不同程度近视患者视盘区视网膜微循环变化特点分析

目的:基于光学相干断层扫描血管成像(OCTA)分析不同程度近视患者视盘区微血管密度(MVD)和视网膜神经纤维层(RNFL)厚度与眼轴长度(AL)的关系。方法:前瞻性病例对照研究。本研究于2020-05/2021-01在安徽理工大学第一附属医院(淮南市第一人民医院)共招募51名健康受试者,符合标准共94眼依据AL划分为三组,23mm≤AL<24mm且等效球镜度数(SE)+0.50~-0.50D为正视组31眼,24mm≤AL<26mm且-0.75≤SE<-6.00D为低中度近视组32眼,AL≥26mm且SE≥-6.00D为高度近视组31眼。利用OCTA对受试者视盘为中心的4.5mm×4.5mm扫描区成像并自动定量测出视盘不同分区的MVD和RNFL厚度,并进行相关分析。结果:ISNT四分区中,颞侧RNFL厚度与AL呈正相关(r=0.343,P<0.05)。上侧、下侧及鼻侧象限RNFL厚度与AL呈负相关(r=-0.341、-0.289、-0.269,均P<0.05)。在Garway Heath分区法中,颞上象限RNFL厚度与AL呈正相关(r=0.382,P<0.05),鼻上、鼻下及下鼻象限RNFL厚度、MVD与AL呈负相关(r=-0.226、-0.211、-0.369、-0.316、-0.304、-0.241,均P<0.05)。盘内整体MVD随AL增加而密集(r=0.376,P<0.05),而盘周MVD却与AL呈负相关(r=-0.361,P<0.05)。结论:视盘区MVD变化、RNFL厚度与AL紧密相关。随AL增加,鼻上、鼻下和下鼻象限RNFL厚度和MVD均减少,盘周整体MVD降低,颞上象限RNFL厚度及盘内MVD增加,尤以高度近视患者变化显著。

Characteristics of retinal microcirculation changes in optic discs of patients with different degrees of myopia

AIM:To compare the optic disc microvessel density(MVD)with different degrees of myopia and to evaluate the association of MVD with axial length(AL)and retinal nerve fibre layer thickness(RNFL)by using optical coherence tomography angiography(OCTA).METHODS:Prospective and pathological control study.A total of 94 eyes[31 eyes with mild myopia(SE:+0.50D to-0.50D),32 eyes with low and moderate myopia(-0.75D≤SE<-6.00D),and 31 eyes with high myopia(SE≥-6.00D)]underwent optical coherence tomography angiography imaging.OCTA was used to image 4.5mm×4.5mm scanning area centered on the subject’s optic disc,and to automatically and quantitatively measure the MVD and RNFL thickness in different partitions of the optic disc in order to carry out relevant discussions.RESULTS:Among ISNT partition,temporal RNFL thickness was positively correlated with AL(r=0.343,P<0.05).RNFL thickness in the nasal,inferior and superior quadrants was negatively correlated with AL(r=-0.341,-0.289,-0.269,all P<0.05).In Garway Heath partition,temporal superior RNFL thickness was positively correlated with AL(r=0.382,P<0.05).Negative correlations were found in the thickness of RNFL with AL at the nasal superior,nasal inferior and inferior nasal quadrant(r=-0.226,-0.211,-0.369,-0.316,-0.304,-0.241,all P<0.05).The overall MVD in optic disc increased with the increase of AL(r=0.376,P<0.05),while the overall MVD around optic disc was negatively correlated with AL(r=-0.361,P<0.05).CONCLUSION:The change of MVD and RNFL thickness of optic disc are closely related to AL.With the increase of AL,the thickness of RNFL and MVD in the nasal superior,nasal inferior and inferior nasal quadratons decreased,the overall MVD in optic disc decreased,and the MVD in optic disc and the temporal superior quadratons increased,especially in high myopia.