近视人群盘周放射状毛细血管网血流与视网膜神经纤维层厚度的相关性研究
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南京医科大学第一附属医院眼科

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Correlational research between vascular changes of radial peripapillary capillary and retinal nerve fiber layer thickness in myopes
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Department of Ophthalmology,The First Affiliated Hospital of Nanjing Medical University

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    摘要:

    目的 基于新的血管密度量化方法探讨近视人群盘周放射状毛细血管(RPC)血流密度与盘周视网膜神经纤维层(RNFL)厚度、脉络膜血流参数的相关性。方法 横断面研究。2019年4月至2020年1月于江苏省人民医院眼科行眼底筛查的高度近视人群100只眼(HM组)和中低度近视人群82只眼(LMM组)纳入研究。测量所有受检者最佳矫正视力(BCVA)、眼压、眼轴(AL)、等效球镜(SE),行裂隙灯显微镜和散瞳后眼底、眼底彩色及无赤光照相、光学相干断层扫描血管成像(OCTA)检查。采用OCTA仪对受检眼视盘区4.5mm × 4.5mm范围进行扫描,软件自动获取视盘多色超广域激光扫描眼底镜(SLO)图像,分别有两条放射线将其分为以视盘为中心的上方、下方、鼻侧、颞侧4个区。所有的SLO图像由同一名眼科医生绘制盘周β区萎缩弧(PPA-β),经另一名高年资眼科专家审核后使用PyCharm软件计算PPA-β区面积及相应的脉络膜层血流密度。将AL、SE、PPA-β区面积及血流密度、盘周RNFL厚度与RPC血流密度进行Spearman相关性分析和多元线性回归分析。结果 HM组与LMM组受检眼对比,平均盘周RNFL厚度及除颞侧以外的分区RNFL厚度、RPC平均血流密度及除颞侧以外的分区血流密度、PPA-β区面积及其内脉络膜层血流密度比较,差异有统计学意义(P < 0.05)。SE、平均盘周RNFL厚度、PPA-β区相应的脉络膜血流密度与RPC平均血流密度呈正相关(P < 0.001);AL、PPA-β区面积与RPC平均血流密度呈负相关性(P < 0.001)。多元线性回归分析发现仅平均RNFL厚度(P < 0.001)和PPA-β区面积(P = 0.014)为RPC平均血流密度的独立影响因素。对同一区域的RNFL厚度和RPC血流进行亚组分析,上方、下方、鼻侧、颞侧都表现出正相关关系(P < 0.001)。结论 盘周RNFL厚度和PPA-β区面积是RPC血流变化的重要成因,提示眼底结构和血流之间存在关联,需重视近视相关视神经病变。

    Abstract:

    Objective To analyze the correlation between retinal nerve fiber layer (RNFL) thickness, choroidal microcirculation and radial peripapillary capillary (RPC) in myopes based on a new quantitative method. Methods A cross-sectional study. From April 2019 to January 2020, 100 eyes with high myopia (HM group) and 82 eyes with low-to-moderate myopia (LMM group) were enrolled in Jiangsu Provincial Hospital. All subjects underwent measurements of best corrected visual acuity (BCVA), intraocular pressure, axial length (AL) and spherical equivalent (SE) before anterior segment examination via slip-lamp biomicroscopy, dilated fundus examination, color and red-free fundus photographs and OCT angiography (OCTA). A 4.5mm × 4.5mm scanning area centered on the optic disc was scanned using a frequency domain OCTA instrument, which was divided into 4 quadrants centered on the optic disc by the software automatically. On the scanning laser ophthalmoscope (SLO) and choroidal vasculature images, one ophthalmologist contoured the peripapillary atrophy-β (PPA-β) zones under the supervision of another veteran ophthalmologist before calculating the area and choroidal vessel density of PPA-β zone using PyCharm software. The correlation between AL, SE, the area and vessel density of PPA-βzone, peripapillary RNFL thickness and RPC vessel density was analyzed by Spearman correlation analysis and multivariate linear regression model. Results The difference in average, nasal, superior and inferior RNFL thickness and RPC vessel density, as well as the area and choroidal vessel density of PPA-β zone was statistically significant between HM and LMM groups (P < 0.05). SE, average peripapillary RNFL thickness and the choroidal vessel density of PPA-β zone were positively correlated with the average blood flow density of RPC (P < 0.001), while AL and the area of PPA-β zone were negatively correlated with RPC vessel density (P < 0.001). The multivariable model revealed that only average RNFL thickness (P < 0.001) and the area of PPA-β zone (P = 0.014) were associated with average RPC vessel density. The results of Spearman correlation analysis for 4 quadrantile subgroups indicated that RNFL thickness remained positively correlated with RPC vessel density (P < 0.001). Conclusion Peripapillary RNFL thickness and the area of PPA-β zone were two crucial causes of RPC vessel density changes, which may indicate the close relationship between retinal constructure and microvascular changes and emphasize the importance of myopia-related optic neuropathy.

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  • 收稿日期:2022-11-30
  • 最后修改日期:2023-03-11
  • 录用日期:2023-05-23
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