病理性近视黄斑病变荧光素眼底血管造影表现类型及相关影响因素分析

Analysis of associated factors and characteristics of different types of pathologic myopia maculopathy in fundus fluorescein angiography

目的 观察病理性近视黄斑病变荧光素眼底血管造影（FFA）的图像特征，分析不同类型黄斑病变及其影响因素。 方法 回顾性分析病理性近视黄斑病变患者251例451只眼的临床资料。根据其临床特点及FFA特征将病理性近视黄斑病变分为6种类型： （1）漆样裂纹；（2）脉络新生血管（CNV）；（3）漆样裂纹性黄斑出血；（4）Fuchs 斑；（5）黄斑萎缩；（6） 黄斑裂孔。分析年龄、性别、屈光度及矫正视力与各类型黄斑病变的关系。结果 年龄、近视屈光度及矫正视力在不同类型病理性近视黄斑病变之间差异均有统计学意义（年龄：F=29.734,P＜0.001；屈光度：F=22.259,P＜0.001；矫正视力：F=5.932,P＜0.001）。Logistic 回归分析显示，随年龄增加，CNV及黄斑萎缩构成比均呈上升趋势［比值比（OR）=1.034, 95%可信区间（CI）=1.019~1.049,P＜0.001; OR=1.054, 95%CI=1.031~1.076,P＜0.001］；而漆样裂纹性黄斑出血则呈下降趋势（OR=0.906, 95%CI=0.876~0.937,P＜0.001）；CNV及黄斑裂孔随近视屈光度增加而构成比呈下降趋势（OR=1.233, 95%CI=1.136~1.338,P＜0.001;OR=1.554, 95%CI=1.185~2.038,P＜0.001），黄斑萎缩呈上升趋势（OR=0.762, 95%CI=0.705~0.824,P＜0.001）。各类型黄斑病变可造成不同程度的视力损害，CNV对视力损害程度较重（OR=1.835, 95%CI=1.180~2.854,P=0.007），漆样裂纹则较轻（OR=0.506, 95%CI=0.328~0.782,P=0.002）。结论 病理性近视黄斑病变根据FFA可分为6大类型，CNV及黄斑萎缩随年龄增长而增加，漆样裂纹黄斑出血则随之减少，CNV及黄斑裂孔随近视屈光度增高而减少，黄斑萎缩则随之增加；病变类型不同，最佳矫正视力不同。

Objective To observe the characteristics of fundus fluorescein angiography （FFA） in different types of pathologic myopic maculopathy and evaluate the influence factor.Methods The clinical data of 251 patients （451 eyes） with pathologic myopic maculopathy were retrospectively analyzed. The patients were divided into 6 groups according to FFA characteristics： （1） lacquer cracks （LC）; （2） choroidal neovascularization （CNV）; （3） macular hemorrhage with LCs; （4） Fuchs spots; （5） macular atrophy; （6） macular hole. Their relationship with age, gender, refraction and （BCVA） were analyzed.Results Older age was significantly associated with CNV and macular atrophy （OR=1.034,CI=1.019-1.049,P〈0.001;OR=1.054,CI=1.031-1.076,P〈0.001; respectively）;younger age was associated with hemorrhage with LC （OR=0.906,CI=0.876-0.937,P〈0.001）. Higher myopic refractive error was associated with macular atrophy （OR=0.762,CI=0.705-0.824,P〈0.001）, whereas lower myopic refractive error was associated with CNV and macular hole（OR=1.233,CI=1.136-1.338,P〈0.001;OR=1.554,CI=1.185-2.038,P〈0.001; respectively）. A worse visual acuity was associated with CNV （OR=1.835,CI=1.180 -2.854,P=0.007）, while better visual acuity was associated with LC （OR=0.506,CI=0.328 - 0.782,P=0.002）. There was no gender difference in distribution of high myopic maculopathy types. Conclusions Pathologic myopic maculopathy can be divided into six types. With increasing age, the incidence rates of CNV and macular atrophy increases, hemorrhage with LC but decreases. With the rise of myopic refractive, the incidence rates of CNV and macular hole decreases, macular atrophy but increases.