儿童青少年近视眼患者视盘旁高反射卵圆样团块状结构的临床观察  

Observational study on peripapillary hyper-reflective ovoid mass-like structures in children and adolescents with myopia

作　　者：张露 陈长征[2] 孙功鹏 郁继国 赵芳 Zhang Lu;Chen Changzheng;Sun Gongpeng;Yu Jiguo;Zhao Fang(Department of Ophthalmology,Central Hospital of Wuhan,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430014,China;Eye Center,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]华中科技大学同济医学院附属武汉市中心医院眼科,武汉430014 [2]武汉大学人民医院眼科中心,武汉430060

出　　处：《中华眼科杂志》2023年第1期44-49,共6页Chinese Journal of Ophthalmology

基　　金：武汉市中心医院学科基金(2021XK017)。

摘　　要：目的观察儿童青少年近视眼患者视盘旁高反射卵圆样团块状结构(PHOMS)的临床特征并分析其相关因素。方法横断面研究。连续收集2021年9月至2022年1月就诊于武汉市中心医院和武汉大学人民医院且近视等效球镜度数(SE)≥0.50 D的6~16岁儿童青少年近视眼患者。所有患者均行最佳矫正视力、屈光状态、眼轴长度检查, 采用裂隙灯显微镜联合检眼镜检查患者眼底, 并行眼底彩照以及视盘加强深度扫描模式的相干光层析成像术(EDI-OCT)检查, 测量参数包括视盘直径、视盘倾斜度、视盘平移度和PHOMS高度。根据是否存在PHOMS分为PHOMS组及无PHOMS组, 根据PHOMS高度分为大(>400 μm)、中(200~400 μm)和小(<200 μm)型PHOMS 3个亚组。观察PHOMS组和无PHOMS组以及各亚组的视盘特征, 并分析PHOMS的相关因素。主要采用 Mann-WhitneyU检验、Kruskal-Wallis 检验、χ2检验以及Logistic回归分析和Kendall′s tau-b相关系数进行统计学分析。结果共纳入108例(108只眼)患者, 其中男性46例(46只眼), 女性62例(62只眼), PHOMS组为70只眼(64.8%), 无PHOMS组为38只眼(35.2%)。小型PHOMS仅可在EDI-OCT中检出, 中、大型PHOMS检眼镜下表现为视盘边界模糊。单因素Logistic回归模型显示, PHOMS与年龄(OR=1.36, 95%CI:1.13~1.65, P=0.001)、近视等效球镜度数(OR=4.57, 95%CI:2.51~8.32, P<0.001)、眼轴长度(OR=2.28, 95%CI:1.37~3.82, P=0.002)、视盘倾斜度(OR=3.44, 95%CI:2.09~5.66, P<0.001)、视盘平移度(OR=0.95, 95%CI:0.93~0.98, P<0.001)、视盘直径(OR=0.75, 95%CI:0.58~0.95, P=0.019)相关。多因素Logistic回归模型显示, 近视等效球镜度数较高(OR=3.01, 95%CI:1.27~7.17, P=0.013)和视盘倾斜度较大(OR=4.06, 95%CI:1.99~8.29, P<0.001), PHOMS出现的风险较大。Kendall′s tau-b相关系数分析显示, PHOMS高度与视盘平移度呈负相关(r=-0.31, P<0.001)。结论 PHOMS存在于部分儿童青少年近视眼患者, 不同高度PHOMS的眼底表现略有差异Objective To investigate the correlation of peripapillary hyper-reflective ovoid mass-like structures(PHOMS)in children and adolescents with myopia and its correlation factors.Methods It was a cross-sectional study.From September 2021 to January 2022,myopic children and adolescents aged 6-16 years treated in Wuhan Central Hospital and Renmin Hospital of Wuhan University with a myopic spherical equivalent(SE)≥0.5 D were consecutively included.All patients underwent best corrected visual acuity,refraction,intraocular pressure,slit lamp microscope,axial length,fundus photography and enhanced depth imaging optical coherence tomography(EDI-OCT)examination.EDI-OCT optic disc parameter measurements included diameter,degree of tilt and shift and PHOMS height.The patients were divided into PHOMS group and non-PHOMS group according to the presence or absence of PHOMS.According to the height of PHOMS,the patients were further divided into 3 subgroups:large(>400μm),medium(200-400μm)and small(<200μm).The optic disc characteristics of the PHOMS group and the non-PHOMS group and each subgroup were observed,and the correlation factors of PHOMS were analyzed.Mann-Whitney U test,Kruskal-Wallis test,chi-square test,Logistic regression analysis and Kendall′s tau-b correlation coefficient were used.Results A total of 108 patients(108 eyes)were included,including 46 males(46 eyes)and 62 females(62 eyes).There were 70 eyes(64.8%)in the PHOMS group and 38 eyes(35.2%)in the non-PHOMS group.Small PHOMS can only be detected by EDI-OCT,while medium to large PHOMS showed blurred optic disc boundaries on fundoscopy images.Univariate Logistic regression analysis showed that PHOMS was associated with age(OR=1.36,95%CI:1.13-1.65,P=0.001)and myopic SE(OR=4.57,95%CI:2.51-8.32,P<0.001),axial length(OR=2.28,95%CI:1.37-3.82,P=0.002),optic disc tilt(OR=3.44,95%CI:2.09-5.66,P<0.001),optic disc shift(OR=0.95,95%CI:0.93-0.98,P<0.001)and optic disc diameter(OR=0.75,95%CI:0.58-0.95,P=0.019).Multivariate Logistic regression analysis showed that the h

关 键 词：近视 视盘 视盘小疣 神经纤维 体层摄影术 光学相干 青少年 儿童 

分 类 号：R778.11[医药卫生—眼科]