健康学龄儿童视网膜血管发育的临床研究

doi:10.3877/cma.j.issn.2095-2007.2020.02.006

目的

探讨健康学龄儿童视网膜血管发育的情况。

方法

横断面研究。收集2019年1月至2019年7月于成都爱尔眼科医院体检的健康学龄儿童和成年人共50例(50只眼)的临床资料。其中，儿童25例(25只眼)，男性10例(10只眼)，女性15例(15只眼)，年龄4~11岁，平均年龄(6.68±2.22)岁；成年人25例(25只眼)，男性9例(9只眼)，女性16例(16只眼)，年龄25~40岁，平均年龄(32.45±5.10)岁。根据年龄分为儿童组和成人组。检查并收集全部受检者的视力、眼压、血压、眼轴长度、视盘周围视网膜血流密度(VD)及视网膜神经纤维层(RNFL)厚度，采用均数±标准差描述。上述指标，儿童组与成人组组间比较采用独立样本t检验，组内比较采用配对t检验；此外，收集并记录受检者的性别资料，以例数和百分比进行描述，组间比较采用卡方检验。VD与各个因素的相关性，使用Person相关系数进行评价。

结果

儿童组受检者视盘周围上方、下方、鼻侧及颞侧区域四个象限的VD分别为(19.48±0.46)mm^-1、(19.78±0.37)mm^-1、(18.70±0.69)mm^-1及(20.05±0.74)mm^-1；成人组分别为(19.25±0.53)mm^-1、(19.67±0.51)mm^-1、(18.53±0.81)mm^-1及(19.43±1.37)mm^-1。经配对t检验，两组VD均一致表现为下方象限大于上方，差异有统计学意义(t＝-2.890，-3.535; P<0.05)；颞侧大于鼻侧，差异有统计学意义(t＝-3.429，-7.619；P<0.05)；独立样本t检验分析儿童组与成人组组间各象限VD差异均无统计学意义(t＝-1.660，-0.925，-0.802，-2.201；P>0.05)。儿童组视盘周围上方、下方、鼻侧及颞侧的RNFL厚度分别为(132.92±14.16)μm、(135.63±14.82)μm、(70.50±12.43)μm及(80.71±13.50)μm；成人组分别为(132.40±19.33)μm、(138.16±16.71)μm、(74.08±13.59)μm及(81.12±11.95)μm。Person相关系数分别评价儿童组和成人组各象限VD与RNFL厚度呈正相关，且具有一致的象限性，差异有统计学意义(r＝0.403，0.418；P<0.05)。

结论

健康学龄儿童视盘周围视网膜血管已发育至成人水平，且与RNFL厚度具有一致的象限性分布。

关键词: 视网膜血流密度, 光学相干断层扫描血管成像, 视网膜神经纤维层厚度, 健康儿童, 学龄

Objective

The aim of this study was to investigate the development of retinal vessel in healthy children.

Methods

Cross-sectional study. The clinical data of 50 healthy children and adults (50 eyes) who were examined in Aier Eye Hospital (Chengdu) from January 2019 to July 2019 were collected. The children group recruited 25 children (25 eyes), including 10 males (10 eyes) and 15 females (15 eyes). They were 4 to 11 years-old with an average age (6.68±2.22) years-old. The adults group recruited 25 adults (25 eyes), including 9 males (9 eyes) and 16 females (16 eyes), with an average age (32.45±5.10) years-old ranging from 25 to 40 years-old. Visual acuity, intraocular pressure, blood pressure, axial length, peripapillary vessel density (VD) and retinal nerve fiber layer (RNFL) thickness were collected and described by mean±SD. The independent sample t-test was used for the comparison between two groups; the paired t-test was used for the comparison within the group and the correlation between VD and various factors was evaluated by Person correlation coefficient.

Results

The VD of the four quadrants of superior, inferior, nasal and temporal around the optic disc was (19.48±0.46) mm^-1, (19.78±0.37) mm^-1, (18.70±0.69) mm^-1 and (20.05±0.74) mm^-1 in the children group, and (19.25±0.53) mm^-1, (19.67±0.51) mm^-1, (18.53±0.81) mm^-1 and (19.43±1.37) mm^-1 in the adults. According to paired t test, VD in the inferior was significantly greater than that in the superior in both groups (t=-2.890, - 3.535; P<0.05), while that in the temporal was significantly greater than that in the nasal (t=-3.429, - 7.619; P<0.05). There was no statistical significance in VD in each quadrant between two groups (t=-1.660, - 0.925, - 0.802, - 2.201; P>0.05). RNFL in children of four quadrants of superior, inferior, nasal and temporal around the optic disc was (132.92±14.16) μm, (135.63±14.82) μm, (70.50±12.43) μm and (80.71±13.50) μm; while that in adults was (132.40±19.33) μm, (138.16±16.71) μm, (74.08±13.59) μm and (81.12±11.95) μm, respectively. There was a positive correlation between VD and RNFL in each quadrant of both groups (r=0.403, 0.418; P<0.05).

Conclusions

The development level of the peripapillary vessel in healthy school-age children had the same with adults, and the thickness of the peripapillary vessel had the same the quadrant distribution with RNFL.

Key words: Retinal vessel density, Optical coherence tomography angiography, Retinal nerve fiber layer, Healthy children, School-age

图4 儿童组与成人组成员视盘周围各象限视网膜神经纤维层厚度的比较　图中^*和^#表示比较的项目，相同数目的^*或相同数目的^#相比较，结果显示两组内上方，下方与鼻侧，颞侧差异有统计学意义

表1 儿童组与成人组成员基本情况的比较

组别	例数	年龄(岁)	男(%)	视力	眼压(mmHg)	眼轴长度(mm)	收缩压(mmHg)	舒张压(mmHg)
儿童组	25	6.68±2.22	10(40.00)	1.0	14.02±2.90	22.60±0.86	89.88±10.42	52.48±10.19
成人组	25	32.45±5.10	9(36.00)	1.0	15.42±2.60	23.77±1.06	110.72± 6.74	71.36± 8.08
t值		32.434	0.46^*	0.001	0.375	0.821	25.443	27.352
P值		<0.05	>0.05	>0.05	>0.05	>0.05	<0.05	<0.05

表1 儿童组与成人组成员基本情况的比较

组别	例数	年龄(岁)	男(%)	视力	眼压(mmHg)	眼轴长度(mm)	收缩压(mmHg)	舒张压(mmHg)
儿童组	25	6.68±2.22	10(40.00)	1.0	14.02±2.90	22.60±0.86	89.88±10.42	52.48±10.19
成人组	25	32.45±5.10	9(36.00)	1.0	15.42±2.60	23.77±1.06	110.72± 6.74	71.36± 8.08
t值		32.434	0.46^*	0.001	0.375	0.821	25.443	27.352
P值		<0.05	>0.05	>0.05	>0.05	>0.05	<0.05	<0.05

表2 两组成员视网膜血流密度与眼轴长度、血压、RNFL厚度及眼压的相关性(±s )

组别	例数	眼轴(mm)	舒张压(mmHg)	收缩压(mmHg)	RNFL厚度(μm)	眼压(mmHg)
儿童组	25	22.60±0.86	52.48±10.19	89.88±10.42	104.94±8.79	14.02±2.90
成人组	25	23.77±1.06	71.36± 8.08	110.72± 6.74	106.44±6.51	15.42±2.60
r_儿童组值		-0.318	-0.526	-0.252	0.403	0.108
r_成人组值		0.139	-0.018	-0.187	0.418	-0.012
P_儿童组值		>0.05	<0.05	>0.05	<0.05	>0.05
P_成人组值		>0.05	>0.05	>0.05	<0.05	>0.05

表2 两组成员视网膜血流密度与眼轴长度、血压、RNFL厚度及眼压的相关性(±s )

组别	例数	眼轴(mm)	舒张压(mmHg)	收缩压(mmHg)	RNFL厚度(μm)	眼压(mmHg)
儿童组	25	22.60±0.86	52.48±10.19	89.88±10.42	104.94±8.79	14.02±2.90
成人组	25	23.77±1.06	71.36± 8.08	110.72± 6.74	106.44±6.51	15.42±2.60
r_儿童组值		-0.318	-0.526	-0.252	0.403	0.108
r_成人组值		0.139	-0.018	-0.187	0.418	-0.012
P_儿童组值		>0.05	<0.05	>0.05	<0.05	>0.05
P_成人组值		>0.05	>0.05	>0.05	<0.05	>0.05

[1]	Li D, Kishi S, Itakura H, et al. Posterior precortical vitreous pockets and connecting channels in children on swept-source optical coherence tomography[J]. Investigative ophthalmology & visual science, 2014, 55(4): 2412-2416.
[2]	Powell C, Hatt SR. Vision screening for amblyopia in childhood[J]. Cochrane Database Syst Rev, 2009, 120(3): CD005020.
[3]	Shakeel T. Changes in pulsatile ocular blood flow in normal tension glaucoma patients[J]. International Journal of Ophthalmology, 2016, 16(11): 1997-2000.
[4]	Kurvinen L, Kytö JP, Summanen P, et al. Change in retinal blood flow and retinal arterial diameter after intraocular pressure reduction in glaucomatous eyes[J]. Acta Ophthalmol, 2014, 92(6): 507-512.
[5]	Spaide RF, Klancnik JM, Cooney MJ. Retinal vascular layers in macular telangiectasia type 2 imaged by optical coherence tomographic angiography[J]. JAMA ophthalmology, 2015, 133(1): 66-73.
[6]	Weinhaus RS, Burke JM, Delori FC, et al. Comparison of fluorescein angiography with microvascular anatomy of macaque retinas[J]. Exp Eye Res, 1995, 61(1): 1-16.
[7]	Snodderly DM, Weinhaus RS, Choi JC. Neural-vascular relationships in central retina of macaque monkeys(Macacafascicularis)[J]. Neurosci, 1992, 12(4): 1169-1193.
[8]	Jia Y, Tan O, Tokayer J, et al. Split-spectrum amplitude-decorrelation angiography with optical coherence tomography[J]. Opt Express, 2012, 20(4): 4710-4725.
[9]	You Q, Freeman WR, Weinreb RN, et al. Reproducibility of vessel density measurement with optical coherence tomography angiography in eyes with and without retinopathy[J]. Retina(Philadelphia Pa), 2017, 37(8): 1475-1482.
[10]	La Spina C, Carnevali A, Marchese A, et al. Reproducibility and reliability of optical coherence tomography angiography for foveal avascular zone evaluation and measurement in different settings[J]. Retina(Philadelphia Pa), 2017, 37(9): 1636-1641.
[11]	Mastropasqua R, oto L, Mattei PA, et al. Reproducibility and repeatability of foveal avascular zone area measurements using swept-source optical coherence tomography angiography in healthy subjects[J]. Eur J Ophthalmol, 2017, 27: 336-341.
[12]	Matsungag D, Yi J, Puliafito CA, et al. OCT angiography in healthy human subjects[J]. Ophthalmic Surg Lasers Imaging Retina, 2014, 45(6): 510-515.
[13]	Fan W, Uji A, Borrelli E, et al. Precise measurement of retinal vascular bed area and density on ultra-wide fluorescein angiography in normal subjects[J]. American journal of ophthalmology, 2018, 188: 155-163.
[14]	张美霞，张韵. 强化光相干断层扫描血管成像检查图像采集质量与报告规范及提升其临床应用研究水平[J]. 中华眼底病杂志，2018，34(1)：4-7.
[15]	Nagiel A, Sadda SR. A promising future for optical coherence tomography angiography[J]. JAMA ophthalmology, 2015, 133(6): 629-630.
[16]	Yarmohammadi A, Zangwill LM, Diniz-Filho A, et al. Optical coherence tomography angiography vessel density in healthy, glaucoma suspect, and glaucoma eyes[J]. Investigative ophthalmology & visual science, 2016, 57(9): 451-459.
[17]	Gołębiewska J, Biała-Gosek K, Czeszyk A. Optical coherence tomography angiography of superficial retinal vessel density and foveal avascular zone in myopic children[J]. PloS one, 2019, 14(7): e0219785.
[18]	Iafe NA, Phasukkijwatana N, Chen X, et al. Retinal capillary density and foveal avascular zone area are age-dependent: quantitative analysis using optical coherence tomography angiography[J]. Invest Ophthalmol Vis Sci, 2016, 1: 5780-5787.
[19]	Yilmaz I, Ocak OB, Yilmaz BS, et al. Comparison of quantitative measurement of foveal avascular zone and macular vessel density in eyes of children with amblyopia and healthy controls: an optical coherence tomography angiography study[J]. Journal of AAPOS, 2017, 21(3): 224-228.
[20]	Hautz W, Gołębiewska J. Optical coherence tomography-based angiography in retinal artery occlusion in children[J]. Ophthalmic research, 2018, 59(4): 177-181.
[21]	Tarakcioglu HN, Yilmaz S, Kara T, et al. Foveal avascular zone and vessel density in children with attention deficit hyperactivity disorder[J]. International ophthalmology, 2020，19: 1281-1288.
[22]	Gołębiewska J, Olechowski A, Wysocka-Mincewicz M, et al. Optical coherence tomography angiography vessel density in children with type 1 diabetes[J]. PloS one, 2017, 12(10): e0186479.
[23]	Bidaut-Gamier M, Schwartz C, Puyraveau M, et a1. Choroidal thickness measurement in children using optical coherence tomography[J]. Retina, 2014, 34(4): 768-774.
[24]	Morj T, Sugano Y, Maruko L, et a1. Subfoveal choroidal thickness and axial length in preschool children with hyperupic anisometropic amblyopia[J]. Curr Eye Res, 2015, 40(9): 954-961.
[25]	Zengin MO, Karahan E, Yilmaz S, et a1. Association of choroidal thickness with eye growth: a cross-sectional sludy of individuals between 4 and 23 years[J]. Eye(Lond), 2014, 28 (12): 1482-1487.
[26]	Read SA, Alonso-Caneiro D, Vincent SJ, et a1. Longitudinal changes in choroidal thickness and eye growth in childhood[J]. Invest Ophthalmol Vis Sci, 2015, 56(5): 3103-3112.
[27]	康峥，杨晖. 学龄前儿童脉络膜厚度的研究[J]. 中华眼科杂志，2019，55(2)：111-114.
[28]	Magrath GN, Say EA, Sioufi K, et al. Variability in foveal avascular zone and capillary density using optical coherence tomography angiography machines in healthy eyes[J]. Retina(Philadelphia pa), 2017, 37(11): 2102-2111.
[29]	Yu J, Gu R, Zong Y, et al. Relationship between retinal perfusion and retinal thickness in healthy subjects: an optical coherence tomography angiography study[J]. Investigative ophthalmology & visual science, 2016, 57(9): 204-210.
[30]	Moghimi S, Zangwill LM, Penteado RC, et al. Macular and optic nerve head vessel density and progressive retinal nerve fiber layer loss in glaucoma[J]. Ophthalmology, 2018, 125(11): 1720-1728.
[31]	Lommatzsch C, Rothaus K, Koch JM, et al. Vessel density in OCT angiography permits differentiation between normal and glaucomatous optic nerve heads[J]. International journal of ophthalmology, 2018, 11(5): 835-843.
[32]	Dastiridou AI, Ginis H, Tsilimbaris M, et al. Ocular rigidity, ocular pulse amplitude, and pulsatile ocular blood flow: the effect of axial length[J]. Investigative ophthalmology & visual science, 2013, 54(3): 2087-2092.
[33]	Hayreh SS. Neovascular glaucoma[J]. Progress in retinal and eye research, 2007, 26(5): 470-485.
[34]	Hashimoto R, Sugiyama T, Ubuka M, et al. Autoregulation of optic nerve head blood flow induced by elevated intraocular pressure during vitreous surgery [J]. Current eye research, 2017, 42(4): 625-628.
[35]	Iwase T, Akahori T, Yamamoto K, et al. Evaluation of optic nerve head blood flow in response to increase of intraocular pressure[J]. Scientific reports, 2018, 8(1): 17235.
[36]	刘祥祥，林丹婷，孙云晓，等. 颅内压下降所致眼颅压力梯度增大对视盘血流密度影响的临床研究[J/CD]. 中华眼科医学杂志(电子版)，2019，9(5)：273-278.

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