高度近视患者视盘结构与眼底形态学标记相关性分析

Correlation analysis of optic disc structure and fundus morphological markers in highly myopic eyes

目的:观察高度近视患者视盘结构改变以及与眼底形态学标记的相关性。方法:回顾性研究。2018年7月至2020年1月于首都医科大学附属北京友谊医院眼科检查确诊的高度近视患者90例155只眼纳入研究。其中,男性31例52只眼,女性59例103只眼;年龄(57.1±14.2)岁;眼轴长度(AL)(28.5±2.6)mm。患者均行眼底彩色照相检查。依据近视性黄斑病变分型将患者按照病变类型和程度分为非病理性近视组、轻度牵拉型病变组、重度牵拉型病变组、新生血管型病变组,分别为35、58、41、21只眼。通过数字化眼底照片和ImageJ图像分析软件测量患眼视盘水平、垂直、最大、最小直径,视盘旁萎缩弧中δ区和γ区水平和垂直直径,椭圆指数,颞上动脉血管弓最上点和颞下动脉血管弓最下点之间垂直距离(VDA),颞侧动脉血管弓和视盘间夹角(Kappa角),视盘中心和黄斑中心凹之间距离(DFD),以及视盘水平轴和视盘中心至黄斑中心凹连线间夹角(DFA)。视盘直径和其他参数之间行相关性分析。组间差异比较采用单因素分析和多因素分析。结果:视盘水平直径与δ区水平直径(r=0.300,P<0.001)、Kappa角(r=0.260,P=0.003)、椭圆指数(r=0.650,P<0.001)呈正相关;与DFD呈负相关(r=-0.190,P=0.030)。视盘垂直直径与视盘水平直径(r=0.280)、δ区水平直径(r=0.330)和垂直直径(r=0.460)、γ区水平直径(r=0.430)和垂直直径(r=0.390)、DFD(r=0.390)呈正相关(P<0.001);与DFA(r=-0.210,P=0.001)、Kappa角(r=-0.210,P=0.004)呈负相关。与非病理性近视组比较,重度牵拉型病变组患眼视盘水平、垂直直径差异有统计学意义(P<0.05)。其中,水平直径差异不依赖眼轴和年龄差异;垂直直径差异由眼轴差异引起。与非病理性近视组比较,新生血管型病变组患眼视盘水平直径差异有统计学意义(P<0.05),且不依赖眼轴和年龄差异;视盘垂直直径差异无统计学意义(P>0.05)。结论:视盘结构与多个眼底形态学标记相关,并根据高度近视患者年龄、眼轴及病变程度不同而呈现差异化。

Objective To observe the changes of optic disc structure in patients with high myopia and the correlation with the morphological markers of the fundus.Methods A retrospective study.From July 2018 to January 2020,90 patients(155 eyes)diagnosed as high myopia in Department of Ophthalmology of Beijing Friendship Hospital affiliated to Capital Medical University were included in the study.Among them,there were 31 males(52 eyes)and 59 females(103 eyes),with age of 57.1±14.2 years old and axial length(AL)of 28.5±2.6 mm.According to the classification of myopic macular degeneration,patients were divided into 4 groups based on forms and degree of lesions,including non-pathological myopia group,mild traction lesions group,severe traction lesions group and neovascular lesions group,35,58,41,21 eyes,respectively.The digitized fundus photographs and an Image J system were used to measure the horizontal,vertical,maximal,and minimal diameter of the optic disc,the horizontal and vertical diameter of the parapapillaryδzone andγzone,ovality index,distance between the most superior point of the temporal superior arterial arcade and most inferior point of the temporal inferior arterial arcade(VDA),angle between the temporal arterial arcade and optic disc(angle kappa),distance between the optic disc center and the fovea(DFD),angle between the horizontal disc axis and the disc-fovea line(DFA).The correlation between the diameter of the optic disc and other parameters was analyzed.Univariate and multivariate analysis were used to compare differences between groups.Results The horizontal diameter of the optic disc was positively correlated with the horizontal diameter of theδzone(r=0.300,P<0.001),Kappa angle(r=0.260,P=0.003),and elliptic index(r=0.650,P<0.001);it was negatively correlated with DFD(r=-0.190,P=0.030).Optic disc vertical diameter and optic disc horizontal diameter(r=0.280),δ-zone horizontal diameter(r=0.330)and vertical diameter(r=0.460),γ-zone horizontal diameter(r=0.430)and vertical diameter(r=0.390),DFD(r=0.390)was positively correlated(P<0.001);it was negatively correlated with DFA(r=-0.210,P=0.001)and Kappa angle(r=-0.210,P=0.004).Compared with the non-pathological myopia group,there were statistically significant differences in the horizontal and vertical diameters of the optic disc in the severe traction disease group(P<0.05).Among them,the horizontal diameter difference did not depend on the eye axis and age difference;the vertical diameter difference was caused by the eye axis difference.Compared with the non-pathological myopia group,the difference in the horizontal diameter of the optic disc in the neovascular disease group was statistically significant(P<0.05),and did not depend on the difference in the axis and age;the difference in the vertical diameter of the optic disc was not statistically significant(P>0.05).Conclusion The morphology of optic disc was related to several fundus morphological markers,which was differentiated according to the age,AL and the degree of disease in patients with high myopia.