Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan.
Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan; Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China.
Ophthalmology. 2019 Jul;126(7):1018-1032. doi: 10.1016/j.ophtha.2019.01.012. Epub 2019 Jan 29.
To analyze the choroidal thickness (CT) of each type of myopic maculopathy, and to establish an OCT-based classification of myopic maculopathy.
Retrospective, hospital-based, cross-sectional study.
Highly myopic (HM) eyes that were examined by swept-source OCT.
The CT was measured at the subfovea and at 3 mm nasal, temporal, superior, and inferior to the fovea. Myopic maculopathy was classified as tessellation, diffuse atrophy, patchy atrophy, and macular atrophy (MA) based on the fundus photographs. Diffuse atrophy was subdivided into peripapillary diffuse choroidal atrophy (PDCA) or macular diffuse choroidal atrophy (MDCA).
The CT of each type of myopic maculopathy and cut-off value for diagnosis of diffuse atrophy.
We studied 1487 eyes of 884 patients (mean age: 58 years; mean axial length [AxL]: 29.9 mm). Subfoveal CT decreased with an increase in the severity of the myopic maculopathy. The mean subfoveal CT in HM eyes with normal fundus was 274.5 μm, with tessellation was 129.1 μm, with PDCA was 84.6 μm, with MDCA was 50.2 μm, with patchy atrophy was 48.6 μm, with choroidal neovascularization-related MA was 27.3 μm, and with patchy atrophy-related MA was 3.5 μm. Using receiver operating characteristic curves, the optimal CT to predict the presence of PDCA was 56.5 μm nasally, and the CT to predict the presence of MDCA was 62 μm subfoveally. The subfoveal CT was not significantly different in eyes with MDCA and patchy atrophy. A decrease of the subfoveal CT was associated with an older age (P < 0.001), longer AxL (P < 0.001), presence of myopic maculopathy (P < 0.001), and presence of CNV (P = 0.002). A decrease of best-corrected visual acuity was not significantly associated with the subfoveal CT.
Progressive and continuous choroidal thinning plays a key role in the progression from no maculopathy to tessellation and to diffuse atrophy. The cut-off value of CT can be used for diagnosing PDCA and MDCA. For progression from MDCA to patchy atrophy, factors other than further choroidal thinning such as Bruch membrane defect may be involved. The subfoveal CT was not a predictor of visual acuity in HM eyes without CNV.
分析各型病理性近视黄斑病变的脉络膜厚度（CT），建立基于 OCT 的病理性近视黄斑病变分类。
回顾性、基于医院的、横断面研究。
经扫频源 OCT 检查的高度近视（HM）眼。
在黄斑中心凹下、鼻侧、颞侧、上侧和下侧 3mm 处测量 CT。根据眼底照片将病理性近视黄斑病变分为格子样变性、弥漫性萎缩、斑状萎缩和黄斑萎缩（MA）。弥漫性萎缩进一步分为视盘周围弥漫性脉络膜萎缩（PDCA）或黄斑弥漫性脉络膜萎缩（MDCA）。
各型病理性近视黄斑病变的 CT 和弥漫性萎缩的诊断截断值。
我们研究了 884 例患者的 1487 只眼（平均年龄：58 岁；平均眼轴长度[AxL]：29.9mm）。黄斑中心凹下 CT 随病理性近视黄斑病变严重程度的增加而降低。HM 眼眼底正常者黄斑中心凹下 CT 平均值为 274.5μm，格子样变性者为 129.1μm，PDCA 者为 84.6μm，MDCA 者为 50.2μm，斑状萎缩者为 48.6μm，脉络膜新生血管相关 MA 者为 27.3μm，斑状萎缩相关 MA 者为 3.5μm。使用受试者工作特征曲线，预测 PDCA 存在的最佳 CT 值为鼻侧 56.5μm，预测 MDCA 存在的 CT 值为黄斑中心凹下 62μm。MDCA 和斑状萎缩眼的黄斑中心凹下 CT 无显著差异。黄斑中心凹下 CT 降低与年龄较大（P<0.001）、AxL 较长（P<0.001）、存在病理性近视黄斑病变（P<0.001）和存在脉络膜新生血管（P=0.002）相关。黄斑中心凹下 CT 降低与最佳矫正视力无显著相关性。
进行性和连续性脉络膜变薄在从不伴有黄斑病变到格子样变性和弥漫性萎缩的进展中起关键作用。CT 截断值可用于诊断 PDCA 和 MDCA。从 MDCA 进展为斑状萎缩，除了脉络膜进一步变薄外，可能还涉及其他因素，如 Bruch 膜缺陷。HM 眼无脉络膜新生血管时，黄斑中心凹下 CT 不是视力的预测指标。
