Wu Hao, Peng Tianli, Zhou Weihe, Huang Zihan, Li Hongyu, Wang Tengfei, Zhang Jingwei, Zhang Kou, Li Haoer, Zhao Yunpeng, Qu Jia, Lu Fan, Zhou Xiangtian, Jiang Jun
National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
Eye Vis (Lond). 2023 Jun 6;10(1):27. doi: 10.1186/s40662-023-00345-2.
Despite receiving orthokeratology (ortho-k), the efficacy of retarding ocular elongation during myopia varies among myopic children. The current study aimed to investigate the early changes of choroidal vasculature at one month after ortho-k treatment and its association with one-year ocular elongation, as well as the role of such choroidal responses in predicting the one-year control efficacy of ortho-k treatment.
A prospective cohort study was conducted in myopic children treated with ortho-k. Myopic children aged between 8 and 12 years who were willing to wear ortho-k lenses were recruited consecutively from the Eye Hospital of Wenzhou Medical University. Subfoveal choroidal thickness (SFCT), submacular total choroidal luminal area (LA), stromal area (SA), choroidal vascularity index (CVI), choriocapillaris flow deficit (CcFD) were evaluated by optical coherence tomography (OCT) and OCT angiography over a one-year period.
Fifty eyes from 50 participants (24 males) who finished one-year follow-ups as scheduled were included, with a mean age of 10.31 ± 1.45 years. The one-year ocular elongation was 0.19 ± 0.17 mm. The LA (0.03 ± 0.07 mm), SA (0.02 ± 0.05 mm) increased proportionally after one-month of ortho-k wear (both P < 0.01), as did the SFCT (10.62 ± 19.98 μm, P < 0.001). Multivariable linear regression analyses showed that baseline CVI (β = - 0.023 mm/1%, 95% CI: - 0.036 to - 0.010), one-month LA change (β = - 0.009 mm/0.01 mm, 95% CI: - 0.014 to - 0.003), one-month SFCT change (β = - 0.035 mm/10 µm, 95% CI: - 0.053 to - 0.017) were independently associated with one-year ocular elongation during ortho-k treatment after adjusting with age and sex (all P < 0.01). The area under the receiver operating characteristic curve of prediction model including baseline CVI, one-month SFCT change, age, and sex achieved 0.872 (95% CI: 0.771 to 0.973) for discriminating children with slow or fast ocular elongation.
Choroidal vasculature is associated with ocular elongation during ortho-k treatment. Ortho-k treatment induces increases in choroidal vascularity and choroidal thickness as early as one month. Such early changes can act as predictive biomarkers of myopia control efficacy over a long term. The utilization of these biomarkers may help clinicians identify children who can benefit from ortho-k treatment, and thus has critical implications for the management strategies towards myopia control.
尽管接受了角膜塑形术（ortho-k），但近视儿童延缓眼轴伸长的效果存在差异。本研究旨在探讨角膜塑形术治疗1个月后脉络膜血管系统的早期变化及其与1年眼轴伸长的关系，以及这种脉络膜反应在预测角膜塑形术治疗1年控制效果中的作用。
对接受角膜塑形术治疗的近视儿童进行前瞻性队列研究。从温州医科大学附属眼视光医院连续招募8至12岁愿意佩戴角膜塑形镜的近视儿童。在1年的时间里，通过光学相干断层扫描（OCT）和OCT血管造影评估黄斑中心凹下脉络膜厚度（SFCT）、黄斑下脉络膜总腔面积（LA）、基质面积（SA）、脉络膜血管指数（CVI）、脉络膜毛细血管血流缺损（CcFD）。
纳入50名按计划完成1年随访的参与者（24名男性）的50只眼，平均年龄为10.31±1.45岁。1年眼轴伸长为0.19±0.17mm。佩戴角膜塑形镜1个月后，LA（0.03±0.07mm）、SA（0.02±0.05mm）成比例增加（均P<0.01），SFCT也增加（10.62±19.98μm，P<0.001）。多变量线性回归分析显示，在校正年龄和性别后，基线CVI（β=-0.023mm/1%，95%CI：-0.036至-0.010）、1个月LA变化（β=-0.009mm/0.01mm，95%CI：-0.014至-0.003）、1个月SFCT变化（β=-0.035mm/10μm，95%CI：-0.053至-0.017）与角膜塑形术治疗期间的1年眼轴伸长独立相关（均P<0.01）。包括基线CVI、1个月SFCT变化、年龄和性别的预测模型的受试者工作特征曲线下面积在区分眼轴伸长缓慢或快速的儿童时达到0.872（95%CI：0.771至0.973）。
脉络膜血管系统与角膜塑形术治疗期间的眼轴伸长有关。角膜塑形术治疗早在1个月时就可诱导脉络膜血管化和脉络膜厚度增加。这种早期变化可作为长期近视控制效果的预测生物标志物。利用这些生物标志物可能有助于临床医生识别可从角膜塑形术治疗中获益的儿童，因此对近视控制管理策略具有关键意义。
