高度近视黄斑病变的OCT和FFA形态学分类的对比分析

目的：探讨高度近视黄斑病变的光学相干断层扫描(OCT)和眼底荧光血管造影(FFA)的形态学特征、分类和对比分析。

方法：对入选的高度近视黄斑病变患者61例101眼均行标准对数视力表检查，验光确定屈光度及最佳矫正视力(BCVA)，并用IOL-Master测量眼轴长度。入选者需在同一天内行散瞳眼底检查、OCT及FFA检查，必要时行眼底联合造影(FFA&ICGA)。分析不同类型的OCT及FFA形态学特征之间的相互联系，并探讨其与屈光度、最佳矫正视力、眼轴长度及中心凹厚度之间的关系。

结果：FFA分类的漆样裂纹型在OCT分类的1型中所占比例为57.14%，显著高于新生血管型和黄斑萎缩型(21.43%)，差异有统计学意义(P<0.05)。FFA分类的黄斑萎缩型在OCT分类的2型中所占的比例为67.80%，显著高于漆样裂纹型(18.64%)和新生血管型(13.56%)，差异有统计学意义(P<0.05)。OCT 3型均属于FFA分类的黄斑萎缩型。OCT 1型的屈光度、眼轴长度明显低于2型和3型，而最佳矫正视力和中心凹厚度则明显高于2型和3型。FFA的漆样裂纹型与新生血管型在屈光度及眼轴长度上虽无明显差异，但后者的BCVA及中心凹厚度显著低于前者(P<0.05)。漆样裂纹型及新生血管型的屈光度、眼轴长度均显著低于黄斑萎缩型，最佳矫正视力则明显高于黄斑萎缩型(P<0.05)。

结论：高度近视黄斑病变的OCT和FFA形态学特征密切相关，结合OCT和FFA的图像特征对高度近视黄斑病变形态学改变进行对比分析，不仅有助于明确病变的性质，提高我们对疾病发病机制及预后转归的认识，更为临床诊疗提供了有力的支持。

Contrastive analysis between the features of OCT and FFA in high myopic maculopathy

AIM: To assess the morphological features, classification, and contrastive analysis between the features of optical coherence tomography(OCT)and fundus fluorescein angiography(FFA)in clinically high myopic maculopathy.

METHODS: Totally 61 patients(101 eyes)with clinically high myopic maculopathy. Distant vision was examined through E Standard Logarithm Eyesight Table. Integrated optometry to determine the dioptre and best corrected visual acuity(BCVA). Axial length(AL)measurements obtained through IOL-Master. Fundus examinations performed in patients with high myopia after pupil dilation. OCT and FFA were done separately in each case of myopic maculopathy on the same day. FFA and indocyanine green angiogrsphy(FFA& ICGA)was done if need be. The correlation between FFA types and OCT types were analyzed, and their associations with dioptre, BCVA, AL and central foveal thickness were evaluated.

RESULTS: The prevalence of lacquer crack type was higher in the OCT type 1(57.14%)than in the choroidal neovascularization(CNV)type and macular atrophy type(21.43%)of fluorescein angiography, the difference was statistically significant(P<0.05). The prevalence of macular atrophy type was higher in the OCT type 2(67.80%)than in the lacquer crack(18.64%)and CNV type(13.56%), the difference was statistically significant(P<0.05). The macular atrophy type all belong to the OCT type 3. OCT type 1 showed the least dioptre and AL, conversely the highest central foveal thickness and/or BCVA(P<0.05). There was no obvious difference between lacquer crack type and CNV type on diopter and AL, but lacquer crack type showed better BCVA and foveal thickness(P<0.05). The diopter and AL of lacquer crack type and CNV type were significantly lower than that of macular atrophy type, while BCVA was higher(P<0.05).

CONCLUSION: There was a significant correlation between the features of OCT and FFA in high myopicmaculopathy. The analysis of clinically high myopic maculopathy based on combination of OCT and FFA can provide information that may be useful to make sure the nature of high myopia, disclose the pathogenesis and to optimize the treatment for each type.