超广角眼底成像技术在变性近视周边视网膜形态改变中的应用

Application of ultra-widefield scanning laser ophthalmoscope in detecting peripheral retinal lesions in degenerativemyopia

目的分析超广角眼底成像系统检查发现的远周部视网膜异常改变的种类和发生率。方法前瞻性病例对照研究。随机选取2020年10月至2021年3月在山西省眼科医院门诊就诊的变性近视患者59例(118只眼), 均接受了OCT及Optos California 200度超广角激光扫描眼底照相自发荧光(UWAF)检查。其中16例(32只眼)疑似为脉络膜新生血管(CNV), 行超广角荧光素底造影(UWFA)。有患者按眼轴长度分为<30 mm组(66只眼)和≥30 mm(52只眼)组, 比较两组周边视网膜异常改变的发生率。结果眼轴长度≥30 mm组与眼轴长度<30 mm组相比:非压迫变白[48.08%(25/52)vs.28.79% (19/66),χ^(2)=4.63, P=0.031]、周边视网膜格子样变性[30.77%(16/52)vs.10.61%(7/66), χ^(2)=7.54, P=0.006]及视网膜裂孔或脱离[21.15%(11/52)vs.7.58(5/66), χ^(2)=4.58, P=0.032]的发生率差异均有统计学意义。确诊为CNV者32只眼中眼轴长度≥30 mm组17只眼和眼轴长度<30 mm组15只眼行UWFA检查, 两组患者的微动脉瘤[58.82%(10/17)vs.20.00%(3/15),χ^(2)=4.98, P=0.026]、远周部视网膜无灌注区[52.94%(9/17)vs.13.33%(2/15), χ^(2)=5.54, P=0.019]和荧光素钠渗漏[76.47%(13/17)vs.40.00% (6/15),χ^(2)=4.39, P=0.036]相比, 差异均有统计学意义。结论超广角激光扫描眼底成像系统能够发现变性近视远周部视网膜结构及血管走行的异常, 能为诊断变性近视眼底病变、评估病情严重程度及预后提供参考价值。

Objective To analyze the types and proportions of peripheral retinal lesions in pathological myopia using ultra-widefield scanning laser imaging system.Methods In this prospective case control study,118 eyes of 59 patients with degenerative myopia in the outpatient department of Shanxi Eye Hospital from Oct.2020 to Mar.2021 were selected randomly.All cases were measured with OCT and Optos California 200 degree ultra-widefield fundus autofluorescence(UWAF).Among them,32 eyes of 16 cases with suspected choroidal neovascularization(CNV)received ultrawidefied fundus fluorescein angiography(UWFA).All cases in this study were divided into two groups based on the axial length(AL),66 eyes in AL<30 mm group and 52 eyes in AL≥30 mm group.The incidence of peripheral retinal abnormalities was compared between the two groups.ResultsThe incidence of non-oppressive whitening[48.08%(25/52)us.28.79%(19/66),X2=4.63,P=0.031],peripheral retinal lattice degeneration[30.77%(16/52)us.10.61%(7/66),X²=7.54,P=0.006]and retinal hiatal or detachment[21.15%(11/52)us.7.58(5/66),χ^(2)=4.58,P=0.032]in the AL≥30 mm group were significantly higher than those in the AL<30 mm group.Among 32 eyes with suspected CNV,there were 17 eyes in the AL≥30 mm group and 15 eyes in the AL<30 mm group.UWFA examination,the incidence of retinal microaneurysms[58.82%(10/17)us.20.00%(3/15),χ^(2)=4.98,P=0.026],nonperfusion of retina in far periphery[52.94%(9/17)us.13.33%(2/15),X2=5.54,P=0.019],and fluorescein leakage[76.47%(13/17)us.40.00%(6/15),χ^(2)=4.39,P=0.036]in the AL≥30 mm group was significantly higher than those in the AL<30 mm group.Conclusion Ultra-widefield scanning laser ophthalmoscope can detect the abnormal retinal structure and vascular course in the distal periphery of degenerative myopia,which can provide reference value for the diagnosis of degenerative myopia fundus lesions,evaluation of disease severity and prognosis.