中老年近视患者黄斑区视网膜厚度的分区测量观察

Measurement of retinal thickness in different regions of macular in middle-aged and elderly myopic patients

目的 观察中老年近视患者黄斑区视网膜厚度,探讨其与眼轴长度（AL）、屈光度、矫正视力和性别的关系.方法 中老年近视患者85例96只眼纳入研究.其中,男性42例44只眼,女性43例52只眼;平均年龄（63.0±6.0）岁.所有患者均行矫正视力、眼压、裂隙灯显微镜、间接检眼镜、光相干断层扫描（OCT）、屈光度、AL检查.根据AL、等效球镜度数（SED）检查结果,将患者分为低中度近视组、高度近视组、超高度近视组.3组间年龄（χ^2=1.875）、性别（χ^2=0.667）、眼别（χ^2=0.375）比较,差异无统计学意义（P＞0.05）;平均SED（F=239.05）、平均AL（F=345.75）、平均矫正视力（F=3.679）比较,差异有统计学意义（P＜0.05）.采用日本Topcon公司3D-OCT 2000仪对患眼黄斑区进行扫描.测量黄斑整体视网膜平均厚度（TR）和黄斑中心区,内、外环上方、颞侧、下方、鼻侧象限共9个区域的视网膜厚度.性别、AL、SED与黄斑区视网膜厚度的相关性采用Pearson相关分析;不同性别TR和各区域视网膜厚度的比较采用独立样本t检验.结果 低中度近视组、高度近视组、超高度近视组间视网膜厚度比较,除内环上方、下方,其余所有区域视网膜厚度均有统计学意义（F=6.794、10.155、5.861、6.692、12.081、10.729、5.137,P＜0.05）;3组间内、外环视网膜厚度以及TR比较,差异有统计学意义（F=7.370、17.939、15.553,P＜0.05）.内环上方视网膜厚度与AL、SED均无相关性（r=-0.103、-0.098,P＞0.05）.内环下方视网膜厚度与AL无相关性（r=-0.161,P＞0.05）,但与SED呈负相关（r=-0.203,P＜0.05）.女性黄斑中心区（r=-2.082）、内环颞侧（r=-2.564）、内环下方（r=-2.958）、内环（r=-2.777）视网膜厚度及TR（r=-2.400）均较男性降低,差异有统计学意义（P＜0.05）.结论 中老年近视患者随近视程度加深,黄斑区视网膜普遍变薄;中老年女性近视患者黄斑内环区平均视网膜厚度及TR均较男性降低.

Objective To measure the macular retinal thickness of middle-aged and elderly myopic patients and examine the correlations between the macular retinal thickness and the axial length （AL）,diopter,corrected visual acuity and gender.Methods Eight-five middle-aged and elderly myopic patients （96 eyes）,including 43 females （52 eyes） and 42 males （44 eyes）,with an average age of 63±6 years,were enrolled in this study.All subjects underwent a full ophthalmic examination including visual acuity,intraocular pressure,slit lamp,indirect ophthalmoscopy,OCT,refraction and diopter and A-scan ultrasound biometry.The patients were divided into three groups according to the AL and spherical equivalent degree （SED） that stands for diopter,including low and intermediate myopia group,high myopia group and super high myopia group.There were no significant differences in age （χ^2=1.875）,gender （χ^2 =0.667） and right/left eye distribution （χ^2 =0.375） among the 3 groups （P〉0.05）,and significant differences were found in the AL （F=345.75）,SED （F=239.05） and corrected visual acuity （F=3.679） among the 3 groups of patients （P〈 0.05）.SD-OCT was used to measure the total average macular thickness （TR）,central subfield thickness,and the retina thickness in 4 quadrants of the inner and outer ring （IR/OR） of macular.Correlation between AL,SED,and corrected visual acuity with macular TR was analyzed by Pearson correlation analysis.Independent-Sample Test was used in TR comparison in different sex-group and macular retina area.Results The retinal thickness of all the macular regions,except those at inferior and superior inner ring of macular,was significantly different among the 3 groups （F=6.794,10.155,5.861,6.692,12.081,10.729,5.137; P〈0.05）.The retinal thickness of IR,OR and TR was significantly different among the 3 groups（F=7.370,17.939,15.553; P〈0.05）.Superior inner macular thickness had no correlations with both AL and SED （r=-0.103,-0.098; P〉0.05）.Inferior inner macular thickness had no correlations with AL,but had negative correlations with SED （r=-0.203,P〈 0.05）.The central subfield thickness （t =-2.082）,temporal inner macular thickness （t =-2.564）,superior inner thickness （t =-2.958）,average inner macular thickness （t =-2.777） and TR （t =-2.400） was lower in females compared to males,and significant differences were existed （P〈0.05）.Conclusions In our study,middle-aged and elderly myopic patients featured generally thinner macular retinal thickness,and the central subfield thickness,temporary and nasal inner macular thickness and all the quadrants of outer macular thickness was decreased significantly.Females are characterized by thinner central subfield thickness,inner macular thickness and total average macular thickness compared to males.