摘要目的:应用光学相干断层扫描血管成像(OCTA)技术分析伴有高度近视的糖尿病患者黄斑区视网膜毛细血管血流密度及黄斑中心凹无血管区(FAZ)的变化特征。方法:横断面对照研究。纳入山西省人民医院2022年6月至2024年6月伴有高度近视的糖尿病患者40例(80只眼)和高度近视者40例(80只眼)，同期纳入性别、年龄匹配的健康体检者40名(80只眼)分别为A组、B组和C组。所有受试者进行OCTA检查。A组中双眼伴有屈光参差的高度近视患者[双眼等效球镜度(SE)差值≤-2.0 D]30例(60只眼)，患者双眼按SE分为高度数眼(30只眼)和低度数眼(30只眼)(对侧眼)观察分析。利用OCTA分别评估比较各组的黄斑区视网膜浅层毛细血管丛(SCP)血流密度、深层毛细血管丛(DCP)血流密度、黄斑中心区视网膜厚度(CMT)、黄斑中心凹无血管区(FAZ)面积、周长、黄斑中心凹无血管区范围300 μm宽度内的毛细血管血流密度(FD-300)及非圆周指数(AI)相关参数。结果:A组伴有屈光参差的高度近视者中，低度数眼的FD-300 ( t＝-4.111， P<0.001)、颞侧SCP( t＝-2.928， P＝0.007)明显低于对侧眼，且差异有统计学意义，余参数差异无统计学意义(均 P>0.05)。A、B、C 3组间FAZ面积( F＝2.994， P＝0.046)、AI( F＝3.557， P＝0.031)、FD-300 ( F＝14.993， P<0.001)及SCP血流密度(颞侧 F＝14.883，上方 F＝14.485，鼻侧 F＝17.023，下方 F＝16.596，旁中心凹处 F＝14.265；均 P<0.001)、DCP血流密度(颞侧 F＝19.588，上方 F＝15.895，鼻侧 F＝24.362，下方 F＝21.143，旁中心凹处 F＝17.132，均 P<0.001)的差异均有统计学意义。A组患者SCP(颞侧 t＝-2.794，上方 t＝-2.900，鼻侧 t＝-3.833，下方 t＝-2.858，旁中心凹处 t＝-3.709； P分别为0.006、0.005、<0.001、0.005、0.029)、深层颞侧DCP( t＝-2.270， P＝0.026)及旁黄斑中心凹DCP( t＝-2.010， P＝0.006)均低于B组且差异有统计学意义；FAZ面积( t＝-2.369， P＝0.020)及FD-300( t＝-3.640， P<0.001)低于B组，AI ( t＝0.167， P＝0.011)高于B组且差异有统计学意义。A组患者SCP血流密度(颞侧 t＝-4.812，上方 t＝-5.038，鼻侧 t＝-5.407，下方 t＝-5.238，旁中心凹处 t＝6.411；均 P<0.001)、DCP血流密度(颞侧 t＝-6.116，上方 t＝-6.096，鼻侧 t＝-7.575，下方 t＝-6.768，旁中心凹处 t＝6.841，均 P<0.001)、FAZ面积( t＝-2.117， P＝0.038)及FD-300( t＝-4.852, P<0.001)均低于C组且差异有统计学意义，AI ( t＝0.313, P＝0.023)高于C组且差异有统计学意义。Pearson相关性分析显示，AL和CMT间存在着明显的正相关关系( r＝0.327， P＝0.008)，AL和AI间存在着明显的正相关关系( r＝0.308， P＝0.014)。DCP、FAZ面积、周长与AL呈现负相关关系( r＝-0.305、-0.288、-0.289， P＝0.014、0.022、0.021)。对于其他区域的视网膜血流密度和AL之间的关联并未表现出相关性(均 P>0.05)。 结论:伴有屈光参差的高度近视的糖尿病患者中，较低度数眼更容易出现黄斑区灌注不足。FAZ面积、SCP、DCP及AI是可以预估伴有高度近视的糖尿病患者出现DR的有效性指标。对于早期伴有高度近视的糖尿病患者，高度近视与糖尿病相互叠加会导致更显著的黄斑区微循环参数变化。

abstractsObjective:To analyze the characteristics of changes in retinal capillary blood flow density in the macular region and the foveal avascular zone (FAZ) in diabetic patients with high myopia using optical coherence tomography angiography (OCTA).Methods:This was a cross-sectional controlled study. Group A consisted of 40 cases (80 eyes) of diabetic patients with high myopia, group B consisted of 40 cases (80 eyes) with high myopia, and group C consisted of 40 cases (80 eyes) with healthy medical checkups, matched for gender and age. These participants were recruited by Shanxi Provincial People′s Hospital from Jun. 2022 to Jun. 2024 for this study by applying OCTA. Thirty patients(60 eyes)with anisometropic high myopia [spherical equivalent (SE) difference ≤-2.0 D] in both eyes in group A were selected first, and the patients′ eyes were grouped into high and low degree eyes according to SE. Superficial capillary plexus (SCP) blood flow density of the retina in the macular region, deep capillary plexus (DCP) blood flow density, central macular retinal thickness (CMT), the area and circumference of foveal avascular zone (FAZ), the capillary blood flow density within 300 μm width ring surrounding the FAZ (FD-300), and acircularity index (AI) related parameters were evaluated and compared among each groups using OCTA.Results:In group A of anisometropic high myopia patients, the FD-300 ( t=-4.111, P<0.001) and temporal SCP ( t=-2.928, P=0.007) of the low degree eyes were significantly lower than those of the contralateral eyes, and the differences were statistically significant, while the differences in other parameters were not statistically significant (all P>0.05). The differences were statistically significant in FAZ area ( F=2.994, P=0.046), AI ( F=3.557, P=0.031), FD-300 ( F=14.993, P<0.001), SCP blood flow density (temporal F=14.883, superior F=14.485, nasal F=17.023, inferior F=16.596, parafoveal F=14.265; all P<0.001), and DCP blood flow density (temporal F=19.588, superior F=15.895, nasal F=24.362, inferior F=21.143, parafoveal F=17.132; all P<0.001) among the three groups. SCP blood flow density (temporal t=-2.794, superior t=-2.900, nasal t=-3.833, inferior t=-2.858, parafoveal t=-3.709; P=0.006, 0.005, <0.001, 0.005, 0.029), DCP blood flow density of the deep temporal ( t=-2.270, P=0.026), and DCP of the parafoveal areas ( t=-2.010, P=0.006) in group A were all lower than those in group B and the differences were statistically significant; FAZ area ( t=-2.369, P=0.020) and FD-300 ( t=-3.640, P<0.001) were lower than those in group B, while AI ( t=0.167, P=0.011) was higher than that in group B and the difference was statistically significant. SCP(temporal t=-4.812, superior t=-5.038, nasal t=-5.407, inferior t=-5.238, and parafoveal t=6.411; all P<0.001), DCP(temporal t=-6.116, superior t=-6.096, nasal t=-7.575, inferior t=-6.768, and parafoveal t=6.841; all P<0.001), FAZ area ( t=-2.117, P=0.038), and FD-300 ( t=-4.852, P<0.001) in group A were lower than those in group C and the differences were statistically significant, while AI ( t=0.313, P=0.023) was higher than that of group C and the difference was statistically significant. Pearson correlation analysis showed that there were significant positive correlations between AL and CMT ( r=0.327, P=0.008), and a significant positive correlation between AL and AI ( r=0.308, P=0.014). DCP, FAZ area, perimeter, and AL showed a significant negative correlation ( r=-0.305, -0.288, -0.289; P=0.014, 0.022, 0.021). There was no significant relationship between retinal blood flow density in other regions and AL (all P>0.05). Conclusion:In diabetic patients with anisometropic high myopia, macular underperfusion is more likely to occur in lower-degree eyes. FAZ area, SCP, DCP, and AI are valid indicators that can predict the presence of DR in diabetic patients with high myopia. In early diabetic patients with high myopia, the co-occurence of high myopia and diabetes leads to more significant changes in macular microcirculatory parameters.