基于扫频光源光学相干断层成像观察病理性近视眼脉络膜厚度和血管变化

doi:10.3760/cma.j.cn115909-20200807-00325

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摘要目的：利用扫频光源光学相干断层扫描研究病理性近视眼脉络膜厚度（CT）和血管的变化。方法：系列病例研究。共纳入2019年9月至2020年6月在温州医科大学附属眼视光医院就诊的40名受试者，根据诊断分为高度近视组和病理性近视组2组，其中高度近视组20例，病理性近视组20例，用 VG200 OCT对受试者右眼以黄斑中心凹为中心12 mm扫描区进行成像，然后利用实验室自行编写的软件对黄斑中心凹为中心的直径6 mm范围内CT进行测量，并对图像二值化，计算出脉络膜血管指数（CVI）。采用独立样本t检验和Mann Whitney U检验进行2组间差异的比较，并进行相关性分析。结果：相较于高度近视眼，病理性近视眼以黄斑为中心6 mm范围内的CT及CVI均有所下降。高度近视组和病理性近视组6 mm范围内CT在垂直方向分别为（171±54）μm和（92±37）μm（t=5.269， P<0.001），水平方向上分别为（149±47）μm和（81±34）μm（t=5.132，P<0.001）。2组中央1 mm范围内CT在垂直方向（t=4.386，P<0.001）和水平方向（t=4.468，P<0.001）差异均有统计学意义；1～3 mm 范围内，垂直方向上方（t=4.836，P<0.001）、下方（t=4.452，P<0.001），水平方向颞侧（t=4.001， P<0.001）、鼻侧（t=4.747，P<0.001）的CT在2组间差异均有统计学意义；在3～6 mm范围内，垂直方向上方（t=5.149, P<0.001）、下方（t=5.390，P<0.001），水平方向颞侧（t=4.999，P<0.001）、鼻侧（t=5.646，P<0.001）的CT在2组间差异均有统计学意义。同时在直径6 mm范围内，2组间垂直方向 CVI分别为0.593±0.030和0.535±0.069，水平方向分别为0.595±0.025和0.545±0.073；中央1 mm 范围内CVI的在垂直方向（Z=-2.353，P=0.019）和水平方向（t=3.109，P=0.004）差异有统计学意义； 1～3 mm范围内，垂直方向上方（t=3.339，P=0.002）、水平方向鼻侧（Z=-2.029，P=0.042）的CVI在 2组间差异有统计学意义；3～6 mm范围内，垂直方向上方（Z=-3.111，P=0.002）、水平方向鼻侧（Z=-2.083，P=0.037）区域2组间CVI差异有统计学意义。相关性分析结果表明，随着眼轴的增长，垂直方向（r=-0.814，P<0.001）、水平方向上（r=-0.798，P<0.001）在直径6 mm范围内CT明显变薄；垂直方向（r=-0.603，P<0.001）、水平方向上（r=-0.506，P<0.001）CVI明显减小。随着近视程度的增加，垂直方向（r=0.724，P<0.001）、水平方向上（r=0.742，P<0.001）直径6 mm范围内CT明显变薄；垂直方向（r=0.588，P<0.001）、水平方向上（r=0.520，P<0.001）CVI明显减小。结论：与高度近视眼相比，病理性近视的CT和血流有所差异，且随眼轴延长和近视度数增加而下降。

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关键词 ： , 病理性近视, 扫频光源光学相干断层成像, 脉络膜厚度, 脉络膜血管指数

Abstract： Objective: To investigate the changes in the choroidal thickness (CT) and blood flow in pathologically myopic eyes using swept-source optical coherence tomography. Methods: Using a cross-sectional design, a total of 40 subjects who visited the Eye Hospital, Wenzhou Medical University from September 2019 to June 2020 were included and divided into two groups: 20 cases of high myopia and 20 cases of pathological myopia, which were imaged with VG200 OCT in the 12 mm scan area of the subjects' right eyes centered on the central macular fovea. Then custom-built software was used to measure the CT of the macular central concavity within a diameter of 6 mm, and the images were binarized to calculate the choroidal vascular index (CVI). Results: Compared to highly myopic eyes, pathologically myopic eyes had decreased CT and CVI in the 6 mm range centered on the macula. CT in the 6 mm range was 171±54 and 92±37 μm in the vertical direction (t=5.269, P<0.001) and 149±47 and 81±34 μm in the horizontal direction (t=5.132, P<0.001). There were statistically significant differences between the two groups in the central 1 mm range of CT, both vertically (t=4.386, P<0.001) and horizontally (t=4.468, P<0.001). There was a statistically significant difference in CT on the nasal side (t=4.747, P<0.001) in the 1-3 mm range of the vertical superior (t=4.836, P<0.001), inferior (t=4.452, P<0.001), horizontal temporal areas (t=4.001, P<0.001) and nasal (t=4.747, P<0.001). There was a statistically significant difference between the two groups in the 3-6 mm areas of the vertical superior (t=5.149, P<0.001) and inferior (t=5.390, P<0.001), and horizontal temporal (t=4.999, P<0.001) and nasal (t=5.646, P<0.001). At the same time, within the diameter of 6 mm, the vertical CVI between the 2 groups was 0.593±0.030 and 0.535±0.069, and the horizontal CVI was 0.595±0.025 and 0.545±0.073, respectively. Within the central 1 mm area, the CVIs in the vertical (Z=-2.353, P=0.019) and horizontal (t=3.109, P=0.004) directions were 0.595±0.025 and 0.545±0.073, respectively, and there was a statistically significant difference between the 2 groups. In the 1-3 mm range, there was a significant difference in CVI in the upper vertical direction (t=3.339, P=0.002) and in the horizontal nasal direction (Z=-2.029, P=0.042). In the upper vertical direction (Z=-3.111, P=0.002), there was a significant difference in CT on the nasal side (t=4.747, P<0.001). There was a statistically significant difference in CVI between the simple high myopia and pathological myopia groups in each region of the horizontal nasal side (Z=-2.083, P=0.037). The results of correlation analysis showed that CT and CVI decreased with an increase in the degree of myopia and an increase in the ocular axis. Conclusions: Compared with high myopia, the CT and blood flow of pathological myopia show a significant decrease, and the changes have correlations with axial elongation and the decrease in spherical equivalent.

Key words： pathological myopia swept-source optical coherence tomography choroidal thickness choroidal vascularity index

收稿日期: 2020-08-07

PACS:

基金资助: 浙江省重点研发项目（2019C03045）；温州市重大科技创新攻关项目（2018ZY016）；浙江省自然科学基金（LQ17H180004）

通讯作者: 瞿佳（ORCID：0000-0003-1678-966X），Email：jqu@wz.zj.cn

引用本文:

王一益林珏张日炎陈思思邵一磊沈梅晓瞿佳. 基于扫频光源光学相干断层成像观察病理性近视眼脉络膜厚度和血管变化[J]. 中华眼视光学与视觉科学杂志, 2021, 23(3): 171-178. Yiyi Wang, Jue Lin, Riyan Zhang, Sisi Chen, Yilei Shao, Meixiao Shen, Jia Qu. Changes in Choroidal Thickness and Blood Vessels in Pathological Myopia Using Swept-Source Optical Coherence Tomography. Chinese Journal of Optometry Ophthalmology and Visual science, 2021, 23(3): 171-178. DOI: 10.3760/cma.j.cn115909-20200807-00325

链接本文:

https://www.cjoovs.com/CN/10.3760/cma.j.cn115909-20200807-00325 或 https://www.cjoovs.com/CN/Y2021/V23/I3/171

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