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