 5-15 years old admitted to Huizhou Central People's Hospital from January 2022 to January 2023 were divid-ed into emmetropia group(n=30),mild myopia group(n=44),moderate myopia group(n=56),and high myopia group(n=50)based on spherical equivalent(SE).RNFL,PPA-β area,PPA-α area,microvascular loss(MVD)and blood flow density values in PPA-β and PPA-α zone were determinred by OCTA,and SE and axial length(AL)of each group were also collected.Spearman correlation analysis was used to analyze the correlation of MVD area in PPA-β zone with SE,AL,RNFL,and PPA-β area.Results There were significant differences on SE and AL among the four groups(P＜0.05),and the higher the degree of myopia,the higher the SD and AL values.There were significant differences on RNFLT the upper,lower,nasal,and temporal sides and average RNFLT among the four groups(P＜0.05);there were no statisti-cally significant differences on the upper,lower,nasal,and temporal RNFLT and average RNFLT between the mild myopia group and the emme-tropia group(P＞0.05);the upper,lower,temporal,and average RNFLT of the high myopia group were significantly lower than those of the mod-erate myopia group and mild myopia group,and the differences were statistically significant(P＜0.05).A total of 141 out of 150(94.00％)nearsighted eyes were found in PPA-β zone.The MvD area and PPA-β area of PPA-β zone in high myopia group were(0.239±0.106)and(1.104±0.270)mm2,which were significantly higher than those in moderate myopia group[(0.095±0.041)and(0.612±0.264)mm2]and the mild myopia group[(0.071±0.030)and(0.507±0.241)mm2],while blood flow density in PPA-β zone was 198.24±95.89,which was lower than that in the moderate myopia group(349.07±126.32)and the mild myopia group(402.63±132.09),and the differences were statistically significant(P＜0.05).The proportion of MvD in PPA-α zone of high myopia group was 56.00％,which was significantly higher than that in moderate myopia group(26.79％)and mild myopia group(15.91％),and the difference was statistically significant(P＜0.05);while there were no statistically significant differences on MvD area,PPA-α area and blood flow density in PPA-α zone among the three groups(P＞0.05).Spearman correlation analysis showed that MvD area in PPA-β zone was negatively correlated with SE and RNFLT(r=-0.492,-0.574,P＜0.05),while it was positively correlated with AL and PPA-β area(r=0.480,0.798,P＜0.05).Conclusion MvD is an important indicator of microvascular alterations of peripapillary choriocapillaris in adolescents with high myopia,which is associated with SE,AL,RNFLT,and PPA-β area.
维普
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