高度近视眼黄斑区视网膜厚度与视力损害的关系

背景部分高度近视患者在出现眼部并发症的形态改变之前就可表现为视功能的改变，黄斑区视网膜厚度的改变与其是否相关尚不清楚。目的探讨高度近视眼视网膜厚度与视力损害的关系。方法采用连续病例观察研究设计。选取2011年1月至2012年1月在北京同仁医院眼科中心接受准分子激光角膜原位磨镶术（LASIK）的高度近视患者132例245眼，近视等效球镜为一6．00—一20．00D。所有患者均接受最佳矫正视力（BCVA）和傅里叶域光学相干断层扫描仪（FD—OCT）检查，扫描模式为黄斑MM6。所有受检眼根据矫正视力的不同分为矫正视力≥0．9组和矫正视力≤O．8组；根据有无后巩膜葡萄肿将人选眼亚分为无后巩膜葡萄肿组及后巩膜葡萄肿组，后巩膜葡萄肿组再根据OCT图像上后巩膜葡萄肿的形态亚分为黄斑对称组及黄斑倾斜组。利用OCT随机软件生成的视网膜厚度图获取各组患者黄斑区不同象限视网膜厚度的平均值，比较不同视力组间和不同形态后巩膜葡萄肿间黄斑区视网膜厚度的差异。结果不同视力组间和各亚组间受检者的人口基线特征匹配。矫正视力≥0．9组BCVA为1．02±0．16，矫正视力≤0．8组为0．62~0．08，差异有统计学意义（t=3．233，P=0．001）；矫正视力≥0．9组黄斑中心凹区视网膜厚度为（256．28±13．19）斗m，明显较矫正视力≤0．8组的（231．17±10．96）斗m厚，差异有统计学意义（t=2．134，P=0．031）。无后巩膜葡萄肿组及后巩膜葡萄肿I组、Ⅱ组间BCVA分别为1．00~0．27、0．78±O．21和0．90~0．13，3个组间差异有统计学意义（F=15．760，P=0．015），无后巩膜葡萄肿组及后巩膜葡萄肿Ⅱ组患者BCVA均高于后巩膜葡萄肿I组，差异均有统计学意义（q=16．131，P=0．006；q=一10．831，P=0．008）；3个组间黄斑中心凹区平均视网膜厚度值的差异有统计学意义（F=2．316，P=0．025），后巩膜葡萄肿I组患者视网膜厚度为（234．21±15．69）Ixm，明显低于无后巩膜葡萄肿组的（252．25±15．31）斗m，差异有统计学意义（q=12．977，P=0．023）；3个组黄斑旁中心凹区视网膜厚度值的差异无统计学意义（F=0．318，P=0．078）；3个组间黄斑周边区视网膜厚度的差异有统计学意义（F=1．925，P=0．013），后巩膜葡萄肿Ⅱ组视网膜厚度值为（273．26±16．37）斗m，与后巩膜葡萄肿I组患者的（289．11±19．30）txm及无后巩膜葡萄肿组的（290．33±17．12）斗m比较明显下降，差异均有统计学意义（g=一8．305，P=0．023；g=-7．011，P=0．012）。结论高度近视眼黄斑中心凹区视网膜厚度的改变与BCVA损害有关，后巩膜葡萄肿的后顶点对应处视网膜变薄累及黄斑中心凹时会导致视力下降。

Relationship between macular retinal thickness and visual acuity in high myopia

Background It is well known that the diminution of visual acuity appears before notable complications in some high myopic eyes. However, whether the impaired vision is associated with the change of retinal thickness at macula area is still under investigation. Objective This study was to investigate the relationship of macular retinal thickness with the change of visual acuity in high myopic eyes. Methods A consecutive case- observational study was performed. Two hundred and forty-five eyes of 132 patients with the diopter of -6. 00 -20. 00 D were enrolled in this study during the January 2011 to January 2012 in Beijing Tongren Eye Center. All ofthe patients received the measurement of retinal thickness with Fourier Domain Optical Coherence Tomography （ FD- OCT） ,and the scan mode was MM6. The eyes were divided into the corrected vision ~〉0.9 group and the corrected vision ~〈0.8 group. In addition,the eyes were assigned to the non-posterior staphyloma group,posterior staphyloma I group （ macular symmetry） and posterior staphyloma 11 group （ macular gradient）. The retinal thicknesses in different quadrants at the macular zone were measured and calculated by OCT software. Results The demography was matched in different groups. Corrected visual acuity was significantly increased in the corrected vision ≥ 0.9 group than that in the corrected vision ≤0. 8 group （ 1.02±0. 16 vs. 0.62±0. 08 ） （ t = 3. 233,P = 0. 001 ）. Retinal thickness value at fovea was （256.28±13.19） μm in the corrected vision ≥0.9 group,and that in the corrected vision≤0.8 group was （231. 17±10. 96）txm,with a significant difference between the two groups （t = 2. 134,P= 0. 031 ）. The corrected visual acuity was 1.00±0.27,0. 78±0.21 and 0.90±0. 13 in the non-posterior staphyloma group, posterior staphyloma I group and posterior staphyloma I1 group, respectively, showing significant difference among the three groups （F = 15. 760,P = 0. 015 ） , and the corrected visual acuity of the non-posterior staphyloma group and posterior staphyloma It group were significantly higher than that of posterior staphyloma I group （ q = 16. 131, P = 0. 006 ; q = -10. 831 ,P = 0. 008）. A significant difference also was seen in the mean retinal thickness among the three groups （F= 2.316, P = 0. 025 ）. The mean retinal thickness in the posterior staphyloma I group was （ 234.21 ± 15.69 ） i, Lm, which was significantly smaller than （252.25±15.31）μm of the posterior staphyloma 11 group （ q = 12. 977, P = 0. 023 ）. There were no significant difference in the retinal thickness at para-fovea area among the three groups （F = 0.318,P = 0. 078 ）. However,significant difference was found at peri-fovea area in different groups （F= 1. 925 ,P= 0. 013 ）. The mean retinal thicknesses at peri-fovea area was （273.26-± 16.37 ）Ixm in the posterior staphyloma H group and was significantly smaller than （289.11-±19.30） Ixm of the posterior staphyloma I group and （290. 33-±17.12） ixm of the non-posterior staphyloma group （q=-8.305,P=O. O23;q=-7.011,P=O. O12）. Conclusions The retinal thickness at fovea is associated with the corrected visual acuity in high myopic eyes. The thinning of retinal thickness at the vertex of posterior staphyloma is one of causes of visual function impairment.