高度近视眼不同后巩膜形态的视网膜与脉络膜及巩膜厚度变化

The thickness of the retina, choroid and sclera in different posterior sclera shape in high myopia

目的观察高度近视眼不同后巩膜形态视网膜、脉络膜、巩膜厚度变化。方法临床检查确诊的高度近视患者60例96只眼纳入研究。其中，男性18例25只眼，女性42例71只眼；平均年龄（51.32±10.06）岁；平均等效球镜为（？14.38±6.31）DS；平均眼轴长度为（29.49±2.44）mm。患眼均采用日本Topcon公司深度光相干断层扫描（DRI-OCT）仪按照糖尿病早期治疗研究小组黄斑部格子分区方法，对该区域的视网膜、神经纤维层（RNFL）、脉络膜、巩膜厚度进行扫描，测量其厚度。以黄斑中心凹为中心1.0 mm直径的圆形区域为中央区域，围绕中央区域外围1.0 mm圆形为1环区域；1环外围1.5 mm圆形为2环区域。并均分为上方、下方、鼻侧、颞侧。应用设备三维模式将后巩膜形态分为Ⅰ、Ⅱ、Ⅲ、Ⅸ型，分别为27、46、11、12只眼，并据此分组。观察不同后巩膜形态组患眼视网膜、RNFL、脉络膜、巩膜厚度。结果Ⅰ、Ⅱ、Ⅲ、Ⅸ型组患眼之间中央、1、2环区域视网膜厚度比较，差异有统计学意义（F=4.48、5.03、4.98，P＜0.01）；RNFL厚度比较，差异无统计学意义（F=0.13，P=0.93）。中央区域脉络膜厚度比较，差异无统计学意义（F=0.31，P=0.81）；1、2环区域脉络膜厚度比较，差异有统计学意义（F=2.86、2.96，P=0.04、0.04）。不同类型后巩膜组患眼中心凹下巩膜厚度比较，差异无统计学意义（F=0.80，P=0.49）。结论高度近视眼不同后巩膜形态后极部不同区域视网膜、脉络膜厚度出现改变，Ⅸ型改变明显；RNFL、巩膜厚度可能无影响。

ObjectiveTo observe the thickness of the retina, retinal nerve fiber layer （RNFL）, choroid and sclera among the difference posterior sclera shape （PSS） in high myopia （HM）.MethodsSixty HM patients （96 eyes） were enrolled in this study. There were 18 males （25 eyes） and 42 females （71 eyes）. The mean age was （51.32±10.06） years. The mean spherical equivalent was （-14.38±6.31） DS. The mean axial length was （29.49±2.44） mm. The eyes were evaluated from deep range imaging optical coherent tomography （DRI-OCT） Atlantis 3D model, and divided as four groups include PSS-Ⅰ （27 eyes）, PSS-Ⅱ （46 eyes）, PSS-Ⅲ （11 eyes） and PSS-Ⅸ （12 eyes） according to the Curtin classification method. The thickness of the retina, RNFL, choroid and sclera were measured in the EDTRS Grid area.ResultsThere were statistically significant differences in the thickness of retina of the central, first circle, second circle in the EDTRS Grid area among PSS-Ⅰ, PSS-Ⅱ, PSS-Ⅲ and PSS-Ⅸ groups （F=4.48, 5.03, 4.98; P＜0.01）. There was no statistically significant differences in the thickness of RNFL among four groups （F=0.13, P=0.93）. There was no statistically significant differences in the central choroidal thickness （F=0.31, P=0.81）. There were statistically significant differences in the first circle, second circle choroidal thickness among four groups （F=2.86, 2.96; P=0.04, 0.04）. There was no statistically significant differences in the thickness of sclera under macular fovea among four groups （F=0.80, P=0.49）.ConlusionsThere are changes of thickness of the retina, choroid present in the difference EDTRS Grid area among the difference PSS in HM, and changes in PSS-Ⅸ is most obvious.