目的采用超广角扫频源光学相干断层扫描血管成像(SS-OCTA)评估高度近视患者三维脉络膜血管指数(3D-CVI)与脉络膜毛细血管血流密度(CCD)改变，进而探讨眼轴长度(AL)与高度近视脉络膜血管结构改变的关系。
方法采用横断面研究设计，纳入2021年11月至2022年10月于北京大学人民医院行24 mm×20 mm超广角SS-OCTA扫描的正常受试者168例168眼作为对照组及高度近视患者182例182眼作为高度近视组。比较高度近视组与对照组的全域平均及中央区3D-CVI和CCD，对AL与3D-CVI、CCD分别做相关分析及受试者工作特征曲线分析，并得出3D-CVI及CCD降低时的AL界值。
结果高度近视组平均3D-CVI和中央区3D-CVI分别为(31.37±7.85)%和(29.63±9.00)%，均显著低于对照组的(32.86±4.25)%和(35.01±3.96)%，差异均有统计学意义( t＝2.241、7.337，均 P<0.05)。高度近视组平均CCD为(45.59±3.63)%，显著低于对照组的(46.47±1.36)%，差异有统计学意义( t＝3.038， P＝0.003)。相关分析结果提示高度近视组中平均3D-CVI、平均CCD均与AL呈负相关( r＝－0.547，－0.657，均 P<0.001)。进一步对AL和3D-CVI、CCD分别进行受试者工作特征曲线分析，结果提示平均3D-CVI降低的AL界值为28.93 mm，曲线下面积为0.883( P<0.001，灵敏度为0.690，特异度为0.944)；平均CCD降低的AL界值为28.26 mm，曲线下面积为0.884( P<0.001，灵敏度为0.793，特异度为0.832)。
结论高度近视患者3D-CVI和CCD均降低，随着AL增长，CCD早于3D-CVI发生改变。
ObjectiveTo evaluate the three-dimensional choroidal vascularity index (3D-CVI) and choriocapillaris blood flow density (CCD) changes in patients with high myopia using ultra-widefield swept-source optical coherence tomography angiography (SS-OCTA), and to investigate the relationship between axial length (AL) and choroidal vascular structure changes in high myopia.
MethodsA cross-sectional study was performed.A control group of 168 eyes of 168 normal subjects, and a high myopia group of 182 eyes of 182 high myopia patients were enrolled from November 2021 to October 2022 at the Peking University People's Hospital.All subjects underwent an ultra-widefield SS-OCTA scan with an area of 24 mm × 20 mm.Full-field average and central area 3D-CVI and CCD were compared between the two groups.Correlation analysis and receiver operating characteristic curve analysis were used for 3D-CVI, CCD and AL, respectively.The AL cut-off values were determined when 3D-CVI and CCD were reduced.The study followed the Declaration of Helsinki, and the study protocol was approved by the Ethics Committee of Peking University People's Hospital (No.2021PHB058-001).All participants voluntarily signed an informed consent form.
ResultsThe mean 3D-CVI and central 3D-CVI in the high myopia group were (31.37±7.85)% and (29.63±9.00)%, respectively, which were significantly lower than (32.86±4.25)% and (35.01±3.96)% in the control group ( t=2.241, 7.337; both at P<0.05).The mean CCD in the high myopia group was (45.59±3.63)%, which was significantly lower than (46.47±1.36)% in the control group ( t=3.038, P=0.003).Correlation analysis showed that mean 3D-CVI and CCD were negatively correlated with AL in the high myopia group ( r=-0.547, -0.657; both at P<0.001).Receiver operating characteristic curve analysis of 3D-CVI, CCD and AL suggested that the AL cut-off value of mean 3D-CVI-reduction was 28.93 mm and the area under the curve of 0.883 ( P<0.001, sensitivity=0.690, specificity=0.944).The AL cut-off value of mean CCD-reduction was 28.26 mm and the area under the curve was 0.884 ( P<0.001, sensitivity=0.793, specificity=0.832).
Conclusions3D-CVI and CCD are both reduced in patients with high myopia.As AL increases, CCD changes earlier than 3D-CVI.
涂书,姚昱欧,曾巧珠,等. 基于超广角SS-OCTA的高度近视患者脉络膜血管改变[J]. 中华实验眼科杂志,2024,42(11)：1020-1027.
DOI:10.3760/cma.j.cn115989-20230125-00026版权归中华医学会所有。
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涂书：参与选题、研究设计、受试者招募、眼部参数测量、数据收集及分析、论文撰写；姚昱欧：参与研究设计、受试者招募及论文修改；曾巧珠：参与受试者招募、眼部参数测量、数据收集；赵明威：参与选题、对文章的知识性内容作批评性审阅及定稿
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