不同程度近视脉络膜、视网膜黄斑区微循环和视敏度观察及其相关性研究

Observation of microcirculation and light sensitivity in the macular region of choroid and retina with different degrees of myopia

目的观察不同程度近视及正视人群脉络膜、视网膜黄斑区微循环及视敏度变化,初步分析其与眼轴长度(AL)的相关性。方法横断面观察性研究。2019年5月至2020年11月于南昌爱尔眼科医院就诊的不同程度近视者及同期志愿者142名142只眼纳入研究。受试者均行综合验光、OCT血管成像(OCTA)及微视野检查以及AL测量。采用频域OCTA仪测量黄斑区6 mm×6 mm范围视网膜浅层毛细血管丛血流密度(SVD)、深层毛细血管丛血流密度(DVD)、中心凹无血管区(FAZ)面积和脉络膜毛细血管血流空白区(FD)百分比。采用黄斑完整性评估仪测量黄斑10°视网膜平均光敏感度(MS)和黄斑中心凹2°、4°固视率(P1、P2)、63%和95%双曲线椭圆面积(BCEA)。组间两两比较采用最小显著性差异法检验。结果142名142只眼中,男性68名68只眼,女性74名74只眼。依据不同等效球镜度数(SER),将受试者分为正视组、低度近视组、中度近视组、高度近视组,分别为31、36、44、31只眼。4个组受试眼SER(H=132.776)、AL(F=61.118)比较,差异有统计学意义。正视组、低度近视组、中度近视组受试眼SVD(P=0.003、0.002、0.003)、DVD(P<0.001、<0.001,P=0.001)均高于高度近视组,差异有统计学意义;正视组受试眼FAZ面积高于中度近视组,差异有统计学意义(P=0.013);中度近视组、高度近视组受试眼脉络膜毛细血管FD百分比高于正视组,差异有统计学意义(P=0.011、0.030)。高度近视组受试眼视网膜MS显著低于正视组、低度近视组、中度近视组,差异有统计学意义(P<0.001、<0.001,P=0.035)。正视组、低度近视组、中度近视组、高度近视组受试眼63%BCEA、95%BCEA、P1、P2比较,差异均无统计学意义(H=6.936、7.041、5.450、4.239,P>0.05)。相关性分析结果显示,黄斑区SVD(r=-0.256,P=0.002)、DVD(r=-0.465,P<0.001)、FAZ面积(r=-0.308,P<0.001)与AL呈负相关;脉络膜毛细血管FD百分比与AL呈正相关(r=0.170,P=0.043)。视网膜MS与SVD(r=0.252,P=0.003)、DVD(r=0.298,P<0.001)、FAZ面积(r=0.334,P<0.001)呈正相关;与AL呈负相关(r=-0.439,P<0.001);与脉络膜毛细血管FD百分比不相关(r=-0.061,P=0.473)。结论随着近视屈光度和AL增加,黄斑区SVD、DVD、视网膜MS均呈下降趋势;视网膜MS下降与SVD、DVD减少相关。

Objective To observe the changes of choroid,macular microcirculation and retinal light sensitivity(MS)in people with different degrees of myopia and emmetropia,and to analyze the relationship between them and the axial length(AL).Methods A cross-sectional observational study.From May 2019 to November 2020,142 people(142 eyes)of different degrees of myopia and volunteers from Nanchang Aier Eye Hospital were included in the study.All subjects underwent comprehensive optometry,OCT angiography(OCTA),micro-perimetry examination,and axial length(AL)measurement.A frequency domain OCTA instrument was used to measure the blood flow density of the superficial retinal capillary plexus(SVD),the blood flow density of the deep capillary plexus(DVD),the area of the foveal avascular zone(FAZ)and the choroidal capillaries in the 6 mm×6 mm area of the macula,and percentage of vascular blood flow blank area(FD).The macular integrity assessment instrument was used to measure macular 10°retinal MS and macular fovea 2°,4°fixation rate(P1,P2),63%and 95%hyperbolic ellipse area(BCEA).Pairwise comparisons between groups were tested by the least significant difference method.Results Among 142 eyes,68 eyes were in male,74 eyes were in female.According to different equivalent spherical powers(SER),subjects were divided into emmetropia group,low myopia group,moderate myopia group,and high myopia group,with 31 eyes,36 eyes,44 eyes,and 31 eyes,respectively.Compared with SER(H=132.776)and AL(F=61.118)of the tested eyes in the 4 groups,the difference was statistically significant.The SVD(P=0.003,0.002,0.003)and DVD(P<0.001,<0.001,P=0.001)of the emmetropia group,low myopia group,and moderate myopia group were higher than those of the high myopia group,and the difference was statistically significant.The FAZ area of the emmetropia group was higher than that of the moderate myopia group,the difference was statistically significant(P=0.013).The FD percentage of choroidal capillaries in the moderate myopia group and the high myopia group was higher than that of the emmetropia group,the difference was statistically significant(P=0.011,0.030).MS in the high myopia group was significantly lower than that in the emmetropia group,low myopia group,and moderate myopia group,the difference was statistically significant(P<0.001,<0.001,P=0.035).Compared with 63%BCEA,95%BCEA,P1 and P2 among subjects in the emmetropia group,low myopia group,moderate myopia group,and high myopia group,the difference was not statistically significant(H=6.936,7.041,5.450,4.239;P>0.05).The results of correlation analysis showed that the macular area SVD(r=-0.256,P=0.002),DVD(r=-0.465,P<0.001),FAZ area(r=-0.308,P<0.001)were negatively correlated with AL.The percentage of FD of choroidal capillaries was positively correlated with AL(r=0.170,P=0.043).Retinal MS was positively correlated with SVD(r=0.252,P=0.003),DVD(r=0.298,P<0.001),FAZ area(r=0.334,P<0.001),it was negatively correlated with AL(r=-0.439,P<0.001),it was not related to the percentage of FD of choroidal capillaries(r=-0.061,P=0.473).Conclusions With the increase of myopic refractive power and AL,the macular area SVD,DVD,and retinal MS all show a downward trend.The decline of retinal MS is related to the decrease of SVD and DVD.