基于ATN分级系统分析高度近视患者中近视性黄斑病变致盲和视力损伤情况以及相关危险因素  

Analysis of blindness and visual impairment attributed to myopic maculopathy in patients with high myopia and associated risk factors based on the ATN classification system

作　　者：刘兴亮 古世才 艾碧君 董晓云 李晓玲 LIU Xingliang;GU Shicai;AI Bijun;DONG Xiaoyun;LI Xiaoling(Department of Ophthalmology,Chengdu Bright Eye Hospital,Chengdu 610036,Sichuan Province,China)

机构地区：[1]成都普瑞眼科医院眼科,四川省成都市610036

出　　处：《眼科新进展》2024年第8期649-652,共4页Recent Advances in Ophthalmology

摘　　要：目的基于ATN分级系统分析高度近视患者中近视性黄斑病变致盲和视力损伤情况以及相关危险因素。方法回顾性病例对照研究。收集2022年1月至2023年9月在成都普瑞眼科医院眼底病门诊就诊的642例(642眼)成人高度近视患者的临床资料进行分析。对所有患者均进行全面的眼科检查,并根据ATN分级系统对高度近视患者近视性黄斑病变进行诊断和分级。采用WHO关于盲和视力损伤的诊断标准,将患者分为盲或视力损伤组和无或轻度视力损伤组。采用多因素Logistic回归分析高度近视患者盲或视力损伤的危险因素。结果642眼中,患近视性黄斑病变者共355眼(55.30%);其中,近视萎缩性病变(A2及以上)、近视牵拉性病变和近视新生血管性病变分别有330眼(51.40%)、137眼(21.34%)和82眼(12.77%)。盲眼占比为2.02%(95%CI:0.93%~3.11%),视力损伤眼占比为8.41%(95%CI:6.26%~10.56%)。多因素Logistic回归分析结果显示年龄较大、眼轴长度较长、近视萎缩性病变分级较高是高度近视患者发生盲或视力损伤的独立危险因素(均为P<0.05)。结论ATN分级系统能够全面地反映近视性黄斑病变患者病情严重程度及视力受损状况。年龄较大、眼轴长度较长、近视萎缩性病变分级较高是高度近视患者发生盲或视力损伤的独立危险因素。Objective To analyze the blindness and visual impairment attributed to myopic maculopathy in highly myopic patients based on the ATN classification system,as well as associated risk factors.Methods In this retrospective case-control study,clinical data of 642 adult patients(642 eyes)with high myopia admitted to the Department of Fundus Disease,Chengdu Bright Eye Hospital from January 2022 to September 2023 were collected and analyzed.Comprehensive ophthalmic examinations were conducted for all patients.Myopic maculopathy in patients with high myopia was diagnosed and graded according to the ATN classification system.The patients were divided into the blindness or visual impairment group and the non or mild visual impairment group based on the WHO diagnostic criteria for blindness and visual impairment.Multivariate Logistic regression was utilized to analyze the risk factors for blindness or visual impairment in patients with high myopia.Results Among the 642 eyes,myopic maculopathy was identified in 355 eyes(55.30%).Of these,there were 330 eyes(51.40%)with myopic atrophy maculopathy(A2 and above),137 eyes(21.34%)with myopic traction maculopathy,and 82 eyes(12.77%)with myopic neovascular maculopathy.The percentages of blindness and visual impairment were 2.02%(95%CI:0.93%-3.11%)and 8.41%(95%CI:6.26%-10.56%),respectively.Multivariate Logistic regression analysis showed that older age,longer axial length and higher grade of myopic atrophy maculopathy were independent risk factors for blindness or visual impairment in patients with high myopia(all P<0.05).Conclusion The ATN classification system can comprehensively reflect the disease severity and visual impairment of patients with myopic maculopathy.Older age,longer axial length and higher grade of myopic atrophy maculopathy are independent risk factors for blindness or visual impairment in patients with high myopia.

关 键 词：高度近视 盲 视力损伤 危险因素 ATN分级系统 

分 类 号：R778[医药卫生—眼科]