Mu Tong, He Hai-Long, Chen Xuan-Yu, Fang Yu-Xin, Xu Jie, Jin Zi-Bing
Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Science Key Laboratory, Beijing, China.
Eye (Lond). 2025 Apr 25. doi: 10.1038/s41433-025-03782-6.
This study aims to investigate the relationship between axial length (AL) and the severity of myopic macular degeneration (MMD).
We conducted a comprehensive search of PubMed, Web of Science, and China National Knowledge Infrastructure (CNKI) databases from their inception until October 1, 2023, to identify population-based or hospital-based studies reporting AL across different grades of MMD. Only studies employing the International Photographic Classification and Grading System for Myopic Maculopathy (META-PM) were included. A meta-analysis was performed to assess the association between AL and MMD severity. To further validate our findings, we analyzed data from 395 eyes of 206 participants at Beijing Tongren Hospital, Capital Medical University.
The meta-analysis included 20 high-quality studies from seven countries, with 33822 patients studied. Information, including the study name, year of publication, country, sample size, basic demographic characteristics of the participants, AL of different grades of MMD, best corrected visual acuity (BCVA), and spherical equivalent (SE), was extracted. The meta-analysis revealed a significant overall increase in AL as MMD progressed from category C0 to C4 (P < 0.0001). AL exhibited a consistent increasing trend from categories C0 to C3; however, this trend appeared to level off between categories C3 and C4, with no further increase observed. This trend was confirmed by the distribution of our new dataset. A higher prevalence of MMD was significantly associated with longer AL (per 1 mm increase: OR, 1.90; 95% CI, 1.75-2.07; P < 0.001), older age (per 1-year increase: OR, 1.04; 95% CI, 1.02-1.05; P < 0.001), and female gender (OR, 1.89; 95% CI, 1.24-2.89; P < 0.01). Compared with C0, each 1 mm increase in AL was associated with an increasing likelihood of MMD progression, with ORs of 2.8 for C1, 3.6 for C2, 5.2 for C3, and 5.7 for C4. The increase in OR was more pronounced in later stages (C2-C3 and C3-C4) than in earlier transitions (C0-C1 and C1-C2). Similarly, the ORs for age increased significantly from C3 to C4, and the ORs for female gender increased progressively from C2 to C4.
The meta-analysis and new clinical study indicate a clear trend of increasing AL with advancing MMD severity from C0 to C4. However, the relationship between AL and MMD progression from C3 to C4 warrants further investigation. Additionally, older age and female gender are identified as risk factors for MMD progression.
本研究旨在探讨眼轴长度（AL）与近视性黄斑变性（MMD）严重程度之间的关系。
我们对PubMed、科学网和中国知网数据库从建库至2023年10月1日进行了全面检索，以确定报告不同等级MMD患者AL的基于人群或基于医院的研究。仅纳入采用国际近视性黄斑病变摄影分类和分级系统（META-PM）的研究。进行荟萃分析以评估AL与MMD严重程度之间的关联。为进一步验证我们的研究结果，我们分析了首都医科大学附属北京同仁医院206名参与者的395只眼的数据。
荟萃分析纳入了来自7个国家的20项高质量研究，共研究了33822例患者。提取了包括研究名称、发表年份、国家、样本量、参与者的基本人口统计学特征、不同等级MMD的AL、最佳矫正视力（BCVA）和等效球镜度（SE）等信息。荟萃分析显示，随着MMD从C0期进展至C4期，AL总体上显著增加（P < 0.0001）。从C0期到C3期，AL呈现出持续增加的趋势；然而，这种趋势在C3期和C4期之间似乎趋于平稳，未观察到进一步增加。我们的新数据集分布证实了这一趋势。MMD患病率较高与AL较长显著相关（每增加1 mm：OR，1.90；95%CI，1.75 - 2.07；P < 0.001）、年龄较大（每增加1岁：OR，1.04；95%CI，1.02 - 1.05；P < 0.001）以及女性性别（OR，1.89；95%CI，1.24 - 2.89；P < 0.01）。与C0期相比，AL每增加1 mm与MMD进展可能性增加相关，C1期的OR为2.8，C2期为3.6，C3期为5.2，C4期为5.7。OR的增加在后期阶段（C2 - C3和C3 - C4）比早期阶段（C0 - C1和C1 - C2）更为明显。同样，年龄的OR从C3期到C4期显著增加，女性性别的OR从C2期到C4期逐渐增加。
荟萃分析和新的临床研究表明，随着MMD严重程度从C0期进展至C4期，AL有明显增加的趋势。然而，AL与MMD从C3期到C4期进展之间的关系值得进一步研究。此外，年龄较大和女性性别被确定为MMD进展的危险因素。
