方法：收集高度近视患者20例40眼，年龄为29.90±7.92岁，等效球镜屈光度为 -8.95±2.01 D。采用光学相干断层扫描血管成像技术(OCTA)测量黄斑区神经纤维层厚度，获取视网膜浅层毛细血管层、视网膜深层毛细血管层及脉络膜毛细血管层的血流分布图像并计算各层血流密度。直径6 mm的黄斑区分为9个亚区域：黄斑中心凹区，旁中心凹区和中心凹外区各自分为上方、下方、鼻侧和颞侧4个象限。比较黄斑不同亚区域的神经纤维层厚度的差别，分析其与屈光度、眼轴、各层血流密度的关系。

结果：旁中心凹区的4个象限中，上方神经纤维厚度最低，下方神经纤维厚度最高(均P<0.05)。中心凹外区4个象限中颞侧神经纤维厚度最低(均P<0.05)。中心凹外区上方神经纤维层厚度与屈光度存在负相关(r= -0.356，P=0.024)。视网膜浅层毛细血管层的血流密度与旁中心凹区鼻侧和下方象限，以及中心凹外区上方、鼻侧和下方象限的神经纤维层厚度呈正相关(r=0.314、0.408、0.467、0.655、0.737，均P<0.05)； 脉络膜毛细血管层血流密度与中心凹外区的上方象限呈负相关(r=-0.356，P=0.024)。

结论：高度近视眼黄斑区神经纤维层具有各象限不均匀分布特点。随着屈光度的增加，局部神经纤维层变薄，并且存在区域特异性，部分区域神经纤维层厚度的变化与视网膜浅层毛细血管丛及脉络膜毛细血管层的血流密度相关。

METHODS:Forty eyes in 20 patients diagnosed with HM, age 29.90±7.92 years old, with a spherical equivalent(SE)of -8.95±2.01 D, were recruited. The RNFL thickness and the VD of the superficial retinal capillary plexus(SCP), deep retinal capillary plexus, and choroidal capillary(CC)were measured by OCTA. Macular regions within a 6 mm diameter circle were divided into 9 subfields: the central subfield, and the pericentral and peripheral regions of superior, inferior, nasal, and temporal quadrants. The RNFL thickness of different subfields were compared, and their relationships with SE, axial length, and VD were analyzed.

RESULTS:In the pericentral region, the RNFL thickness of the superior quadrant was the lowest, whereas thickness was highest in the inferior quadrant(all P<0.05). In the peripheral region, the RNFL thickness of the temporal quadrant was the lowest(all P<0.05). A negative correlation was found between the RNFL thickness and SE(r=-0.356, P=0.024)in the peripheral superior subfield. The VD of SCP was positively correlated with RNFL thickness in the nasal and inferior quadrants of the pericentral region and in the superior, nasal, and inferior quadrants of the peripheral region(r=0.314, 0.408, 0.467, 0.655, and 0.737 respectively; all P<0.05), whereas the VD of CC was negatively correlated with RNFL thickness in the peripheral superior subfield(r=-0.356, P=0.024).

CONCLUSION:The RNFL of macular areas is not uniformly distributed in HM. As the SE increases, the RNFL thickness decreases in certain areas, which correlates with the VD of SCP and CC layers.