Kurultay-Ersan Isil, Emre Sinan
Department of Ophthalmology, Baskent University Hospital, Izmir - Turkey.
Eur J Ophthalmol. 2017 May 11;27(3):331-335. doi: 10.5301/ejo.5000834. Epub 2016 Jul 18.
To evaluate the alterations in mean central choroidal, central macular, and disk retinal nerve fiber layer (RNFL) thickness measured by optical coherence tomography (OCT) during Valsalva maneuver among patients with high refractive errors.
A total of 60 high myopic (≥-6.0 D) and 50 high hyperopic (≥ + 3.0 D) eyes of 58 patients aged 19-65 years with visual acuity of 20/20 and without any ophthalmologic or systemic diseases were evaluated by OCT before and after the Valsalva maneuver. The choroidal thickness was measured with enhanced depth imaging OCT method. Central macular thickness, disk RNFL thickness, and axial length were also assessed.
Mean choroidal thickness increased significantly from 275.0 ± 27.2 μm at rest to 279.8 ± 31.6 μm after Valsalva maneuver in high myopic patients, and from 308.2 ± 27.3 μm to 313.6 ± 28.5 μm in high hyperopic patients (p<0.01 for each). A significant negative correlation of the choroidal thickness was noted with axial length (r = -0.509, p<0.01) and age (r = -0.224, p = 0.01) in the overall study population. Mean central macular thickness was 242.9 ± 44.4 μm and 254.0 ± 22.8 μm, while mean disk RNFL thickness was 81.6 ± 12.4 μm and 98.4 ± 13.3 μm in high myopic and hyperopic patients, respectively. Valsalva maneuver was not associated with significant change in central macular or disk RNFL thickness.
Significant association of Valsalva maneuver with an increase in choroidal thickness was noted among patients with high degree of myopia and hyperopia. Our findings emphasize the likelihood of increase in choroidal volume due to venous distension to be responsible for the increase observed in choroidal thickness after Valsalva maneuver.
评估高度屈光不正患者在瓦尔萨尔瓦动作期间通过光学相干断层扫描（OCT）测量的脉络膜中央、黄斑中央和视盘视网膜神经纤维层（RNFL）厚度的变化。
对58例年龄在19 - 65岁、视力为20/20且无任何眼科或全身性疾病的患者的60只高度近视（≥ - 6.0 D）眼和50只高度远视（≥ + 3.0 D）眼在瓦尔萨尔瓦动作前后进行OCT评估。采用增强深度成像OCT方法测量脉络膜厚度。还评估了黄斑中央厚度、视盘RNFL厚度和眼轴长度。
高度近视患者在瓦尔萨尔瓦动作后脉络膜平均厚度从静息时的275.0±27.2μm显著增加至279.8±31.6μm，高度远视患者从308.2±27.3μm增加至313.6±28.5μm（每组p<0.01）。在整个研究人群中，脉络膜厚度与眼轴长度（r = -0.509，p<0.01）和年龄（r = -0.224，p = 0.01）呈显著负相关。高度近视和远视患者的黄斑中央平均厚度分别为242.9±44.4μm和254.0±22.8μm，视盘RNFL平均厚度分别为81.6±12.4μm和98.4±13.3μm。瓦尔萨尔瓦动作与黄斑中央或视盘RNFL厚度的显著变化无关。
在高度近视和远视患者中，注意到瓦尔萨尔瓦动作与脉络膜厚度增加之间存在显著关联。我们的研究结果强调，由于静脉扩张导致脉络膜体积增加，可能是瓦尔萨尔瓦动作后脉络膜厚度增加的原因。
