Objective: To investigate macular retinal and choroidal thickness and blood flow change using optical coherence tomography angiography after posterior scleral reinforcement (PSR) surgery. Methods: Prospective study. Twenty eyes of 10 patients with high myopia were enrolled in this open-label, single-treatment group and prospective study. Radial lines and Angio retina (3 mm×3 mm) module were performed for 20 eyes using Angio-vue optical coherence tomography (Avanti, Optovue) without pupil dilation, and best corrected visual acuity, spherical equivalent and axial length were compared before and 60 days after surgery. Retinal and choroidal thickness was measured in the fovea, 1 mm superior, 1 mm inferior, 1 mm nasal and 1 mm temporal to the fovea. Flow area, flow density and flow index were recorded using self-provided software in the superficial retina layer, deep retina layer, outer retina layer and choroid capillary layer, respectively. Statistical analysis was performed using SPSS 16.0. Data that followed normal distribution were compared with paired two-sample t-test, while others were compared with Wilcoxon signed rank test. Results: Of the patients participating in this preliminary study, the mean age was (35.5±4.2) years, and 50% were female. No significant difference was found between before and 60 days after PSR surgery in best corrected visual acuity (t=0.99, P=0.33), spherical equivalent (t=-1.89, P=0.07) and axial length (t=0.2, P=0.08). The retinal thickness in the fovea was thinner (Z=-2.58, P=0.01), while there was no significant difference in the 1 mm superior (t=0.44, P=0.67) , 1 mm inferior (t=0.05, P=0.96) , 1 mm nasal (Z=0.87, P=0.64) and 1 mm temporal (Z=-0.78, P=0.99) to the fovea. No significant difference was found in choroidal thickness (t=-0.12, P=0.87; t=-0.25, P=0.81. t=0.53, P=0.61; t=-0.91, P=0.38. t=1.2, P=0.25) before and after surgery. The postoperative flow density in the superficial and deep retinal layers (48.18±4.56% and 31.47±5.11%) was significantly increased (t=2.66, P=0.02; t=3.16, P=0.01) compared with pre-operation (33.82±4.33% and 14.29±3.89%). The postoperative flow index in the superficial and deep retina layers (0.044±0.005 and 0.025±0.005) was significantly increased (t=2.59, P=0.02. t=2.95, P=0.01) compared with pre-operation (0.028±0.004 and 0.010±0.003). The other flow measurements showed no significant difference. Conclusion: Retinal thickness decreased, and flow density and index increased in the superficial and deep retinal layers after PSR surgery. This suggested blood flow improvement in the macular region after PSR surgery in high myopic eyes. (Chin J Ophthalmol, 2017, 53:39-45).
目的： 探讨后巩膜加固术后视网膜及脉络膜的厚度及血流改变，为后巩膜加固手术应用于病理性近视眼的作用机制提供依据。 方法： 开放性、单一治疗组的前瞻性研究。选取2015年4至8月在首都医科大学北京同仁眼科中心拟行后巩膜加固术的10例病理性近视眼患者的20只眼进行OCT血管成像的放射线扫描及黄斑区3 mm×3 mm血流模式扫描。分析后巩膜加固术前及术后60 d黄斑中心凹及中心凹上方、下方、鼻侧、颞侧各1 mm位置视网膜厚度，脉络膜厚度及表层视网膜、深层视网膜、外层视网膜及脉络膜毛细血管层血流面积、血流密度及血流指数的变化，同时对眼轴长度、等效球镜度数及最佳矫正视力的变化进行比较。正态性分布数据应用配对样本t检验，非正态分布数据应用Wilcoxon非参数检验。 结果： 本组患者包括男性5例（10只眼），女性5例（10只眼），平均年龄（35.5±4.2）岁。术后60 d眼轴长度、等效球镜度数及最佳矫正视力较术前差异无统计学意义（t=0.99，-1.89，0.20；P>0.05）。术后黄斑中心凹视网膜厚度较术前显著降低（Z=-2.58，P=0.01），黄斑中心凹上方、下方、鼻侧、颞侧各1 mm位置视网膜厚度（t=0.44，P=0.67；t=0.05，P=0.96；Z=0.87，t=0.64，Z=-0.78，P=0.99）及脉络膜厚度（t=-0.12，-0.25，0.53，-0.91，1.20；P>0.05）较术前差异无统计学意义。术后表层视网膜及深层视网膜血流密度分别为（48.18±4.56）%和（31.47±5.11）%，较术前的（33.82±4.33）%和（14.29±3.89）%显著增加（t=2.66，P=0.02；t=3.16，P=0.01）。术后表层视网膜及深层视网膜血流指数（0.044±0.005、0.025±0.005）较术前（0.028±0.004、0.010±0.003）显著增加(t=2.59，P=0.02；t=2.95，P=0.01)，表层视网膜及深层视网膜血流面积、外层视网膜及脉络膜毛细血管层血流面积、血流密度及血流指数较术前无明显增加。 结论： 后巩膜加固术后黄斑中心凹视网膜厚度明显变薄，浅层及深层视网膜血流明显增加，脉络膜厚度无明显增厚，可使病理性近视眼患者黄斑区血流循环明显改善。本研究结果为后巩膜加固改善病理性近视眼黄斑区血流循环提供了可靠依据。（中华眼科杂志，2017，53：39-45）.
Keywords: Blood circulation; Choroid; Myopia, degenerative; Ophthalmologic surgical procedures; Regional Blood flow; Retina; Sclera.