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. (Chinese)

Objective: The current study aims 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: Between April 2019 and January 2020, 100 eyes with high myopia (HM group) and 82 eyes with low ⁃to ⁃moderate myopia (LMM group) were enrolled in the First Affiliated Hospital of Nanjing Medical University. All subjects underwent measurements of the 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 optical coherence tomography angiography (OCTA). A 4.5 mm × 4.5 mm scanning area centered on the optic disc was scanned using a frequency domain OCTA instrument, which was divided into four 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⁃β zone, peripapillary RNFL thickness and RPC vessel density was analyzed by Spearman correlation analysis and multivariate linear regression model. Results: The average RNFL thickness, RNFL thickness of nasal, superior and inferior, 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 four 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. [ABSTRACT FROM AUTHOR]

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 (radial peripapillary capillary, RPC) 血流密度 与盘周视网膜神经纤维层 (retinal nerve fiber layer, RNFL) 厚度、脉络膜血流参数的相关性。方法: 2019 年 4 月—2020 年 1 月于 南京医科大学第一附属医院眼科行眼底筛查的高度近视 (high myopia, HM) 人群 100 只眼 (HM组) 和中低度近视 (low⁃to⁃moder⁃ ate myopia, LMM) 人群 82 只眼 (LMM组) 纳入研究。测量所有受检者最佳矫正视力 (best corrected visual acuity, BCVA) 、眼压、 眼轴 (axial length, AL) 、等效球镜 (spherical equivalent, 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 (optical coherence tomography angiography, OCTA) 检查。采用 OCTA 仪对受检眼视盘区 4.5 mm×4.5 mm 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 (scanning laser ophthalmoscope, 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 SLO 和血流图像由同一名眼科医生绘制盘周 β 区萎缩弧 (peripapillary atrophy⁃β, 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, 差异均有统计学意义 (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 血流变化的重要原因, 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 FROM AUTHOR]

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