高度近视黄斑不同区域RNFL厚度特点及其与屈光度、眼轴、血流密度的关系

Characteristics of RNFL thickness in different areas of macula in high myopia and its relationship with diopter,axial length and blood flow density

目的分析高度近视黄斑不同区域视网膜神经纤维层(RNFL)厚度特点,以及与屈光度(SE)、眼轴(AL)、血流密度的关系。方法选取该院2016年1月至2021年6月60例(60眼)近视患者,按照SE分为高度组(38例)与超高度组(22例),采用光学相干断层扫描血管成像技术(OCTA)测量患者黄斑中心凹区、旁中心凹区(上方、下方、鼻侧和颞侧象限)及中心凹外区(上方、下方、鼻侧和颞侧象限)的RNFL厚度,获取视网毛细血管层(SCP)、视网膜深层毛细血管层(DCP)及脉络膜毛细血管层(CC)的血流密度。采用Spearman相关系数分析RNFL厚度与SE、AL、血流密度的关系。结果高度组与超高度组患者黄斑RNFL厚度与血流密度比较,差异无统计学意义(P>0.05)。所有患者黄斑中心凹区、旁中心凹区、中心凹外区的RNFL厚度分别为(13.96±2.80)μm、(88.47±10.25)μm、(151.36±28.75)μm,两两比较差异均有统计学意义(P<0.05)。旁中心凹区中,上方象限RNFL厚度最薄(P<0.05),下方象限RNFL厚度最厚(P<0.05)。中心凹外区中,颞侧象限RNFL厚度最薄(P<0.05)。旁中心凹区各象限RNFL厚度均明显薄于中心凹外区各象限(P<0.05)。中心凹外区上方象限RNFL厚度与SE呈负相关(r=-0.356,P=0.024)。旁中心凹区下方象限及鼻侧象限RNFL厚度与SCP血流密度均呈正相关(r=0.462、0.327,P<0.05)。中心凹外区上方象限、下方象限及鼻侧象限与SCP血流密度均呈正相关(r=0.492、0.742、0.671,P<0.05)。结论高度近视患者黄斑不同区域RNFL厚度分布不均匀,部分区域RNFL厚度与SE、血流密度存在一定相关性。

Objective To analyze the characteristics of retinal nerve fiber layer(RNFL)thickness in different areas of macula in high myopia,and study the relationship between RNFL thickness and diopter(SE),axial length(AL)and blood flow density.Methods A total of 60 cases(60 eyes)of myopia patients of this hospital from January 2016 to June 2021 were selected and divided into the high group(38 cases)and the super high group(22 cases)according to the SE.Optical coherence tomography angiography(OCTA)was used to measure the RNFL thickness in the central foveal,parafoveal(superior,inferior,nasal,and temporal quadrants),and extrafoveal(superior,inferior,nasal,and temporal quadrants).The blood flow densities of superficial capillary plexus(SCP),deep capillary plexus(DCP)and choriocapillaris(CC)were obtained.The Spearman correlation coefficient was used to analyze the relationship between RNFL thickness and SE,AL,and blood flow density.Results There was no significant difference in macular RNFL thickness and blood flow density between the high group and the super high group(P>0.05).The thickness of RNFL in the central fovea,parafovea,and extrafoveal were(13.96±2.80)μm,(88.47±10.25)μm,(151.36±28.75)μm,respectively,and the differences were statistically significant(P<0.05).In the parafoveal area,the RNFL thickness in the upper quadrant was the thinnest(P<0.05),and the RNFL thickness in the lower quadrant was the thickest(P<0.05).In the extrafoveal area,the temporal quadrant had the thinnest RNFL(P<0.05).The thickness of RNFL in each quadrant of the parafoveal area was significantly thinner than that of the quadrants of the extrafoveal area(P<0.05).The thickness of RNFL in the quadrant of the central foveal was significantly negatively correlated with SE(r=-0.356,P=0.024).The thickness of RNFL in the lower quadrant of the parafovea and nasal quadrant was significantly positively correlated with SCP blood flow density(r=0.462,0.327;P<0.05).The upper quadrant,lower quadrant and nasal quadrant of the central fovea were significantly positively correlated with SCP blood flow density(r=0.492,0.742,0.671;P<0.05).Conclusion The distribution of RNFL thickness in different areas of macula in patients with HM is uneven,and there is a certain correlation between RNFL thickness in some areas and SE and blood flow density.