年轻人病理性高度近视的轴向伸长进展模式和危险因素：三年大型纵向队列随访。
Progression Patterns and Risk Factors of Axial Elongation in Young Adults With Nonpathologic High Myopia: Three-Year Large Longitudinal Cohort Follow-Up.
机构信息
From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases (K.K., J.J., P.W., Y.S., F.L., F.L., X.G., X.L., L.J., Z.W., Y.L., M.C., S.C., and X.Z.), Guangzhou, China.
Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University (K.O.-M.), Bunkyo-ku, Japan.
出版信息
Am J Ophthalmol. 2024 Nov;267:293-303. doi: 10.1016/j.ajo.2024.08.006. Epub 2024 Aug 14.
PURPOSE
To investigate the progression patterns and risk factors of axial elongation in young adults with nonpathologic high myopia.
DESIGN
Prospective, clinical observational cohort study with 2- to 4-year follow-up.
METHODS
A total of 1043 eyes of 563 participants (3515 medical records) aged 18 to 50 years with nonpathologic high myopia (axial length [AL] ≥ 26 mm; myopic maculopathy < diffuse chorioretinal atrophy; without posterior staphyloma) were included from 1546 participants (6318 medical records). Annual axial elongation was calculated via linear mixed-effect models. The associated risk factors of axial elongation were determined by ordinal logistic regression analysis, with generalized estimate equations for eliminating an interocular correlation bias.
RESULTS
Based on 5359 times of AL measurements, the annual axial elongation of participants (mean [SD] age 31.39 [9.22] years) was 0.03 mm/year (95% confidence interval [CI], 0.03-0.04; P < .001) during a 30.23 (6.06) months' follow-up. Severe (>0.1 mm/year), moderate (0.05-0.09 mm/year), mild (0-0.049 mm/year), and nil (≤0 mm/year) elongation was observed in 122 (11.7%), 211 (20.2%), 417 (40.0%), and 293 (28.1%) eyes. The following risk factors were significantly associated with axial elongation: baseline AL ≥ 28 mm (odds ratio [OR], 4.23; 95% CI, 2.95-6.06; P < .001); age < 40 years (OR, 1.64; 95% CI, 1.18-2.28; P = .003); axial asymmetry (OR, 2.04; 95% CI, 1.26-3.29; P = .003), and women (OR, 1.52; 95% CI, 1.13-2.2.05; P = .006). Using antiglaucoma medications was a protective factor (OR, 0.46; 95% CI, 0.27-0.79; P = .005), which slowed 75% of axial elongation from 0.04 (0.06) to 0.01 (0.06) mm/y (P < .001).
CONCLUSIONS
Axial elongation continued in young adults with nonpathologic myopia. Risk factors included longer baseline AL and axial asymmetry, younger age, and woman. Topical use of antiglaucoma medications may be useful to reduce ongoing axial elongation.
目的
研究非病理性高度近视年轻人眼轴延长的进展模式和危险因素。
设计
前瞻性、临床观察队列研究，随访 2 至 4 年。
方法
共纳入 1546 名参与者（3515 份病历）的 1043 只眼（563 名参与者；3515 份病历），年龄 18 至 50 岁，非病理性高度近视（眼轴[AL]≥26 毫米；近视性黄斑病变<弥漫性脉络膜视网膜萎缩；无后葡萄肿）。每年的眼轴延长通过线性混合效应模型计算。使用有序逻辑回归分析确定与眼轴延长相关的风险因素，并使用广义估计方程消除眼间相关性偏差。
结果
在 5359 次 AL 测量中，参与者（平均[标准差]年龄 31.39[9.22]岁）在 30.23（6.06）个月的随访中眼轴每年延长 0.03 毫米（95%置信区间[CI]，0.03-0.04；P<0.001）。122 只（11.7%）、211 只（20.2%）、417 只（40.0%）和 293 只（28.1%）眼出现严重（>0.1 毫米/年）、中度（0.05-0.09 毫米/年）、轻度（0-0.049 毫米/年）和无（≤0 毫米/年）延长。以下危险因素与眼轴延长显著相关：基线 AL≥28 毫米（优势比[OR]，4.23；95%CI，2.95-6.06；P<0.001）；年龄<40 岁（OR，1.64；95%CI，1.18-2.28；P=0.003）；轴不对称（OR，2.04；95%CI，1.26-3.29；P=0.003）和女性（OR，1.52；95%CI，1.13-2.20；P=0.006）。使用抗青光眼药物是一种保护因素（OR，0.46；95%CI，0.27-0.79；P=0.005），可将 0.04（0.06）毫米/年的眼轴延长速度降低 75%至 0.01（0.06）毫米/年（P<0.001）。
结论
非病理性近视的年轻人眼轴仍在延长。危险因素包括基线 AL 较长和轴不对称、年龄较小和女性。局部使用抗青光眼药物可能有助于减少眼轴的持续延长。
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