青少年高度近视患眼眼底特征及其与屈光状态的相关性

摘要

目的 观察分析青少年高度近视患眼眼底特征与屈光度、最佳矫正视力的相关性.方法 横断面回顾性研究.年龄≤18岁、屈光度＞-6.00 D的青少年高度近视患者544例1050只眼纳入研究.所有患眼均行散瞳电脑验光及检影验光获得最佳矫正视力(BCVA),并将其转换为最小分辨角对数(logMAR)视力记录.均行裂隙灯显微镜及以黄斑为中心、45°眼底后极部彩色照相检查.排除眼底模糊、眼位不正及判定有异议的图像资料,选取视盘边缘及黄斑区清晰可见的彩色眼底像进行眼底特征分析.最终988只眼的彩色眼底像纳入统计分析,占94.1％.以脉络膜血管暴露程度判断其豹纹状眼底程度并进行分级,观察黄斑区、视盘区豹纹状眼底分级.通过Image J软件,测量视盘旁β区萎缩弧面积、视盘最长径、视盘最短径,并以视盘最长径/最短径比值作为视盘倾斜指数.对比分析豹纹状眼底分级、视盘旁β区萎缩弧面积、视盘倾斜指数与屈光度、BCVA的相关性;观察统计局限性后极部视网膜脉络膜萎缩灶、漆裂纹、Fuehs斑等高度近视后极部眼底病变的发生率.结果 患眼平均屈光度为(-10.66±2.63)D;平均logMAR BCVA为0.11±0.22.豹纹状眼底发生率为66.9％.黄斑区、视盘区豹纹状眼底平均分级分别为(0.83±0.96)、(1.04±1.00)级,二者具有高度相关性(r=0.875,P=0.000).视盘旁β区萎缩弧发生率为97.3％,视盘旁β区萎缩弧平均面积为(0.45±0.57)mm2.视盘倾斜发生率为28.5％,平均视盘倾斜指数为1.25±0.18.黄斑区、视盘区豹纹状眼底不同分级患眼平均屈光度、logMAR BCVA以及视盘旁β区萎缩弧面积、倾斜视盘发生率、视盘倾斜指数比较,差异均有统计学意义(P＜0.05).高度近视后极部眼底病变发生率为2.83％;与未发生高度近视后极部眼底病变者比较,高度近视后极部眼底病变者年龄、屈光度、视盘旁β区萎缩弧面积更大,豹纹状眼底分级、视盘倾斜发生率及视盘倾斜指数更高,BCVA更差.结论 青少年高度近视患眼主要眼底特征是视盘旁β区萎缩弧;出现后极部眼底病变严重影响视功能.%Objective To assess the fundus characteristics and their associations with refractive error,best corrected visual acuity (BCVA) of highly myopic eyes in Chinese teenagers.Methods This is a crosssectional and retrospective study.544 teenagers (1050 eyes) with refraction more than-6.00 D were recruited from Tongren Eye Care Center.All participants underwent examinations including cycloplegic auto-refractometry and retinoscopy,BCVA,slit lamp and 45°color funds photography centered in macular.BCVA was recorded with logarithm of the minimum angle of resolution (logMAR) acuity.988/1050 (94.1％) fundus photographs with clearly visible optic disc and fovea were selected for analysis.Degree of tessellation in optic disc and macular was defined by the exposure of choroidal vessel.Area of beta parapapillary atrophy (PPA),maximal and minimal diameter of optic disc,degree of fundus tessellation were measured by Image J software.Optic disc ovality was calculated by maximal diameter/minimal diameter.Associations between degree of tessellation,beta PPA area,optic disc ovality and refractive error,BCVA were analyzed.Presence of high myopic retinopathy,including chorioretinal atrophy,lacquer crack and Fuchs spot were also observed.Results Mean spherical equivalent was (10.66 ± 2.63) D.Mean logMAR BCVA was 0.11 ± 0.22.Tessellation was in 66.9％ eyes.Mean degree in macular and peripapillary region was 0.83±0.96 and 1.04±1.00(r=0.875,P 0.000).Beta PPA was in 97.3％ eyes and mean area was (0.45±0.57) mm2.Mean ovality factor was 1.25±0.18 and Tilted optic disc was in 28.5％ eyes.Refractive error,logMAR BCVA,beta PPA area,tilted optic disc and ovality factor were related with the degree of optic disc and macular tessellation (P＜0.05).Highly myopic retinopathy was found in 28 eyes,with older age,larger area of PPA,higher presence of tilted optic disc and degree of tessellation,worse BCVA.Conclusions Beta PPA was the main fundus characteristics in teenagers.Visual acuity can be seriously impaired by highly myopic retinopathy,such as chorioretinal atrophy.