基于学校的健康儿童青少年视网膜OCT数据

目的：探讨健康儿童青少年经光学相干断层成像（OCT）测得的黄斑区以及视盘区相关参数的正常 值范围，并分析个体因素对OCT主要参数的可能影响。方法：横断面研究。本研究为爱尔儿童青少年屈光发育队列研究的一部分内容，在2019年3─6月期间，使用 OCT对湖南醴陵市及湖北宜昌市 3所学校的913名中小学生（5～15岁）眼球黄斑区及视盘区进行扫描，以OCT自带软件导出视盘形态学指标、视盘及黄斑区视网膜厚度和神经纤维层厚度（RNFL），分别以P2.5～P97.5及均值±1.96标 准差定义其正常值范围，并通过Spearman相关和多元线性回归模型分析年龄、性别、屈光度和眼轴长度对OCT主要参数的影响。结果：糖尿病早期治疗研究小组黄斑部格子分区（EDTRS）中，黄斑中心区视网膜厚度及RNFL的正常值范围分别为193.72～262.68 μm和0.67～8.18 μm。内环区视 网膜厚度依次为上方（288.07～340.29 μm）>鼻侧（283.89～340.53 μm）及下方（283.85～337.21 μm） >颞侧（275.32～326.32 μm），RNFL依次为下方（24.40～33.01 μm）及上方（24.52～33.24 μm） >鼻侧（20.89～28.35 μm）>颞侧（20.54～24.45 μm）；外环区视网膜厚度依次为鼻侧（266.97～323.27 μm） >上方（254.81～305.03 μm）>下方（241.54～292.42 μm）>颞侧（238.45～286.59 μm），RNFL依次为 鼻侧（42.38～63.03 μm）>下方（36.35～53.74 μm）及上方（36.19～53.64 μm）>颞侧（21.37～26.52 μm）。 视盘视网膜厚度依次为上方（286.13～378.29 μm）及下方（283.20～375.82 μm）>颞侧（256.90～325.30 μm） >鼻侧（235.40～309.79 μm），RNFL依次为下方（122.07～193.79 μm）>上方（113.48～188.28 μm）>颞 侧（71.51～146.15 μm）>鼻侧（45.99～112.26 μm）。视盘面积（DA）、盘沿面积（RA）、视杯容积 （CV）、杯盘面积比（CDAR）、线性杯盘比（LCDR）、垂直杯盘比（VCDR）分别为1.37～3.16 mm2、 0.79～2.64 mm2、0.01～0.51mm3、0.03～0.64、0.17～0.80、0.15～0.78。多元线性回归分析显示等效球镜度与黄斑中心区、黄斑外环鼻侧、视盘鼻侧及视盘下方RNFL厚度和DA、CV、VCDR具有 相关性（r=-0.197、-0.317、4.458、1.633、0.069、0.020、0.040，均P<0.05），年龄与黄斑中心区 RNFL及DA、CV、VCDR呈负相关（r=-0.099、-0.020、-0.005、-0.007，均P<0.05），与黄斑外环鼻侧RNFL呈正相关（r=0.141，P=0.046），眼轴与CV、VCDR、黄斑中心区及外环鼻侧RNFL呈正 相关（r=0.022、0.045、0.414，1.486，均P<0.05），与视盘下方呈负相关（r=-2.192，P=0.012），仅黄斑外环鼻侧RNFL与性别有相关性（r=-1.066，P=0.002）。结论：本研究提供了健康儿童青少年人群黄斑区以及视盘区相关参数正常范围，同时发现性别、年龄、屈光度以及眼轴均会对OCT的检查结果产生一定的影响，提示临床中应用OCT评估及诊治儿童青少年眼底病变时，应考虑这些因素的影响。

Normative Values of Macular and Optic Nerve Head Parameters in Childhood: A School-Based Study with Optical Coherence Tomography

Objective: To determine the normative values of macular and optic nerve head parameters measured by optical coherence tomography (OCT) in healthy schoolchildren and to analyze the possible influence of individual factors on the main parameters of OCT. Methods: This cross-sectional study was part of a cohort study on refractive development in children and adolescents. Nine hundred thirteen students from the age of five to fifteen were recruited at three schools in Liling City, Hunan Province, and Yichang City, Hubei Province. Retinal thickness, retinal nerve fiber thickness (RNFL) and optic nerve head parameters were measured by OCT (DRI OCT Triton, Japan, Topcon). The normal value range was defined by P2.5-P97.5 or Mean±1.96 SD. Then the relationships between age, sex, refractive error, axial length and the main parameters were analyzed by a Spearman's correlation and multiple linear regression analysis. Results: The EDTRS for the foveal region, the normal values of retinal thickness and RNFL thickness in the central area were 193.72-262.68 μm and 0.67-8.18 μm, respectively. In the inner ring region, the retina was thickest in the superior quadrant (288.07-340.29 μm), followed by the nasal (283.89-340.53 μm) and inferior quadrants (283.85-337.21 μm), then the temporal quadrant (275.32-326.32 μm), while the RNFL was thickest in the inferior (24.40-33.01 μm) and superior quadrants (24.52-33.24 μm), followed by the nasal (20.89-28.35 μm) and temporal quadrants (20.54-24.45 μm). In the outer ring region, the retina was thickest in the nasal quadrant (266.97-323.27 μm), followed by the superior (254.81-305.03 μm) and inferior quadrants (241.54-292.42 μm), then the temporal quadrant (238.45-286.59 μm), while the RNFL was thickest in the nasal quadrant (42.38-63.03 μm), followed by the inferior (36.35-53.74 μm) and superior quadrants (36.19-53.64 μm), then the temporal quadrant (21.37-26.52 μm). In the optic disc, the retina was thickest in the superior (286.13-378.29 μm) and inferior quadrants (283.20-375.82 μm), followed by the temporal quadrant (256.90-325.30 μm), then the nasal quadrant (235.40-309.79 μm). The RNFL was thickest in the inferior quadrant (122.07-193.79 μm), followed by the superior (113.48- 188.28 μm), temporal (71.51-146.15 μm), and nasal quadrants (45.99-112.26 μm). The normative values of the disc area (DA), rim area (RA), cup volume (CV), C/D area ratio (CDAR), linear C/D ratio (LCDR) and vertical C/D ratio (VCDR) were 1.37-3.16 mm2 , 0.79-2.64 mm2 , 0.01-0.51 mm3 , 0.03- 0.64, 0.17-0.80 and 0.15-0.78, respectively. Multiple linear regression analysis showed that the spherical equivalent refractive error was correlated with the RNFL thickness of the macular central area, the nasal quadrant of the outer ring, the nasal quadrant of the optic disc, the inferior quadrant of the optic disc and DA, CV, VCDR (r=-0.197, -0.317, 4.458, 1.633, 0.069, 0.020, 0.040, all P<0.05). A significant negative correlation was found between age and the RNFL thickness of the macular central area, DA, CV, VCDR (r=-0.099, -0.020, -0.005, -0.007, all P<0.05), and a positive correlation was found between age and the RNFL thickness of the nasal quadrant of the outer ring (r=0.141, P=0.046). A positive correlation was found between the axial length and RNFL thickness of the macular central area and the nasal quadrant of the outer ring and CV, VCDR (r=0.414, 1.486, 0.022, 0.045, all P<0.001), and a negative correlation was found between the axial length and inferior quadrant of the optic disc (r=-2.192, P=0.012). Moreover, there was no correlation between gender and the other parameters, except for the RNFL thickness of the nasal quadrant of the outer ring (r=-1.066, P=0.002). Conclusions: This study provides the normative values of macular and optic nerve head parameters in healthy children. Meanwhile, we find that gender, age, refractive error and axial length all have a certain influence on the examination results of OCT. Thus, these factors should be taken into account when using OCT to evaluate and diagnose the fundus diseases of young children in clinical practice.