伴发于后巩膜葡萄肿的高度近视性白内障眼底病变相关研究

doi:10.6040/j.issn.1673-3770.0.2022.354

摘要/Abstract

摘要： 目的探讨伴发于后巩膜葡萄肿的高度近视性白内障眼底病变特点。方法采用回顾性病例对照研究,选取2021年8月至12月白内障手术者68例(103眼),根据眼轴长度分为2组:高度近视组,眼轴≥26.5 mm;对照组,眼轴22.0~24.0 mm。高度近视组根据是否伴有后巩膜葡萄肿分为有葡萄肿者和无葡萄肿者2个亚组。采用Cirrus HD-OCT 5000测量黄斑中心凹、离中心凹1 000 μm、3 000 μm处视网膜厚度(retinal thickness, RT)、脉络膜厚度(choroidal thickness, CT),视神经纤维层厚度(retinal nerve fiber layer, RNFL),测量黄斑及视神经光学相干断层成像血管造影(optical coherence tomography angiography, OCTA)等。根据高度近视眼底病变ATN分级对所有眼底病变进行分级。结果对照组白内障术后视力恢复最佳,其次为高度近视无葡萄肿者,而高度近视有葡萄肿者最差。有葡萄肿者ATN分级明显高于无葡萄肿者,差异有统计学意义(P=0.007,0.015,0.001)。与对照组相比,高度近视组RT、CT 和RNFL更薄(P=0.004,0.004,0.001,0.001,0.018,0.001),黄斑无血管区(FAZ)面积更小(P=0.001,0.001),视神经OCTA 血流信号更低(P=0.025,0.001,0.001,0.001,0.026,0.001,0.001,0.001);但有、无葡萄肿者之间差异无统计学意义(P=0.871,0.964,0.888,0.911,0.765,0.999,0.999,0.806)。结论伴发于后巩膜葡萄肿的高度近视患者眼底病变更严重,影响白内障术后视力恢复,可能与RT、CT、RNFL、黄斑及视神经血流和FAZ发育等均有关。

关键词: 高度近视, 白内障, 后巩膜葡萄肿, 光学相干断层扫描

Abstract: Objective To investigate the fundus changes in high myopia cataract with posterior scleral staphyloma. Methods This was a retrospective case-control study, the data of 103 eyes of 68 patients with cataract between August and December 2021 were analyzed. All cases were divided into two groups based on axial length: the high myopia group, with an axial length ≥ 26.5 mm, and the control group, with an axial length of 22.0-24.0 mm. The high myopia group was divided into two subgroups: those with staphyloma and those without staphyloma. Cirrus HD-OCT 5000 was used to measure the retinal thickness(RT), choroidal thickness(CT), retinal nerve fiber layer(RNFL)and optical coherence tomography angiography(OCTA)at the fovea and at 1 000 μm and 3 000 μm from the fovea. Moreover, the optical coherence tomography(OCT)and optical coherence tomography angiography of the macular and optical nerve were measured. All patients were graded according to the ATN classification of high myopia fundus lesions. Results The control group had the best postoperative vision acuity, followed by the high myopia group without staphyloma, while the high myopia group with staphyloma had the worst. The ATN grade of patients with staphyloma was significantly higher than that of patients without staphyloma(P=0.007,0.015,0.001). The high myopia group had thinner RT, CT, and retinal nerve fiber layer(RNFL)compared with those in the control group(P=0.004,0.004,0.001,0.001,0.018,0.001). Moreover, the area of the foveal avascular zone(FAZ)in high myopia group was smaller(P=0.001,0.001)and the optical nerve OCTA blood flow signal was lower(P=0.025,0.001,0.001,0.001,0.026,0.001,0.001,0.001). However, there was no significant difference in OCTA between patients with and without staphyloma(P=0.871,0.964,0.888,0.911,0.765,0.999,0.999,0.806). Conclusion The fundus lesions of high myopia patients with posterior scleral staphyloma are more serious, and this may affect visual recovery after cataract surgery. This may also be related to the RT, CT, RNFL, macular and optic nerve blood flow, and FAZ dysplasia difference.

Key words: High myopia, Cataract, Posterior scleral staphyloma, Optical coherence tomography

中图分类号:

R776.1

买尔哈巴·玉素甫,克里木江·阿不拉,丁琳,秦艳莉,陈雪艺. 伴发于后巩膜葡萄肿的高度近视性白内障眼底病变相关研究[J]. 山东大学耳鼻喉眼学报, 2023, 37(5): 107-114.

YUSUFU·Maierhaba, ABULA·Kelimujiang, DING Lin, QIN Yanli, CHEN Xueyi. Fundus changes in high myopia cataract with posterior scleral staphyloma[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(5): 107-114.

参考文献

[1] Huang Q, Huang YZ, Luo Q, et al. Ocular biometric characteristics of cataract patients in Western China[J]. BMC Ophthalmol, 2018, 18(1): 99. doi:10.1186/s12886-018-0770-x
[2] Guo XX, Xiao O, Chen YX, et al. Three-dimensional eye shape, myopic maculopathy, and visual acuity: the Zhongshan ophthalmic center-brien holden vision institute high Myopia cohort study[J]. Ophthalmology, 2017, 124(5): 679-687. doi:10.1016/j.ophtha.2017.01.009
[3] Lin L, Xu MX, Mo E, et al. Accuracy of newer generation IOL power calculation formulas in eyes with high axial Myopia[J]. J Refract Surg, 2021, 37(11): 754-758. doi:10.3928/1081597X-20210712-08
[4] Ruiz-Medrano J, Montero JA, Flores-Moreno I, et al. Myopic maculopathy: current status and proposal for a new classification and grading system(ATN)[J]. Prog Retin Eye Res, 2019, 69: 80-115. doi:10.1016/j.preteyeres.2018.10.005
[5] Chen CL, Zhang A, Bojikian KD, et al. Peripapillary retinal nerve fiber layer vascular microcirculation in Glaucoma using optical coherence tomography-based microangiography[J]. Invest Ophthalmol Vis Sci, 2016, 57(9): OCT475-OCT485. doi:10.1167/iovs.15-18909
[6] Moon JY, Garg I, Cui Y, et al. Wide-field swept-source optical coherence tomography angiography in the assessment of retinal microvasculature and choroidal thickness in patients with myopia[J]. Br J Ophthalmol, 2023, 107(1): 102-108. doi:10.1136/bjophthalmol-2021-319540
[7] Li M, Yang Y, Jiang H, et al. Retinal microvascular network and microcirculation assessments in high Myopia[J]. Am J Ophthalmol, 2017, 174: 56-67. doi:10.1016/j.ajo.2016.10.018
[8] 许欢, 孔祥梅. 原发性开角型青光眼黄斑区视网膜微循环和结构损伤的研究[J]. 中华眼科杂志, 2017, 53(2): 98-103. doi:10.3760/cma.j.issn.0412-4081.2017.02.006 XU Huan, KONG Xiangmei. Study of retinal microvascular perfusion alteration and structural damage at macular region in primary open-angle glaucoma patients[J]. Journal of Command and Control, 2017, 53(2): 98-103. doi:10.3760/cma.j.issn.0412-4081.2017.02.006
[9] Wu JH, Moghimi S, Nishida T, et al. Association of macular OCT and OCTA parameters with visual acuity in glaucoma[J]. Br J Ophthalmol, 2022: bjophthalmol-2022-321460. doi:10.1136/bjo-2022-321460
[10] AttaAllah HR, Mohamed AAM, Ali MA. Macular vessels density in diabetic retinopathy: quantitative assessment using optical coherence tomography angiography[J]. Int Ophthalmol, 2019, 39(8): 1845-1859. doi:10.1007/s10792-018-1013-0
[11] Attia Ali Ahmed M, Shawkat Abdelhaleem A. Evaluation of microvascular and visual acuity changes in patients with early diabetic retinopathy: optical coherence tomography angiography study[J]. Clin Ophthalmol, 2022, 16: 429-440. doi:10.2147/OPTH.S353426
[12] Jin PY, Zou HD, Zhu JF, et al. Choroidal and retinal thickness in children with different refractive status measured by swept-source optical coherence tomography[J]. Am J Ophthalmol, 2016, 168: 164-176. doi:10.1016/j.ajo.2016.05.008
[13] Park UC, Lee EK, Kim BH, et al. Decreased choroidal and scleral thicknesses in highly myopic eyes with posterior staphyloma[J]. Sci Rep, 2021, 11(1): 7987. doi:10.1038/s41598-021-87065-6
[14] Guo XJ, Chen D, Luo SK, et al. EDI-OCT choroidal thickness in Posner-Schlossman syndrome[J]. Int Ophthalmol, 2020, 40(4): 877-889. doi:10.1007/s10792-019-01251-0
[15] Xiong K, Wang W, Gong X, et al. Influence of high myopia on choriocapillaris perfusion and choroidal thickness in diabetic patients without diabetic retinopathy[J]. Retina, 2022, 42(6): 1077-1084. doi:10.1097/IAE.0000000000003427
[16] Laíns I, Talcott KE, Santos AR, et al. Choroidal thickness in diabetic retinopathy assessed with swept-source optical coherence tomography[J]. Retina, 2018, 38(1): 173-182. doi:10.1097/IAE.0000000000001516
[17] El Matri L, Falfoul Y, El Matri K, et al. Posterior staphylomas in non-highly myopic eyes with retinitis pigmentosa[J]. Int Ophthalmol, 2020, 40(9): 2159-2168. doi:10.1007/s10792-020-01396-3
[18] Xu X, Fang YX, Yokoi T, et al. Posterior staphylomas in eyes with retinitis pigmentosa without high myopia[J]. Retina, 2019, 39(7): 1299-1304. doi:10.1097/IAE.0000000000002180
[19] Li HR, Wang QX, Liu YC, et al. Investigation of macular structural and microcirculatory characteristics of posterior staphyloma in high myopic eyes by swept source optical coherence tomography angiography[J]. Front Physiol, 2022, 13: 856507. doi:10.3389/fphys.2022.856507
[20] 杨茹, 张玉光, 徐湘辉, 等. 超声乳化术对老年性白内障黄斑区视网膜结构影响的临床研究[J]. 山东大学耳鼻喉眼学报, 2022, 36(4): 97-102. doi:10.6040/j.issn.1673-3770.0.2022.020 YANG Ru, ZHANG Yuguang, XU Xianghui, et al. A clinical study on the effect of phacoemulsification on the retinal structure in the macular region of senile cataract[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(4): 97-102. doi:10.6040/j.issn.1673-3770.0.2022.020

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