成年超高度近视眼患者黄斑区巩膜厚度及其相关影响因素

目的观察成年超高度近视(等效球镜度≥-9.00 D)患者黄斑区巩膜厚度的改变，并分析巩膜厚度与年龄、眼轴长度、屈光度数及最佳矫正视力的关系。 方法纳入2016年6月至2018年5月就诊于广州爱尔眼科医院的超高度近视患者112例(195只眼)为研究对象。其中，男性50例(84只眼)，女性62例(111只眼)；年龄18~67岁，平均(33.10±13.27)岁。采用扫频光学相干断层扫描测量黄斑中心凹处及由中心凹向鼻侧、颞侧各500 μm、1000 μm及1500 μm的巩膜厚度值，共测量7个点位。采用单因素方差分析比较超高度近视眼黄斑区不同部位的巩膜厚度有无差异，当差异有统计学意义时，再用最小显著性差异法进行两两比较，计算相关系数并采用多元回归分析法黄斑中心凹处巩膜厚度和眼轴长度、年龄、屈光度数及最佳矫正视力的关系。 结果本研究纳入的患者平均最佳矫正视力(0.68±0.31)，区间为0.01~1.00；平均屈光度数(-14.68±4.31)D，区间为-9.00~-25.25 D；平均眼轴长度(29.14±2.06)mm，区间为25.20~36.00 mm。中心凹颞侧1500 μm处的巩膜厚度均值最小，为(281.17±93.84)μm；中心凹处巩膜厚度均值最大，为(318.13±87.49)μm。颞侧1500 μm处的巩膜厚度与颞侧500 μm、中心凹处和鼻侧相比较薄，差异有统计学意义(t＝-2.78，-3.90，-3.37，-2.85，-3.07；P<0.05)；颞侧1000 μm处的巩膜厚度与中心凹处、鼻侧500 μm和鼻侧1500 μm处相比较薄，差异有统计学意义(t＝-2.87，-2.35，-2.05；P<0.05)。中心凹处巩膜厚度与年龄呈轻度负相关(r＝-0.371，P<0.05)；与眼轴长度呈中度负相关(r＝-0.573，P<0.05)；与屈光度数和最佳矫正视力呈中度正相关(r＝0.469，0.414；P<0.05)。多元线性回归分析表明，眼轴长度和年龄是影响中心凹处巩膜厚度的独立相关因素(β＝-18.436，-1.347；P<0.05)。 结论扫频光学相干断层扫描测量成年超高度近视眼患者黄斑区巩膜全层图像的方法，是无创、实用且简单易行的。本研究结果提示巩膜的病理变化，可能在超高度近视眼并发症的发生与发展过程中发挥作用。测量高度近视眼患者黄斑区巩膜厚度，可作为后巩膜葡萄肿观察的重要指标之一，从而为高度近视眼的防控提供客观依据。

Scleral thickness in macular region and its related factors in adult patients with super-high myopia

ObjectiveThe aim of this study was to investigate the macular scleral thickness in super-high myopic eyes (spherical equivalent ≥ -9.00 D) of adults and estimate the correlation among scleral thickness with age, axial length, spherical equivalent and best corrected visual acuity. Methods195 eyes of 112 adults, among whom with super-high myopia included in this study from June 2016 to May 2018 in Guangzhou Aier Eye Hospital was 84 eyes from 50 males and 111 eyes from 62 females. The age ranged from 18 to 67, with an averaged of (33.10±13.27). Swept-source optical coherence tomography wasused to measure the macular scleral thickness among 7 meridians in a 500 μm intervals and range of 1500 μm for each from fovea toward temporal and nasal lateral, totally 7 sites. The differences of the macular scleral thickness in adults with super-high myopic were observed and the correlation of the scleral thickness with age, spherical equivalent, axial length, and best corrected visual acuity were analyzed. ResultsThe average of best corrected visual acuity, spherical equivalent, and axial length was (0.68±0.31) with the interval of 0.01—1.00; (-14.68±4.31) D with the interval of -9.00—-25.25 D; and (29.14±2.06) mm with the interval of 25.20—36.0 mm, respectively. The scleral thickness at 1500 μm from fovea toward temporal lateral was thinnest [(281.17±93.84) μm], while thickest at macula central fovea [(318.13±87.49) μm]. The scleral thickness at 1500 μm from fovea toward temporal lateral was thinner than that at 500 μm from fovea toward temporal lateral, macula central fovea, and nasal lateral (t=-2.78, -3.90, -3.37, -2.85, -3.07; P<0.05). The scleral thickness at 1000 μm from fovea toward temporal lateral was thinner than that at macula central fovea, 500 μm and 1500 μm from fovea toward nasal lateral (t=-2.87, -2.35, -2.05; P<0.05). The scleral thickness at the macula central fovea was slightly negatively correlated with age and moderately with axial length (r=-0.371, -0.573; P<0.05); while, moderately positively with spherical equivalent and best corrected visual acuity (r=0.469, 0.414; P<0.05). Multivariant analysis showed that axial lengthand age (β=-18.436, -1.347; P<0.05) were independent factors affecting the scleral thickness. ConclusionsSwept-source optical coherence tomography is noninvasive and feasible to measure the scleral thickness of macula in adults with super-high myopia. The results indicates that abnormality of the sclera might play a role in the development of complication of super-high myopia. Measuring the macular scleral thickness in adults with super-high myopia could be regarded as one of the important indicators for the observation on posterior staphyloma, which provides an objective basis for the prevention and control of high myopia.