高度近视合并视盘旁脉络膜空腔黄斑区视网膜血流密度和厚度变化观察

Macular vessel density and thickness in highly myopic eyes with peripapillary intrachoroidal cavitation

目的观察高度近视(HM)合并视盘旁脉络膜空腔(PICC)患眼黄斑区视网膜血流密度和厚度的变化。方法横断面研究。2019年3月至2021年5月于中国中医科学院眼科医院检查确诊的HM合并PICC患眼65例65只眼(HM+PICC组)以及同期年龄、性别匹配的单纯HM患者69例69只眼(单纯HM组)、正常健康志愿者65名65只眼(正常对照组)纳入研究。采用光相干断层扫描血管成像(OCTA)仪对受检眼黄斑区3 mm×3 mm范围进行扫描, 测量黄斑中心凹区、旁中心凹区上方、下方、鼻侧、颞侧视网膜浅层毛细血管层(SCP)、深层毛细血管层(DCP)血流密度以及黄斑区平均、上半侧、下半侧视网膜神经节细胞复合体(mGCC)厚度、全层视网膜厚度。HM+PICC组、单纯HM组、正常对照组受检眼间检测结果比较采用单因素方差分析, 组间两两比较采用Bonferroni法;组内黄斑区上半侧与下半侧检测结果比较采用配对样本t检验。黄斑区相同区域视网膜血流密度与mGCC厚度、全层视网膜厚度之间相关性采用Pearson偏相关分析法。结果 HM+PICC组65只眼中, PICC病灶位于视盘周围颞下、鼻下、颞上、鼻上象限者分别为57 (87.7%, 57/65)、25 (38.5%, 25/65)、3 (4.6%, 3/65)、1 (1.5%, 1/65)只眼。HM+PICC组、单纯HM组、正常对照组受检眼之间黄斑区各区域全层视网膜厚度、mGCC厚度以及SCP、DCP血流密度比较, 差异均有统计学意义(F=29.097、51.929、16.253、6.135, P<0.001)。与正常对照组比较, HM+PICC组黄斑区全层视网膜、mGCC厚度以及除中心凹区外的SCP、DCP血流密度均明显降低(P<0.05);与单纯HM组比较, HM+PICC组患眼黄斑区下半侧全层视网膜厚度、中心凹区DCP血流密度、各区域SCP血流密度和mGCC厚度均明显降低(P<0.05)。HM+PICC组患眼黄斑区下半侧视网膜血流密度以及mGCC厚度、全层视网膜厚度均明显低于上半侧, 差异有统计学意义(t=6.356、11.693、6.212、2.936, P<0.01)。Pearson偏相关分析结果显示, HM+PICC组患眼黄斑区各区域SCP血流密度与所对应的mGCC厚度、全层视网膜厚度呈正相关(r=0.584、0.534、0.592、0.496、0.485、0.517, P<0.001);黄斑区DCP血流密度, 除下半侧与全层视网膜厚度呈弱正相关外(r=0.319, P=0.014 ), 其余区域均与mGCC厚度、全层视网膜厚度无相关性(r=0.066、0.002、0.125、0.184、0.016、0.319, P>0.05 )。结论与单纯HM患眼比较, HM合并PICC患眼黄斑区各区域SCP血流密度、mGCC厚度以及下半侧全层视网膜厚度均明显降低, 尤其以黄斑区下半侧mGCC厚度和SCP血流密度变化最为显著, 且两者呈强正相关关系。

Objective To observe the changes of retinal blood flow density and thickness in the macular region of eyes with high myopia(HM)combined with peripapillary intrachoroidal cavitation(PICC).Methods A cross-sectional study.From March 2019 to May 2021,65 patients(65 eyes)diagnosed as PICC(HM+PICC group)in Eye Hospital,China Academy of Chinese Medical Sciences,sex-and age-matched 69 HM patients of 69 eyes(HM group)and 65 healthy people of 65 eyes(control group)were enrolled in this study.The optical coherence tomography angiography was used to scan macular areas in 3 mm×3 mm,and measure the macular fovea and optic disc on superior,inferior,nasal,temporal superficial capillary plexus(SCP)and deep capillary plexus(DCP)vessel density in the foveal and parafoveal region,and macular retinal ganglion cell complex(mGCC)thickness,full retinal thickness.One-way analysis of variance were used to test the difference of the index values among three groups,and then two groups were compared with Bonferroni test.A paired/-test was used to test the difference of the macular vessel density and thickness between the superior and inferior hemifield in three groups.Pearson partial regression analysis was used to calculate the correlations between them at same sites.Results PICC was located most frequently at the inferior temporal disc border,followed by the inferior nasal region,superior temporal region,and superior nasal region in the HM+PICC group on 57(87.7%,57/65),25(38.5%,25/65),3(4.6%,3/65)and 1(1.5%,1/65)eye.There were significant differences in the global and regional full retinal thickness,mGCC thickness,SCP and DCP vessel density among 3 groups(F=29.097,51.929,16.253,6.135;P<0.001).The macular SCP and DCP vessel density except in the fovea,all regional macular full retinal thickness and mGCC thickness in the HM+PICC group were significantly lower than those in the normal group(P<0.05).Compared to the HM group,the HM+PICC group had lower all regional mGCC thickness and SCP vessel density,as well as full retinal thickness in the inferior hemifield and DCP vessel density in the foveal region(P<0.05).Macular vessel density and thickness in the inferior hemifield were significantly lower than those in the superior hemifield(r=6.356,11.693,6.212,2.936;P<0.01).Pearson partial regression analysis showed the SCP vessel density was positively correlated with corresponding mGCC thickness and full retinal thickness(r=0.584,0.534,0.592,0.496,0.485,0.517;P<0.001).However,there was no significant correlation between the DCP vascular density and mGCC thickness(P>0.05),and only a weak positive correlation between the DCP vascular density and the full retinal thickness in the inferior hemifield(r=0.319,P=0.014).However,no association with average and superior full retinal thickness(r=0.066,0.002,0.125,0.184,0.016,0.319;P>0.05).Conclusion The macular SCP vessel density,mGCC thickness and the full retinal thickness in the inferior hemifield in PICC eyes are lower than those in the HM eyes,especially the mGCC thickness and SCP vessel density in the inferior hemifield,and there is a strong positive correlation between them.