近视人群视盘旁神经纤维层厚度和视盘形态学相关性研究

Study on the correlation between the thickness of paraoptic nerve fiber layer and optic disc morphology in myopia

目的:应用OCT研究近视人群视盘旁神经纤维层厚度和视盘形态学变化以及两者的关系。方法:前瞻性研究。共纳入近视患者61例95眼,平均年龄27.76±7.05岁;对照组15例30眼,平均年龄28.33±3.08岁。根据屈光度将近视患者分为中低度近视组14眼(-3D≤屈光度<-6D)、高度近视组56眼(-6D≤屈光度≤-9D)和超高度近视组25眼(屈光度>-9D)。所有受试者均行标准综合验光(SE)、眼轴长度(AL)、眼压(IOP)、散瞳眼底和OCT检查。分析视盘旁平均视网膜神经纤维层厚度和上、下、鼻、颞四个象限的神经纤维层厚度,以及视盘旁萎缩灶面积(PPA)、视盘椭圆度(OI)和视盘水平倾斜角(HOT)。结果:各象限的神经纤维层厚度,四组受试者均有差异(均P<0.01)。平均神经纤维层厚度、上方和鼻侧神经纤维层厚度比较,对照组显著高于三个近视组(均P<0.05)。颞侧神经纤维层厚度比较,对照组低于高度近视组和超高度近视组(P<0.001、0.002),中低度近视组亦低于超高度近视组(P=0.043);四组受试者PPA比较有差异(P<0.001),其中超高度近视组和高度近视组大于中低度近视组和对照组(均P<0.01);四组受试者HOT有差异(P=0.020),其中高度近视组和超高度近视组高于对照组(P<0.001)。上、下象限神经纤维层厚度与OI、HOT和PPA均呈负相关(均P<0.05),而颞侧神经纤维层厚度与OI、HOT和PPA均呈正相关(均P<0.05)。结论:近视患者平均和上、下方神经纤维层厚度变薄,颞侧变厚,鼻侧无变化。高度近视患者HOT和PPA增大,且与神经纤维层厚度有密切联系。

AIM:To study the thickness of peripapillary retinal nerve fibre layer and morphological changes of optic disc in myopic subjects using optical coherence tomography(OCT).METHODS:Prospective study.A total of 61 myopic subjects(95 eyes)with a mean age of 27.76±7.05 years and 15 controls(30 eyes)with a mean age of 28.33±3.08 years were included.All subjects underwent standard comprehensive refraction(SE),axial length(AL),intraocular pressure(IOP),dilated fundus examination,,and OCT.Based on SE,myopic subjects were divided into three groups:14 eyes in the moderate to low myopia group(-3D≤SE<-6D),56 eyes in the high myopia group(-6D≤SE≤-9D),and 25 eyes in the ultra-high myopia group(SE>-9D).The mean retinal nerve fiber layer thickness of the optic disc and the nerve fiber layer thickness of the four quadrants were analyzed,as well as the peripapillary atrophy area(PPA),optic disc ovality index(OI),and horizontal optic disc tilt(HOT).RESULTS:The thickness of nerve fiber layer in each quadrant was significantly different among the four groups(P<0.01).The mean thickness of nerve fiber layer,the thickness of superior nerve fiber layer and the thickness of nasal nerve fiber layer were significantly higher in the control group than in the three myopic groups(all P<0.05).The thickness of temporal nerve fiber layer in the control group was significantly lower than that in the high myopia group and the super high myopia group(P<0.001,P=0.002),and also significantly lower in the moderate and low myopia group than that in the super high myopia group(P=0.043);the PPA of the four groups was statistically different(P<0.001),in which the super high myopia group and the high myopia group was significantly greater than that in the low myopia group and the control group(P<0.01);the HOT of the four groups was statistically different(P=0.020),in which the high myopia group and the super high myopia group was significantly higher than that in the control group(P<0.001,P<0.001).The nerve fiber layer thickness in the upper and lower quadrants was negatively correlated with OI,HOT,and PPA(all P<0.05),while the nerve fiber layer thickness in the temporal side was positively correlated with OI,HOT,and PPA(all P<0.05).CONCLUSION:Mean and superior and inferior nerve fiber layer thickness was thinner in myopic patients,with temporal thickening and no change in the nasal side.The tilt of optic disc and the area of peripapillary atrophy were increased in high myopia,which were closely related to the thickness of nerve fiber layer.