Wong Chee Wai, Phua Val, Lee Shu Yen, Wong Tien Yin, Cheung Chui Ming Gemmy
Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 2Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore.
Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.
Invest Ophthalmol Vis Sci. 2017 Feb 1;58(2):907-913. doi: 10.1167/iovs.16-20742.
The relative contribution of mechanical and vascular factors to the pathogenesis of myopic macular degeneration (MMD) is unclear. To address this gap, we examined the association of choroidal thickness (CT) and scleral thickness (ST) with MMD.
Prospective, clinic-based case series of 62 eyes of 41 patients with high myopia (≤-6 diopters or axial length ≥26.5 mm). Swept-source optical coherence tomography (SSOCT) was performed to measure subfoveal CT and ST. Myopic macular degeneration was graded from fundus photographs according to the International Meta-Analysis for Pathologic Myopia (META-PM) classification. Presence of MMD was defined as META-PM category ≥ 2 and severe MMD was defined as category ≥ 3.
The distribution of MMD severity was 15 (24.2%) in category 1, 28 (45.2%) in category 2, 10 (16.1%) in category 3, and 9 (14.5%) in category 4. Correlation of MMD severity was strong for subfoveal CT (r = -0.70, P < 0.001) but weak for subfoveal ST (r = -0.31, P = 0.01). Subfoveal CT, but not ST, was independently associated with presence of MMD (age and gender adjusted odds ratio [OR] per 10 μm decrease in CT 1.41, P = 0.002), and subfoveal CT, but not subfoveal ST, was significantly thinner in eyes with severe MMD (≥ category 3) than in eyes with mild MMD (CT: 31.5 ± 40.5 μm versus 82.0 ± 57.1 μm, P < 0.001; ST: 261.6 ± 78.5 μm versus 297.0 ± 73.8 μm, P = 0.09).
We demonstrated significant thinning of the choroid with increasing MMD severity. In contrast, ST was weakly correlated with MMD. These data suggest progressive loss of choroid may be important in the pathogenesis of MMD.
机械因素和血管因素在近视性黄斑变性（MMD）发病机制中的相对作用尚不清楚。为填补这一空白，我们研究了脉络膜厚度（CT）和巩膜厚度（ST）与MMD的相关性。
对41例高度近视患者（≤-6屈光度或眼轴长度≥26.5mm）的62只眼进行基于临床的前瞻性病例系列研究。采用扫频光学相干断层扫描（SSOCT）测量黄斑中心凹下CT和ST。根据国际病理性近视荟萃分析（META-PM）分类法，从眼底照片对近视性黄斑变性进行分级。MMD的存在定义为META-PM分类≥2级，严重MMD定义为分类≥3级。
MMD严重程度分布为1级15例（24.2%），2级28例（45.2%），3级10例（16.1%），4级9例（14.5%）。黄斑中心凹下CT与MMD严重程度相关性强（r=-0.70，P<0.001），而黄斑中心凹下ST与MMD严重程度相关性弱（r=-0.31，P=0.01）。黄斑中心凹下CT而非ST与MMD的存在独立相关（年龄和性别校正后，CT每减少10μm的优势比[OR]为1.41，P=0.002），严重MMD（≥3级）眼的黄斑中心凹下CT显著薄于轻度MMD眼（CT：31.5±40.5μm对82.
