Li Junmeng, Rong Bei, Zhu Lei, Zhu Ruilin, Rong Xin, Wang Yuwei, Zhang Yadi, Gu Xiaopeng, Zeng Shuang, Lu Yanye, Yang Liu
Department of Ophthalmology, Peking University First Hospital, No. 8 Xi Shi Ku Street, Xicheng District, Beijing, 100034, China.
Institute of Medical Technology, Peking University Health Science Center, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing, 100191, China.
Ophthalmol Ther. 2025 Jul 30. doi: 10.1007/s40123-025-01210-2.
Orthokeratology (ortho-K) is an established intervention for myopia control in children, yet the vascular mechanisms within the choroidal sublayers underlying its efficacy remain unclear. This study aims to investigate the changes in the choroidal vascularity index (CVI) of choroid sublayers after ortho-K treatment, the association between 1-month CVI changes and 1-year axial length (AL) elongation, and the role of CVI responses in predicting the 1-year control efficacy of ortho-K treatment.
A prospective cohort study was conducted, enrolling 257 children with myopia aged 7-16 years. The subjects wore ortho-K lenses continuously for 12 months. Choroidal volume, vascular volume (CVV), stromal volume (CSV), and CVI of the choroid sublayers were assessed using optical coherence tomography images at baseline and 1-month follow-up. The total choroidal layer (TCL) includes the large-vessel choroidal layer (LVCL) and the medium-vessel choroidal layer (MVCL). The Early Treatment of Diabetic Retinopathy Study (ETDRS) grid divides the macular area into nine subfields for detailed analysis.
The 1-month CVI of TCL and MVCL in all ETDRS grid regions were significantly lower than the baseline CVI (P ≤ 0.036), except for the superior outer ring subfield in TCL (P = 0.070). After the 1-month ortho-K treatment, both choroidal volume and CSV significantly increased in all choroidal sublayers compared with baseline data (P ≤ 0.027), while CVV also showed significant increases in half of the ETDRS grid regions (14/27). After adjusting for age and gender, the baseline CVI of temporal inner ring subfield in TCL (β = 0.146, P = 0.006), and 1-month CVI changes of the temporal outer ring subfield (β = 0.337, P < 0.001) and nasal inner ring subfield (β = 0.174, P = 0.002) in MVCL, were independently associated with 1-year AL elongation during ortho-K treatment. On the basis of the 1-month CVI changes of temporal outer ring subfield and nasal inner ring subfield in MVCL, as well as age and sex, the prediction model demonstrated an area under the curve (AUC) of 0.905 (95% CI 0.870-0.941) for distinguishing children with myopia who exhibited slow versus fast AL elongation.
After the 1-month ortho-K treatment, choroidal volume, CVV, and CSV, of all choroidal sublayers significantly increased, while CVI of TCL and MVCL significantly decreased. The CVI in LVCL showed no significant changes. The differences in short-term CVI changes among choroidal sublayers indicate disproportionate changes in CVV and CSV, which help to explore the possible choroidal mechanisms of myopia control with ortho-K treatment. Early CVI changes in MVCL possess potential clinical significance for predicting long-term AL elongation.
角膜塑形术（ortho-K）是一种已确立的用于控制儿童近视的干预措施，但其疗效背后脉络膜各亚层内的血管机制仍不清楚。本研究旨在探讨角膜塑形术治疗后脉络膜各亚层的脉络膜血管指数（CVI）变化、1个月时CVI变化与1年眼轴长度（AL）伸长之间的关联，以及CVI反应在预测角膜塑形术治疗1年控制效果中的作用。
进行了一项前瞻性队列研究，纳入257名7至16岁的近视儿童。受试者连续佩戴角膜塑形镜12个月。在基线和1个月随访时，使用光学相干断层扫描图像评估脉络膜各亚层的脉络膜体积、血管体积（CVV）、基质体积（CSV）和CVI。脉络膜全层（TCL）包括大血管脉络膜层（LVCL）和中血管脉络膜层（MVCL）。糖尿病视网膜病变早期治疗研究（ETDRS）网格将黄斑区域划分为九个子区域进行详细分析。
在所有ETDRS网格区域中，TCL和MVCL的1个月CVI均显著低于基线CVI（P≤0.036），TCL的上外侧环子区域除外（P = 0.070）。角膜塑形术治疗1个月后，与基线数据相比，所有脉络膜亚层的脉络膜体积和CSV均显著增加（P≤0.027），而CVV在一半的ETDRS网格区域（14/27）也显著增加。在调整年龄和性别后，TCL颞侧内环子区域的基线CVI（β = 0.146，P = 0.006）以及MVCL颞侧外环子区域（β = 0.337，P < 0.001）和鼻侧内环子区域（β = 0.174，P = 0.002）的1个月CVI变化与角膜塑形术治疗期间的1年AL伸长独立相关。基于MVCL颞侧外环子区域和鼻侧内环子区域的1个月CVI变化以及年龄和性别，预测模型区分近视儿童中AL伸长缓慢与快速的曲线下面积（AUC）为0.905（95%CI 0.870 - 0.941）。
角膜塑形术治疗1个月后，所有脉络膜亚层的脉络膜体积、CVV和CSV均显著增加，而TCL和MVCL的CVI显著降低。LVCL中的CVI无显著变化。脉络膜各亚层短期CVI变化的差异表明CVV和CSV的变化不成比例，这有助于探索角膜塑形术控制近视的可能脉络膜机制。MVCL中早期CVI变化对预测长期AL伸长具有潜在的临床意义。
