0.05%阿托品滴眼液对青少年非病理性高度近视眼底微循环的影响：一项18个月随访研究

doi:10.13281/j.cnki.issn.1004-4469.2025.03.008

摘要/Abstract

摘要： 目的探讨0.05%阿托品滴眼液对青少年基于角膜曲率和屈光度分类的非病理性高度近视眼视网膜微循环的影响。设计随机对照临床试验。研究对象选取2021年7月-2022年6月在聊城爱尔眼科医院就诊的青少年102例（102眼）。根据平均等效球镜（SER）和眼轴长度（AL），将患者分为普通高度近视组（CHM组，SER：6.00~9.00 D，角膜曲率：42~45 D），隐匿高度近视组（OHM组，SER≥-3.00 D，角膜曲率＜41 D），每组分别分为进行0.05%阿托品滴眼液治疗（治疗组，CHM组25眼，OHM组26眼）和不使用0.05%阿托品滴眼液治疗（对照组，CHM组26眼，OHM组25眼）。方法在初诊及治疗后3、6、12、18个月分别用OCT以黄斑中心凹为原点进行垂直扫描，范围6 mm×6 mm，手动测量中心凹的脉络膜厚度（SFCT）。将黄斑中心凹 6 mm 范围分为直径为 1 mm 的中心区、1~3 mm 的内环区、3~6 mm的外环区，应用OCTA对3个区域的浅层视网膜血管长度密度（SRVD）、浅层视网膜血管灌注密度（SBPD）和直径6 mm完整图像的SRVD和SBPD及其内环区和外环区各个象限的数值进行分析，并量化视网膜厚度和黄斑中心凹无血管区（FAZ）进行分析比较，并比较18个月各组SER和AL的变化。为排除脉络膜厚度受昼夜节律的影响，所有测量均在上午8～11点完成。主要指标 SFCT、SRVD、SBPD、SER、AL。结果 CHM组治疗后3、6、12和18个月的SFCT分别为（212.10±36.05）μm、（225.7±37.55）μm、（232.33±36.08）μm和（232.76±35.91）μm，与治疗前的（187.81±37.55）μm比较，均显著增加（P均＜0.05）。3、6、12和18个月的黄斑区中心平均SRVD分别为（5.28±2.70）mm-1、（7.50±2.96）mm-1、（8.93±1.77）mm-1和（8.70±1.73）mm-1，与治疗前的（3.72±2.58）mm-1比较，均显著增加（P均＜0.05）；黄斑区内环、外环的平均SRVD与治疗前比较也均显著增加（P均＜0.05）。3、6、12和18个月的黄斑区中心平均SBPD分别为（13.81±6.82）%、（20.47±10.38）%、（26.54±5.60）%和（26.77±5.46）%与治疗前的（7.98±5.77）%比较，均显著增加（P均＜0.05）；黄斑区内环、外环的平均SBPD与治疗前比较，也均显著增加（P均＜0.05）。OHM组治疗后3、6、12和18个月的SFCT分别为（221.80±29.15）μm、（239.75±23.74）μm、（237.30±22.40）μm和（236.70±22.42）μm，与治疗前的（209.25±31.87）μm比较，均显著增加（P均＜0.05）。6、12和18个月的黄斑区中心平均SRVD分别为（7.44±1.22）mm-1、（7.76±0.74）mm-1和（7.72±0.77）mm-1与治疗前的（4.23±1.75）mm-1比较，均显著增加（P均＜0.05）；黄斑区内环、外环的平均SRVD与治疗前比较，也均显著增加（P均＜0.05）。6、12和18个月的黄斑区中心平均SBPD分别为（13.92±2.80）%、（15.10±2.57）%和（15.60±2.63）%，与治疗前的（10.04±3.74）%比较，均显著增加（P均＜0.05）；黄斑区内环、外环平均SBPD与治疗前比较，也均显著增加（P均＜0.05）；而3个月与治疗前比较黄斑区中心、内环、外环平均SRVD、平均SBPD均无差异（P均＞0.05）。治疗后18个月CHM组和OHM组的AL和SER变化量分别为（0.26±0.16）mm、（-0.54±0.23）D和（0.38 ±0.16）mm、（-0.78±0.38）D，均小于对照组的（0.74±0.14）mm、（-1.51±0.26）D和（0.72±0.13）mm、（-1.50±0.24）D（P均＜0.001）。结论应用0.05%阿托品滴眼液的CHM和OHM患者黄斑区视网膜SFCT、SRVD和SBPD出现一定的增加，而视网膜厚度和FAZ保持相对稳定，AL和SER增长均降低。（眼科，2025，34： 217-226）

关键词: , 0.05%阿托品滴眼液；视网膜微循环；高度近视；相干光断层扫描；相干光断层扫描血管成像

Abstract: Objective To investigate the influence of 0.05% atropine eye drops on the retinal microcirculation of high myopia in adolescents based on corne curvature and refractive power classification. Design Randomized controlled trial. Participants A total of 102 cases (102 eyes) of children and adolescents were selected from Liaocheng Aier Eye Hospital from July 2021 to June 2022. 5 common high myopia (CHM) patients and 26 ocoult high myopia (OHM) patients in atropine treatment group and 26 OHM patients and 25 OHM patients in control group. Methods Subjects were divided into normal high myopia group (CHM Group, SER 6.00 D~9.00 D, corneal curvature 42~45 D), occult high myopia group (OHM group, SER≥-3.00 D, corneal curvature <41 D) according to spherical equivalent refraction (SER) and axial length (AL), each group was treated with 0.05% atropine eye drops and without 0.05% atropine eye drops. The choroidal thickness was measured by optical coherence tomography (OCT) with a scanning range of 6 mm×6 mm. The choroidal thickness of macular fovea was measured manually by using 6 mm scanning line. The macular fovea was divided into three concentric circles with a diameter of 1 mm, an inner ring with a diameter of 1~3 mm and an outer ring with a diameter of 3~6 mm, the superficial retinal vascular density (SRVD) and vascular perfusion density(SBPD) of the three regions, the SRVD and SBPD of the whole image with a diameter of 6 mm, and the values of each quadrant of the inner and outer ring regions were analyzed by using optical coherence tomography angiography(OCTA) , the retinal thickness and macular fovea avascular zone (FAZ) were quantified and compared, and the changes of equivalent spherical degree (SER) and AL were compared in each group after 18 months. Main Outcome Measures Macular fovea choroidal thickness(SFCT) , SRVD, SBPD, SER, AL . In order to exclude the influence of circadian rhythm on choroidal thickness, all measurements were made between 8 am and 11 am. Results The CHM group showed an increase in SFCT at 3, 6, 12, and 18 months after treatment, with values of (212.10±36.05), (225.7±37.55), (232.33±36.08), and (232.76±35.91) μm, respectively, which were all significantly higher than the pre-treatment value of (187.81±37.55) μm (P<0.05); the average SRVD in the macular center was increased at 3, 6, 12, and 18 months after treatment, with values of (5.28±2.70), (7.50±2.96), (8.93±1.77), and (8.70±1.73) mm-1, respectively, which were all significantly higher than the pre-treatment value of (3.72±2.58) mm-1 (P<0.05); the average SRVD in the macular inner ring was increased at 3, 6, 12, and 18 months after treatment, with values of (15.11±2.06), (16.81±2.35), (18.28±1.26), and (18.25±1.24) mm-1, respectively, which were all significantly higher than the pre-treatment value of (12.44±3.14) mm-1 (P<0.05); the average SRVD in the macular outer ring was increased at 3, 6, 12, and 18 months after treatment, with values of (16.73±1.55), (17.33±1.94), (18.55±1.18), and (18.44±1.24) mm-1, respectively, which were all significantly higher than the pre-treatment value of (14.96±1.94) mm-1 (P<0.05); the average SBPD in the macular center was increased at 3, 6, 12, and 18 months after treatment, with values of (13.81±6.82)%, (20.47±10.38)%, (26.54±5.60)%, and (26.77±5.46)%, respectively, which were all significantly higher than the pre-treatment value of (7.98±5.77)% (P<0.05); the average SBPD in the macular inner ring was increased at 3, 6, 12, In the CHM group, The changes of AL and SER in CHM group were (0.26 ± 0.16)mm and (-0.54±0.23)D, respectively, which were smaller than those in CHM control group (0.74±0.14)mm and (-1.51±0.26) D (P<0.001). The changes of AL and SER in OHM group were (0.38 ±0.16) mm and (-0.78±0.38) D at 18 months, which were smaller than those in OHM control group (0.72±0.13) mm and (-1.50±0.24)D (P<0.001). Conclusion The SFCT, SRVD and SBPD in the macula of CHM and OHM patients treated with 0.05% atropine eye drops increased, but retinal thickness and FAZ remained relatively stable, and AL and SER decreased. (Ophthalmol CHN, 2025, 34: 217-226)

Key words: 0.05% atropine eye drops, retinal microcirculation, high myopia, optical coherence tomography, optical coherence tomography angiography

吉艳艳, 黄法友魏自广陈松, . 0.05%阿托品滴眼液对青少年非病理性高度近视眼底微循环的影响：一项18个月随访研究[J]. 眼科, 2025, 34(3): 217-226.

Ji Yanyan, Huang Fayou, Wei Ziguang, Chen Song, . Effects of 0.05% atropine eye drops on fundus microcirculation in non-pathological high myopia: an 18-month follow-up study[J]. Ophthalmology in China, 2025, 34(3): 217-226.

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0.05%阿托品滴眼液对青少年非病理性高度近视眼底微循环的影响：一项18个月随访研究

Effects of 0.05% atropine eye drops on fundus microcirculation in non-pathological high myopia: an 18-month follow-up study

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