光学相干断层扫描血管造影对近视性黄斑变性脉络膜血管系统的定量评估

Quantitative assessment of the choroidal vasculature in myopic macular degeneration with optical coherence tomographic angiography.

作者信息

Dan Yee Shan, Cheong Kai Xiong, Lim Shen Yi, Wong Qiu Ying, Chong Rachel S, Wong Chee Wai, Hoang Quan V

机构信息

Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.

Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Singapore.

出版信息

Front Ophthalmol (Lausanne). 2023 Jun 14;3:1202445. doi: 10.3389/fopht.2023.1202445. eCollection 2023.

BACKGROUND

To assess and compare choroidal morphometric vascular parameters, using optical coherence tomographic angiography (OCTA), in highly myopic adults with and without myopic macular degeneration (MMD).

METHODS

This is a clinic-based observational study of 148 eyes with axial length (AL) ≥25mm, enrolled from the high myopia clinic of the Singapore National Eye Centre. MMD was graded from fundus photographs. Swept source OCT (SS-OCT) and OCTA were performed and assessed for choroidal layer thickness (CT) and choroidal vasculature (choroidal vessel density (CVD), choroidal branch area (CBA) and mean choroidal vessel width (MCVW)) in the different choroidal layers (overall choroidal layer (CL), medium-vessel choroidal layer (MVCL), large-vessel choroidal layer (LVCL)).

RESULTS

CT (r=-0.58, p<0.001), CT (r=-0.22, p=0.04), MCVW (r=-0.58, p<0.001), and CVD (r=-0.19, p=0.02) were negatively correlated with AL, while CBA (r=0.61, p<0.001) was positively correlated. Compared to eyes with no MMD, eyes with MMD2 had lower CT (120.37±47.18µm vs 218.33±92.70µm, p<0.001), CT (70.57±15.28µm vs 85.32±23.71µm, p=0.04), CT (101.65±25.36µm vs 154.55±68.41µm, p=0.001) and greater CVD (71.10±3.97% vs 66.97±3.63%, p<0.001), CVD (66.96±2.35% vs 65.06±2.69%, p=0.002), CVD (68.36±2.56% vs 66.58±2.88%, p=0.012), MCVW (6.14±0.34µm vs 5.90±0.35µm, p=0.007), and CBA (12.69±1.38% vs 11.34±1.18%, p<0.001). After adjusting for age, thicker CT (odds ratio (OR) 0.98, 95% confidence interval (CI) 0.97-0.99, p<0.001), CT (OR 0.97 (0.94-0.99), p=0.002) and CT (OR 0.97 (0.96-0.98, p<0.001) were significantly associated with lower odds of MMD2, while increased CVD (OR 1.37 (1.20-1.55), p<0.001), CVD (OR 1.39 (1.12-1.73), p=0.003), CVD (OR 1.31 (1.07-1.60), p=0.009), CBA (OR 2.19 (1.55-3.08), p<0.001) and MCVW (OR 6.97 (1.59-30.51), p=0.01) was significantly associated with higher odds of MMD2.

CONCLUSION

Decrease in choroidal vessel width, density and thickness, and an increase in vascular branching were observed in eyes with long AL. A thinner and denser choroid with greater branching area and vessel width, which may all be signs of hypoxia, were associated with greater odds of MMD2.

背景

使用光学相干断层扫描血管造影（OCTA）评估和比较患有和未患有近视性黄斑变性（MMD）的高度近视成年人的脉络膜形态学血管参数。

方法

这是一项基于临床的观察性研究，对148只眼轴长度（AL）≥25mm的眼睛进行研究，这些眼睛来自新加坡国家眼科中心的高度近视诊所。根据眼底照片对MMD进行分级。进行扫频源光学相干断层扫描（SS - OCT）和OCTA，并评估不同脉络膜层（整体脉络膜层（CL）、中血管脉络膜层（MVCL）、大血管脉络膜层（LVCL））的脉络膜层厚度（CT）和脉络膜血管系统（脉络膜血管密度（CVD）、脉络膜分支面积（CBA）和平均脉络膜血管宽度（MCVW））。

结果

CT（r = - 0.58，p < 0.001）、CT（r = - 0.22，p = 0.04）、MCVW（r = - 0.58，p < 0.001）和CVD（r = - 0.19，p = 0.02）与AL呈负相关，而CBA（r = 0.61，p < 0.001）呈正相关。与未患有MMD的眼睛相比，患有MMD2的眼睛CT更低（120.37±47.18μm对218.33±92.70μm，p < 0.001）、CT更低（70.57±15.28μm对85.32±23.71μm，p = 0.04）、CT更低（101.65±25.36μm对154.55±68.41μm，p = 0.001），且CVD更高（71.10±3.97%对66.97±3.63%，p < 0.001）、CVD更高（66.96±2.35%对65.06±2.69%，p = 0.002）、CVD更高（68.36±2.56%对66.58±2.88%，p = 0.012）、MCVW更高（6.14±0.34μm对5.90±0.35μm，p = 0.007）以及CBA更高（12.69±1.38%对11.34±1.18%，p < 0.001）。在调整年龄后，较厚的CT（比值比（OR）0.98，95%置信区间（CI）0.97 - 0.99，p < 0.001）、CT（OR 0.97（0.94 - 0.99），p = 0.002）和CT（OR 0.97（0.96 - 0.98，p < 0.001）与MMD2的较低发生几率显著相关，而CVD增加（OR 1.37（1.20 - 1.55），p < 0.001）、CVD增加（OR 1.39（1.12 - 1.73），p = 0.003）、CVD增加（OR 1.31（1.07 - 1.60），p = 0.009）、CBA增加（OR 2.19（1.55 - 3.08），p < 0.001）和MCVW增加（OR 6.97（1.59 - 30.51），p = 0.01）与MMD2的较高发生几率显著相关。