高度近视血管旁异常与近视牵拉性黄斑病变的相关性研究

Correlation between high myopia paravascular abnormalities and myopic traction maculopathy

目的观察高度近视(HM)血管旁异常(PVA)的形态特征,初步分析PVA不同表现与近视牵拉性黄斑病变(MTM)之间的相关性。方法横断面临床研究。2021年6~12月于河北医科大学第二医院眼科检查确诊的中老年HM伴PVA患者42例72只眼纳人研究。其中,男性16例24只眼,女性26例48只眼;年龄(56.71±8.10)岁;屈光度(-13.05±3.10)D;眼轴长度(AL)(28.22±1.04)mm。根据超广角扫频源光相干断层扫描图像特征,将PVA形态分为血管旁微皱褶(PM)、血管旁囊肿(PC)、血管旁板层裂孔(PLH);MTM分为TO~T5级,其中MTM≥T3级定义为严重MTM。观察玻璃体视网膜交界面状态,记录玻璃体后脱离(PVD)状态,并将其分为完全型PVD、部分型PVD。部分型PVD根据玻璃体视网膜粘连部分分为黄斑中心凹粘连和血管旁粘连。联合超广角眼底照相将后巩膜葡萄肿(PS)分为6型。与MTM的相关因素采用logistic回归模型行单因素及多因素分析。结果果72只眼中,存在PM、PC、PLH分别为72(100.0%,72/72)、62(86.1%,62/72)、29(40.3%,29/72)只眼。其中,单纯PM、PM合并PC和PM、PC、PLH并存者分别为10(13.9%,10/72)、33(45.8%,33/72)、29(40.3%,29/72)只眼。部分型PVD者42只眼(58.3%,42/72),其中黄斑中心凹粘连、血管旁粘连分别为22(52.4%,22/42)、24(57.1%,24/42)只眼。存在PS者50只眼(69.4%,50/72),其中Ⅰ~Ⅳ型分别为27(54.0%,27/50)、21(42.0%,21/50)、1(2.0%,1/50)、1(2.0%,1/50)只眼。多因素logistic回归分析结果显示,AL[比值比(OR)=16.139,95%可信区间(CI)4.062~64.120,P<0.001]、PS(OR=4.212,95%CI1.234~14.378,P=0.022)、血管旁玻璃体视网膜粘连(OR=3.478,95%CI1.354~11.124,P=0.036)是PM、PC、PLH并存的危险因素。存在MTM者58只眼(80.6%,58/72),其中T1级19只眼(26.4%,19/72),为最常见类型。单因素logistic回归分析结果显示,MTM发生与PS(OR=4.190,95%CI1.240~14.157,P=0.021)及PM、PC、PLH并存(OR=11.323,95%CI1.38992.311,P=0.023)呈显著相关;与PVD(OR=1.889,95%CI0.580~6.150,P=0.291)、不同类型PS(OR=2.778、1.786,95%CI0.700~11.023、0.445~7.167,P=0.146、0.413)不相关。单纯PM、PM合并PC和PM、PC、PLH并存者严重MTM发生率比较,差异有统计学意义(x²=20.943,P<0.001)。结论PM是中老年HM患者出现PVA的最常见、最早表现;AL、PS及血管旁玻璃体视网膜粘连是PM、PC、PLH并存的危险因素;PVA三种形态并存可能是严重MTM的标志物。

Objective To observe the morphological characteristics of high myopia(HM)paravalvular abnormalities(PVA),and the correlation between different manifestations of PVA and myopic traction maculopathy(MTM)was analyzed.Methods A cross-sectional clinical study.A total of 42 middle-aged and elderly patients with HM and PVA diagnosed by ophthalmology examination in Department of Ophthalmology,The Second Hospital of Hebei Medical University from June to December 2021 were included in the study.There were 24 eyes in 16 males and 48 eyes in 26 females.Age was(56.71±8.10)years old.Diopter was(-13.05±3.10)D.Axial length(AL)was(28.22±1.04)mm.According to the characteristics of ultra-wide-angle optical coherence tomography images,PVA morphology was divided into paravascular microfolds(PM),paravascular cysts(PC)and paravascular lamellar holes(PLH).MTM was divided into TO-T5 grades,of which MTM≥T3 was defined as severe MTM.The state of vitreoretinal junction was observed and the state of posterior vitreous detachment(PVD)was recorded,which divided into complete PVD and partial PVD.Partial PVD was divided into macular fovea adhesions and paravascular adhesions according to the vitreoretinal adhesions.Posterior scleral staphyloma(PS)was divided into 6 types by ultra-wide-angle fundus photography.Logistic regression model was used to analyze the factors related to MTM.Results In 72 eyes,PM,PC and PLH were 72(100.0%,72/72),62(86.1%,62/72)and 29(40.3%,29/72)eyes,respectively.Among them,there were 10(13.9%,10/72)eyes with PM alone,33(45.8%,33/72)eyes with PM and PC,and 29(40.3%,29/72)eyes with PM,PC and PLH,respectively.There were 42 eyes with partial PVD(58.3%,42/72),among which the macular fovea and paravascular adhesion were 22(52.4%,22/42)and 24(57.1%,24/42)eyes,respectively.PS was present in 50 eyes(69.4%,50/72),among which 27(54.0%,27/50),21(42.0%,21/50),1(2.0%,1/50),and 1(2.0%,1/50)eyes were types Ⅰ to Ⅳ,respectively.Multivariate logistic regression analysis showed that AL[odds ratio(OR)=16.139,95%confidence interval(C)4.062-64.120,P<0.001],PS(OR=4.212,95%CI 1.234-14.378,P=0.022),paravascular vitreoretinal adhesion(OR=3.478,95%CI 11.124,P-0.036)were risk factors for PM,PC and PLH.MTM was present in 58 eyes(80.6%,58/72),among which T1 was the most common type in 19 eyes(26.4%,19/72).Univariate logistic regression analysis showed that the occurrence of MTM was significantly correlated to PS(OR=4.190,95%CI 1.240-14.157,P=0.021),coexistence of PM,PC and PLH(OR=11.323,95%CI 1.389-92.311,P=0.023),and PS were significantly correlated.There was no correlation with PVD(OR=1.889,95%CI 0.580-6.150,P=0.291)or PS(OR=2.778,1.786;95%CI 0.700-11.023;0.445-7.167;P=0.146,0.413).There was significant difference in the incidence of severe MTM between PM alone,PM combined with PC and coexistence of PM,PC and PLH(2=20.943,P<0.001).Conclusions PM is the most common and earliest manifestation of PVA in middle-aged and elderly HM patients.AL,PS and paravascular vitreoretinal adhesion are risk factors for PM,PC and PLH.The coexistence of three PVA forms may be a marker of severe MTM.