Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
School of Statistics, University of International Business and Economics, Beijing, China.
Asia Pac J Ophthalmol (Phila). 2024 Jul-Aug;13(4):100086. doi: 10.1016/j.apjo.2024.100086. Epub 2024 Jul 23.
To investigate the potential phases in myopic retinal vascular alterations for further elucidating the mechanisms underlying the progression of high myopia (HM).
For this retrospective study, participants diagnosed with high myopia at Beijing Tongren Hospital were recruited. Based on bionic mechanisms of human vision, an intelligent image processing model was developed and utilized to extract and quantify the morphological characteristics of retinal vasculatures in different regions measured by papilla-diameter (PD), including vascular caliber, arteriole-to-venule ratio (AVR), tortuosity, the angle of the vascular arch (AVA), the distance of the vascular arch (DVA), density, fractal dimension, and venular length. In addition, the optic disc and the area of peripapillary atrophy (PPA) were also quantified. The characteristics of the overall population, as well as patients aged less than 25 years old, were compared by different genders. Univariate and multiple linear regression analyses were conducted to investigate the correlation of retinal vasculature parameters with PPA width, and detailed trends of the vascular indicators were analyzed to explore the potential existence of staged morphological changes.
The study included 14,066 fundus photographs of 5775 patients (aged 41.2 ± 18.6 years), of whom 7379 (61.2 %) were female. The study included 12,067 fundus photographs of 5320 patients (aged 41.2 ± 18.6 years). Significant variations in the morphological parameters of retinal vessels were observed between males and females. After adjusting for age and sex, multiple linear regression analysis showed that an increased PPA width ratio was associated with lower AVA (1PD), DVA (1PD), vascular caliber (0.5-1.0 PD), tortuosity (0.5-1.0 PD), density and fractal dimension (all P < 0.001, Spearman's ρ < 0). Overall, the changes in retinal vascular morphology showed two phases: tortuosity (0.5-1.0PD) and AVA (1PD) decreased rapidly in the first stage but significantly more slowly in the second stage, while vascular density and fractal dimension showed a completely opposite trend with an initial slow decline followed by a rapid decrease.
This study identified two distinct phases of retinal vascular morphological changes during the progression of HM. Traction lesions were predominant in the initial stage, while atrophic lesions were predominant in the later stage. These findings provide further insight into the development mechanism of HM from the perspective of retinal vasculature.
研究近视视网膜血管改变的潜在阶段，以进一步阐明高度近视（HM）进展的机制。
本回顾性研究招募了在北京同仁医院诊断为高度近视的患者。基于人类视觉仿生机制，开发并利用智能图像处理模型，从视盘直径（PD）测量的不同区域提取并量化视网膜血管的形态特征，包括血管口径、小动脉与小静脉比（AVR）、迂曲度、血管弓角（AVA）、血管弓距（DVA）、密度、分形维数和静脉长度。此外，还对视盘和视盘周围萎缩（PPA）区域进行了量化。比较了不同性别总体人群和年龄小于 25 岁患者的特征。采用单变量和多元线性回归分析探讨视网膜血管参数与 PPA 宽度的相关性，并对血管指标的详细趋势进行分析，以探讨潜在的阶段性形态变化。
该研究共纳入 5775 名患者的 14066 张眼底照片（年龄 41.2±18.6 岁），其中 7379 名（61.2%）为女性。该研究共纳入 5320 名患者的 12067 张眼底照片（年龄 41.2±18.6 岁）。男性和女性之间观察到视网膜血管形态参数存在显著差异。在校正年龄和性别后，多元线性回归分析显示，PPA 比值增加与较低的 AVA（1PD）、DVA（1PD）、血管口径（0.5-1.0PD）、迂曲度（0.5-1.0PD）、密度和分形维数（均 P<0.001，Spearman's ρ<0）相关。总体而言，视网膜血管形态的变化呈现两个阶段：在第一阶段，AVA（1PD）和 DVA（1PD）迅速下降，而在第二阶段下降速度显著较慢，而血管密度和分形维数则呈现出相反的趋势，初始下降缓慢，随后迅速下降。
本研究确定了 HM 进展过程中视网膜血管形态变化的两个不同阶段。在初始阶段以牵引病变为主，而在后期阶段以萎缩病变为主。这些发现从视网膜血管的角度为 HM 的发展机制提供了进一步的见解。
