青少年不同程度高度近视患者视网膜微血管变化情况分析

目的　探讨青少年高度近视（HM）和超高度近视（SHM）患者视网膜微血管的变化。方法　收集2021年1月至2021年11月在聊城爱尔眼科医院就诊的37例（64眼）近视青少年患者进行分析。根据平均等效球镜度(MSE)和眼轴长度(AL)，将受试者分为HM组(23例41眼，-9.0 D< MSE≤-6.0 D，25 mm≤AL≤27 mm)和SHM组(14例23眼，MSE≤-9.0 D，AL>27 mm)。 将黄斑中心凹 6 mm 范围内划分为以黄斑中心凹为中心的3个同心圆，直径为 1 mm 的黄斑中心凹、1~3 mm 的内环区、3~6 mm 的外环区，应用光学相干断层扫描血流成像(OCTA)对3个区域的浅层视网膜血管长度密度（SRVD）、浅层视网膜血管灌注密度（SBPD）和直径6 mm完整图像（整体黄斑区）的SRVD和SBPD及其内环区和外环区各个象限的患者SRVD和SBPD进行分析，并对两组患者视网膜厚度和黄斑中心凹无血管区（FAZ）面积进行分析。结果　SHM组患者整体黄斑区、黄斑中心凹、内环和外环的SRVD分别为（15.63±1.91）mm^-1、（4.99±3.05）mm^-1、（14.09±2.71）mm^-1和（16.49±1.78）mm^-1，HM组患者整体黄斑区、黄斑中心凹、内环和外环的SRVD分别为（16.94±1.30）mm^-1、（7.46±2.96）mm^-1、（16.18±2.12）mm^-1和（17.52±1.15）mm^-1，两组患者间的各区域SRVD比较差异均有统计学意义（均为P<0.05）；SHM组患者整体黄斑区、黄斑中心凹、内环和外环SBPD分别为（37.33±4.87）%、（11.01±7.07）%、（32.60±6.69 ）%和（39.50±4.92）%，HM组患者整体黄斑区、黄斑中心凹、内环和外环SBPD别为（40.57±3.26）%、（15.95±6.68）%、（37.77±5.24）%和（42.33±2.89）%，两组患者间各区域SBPD比较差异均有统计学意义（均为P<0.05）；两组患者间内环和外环各象限比较，除外环区鼻侧和下方SRVD和SBPD比较差异均无统计学意义（均为P>0.05)外，其余内环区和外环区各象限SRVD和SBPD比较差异均有统计学意义 (均为P<0.05)。 SHM组和HM组患者各区域视网膜厚度和FAZ面积比较差异均无统计学意义（均为P>0.05）。结论　SHM患者黄斑区视网膜SRVD和SBPD明显低于HM患者，而视网膜厚度和FAZ保持稳定。

Evaluation of retinal microvascular changes in adolescents with different degrees of high myopia

Objective　To evaluate the retinal microvascular changes in adolescents with high myopia (HM) or super high myopia (SHM). Methods　A total of 37 adolescents (64 eyes) with myopia who received treatment at Liaocheng Aier Eye Hospital from January to November 2021 were included. According to the mean spherical equivalent (MSE) and axial length (AL), they were divided into the HM group (23 patients with 41 eyes, -9.0 D27 mm). The macula (6 mm in diameter) was divided into the fovea (1 mm in diameter), inner ring (1-3 mm in diameter), and outer ring (3-6 mm in diameter). Optical coherence tomography angiography (OCTA) was applied to image the superficial retinal vessel density (SRVD) and superficial blood perfusion density (SBPD) in the three regions, in the whole macula, and in all quadrants of inner and outer rings. Retinal thickness and foveal avascular zone (FAZ) area were also measured and compared between the two groups.Results　In the SHM group, the SRVD at the whole macular area, fovea, inner ring, and outer ring were (15.63±1.91) mm^-1, (4.99±3.05) mm^-1, (14.09±2.71) mm^-1, and (16.49±1.78) mm^-1, respectively. In the HM group, the SRVD at the whole macular area, fovea, inner ring, and outer ring was (16.94±1.30) mm^-1, (7.46±2.96) mm^-1, (16.18±2.12) mm^-1, and (17.52±1.15) mm^-1, respectively. There were significant differences in the SRVD of all regions between the two groups (all P<0.05).In the SHM group, the SBPD at the whole macular area, fovea, inner ring, and outer ring was (37.33±4.87)%, (11.01±7.07)%, (32.60±6.69)%, and (39.50±4.92)%, respectively. In the HM group, the SBPD at the whole macular area, fovea, inner ring, and outer ring was (40.57±3.26)%, (15.95±6.68)%, (37.77±5.24)%, and (42.33±2.89)%, respectively. There were significant differences in the SBPD of all regions between the two groups (all P<0.05). Significant differences were found in the SRVD and SBPD in all quadrants of inner and outer rings between the two groups (all P<0.05), except nasal and inferior sides of the outer ring. There were no significant differences in the retinal thickness and FAZ area between the two groups (both P>0.05). Conclusion　The SRVD and SBPD in macular area of SHM patients are significantly lower than those of HM patients, but the retinal thickness and FAZ remain stable.