学龄儿童眼球后极部脉络膜厚度及相关因素分析

Observation on Choroidal Thickness of School-aged Children and Relevant Factors

[目的]探讨岭南地区学龄儿童黄斑中心凹及周围3mm范围内脉络膜厚度的变化以及相关影响因素。[方法]招募2017年1月1日至2018年6月1日就诊于海南省眼科医院的健康学龄儿童195人,测量眼轴(A XL)、黄斑中心凹下脉络膜厚度(SFCT)以及黄斑中心凹上方、下方、鼻侧、颞侧1mm及3mm脉络膜厚度。根据等效球镜度(SE)分为远视组、正视组及低中高度近视组,比较各组黄斑区不同位点脉络膜厚度分布。跟踪观察香港特区新界东华三院马锦灿纪念小学二年级同学45人,根据儿童屈光状态分为近视组(基础SE<-0.25D或者1年后SE<-0.25D)和正视远视组(基础SE和1年后SE均≥-0.25D),比较1年前后黄斑区不同位点脉络膜厚度变化,并研究其变化与SE、眼轴改变的相关性。[结果]7~16岁学龄儿童脉络膜厚度在黄斑中心凹下为(SF)250(204~314)μm,以黄斑中心凹为中心向鼻侧和下方变薄,向颞侧和上方变厚,最薄点位于鼻侧3mm处,最厚位于颞侧1mm处,随近视度数增加,黄斑区各测量点脉络膜厚度均有不同程度变薄,且黄斑中心凹及周围1mm处脉络膜变薄较周边更加显著(成组秩和检验,P<0.05)。45名香港小学生随访1年后观察结果显示被检儿童各测量点脉络膜厚度与一年前比较均有不同程度的减少(配对t检验,P<0.05)。近视组与正视远视组比较AXL增长、SE减少明显,SFCT和周围各点脉络膜厚度减少均大于正视远视组,差异有统计学意义(成组秩和检验,P<0.05)。[结论]学龄儿童的后极部黄斑区的脉络膜厚度呈现不均匀分布,黄斑中心凹下脉络膜厚度较周边脉络膜厚度对近视的发展更为敏感。

【Objective】To observe macular choroidal thickness and topographical variation in Chinese healthy and myopic children and to investigate the correlated factors.【Methods】A total of 196 myopic children treated at Hainan Province Eye Hospital were selected and divided into hyperopia,emmetropia,low,moderate and severe myopia groups according to their spherical equivalents(SE).Axial length(AXL),subfovealchoroidal thickness(SFCT)and 1 mm,3 mm nasal,temporal,superior,and inferior to the fovealchoroidal thickness were recorded.Forty-five students from Tung Wah Group of Hospital′s MA Kam Chan Memorial Primary School in Hong Kong were also recruited in this 1-year longitudinal study.Children were grouped to myopic group and emmetropic or hyperopic group according to SE,thickness changes of choroid were compared among children with or without myopic shift.The correlation among choroidal SE,and AXL variations were also investigated.【Results】Mean SFCT was 250(204~314)μm.The choroid was thinner at the na⁃sal and inferior sectors,the thinnest being at 3mm nasal to the fovea,and the thickest at 1mm temporal to the fovea.Choroidal thickness in all orientations became thinner with progressively descending refractive degree.SFCT and 1 mm around fovea decreased most compared with other surrounding directions in all groups(Kruskal-Wallis test,P<0.05).The choroidal thickness in subfovea and other sectors got thinned after 1 year follow-up time(Pair t test,P<0.05).The variation of the choroidal thickness in forvea and surrounding positions was positively correlated with the change of SE and negatively related to the change of the AXL.The myopic group had a faster descent of SE and a faster growth of AXL than the emmetropic or hyperopic group.SFCT and surrounding choroidal thickness showed a progressive descent in the myopic group,but a slight decrease in the emmetropic or hyperopic groups.【Conclusions】There is significant topographic varia⁃tion of choroidal at different regions of the macular.The choroidal thickness decreases faster in myopes.SFCT is more sen⁃sitive to myopic progression compared with surrounding regions.