儿童青少年近视眼患者视盘旁高反射卵圆样团块状结构的临床观察

Observational study on peripapillary hyper-reflective ovoid mass-like structures in children and adolescents with myopia

目的观察儿童青少年近视眼患者视盘旁高反射卵圆样团块状结构(PHOMS)的临床特征并分析其相关因素。方法横断面研究。连续收集2021年9月至2022年1月就诊于武汉市中心医院和武汉大学人民医院且近视等效球镜度数(SE)≥0.50 D的6~16岁儿童青少年近视眼患者。所有患者均行最佳矫正视力、屈光状态、眼轴长度检查, 采用裂隙灯显微镜联合检眼镜检查患者眼底, 并行眼底彩照以及视盘加强深度扫描模式的相干光层析成像术(EDI-OCT)检查, 测量参数包括视盘直径、视盘倾斜度、视盘平移度和PHOMS高度。根据是否存在PHOMS分为PHOMS组及无PHOMS组, 根据PHOMS高度分为大(>400 μm)、中(200~400 μm)和小(<200 μm)型PHOMS 3个亚组。观察PHOMS组和无PHOMS组以及各亚组的视盘特征, 并分析PHOMS的相关因素。主要采用 Mann-WhitneyU检验、Kruskal-Wallis 检验、χ2检验以及Logistic回归分析和Kendall′s tau-b相关系数进行统计学分析。结果共纳入108例(108只眼)患者, 其中男性46例(46只眼), 女性62例(62只眼), PHOMS组为70只眼(64.8%), 无PHOMS组为38只眼(35.2%)。小型PHOMS仅可在EDI-OCT中检出, 中、大型PHOMS检眼镜下表现为视盘边界模糊。单因素Logistic回归模型显示, PHOMS与年龄(OR=1.36, 95%CI:1.13~1.65, P=0.001)、近视等效球镜度数(OR=4.57, 95%CI:2.51~8.32, P<0.001)、眼轴长度(OR=2.28, 95%CI:1.37~3.82, P=0.002)、视盘倾斜度(OR=3.44, 95%CI:2.09~5.66, P<0.001)、视盘平移度(OR=0.95, 95%CI:0.93~0.98, P<0.001)、视盘直径(OR=0.75, 95%CI:0.58~0.95, P=0.019)相关。多因素Logistic回归模型显示, 近视等效球镜度数较高(OR=3.01, 95%CI:1.27~7.17, P=0.013)和视盘倾斜度较大(OR=4.06, 95%CI:1.99~8.29, P<0.001), PHOMS出现的风险较大。Kendall′s tau-b相关系数分析显示, PHOMS高度与视盘平移度呈负相关(r=-0.31, P<0.001)。结论 PHOMS存在于部分儿童青少年近视眼患者, 不同高度PHOMS的眼底表现略有差异。近视等效球镜度数较高与视盘倾斜度较大的患者, PHOMS出现的风险更大;其高度与视盘平移相关。

Objective To investigate the correlation of peripapillary hyper-reflective ovoid mass-like structures(PHOMS)in children and adolescents with myopia and its correlation factors.Methods It was a cross-sectional study.From September 2021 to January 2022,myopic children and adolescents aged 6-16 years treated in Wuhan Central Hospital and Renmin Hospital of Wuhan University with a myopic spherical equivalent(SE)≥0.5 D were consecutively included.All patients underwent best corrected visual acuity,refraction,intraocular pressure,slit lamp microscope,axial length,fundus photography and enhanced depth imaging optical coherence tomography(EDI-OCT)examination.EDI-OCT optic disc parameter measurements included diameter,degree of tilt and shift and PHOMS height.The patients were divided into PHOMS group and non-PHOMS group according to the presence or absence of PHOMS.According to the height of PHOMS,the patients were further divided into 3 subgroups:large(>400μm),medium(200-400μm)and small(<200μm).The optic disc characteristics of the PHOMS group and the non-PHOMS group and each subgroup were observed,and the correlation factors of PHOMS were analyzed.Mann-Whitney U test,Kruskal-Wallis test,chi-square test,Logistic regression analysis and Kendall′s tau-b correlation coefficient were used.Results A total of 108 patients(108 eyes)were included,including 46 males(46 eyes)and 62 females(62 eyes).There were 70 eyes(64.8%)in the PHOMS group and 38 eyes(35.2%)in the non-PHOMS group.Small PHOMS can only be detected by EDI-OCT,while medium to large PHOMS showed blurred optic disc boundaries on fundoscopy images.Univariate Logistic regression analysis showed that PHOMS was associated with age(OR=1.36,95%CI:1.13-1.65,P=0.001)and myopic SE(OR=4.57,95%CI:2.51-8.32,P<0.001),axial length(OR=2.28,95%CI:1.37-3.82,P=0.002),optic disc tilt(OR=3.44,95%CI:2.09-5.66,P<0.001),optic disc shift(OR=0.95,95%CI:0.93-0.98,P<0.001)and optic disc diameter(OR=0.75,95%CI:0.58-0.95,P=0.019).Multivariate Logistic regression analysis showed that the higher the myopic SE(OR=3.01,95%CI:1.27-7.17,P=0.013)and the greater the tilt of the optic disc(OR=4.06,95%CI:1.99-8.29,P<0.001),the higher the risk of PHOMS.Kendall′s tau-b correlation coefficient analysis showed that the height of PHOMS was negatively correlated with optic disc shift(r=-0.31,P<0.001).Conclusions PHOMS can be found in a subset of myopic children.The fundus manifestations of PHOMS of different heights are slightly different.The large myopic SE and great optic disc tilt are risk factors of PHOMS,and their magnitudes correlate with the border tissue angle.