[Characteristics and significance of outer retinal thickness changes in reticular macular disease].

Objective: To study the characteristics and significance of changes in the thickness of the outer retinal layer (ORL) outside the macula in patients with reticular macular disease (RMD). Methods: A cross-sectional study was conducted. The clinical data of patients who visited the Department of Ophthalmology of the First Affiliated Hospital of Guangzhou Medical University from February to September 2019 were retrospectively collected. Thirty-one patients with at least one eye (54 eyes in total) diagnosed with early/mid-stage age-related macular degeneration (AMD) were consecutively included in the AMD group, and 33 patients with at least one eye (64 eyes in total) showing subretinal wart-like deposits on optical coherence tomography images were consecutively included in the RMD group. Thirty-two volunteers aged between 50 to 90 years with a normal fundus in both eyes (64 eyes in total) were consecutively included in the healthy control (HC) group. Frequency domain optical coherence tomography was applied to examine and analyze the thickness features of the ORL, inner retinal layer and choroid at the macular fovea (F), 2 mm of the temporal edge (T), the nasal edge (N), the superior edge (S) and inferior edge (I) of the macular fovea in each group. The correlations of the thickness of ORL with the choroidal thickness and the blood flow density of the choriocapillaris layer in patients with RMD were also analyzed. Results: The thickness of ORL at the F, T, S and I sites in the RMD group was significantly thinner than that in the AMD and HC groups. The difference was most obvious at the F site [(90.27±8.93), (98.04±11.7) and (97.19±7.02)μm] in the RMD, AMD and HC groups, respectively; all P<0.01). In the logistic regression model with independent variables of the ORL thickness at the macular F site, gender and age, there was a significant association between the thickness of ORL at the F site and the incidence of RMD (odds ratio=0.926, P<0.05). The ORL and choroid in the eyes of patients with RMD were significantly thinner at the F site [(90.27±8.93) and (163.21±72.43) μm, respectively; both P<0.01] compared with the AMD [(98.04±11.7) and (235.34±64.15) μm, respectively] and HC [(97.19±7.02) and (240.08±62.27) μm, respectively] groups. However, the ORL and choroidal thickness did not show significant and strong linear correlations at multiple sites. In contrast, there was a significant linear correlation between the blood flow density of the choriocapillaris layer and the thickness of ORL at the F, T and S sites in patients with RMD (r=0.487, 0.722, 0.467, respectively; all P<0.05). Conclusions: The thickness of ORL outside the macula of eyes with RMD is thinner than that of healthy eyes and eyes with early/mid-stage AMD. The thinning of ORL outside the macula is related to the decrease in the blood flow density of the choriocapillaris layer in patients with RMD.目的： 研究网状黄斑病变（RMD）患眼黄斑区外层视网膜厚度变化的特征和意义。 方法： 横断面研究。回顾性收集2019年2至9月在广州医科大学附属第一医院眼科就诊者资料，连续纳入至少1只眼确诊为早中期年龄相关性黄斑变性（AMD）患者31例（54只眼）为AMD组，连续纳入至少1只眼相干光层析成像术（OCT）图像存在视网膜下疣样沉积物者33例（62只眼）为RMD组，同期连续纳入50~83岁的双眼眼底正常志愿者32例（64只眼）作为健康对照组（HC组）。应用谱域OCT检查并分析各组视网膜黄斑中心凹（F）和黄斑中心凹颞侧（T）、鼻侧（N）、上方（S）和下方（I）2 mm的外层视网膜（ORL）、内层视网膜（IRL）、脉络膜的厚度特征，分析RMD黄斑区ORL厚度与脉络膜厚度、脉络膜毛细血管层血流密度的相关性。主要采用单因素方差分析、LSD-t检验、χ检验、多重Logistic回归分析和Pearson线性相关分析等统计学方法。 结果： RMD组黄斑区F、T、S、I位点ORL厚度相较于AMD组和HC组明显变薄，以F位点最为明显［RMD组、AMD组和HC组分别为（90.27±8.93）、（98.04±11.7）和（97.19±7.02）μm；P<0.01］。在自变量包括了黄斑区F位点ORL厚度、性别、年龄的Logistic回归模型中，黄斑区F位点ORL厚度与RMD患病之间存在关联（比值比=0.926，P<0.05）。RMD组黄斑区ORL和脉络膜厚度明显变薄［其中F位点ORL和脉络膜厚度RMD组分别为（90.27±8.93）和（163.21±72.43）μm；AMD组分别为（98.04±11.7）和（235.34±64.15）μm；HC组分别为（97.19±7.02）和（240.08±62.27）μm；P<0.01］，但两者间没有很强的线性相关关系，多个位点的线性关系不显著；RMD患眼的脉络膜毛细血管层血流密度与黄斑区F、T、S位点的ORL厚度具有显著线性相关关系（r =0.487，0.722，0.467，P<0.05）。 结论： RMD患眼黄斑区的ORL较健康眼及不伴RPD的早中期AMD患眼更薄。RMD患眼黄斑区ORL变薄与脉络膜毛细血管层血流密度降低相关。.