病理性近视脉络膜厚度与后巩膜葡萄肿的关联分析

Correlation analysis between posterior staphyloma and choroidal thickness in pathologic myopic eyes

目的:探讨病理性近视中心凹下脉络膜厚度与后巩膜葡萄肿间的相关性。方法:回顾性连续收集病理性近视患者129例,共258眼。根据B超及眼底检查,将患者分为后巩膜葡萄肿组(52例,80眼)和无后巩膜葡萄肿组(77例,154眼)。采用光学相干断层扫描仪增强深度扫描模式(optical coherence tomography with enhanced depth imaging,EDI-OCT)测量中心凹下脉络膜厚度(CSFCT)。分析各组研究对象的眼部生物学特征与后巩膜葡萄肿之间的关系。结果:与无后巩膜葡萄肿组患者相比,后巩膜葡萄肿组患者年龄较大、眼轴较长、近视较深及CSFCT较薄(P<0.05)。年龄、性别1∶1配对的病例对照亚组分析提示,后巩膜葡萄肿组患眼眼轴长、CSFCT薄(P<0.001)。多因素logistics回归分析发现,矫正年龄、眼轴和CSFCT后,年龄增加[Δ=5岁,OR(95%CI)=1.319(1.120~1.554);P=0.001]、眼轴变长[Δ=1mm,OR(95%CI)=1.898(1.418~2.541);P<0.001]是后巩膜葡萄肿发生的危险因素;而CSFCT增加[Δ=50μm,OR(95%CI)=0.314(0.174~0.567);P<0.001]是后巩膜葡萄肿发生的保护因素。其中,CSFCT下降诊断后巩膜葡萄肿的曲线下面积(area under the curve,AUC)最高,为0.866(95%CI0.821~0.911,P<0.001);Youden指数最大化时,其诊断后巩膜葡萄肿的灵敏度为90.0%、特异度为68.8%,阳性似然比为2.718。结论:病理性近视伴发后巩膜葡萄肿患者具有眼轴长、脉络膜薄等特点;CSFCT下降诊断后巩膜葡萄肿的价值较高,但不能作为诊断后巩膜葡萄肿的特异性指标。

Objective: To investigate the relationship between posterior staphyloma and choroidal thickness in pathologic myopic eyes. Methods: A total of 129 consecutive patients with pathologic myopia (258 eyes) were retrospectively selected. Patients were classified as posterior staphyloma (80 eyes of 52 patients) and non-posterior staphyloma (154 eyes of 77 patients), according to ultrasonography and fundus examination. Central subfoveal choroidal thickness (CSFCT) was measured by optical coherence tomography using enhanced depth imaging (EDI-OCT). The relationship between ocular biometric characteristics and posterior staphyloma was further analyzed. Results: Compared with patients without posterior staphyloma, patients with posterior staphyloma were older, had longer axial length, deeper myopia and thinner CSFCT. Moreover, 1∶1 age- and gender-matched case-control subgroup analysis showed that patients had longer axial length and thinner CSFCT ( P <0.001). After adjusting age, axial length, and CSFCT, the risk of posterior staphyloma increased when age (Δ=5 years old, OR [95%CI]=1.319 [1.120, 1.554], P =0.001) or axial length increased (Δ=1 mm, OR [95%CI]=1.898 [1.418, 2.541 ], P <0.001);while the risk of posterior staphyloma decreased when CSFCT increased (Δ=50 μm, OR [95%CI]= 0.314 [0.174, 0.567], P <0.001). Among these indexes, the area under the curve (AUC) of CSFCT was the highest ( AUC= 0.866, 95%CI 0.821-0.911, P <0.001). The positive likelihood ratio of CSCF diagnosed posterior staphyloma was 2.718 with 90.0% of sensitivity and 68.8% of specificity, when Youden’s index was the highest (sensitivity, 90.0%;specificity, 68.8%). Conclusions: Comparing to pathologic myopic eyes without posterior staphyloma, posterior staphyloma eyes have longer axial length and thinner CSFCT. The decline of CSFCT is of high value in the diagnosis of posterior scleral staphyloma, but it cannot be used as a specific indicator.