OCTA联合频域OCT评估高度近视患者黄斑区微循环及脉络膜结构的临床研究

doi:10.13281/j.cnki.issn.1004-4469.2026.03.005.

摘要/Abstract

摘要： 目的探讨相干光断层扫描血管成像（optical coherence tomography angiography，OCTA）联合频域（spectral-domain，SD）OCT量化评估高度近视患者黄斑区微循环及脉络膜结构改变的临床价值，明确二者协同评估的优势及各项参数与近视性黄斑病变的关联。设计前瞻性病例对照研究。研究对象 2023年1月-2024年12月在中国人民解放军联勤保障部队第九六九医院就诊的高度近视患者50例（50眼，等效球镜屈光度≤-6.00 D，眼轴≥26.5 mm）及年龄、性别匹配的正常对照40例（40眼，屈光度数±0.50 D，眼轴22.0～24.5 mm）。高度近视组进一步分为屈光度亚组（-6.00 D~9.00 D组30例、<-9.00 D组20例）、病变亚型组[单纯高度近视35例、近视性黄斑病变15例（含脉络膜新生血管（choroidal neovascularization，CNV）亚组7例]。方法所有研究对象均行OCTA（5 mm×5 mm扫描）检测浅层/深层视网膜血管密度、脉络膜毛细血管密度、黄斑中心凹无灌注区（foveal avascular zone，FAZ）特征及血流动力学参数，行SD-OCT检测黄斑中心凹下脉络膜厚度（subfoveal choroidal thickness，SFCT）、脉络膜分层参数及脉络膜无灌注点密度；采用独立样本t检验、卡方检验比较组间指标差异，Spearman秩相关分析参数间相关性，偏相关分析控制屈光度后视功能与微循环参数的关联。主要指标循环参数（基于OCTA）：浅层/深层视网膜血管密度、脉络膜毛细血管密度、脉络膜无灌注点密度、FAZ面积及形态异常率；脉络膜结构参数（基于SD-OCT）： SFCT；临床关联指标：最佳矫正视力（BCVA，LogMAR）、黄斑缺血指数、CNV检出率。结果高度近视组浅层/深层视网膜血管密度、脉络膜毛细血管密度均显著低于对照组（P均<0.001），FAZ面积、形态异常率及脉络膜无灌注点密度显著高于对照组（P均<0.001）；SFCT随近视度数加深显著变薄[-6.00 D~-9.00 D组（215.34±32.15）μm，<-9.00 D组（168.76±28.45）μm，P<0.001]，且与脉络膜毛细血管密度呈显著正相关（r=0.412，P=0.005），与BCVA（LogMAR）呈显著负相关（r=-0.456，P=0.002）。CNV亚组较无CNV高度近视患者深层视网膜血管密度更低（19.87%±2.89% vs 27.02%±2.65%，P<0.001）、黄斑缺血指数更高（32.15%±5.12% vs 18.67%±3.56%，P<0.001）、脉络膜无灌注点密度更高（0.92±0.31 个/mm2 vs 0.45±0.18 个/mm2，P<0.001）、SFCT更薄（156.34±25.78 μm vs 208.67±30.25 μm，P<0.001）。近视性黄斑病变组较单纯高度近视组深层血管密度更低（22.15%±3.12% vs 27.89±2.34%，P<0.001），CNV检出率达46.67%。结论 OCTA可无创量化高度近视黄斑区视网膜-脉络膜血管密度、血流动力学及无灌注特征，SFCT可精准反映脉络膜解剖结构的萎缩性改变，二者协同评估可实现黄斑微循环“结构-功能”的双重量化，较单一方法更能全面揭示高度近视的微循环损伤层级；CNV亚组存在更显著的黄斑微循环障碍，提示微循环严重损伤可能是CNV发生的重要病理基础，OCTA联合SFCT可为高度近视黄斑病变的早期筛查、亚型鉴别及病情评估提供全面的影像学依据。

关键词: , 高度近视；黄斑区；微循环；黄斑中心凹下脉络膜厚度

Abstract: Objective To investigate the clinical value of optical coherence tomography angiography (OCTA) combined with spectral-domain OCT (SD-OCT) in the quantitative assessment of macular microcirculation and choroidal structural changes in patients with high myopia, and to clarify the advantages of their synergistic evaluation and the correlations between various parameters and myopic maculopathy. Design Prospective case-control study. Participants A total of 50 patients (50 eyes) with high myopia (spherical equivalent ≤-6.00 D, axial length ≥26.5 mm) who visited the 969th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from January 2023 to December 2024 were included. Forty age- and sex-matched healthy individuals (40 eyes, refractive error ±0.50 D, axial length 22.0~24.5 mm) served as normal controls. The high myopia group was further divided into refractive subgroups (30 cases in the -6.00 D to -9.00 D group, and 20 cases in the <-9.00 D group) and lesion subtype subgroups [35 cases of simple high myopia, and 15 cases of myopic maculopathy, which included a choroidal neovascularization (CNV) subgroup of 7 cases]. Methods All participants underwent OCTA (5 mm×5 mm scan) to detect superficial and deep retinal vessel density, choriocapillaris density, foveal avascular zone (FAZ) characteristics, and hemodynamic parameters. SD-OCT was performed to measure the subfoveal choroidal thickness (SFCT), choroidal layer parameters, and choroidal non-perfusion spot density. Independent sample t-tests and Chi-square tests were used to compare differences between groups. Spearman rank correlation was utilized to analyze the correlation among parameters, and partial correlation analysis was applied to evaluate the association between visual function and microcirculation parameters after controlling for refractive error. Main Outcome Measures Microcirculation parameters (based on OCTA): superficial/deep retinal vessel density, choriocapillaris density, choroidal non-perfusion spot density, FAZ area, and morphological abnormality rate; Choroidal structural parameter (based on SD-OCT): SFCT; Clinical correlation indicators: best-corrected visual acuity (BCVA, LogMAR), macular ischemia index, and CNV detection rate. Results The superficial/deep retinal vessel density and choriocapillaris density in the high myopia group were significantly lower than those in the control group (all P<0.001), while the FAZ area, morphological abnormality rate, and choroidal non-perfusion spot density were significantly higher than those in the control group (all P<0.001). The SFCT significantly thinned with the progression of myopia severity [(215.34±32.15)μm in the -6.00 D to -9.00 D group vs. (168.76±28.45)μm in the <-9.00 D group, P<0.001)], and was significantly positively correlated with choriocapillaris density (r=0.412, P=0.005) and negatively correlated with BCVA (LogMAR) (r=-0.456, P=0.002). Compared with high myopia patients without CNV, the CNV subgroup exhibited lower deep retinal vessel density (19.87%±2.89% vs. 27.02%±2.65%, P<0.001), higher macular ischemia index (32.15%±5.12% vs. 18.67%±3.56%, P<0.001), greater choroidal non-perfusion spot density (0.92±0.31 spots/mm2 vs. 0.45±0.18 spots/mm2, P<0.001), and thinner SFCT (156.34±25.78 μm vs. 208.67±30.25 μm, P<0.001). The deep vessel density in the myopic maculopathy group was significantly lower than that in the simple high myopia group (22.15%±3.12% vs. 27.89%±2.34%, P<0.001), with a CNV detection rate reaching 46.67%. Conclusions OCTA can non-invasively quantify the retinochoroidal vessel density, hemodynamics, and non-perfusion characteristics of the macular region in high myopia, whereas SFCT can accurately reflect the atrophic changes of choroidal anatomy. Their synergistic evaluation achieves a dual quantification of macular microvascular "structure-function," revealing the multi-level microcirculatory damage in high myopia more comprehensively than a single modality. The CNV subgroup presents with more prominent macular microcirculation impairments, suggesting that severe microcirculatory damage may be an essential pathological basis for CNV development. The combination of OCTA and SFCT provides comprehensive imaging evidence for the early screening, subtype differentiation, and severity assessment of myopic maculopathy.

Key words: High myopia, Macular area, Microcirculation, Subfoveal choroidal thickness

关小荣杜婧张煜. OCTA联合频域OCT评估高度近视患者黄斑区微循环及脉络膜结构的临床研究[J]. 眼科, 2026, 35(3): 209-215.

Guan Xiaorong, Du Jing, Zhang Yu. Combined OCTA and spectral-domain-OCT for assessing macular microcirculation and choroidal structure in high myopia [J]. Ophthalmology in China, 2026, 35(3): 209-215.

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OCTA联合频域OCT评估高度近视患者黄斑区微循环及脉络膜结构的临床研究

Combined OCTA and spectral-domain-OCT for assessing macular microcirculation and choroidal structure in high myopia

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