无黄斑病变近视患者黄斑区视网膜结构与视功能改变的相关性

Correlation of macular retinal structure with changes of visual function in myopic patients without maculopathy

目的研究不同近视程度的无黄斑病变患者黄斑区视网膜厚度(retinal thickness,RT)、视网膜神经节细胞和内丛状层(ganglion cell and inner plexiform layer,GCIPL)厚度及微视野改变规律,并分析结构与功能改变之间的相关性。方法收集2018年6至12月就诊于我院的100例(199眼)无黄斑病变的不同程度近视患者资料,记录患者性别、年龄、等效球镜度数、眼轴长度。HD-OCT测量RT及GCIPL厚度;采用MAIA微视野计检测视网膜黄斑区10°范围平均光敏感度(MS)。根据屈光度不同分为A组(-1.0^-3.0 D)、B组(>-3.0^-6.0 D)、C组(>-6.0 D),比较各组所有测量参数的差异。分析患者屈光度与微视野计测量参数的相关性,相同解剖位置的黄斑区RT、GCIPL厚度与MS相关性。结果黄斑区4个方位RT 3组间差异均有统计学意义(均为P<0.05),中心方位组间差异无统计学意义(P>0.05);黄斑区4个方位视网膜GCIPL厚度3组间差异均有统计学意义(均为P<0.05)。黄斑区总体MS,4个方位MS 3组间差异均有统计学意义(均为P<0.05),中心方位视网膜MS 3组间差异无统计学意义(P=0.060)。所有参数在3组间两两比较结果均显示A组与B组、C组间差异均有统计学意义(均为P<0.05),但B组、C组间差异均无统计学意义(均为P>0.05)。总体视网膜MS及4个方位视网膜MS与屈光度均呈显著正相关(均为P<0.05),中心方位视网膜MS与屈光度无相关性(P>0.05)。黄斑区RT与视网膜GCIPL厚度4个方位均呈正相关(均为P<0.05),两者上、下方位2个参数与视网膜MS均呈正相关(均为P<0.05),余方位均无相关性(均为P>0.05)。结论无黄斑病变近视患者即使最佳矫正视力≥1.0,也会有一定程度的黄斑区结构及功能改变,二者具有一定相关性。临床中可采用OCT和微视野二者相结合进行近视患者黄斑区结构与功能改变的监测。

Objective To investigate the changes of retinal thickness(RT),retinal ganglion cell and inner plexiform layer(GCIPL)thickness and micro-visual field in myopic patients without maculopathy,and analyze the correlation of structure with functional changes.Methods The study recruited myopic patients without maculopathy who received treatment in our hospital from June to December 2018.Gender,age,spherical equivalent(SE)and axial length(AL)were recorded.HD-OCT was used to measure RT and GCIPL thickness;MAIA microperimetry was used to measure mean sensitivity(MS)at 10 degree around macular area.All patients were divided into group A(-1.0^-3.0 D),group B(>-3.0^-6.0 D)and group C(>-6.0 D),and the differences of all measurement parameters were compared among groups.The correlation of diopter with parameters detected by microperimetry,and correlation of macular RT,GCIPL thickness at the same anatomical position with MS were analyzed.Results Statistical differences were found in RT at the four directions(upper,lower nasal and temporal sides of macular area)among the three groups(all P<0.05),but no difference was found in RT at central position among three groups(P>0.05).Statistical differences were found in GCIPL thickness at four different directions of macular area among three groups(all P<0.05).There were statistical differences in total MS,MS at four directions among three groups(all P<0.05),but no difference was found in MA at central position among three groups(P=0.060).Pairwise comparison in all parameters showed statistical differences were found for group A comparing with group B or group C(both P<0.05),but no difference was found between group B and group C(all P>0.05).Significant negative correlation was found for diopter with total MS and MS at four directions(all P<0.05),but no correlation was found for MS at central position with diopter(P>0.05).Macular RT and GCIPL thickness Significant positive correlation was found at four directions(all P<0.05),these two parameters negatively correlated with MS at upper and lower directions(all P<0.05),but no correlation was found at other directions(all P>0.05).Conclusion Even if corrected visual acuity is more than 1.0,there will be some changes of macular structure and function in the myopic patients without macular lesions,and there is a certain correlation between them.OCT combined with microperimetry can be used to monitor the changes of macular structure and function in myopic patients.