近视快速增长儿童眼底神经纤维层厚度和血流参数特征

doi:10.3760/cma.j.cn115909-20191118-00310

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摘要目的：利用光学相干断层扫描血管成像技术（OCTA）研究近视快速增长儿童的眼底黄斑区和视乳头区微细结构和血流灌注等临床特征。方法：病例对照研究。纳入7～14岁快速增长（1年近视增长 >1.00 D）的近视患儿40例（快速增长组），同时选取39例增长缓慢（1年近视增长≤0.50 D）的近视患儿作为对照（稳定增长组），分别测量其屈光度和最佳矫正视力，通过LenStar测量眼轴，OCTA测量黄斑区和视乳头区血流参数和神经纤维层（RNFL）厚度。2组间血流参数和RNFL厚度比较采用协方差分析，眼轴、屈光度、视网膜厚度、血流密度之间相关性采用Pearson相关。结果：快速增长组和稳定增长组眼轴分别为（24.7±0.9）mm和（24.5±0.8）mm，2组差异无统计学意义。黄斑区3 mm早期糖尿病视网膜病变研究（ETDRS）分区视网膜深层和浅层以及视乳头4.5 mm GH（Garway heath）分区的毛细血管血流密度的比较，2组在各局部区域的差异均无统计学意义，但在视乳头旁平均RNFL 厚度和视乳头鼻侧区域，快速增长组明显较缓慢增长组薄（P<0.05）。近视增长量和眼底血流参数不相关，但与视乳头鼻侧区域RNFL厚度呈负相关。结论：儿童近视快速增长未伴有眼底血流密度的异常，但可伴有视乳头旁鼻侧、鼻上方和鼻下方RNFL厚度变薄，眼底血流参数对近视发展速度的预估作用尚需进一步研究。

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关键词 ：光学相干断层扫描血管成像技术, 近视快速增长, 视乳头旁神经纤维层厚度, 视网膜血流密度

Abstract：Objective: To investigate the clinical characteristics of macular and peripapillary microstructures and blood perfusion in children with rapid myopic progression using optical coherence tomography angiography (OCTA). Methods: In this case-control study, 40 children aged 7-14 years with rapid myopia progression (myopia progression in one year >1.00 D) and 39 children with stable progression (myopia progression in one year ≤0.50 D) were included. Macular vessel densities of the superficial and deep capillary plexuses (SCP, DCP, respectively) and peripapillaryretinal nerve fiber layer (RNFL) thickness were measured by clinical OCTA. The retinal blood flow parameters and the thickness of the peripapillary RNFL were analyzed. The blood flow parameters and RNFL thickness between the two groups were compared by covariance analysis, and the correlations between axial length, refraction, retinal thickness and blood flow density were analyzed by Pearson correlation. Results: There was no significant difference in axial length between the rapid progression group and stable progression group (24.7±0.9 vs. 24.5±0.8, respectively). There was no significant difference in the parameters of retinal blood flow between the two groups, whether in the 3 mm macular area of the superficial or deep vascular network or the 4.5 mm optic papilla area. However, the thickness of the RNFL in the superior-nasal, nasal-superior, nasal-inferior and inferiornasal parts of the peripapillary in the rapid progression group was significantly thinner. At the same time, there was no significant correlation between myopia progression and fundus blood flow parameters, but there was a negative correlation between myopia progression and RNFL thickness in the nasal peripapillary region. Conclusions: Rapid myopia progression is not accompanied by an abnormal fundus blood flow density, but it can be accompanied by thinning of the peripapillary RNFL thickness. The prediction of the rate of myopia development needs further study.

Key words： optical coherence tomography angiography rapid growth of myopia peripapillary nerve fiber layer thickness retinal blood flow density

收稿日期: 2019-11-18

基金资助:温州市科技计划项目（Y20180714）

通讯作者: 余新平（ORCID：0000-0001-5599-4151），Email：yu-xinping@163.com

引用本文:

许梅萍1 叶聪1 陈园园1 许金玲1 楼江涛2 余新平1. 近视快速增长儿童眼底神经纤维层厚度和血流参数特征[J]. 中华眼视光学与视觉科学杂志, 2020, 22(6): 448-454. Meiping Xu1,Cong Ye1,Yuanyuan Chen1,Jinling Xu1,Jiangtao Lou2,Xinping Yu1. Clinical Study on the Characteristics of Peripapillary Retinal Nerve Fiber Layer Thickness and Fundus Blood Flow Parameters in Children with Rapid Myopia Progression. Chinese Journal of Optometry Ophthalmology and Visual science, 2020, 22(6): 448-454. DOI: 10.3760/cma.j.cn115909-20191118-00310

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https://www.cjoovs.com/CN/10.3760/cma.j.cn115909-20191118-00310 或 https://www.cjoovs.com/CN/Y2020/V22/I6/448

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