高度近视豹纹状眼底视网膜脉络膜血流改变及相关性分析

目的 观察并定量分析高度近视不同级别豹纹状眼底患者黄斑及视盘区域视网膜、脉络膜血流参数变化。 方法 采用横断面临床研究,收集2018年6月~12月在医院就诊的高度近视患者42例(76眼),所有患者均行彩色眼底照相和光学相干断层扫描血管成像(OCTA)检查。应用ETDRS分区,根据脉络膜大血管暴露程度,将受检眼分为0级组、1级组、2级组和3级组。采用OCTA测量黄斑不同区域视网膜浅层毛细血管丛、视网膜深层毛细血管丛(DCP)以及视盘区视乳头层、放射状视盘周围毛细血管层(RPC)血管密度,测量中心凹下脉络膜厚度(SFCT)、脉络膜总面积(TCA)、脉络膜管腔面积(LA)、脉络膜基质面积(SA),并计算脉络膜血管指数(CVI)。统计学采用Kruskal-Wallis H检验、单因素方差分析、Dunnett's检验及多重线性回归,视网膜、脉络膜血流参数与豹纹状眼底分级的关系采用偏相关分析。 结果 各组间黄斑中心凹DCP血管密度、视盘区RPC层血管密度、SFCT、TCA、LA、SA、CVI比较差异有统计学意义(P均<0.05)。豹纹状眼底分级与黄斑中心凹DCP血管密度、CVI呈正相关(r=0.441、0.280,P均<0.05);与视盘区RPC层血管密度、SFCT、TCA、LA、SA呈负相关(r=-0.290、-0.567、-0.511、-0.475、-0.512,P均<0.05)。 结论 随着高度近视眼豹纹状眼底程度的加深,黄斑中心凹视网膜深层毛细血管丛血管密度及脉络膜血管指数增高,视盘区放射状视盘周围毛细血管层血管密度及中心凹下脉络膜厚度降低。

Analysis of retinal choroidal blood flow changes and correlation with tessellated fundus in highly myopic eyes

Objective To observe and quantify the changes of parameters related to the macular, optic disc, and choroidal blood flow of high myopia patients with different degrees of fundus tessellation. Methods A cross-sectional study. From June 2018 to December 2018, 76 eyes of 42 individuals with high myopia were included in the study. Participants underwent color fundus photography and optical coherence tomography angiography(OCTA). The degree of tessellated fundus was assessed by an application of ETDRS grid and then divided into four groups(grade 0, grade 1, grade 2, and grade 3). The vascular density of superficial retinal capillary plexus and deep retinal capillary plexus(DCP)in the macular region, optic nerve head and radial peripapillary capillary(RPC)in the optic disc were measured by OCTA. The subfoveal choroidal thickness(SFCT), the total choroidal area(TCA), luminal area(LA), and stromal area(SA)were measured as well, and then the choroidal vascular index(CVI)was calculated. Kruskal-Wallis H test,analysis of variance, Dunnett's test, and multiple linear regression were used to analyze the collected data from the four groups. Partial correlation analysis was used to analyze the relationship between fundus tessellation and retinal choroidal blood flow parameters. Results There were significant differences in the DCP vascular density in the fovea, vascular density of RPC in the optic disc, SFCT, TCA, LA, SA, and CVI(all P<0.05). The degree of fundus tessellation was positively correlated with the vascular density of DCP in the fovea and CVI(r=0.441, 0.280,all P<0.05); while negatively correlated with the vascular density of RPC in the optic disc, SFCT, TCA, LA, and SA(r=-0.290, -0.567, -0.511, -0.475, -0.512, all P<0.05). Conclusion As the degree of fundus tessellation increases, the vascular density of the deep retinal capillary plexus in the fovea and choroidal vascular index increase as well, while the vascular density of radial peripapillary capillary in the optic disc and subfoveal choroidal thickness decrease.