정상 소아에서 근시 진행에 따른 망막내층의 두께 변화
Longitudinal Changes in Layered Retinal Thickness during Axial Elongation in Healthy Myopic Eyes
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목적: 근시안에서 안축장 증가에 따른 황반부 망막두께 변화를 살펴보고자 한다. 대상과 방법: 2013년 2월부터 2014년 9월까지 서울특별시보라매병원에서 굴절 이상으로 검진 받는 만 13세 미만, 구면렌즈대응치 -0.75 diopters (D)보다 근시인 소아를 대상으로 전향적 코호트를 구축하였다. 빛간섭단층촬영을 통해 망막전층, 내망막층, 신경섬유층, 신경절세포-속얼기층의 두께를 9개의 Early Treatment Diabetic Retinopathy Study (ETDRS) subfield에서 측정하였고, 코호트 진입과 마지막 방문시 유의한 변화가 있는지 분석하였다. 동일 개체의 양안 데이터를 사용하였고 ETDRS subfield 사이의 개체 내 상관을 linear mixed-effects model을 통해 보정하였다. 결과: 평균 2.7년의 관찰 기간 동안 굴절 이상은 조절마비검사 구면렌즈대응치 -4.26 ± 2.34 D에서 -6.09 ± 2.64 D로(p<0.001, paired t-test), 안축장은 24.80 ± 1.28 mm에서 25.58 ± 1.38 mm로 변화하였다(p<0.001, paired t-test). 그러나 망막전층 및 세부층두께는 전 구역 평균 두께 및 9개 ETDRS subfield 모두에서 유의한 변화를 보이지 않았다(모두 p>0.05, linear mixed-effects model). 결론: 근시 진행에도 불구하고 황반부의 망막세부층은 두께 변화를 보이지 않았다. 이는 안축장이 길어지는 시기에 두께로 측정되는 황반부의 거시적 구조는 큰 변화가 없음을 시사한다.
Abstract
Purpose: To investigate longitudinal changes in foveal retinal sublayer thicknesses during axial elongation. Methods: From February 2013 to September 2014, a prospective cohort was established comprising pediatric patients aged < 13 years exhibiting myopia with a spherical equivalent of less than -0.75 diopters (D). At each visit, the foveal retinal thickness was measured using spectral-domain optical coherence tomography and sublayers were distinguished as follows: 1) total retinal layer, 2) inner retinal layer, 3) retinal nerve fiber layer, and 4) ganglion cell-inner plexiform layer. The average thickness was calculated based on the nine subfields of the Early Treatment Diabetic Retinopathy Study (ETDRS) map and compared between the initial and final visits. Intra-individual correlations were analyzed using a linear mixed-effects model. Results: Twenty-three subjects (46 eyes) were observed for 2.7 ± 1.0 years. During that period, the myopia progressed (spherical equivalent of cycloplegic refraction: from -4.26 ± 2.34 to -6.09 ± 2.64 D; p < 0.001, paired t-test), and the axial length increased from 24.80 ± 1.28 to 25.58 ± 1.38 mm (p < 0.001, paired t-test). Nevertheless, the thicknesses of foveal retinal layers (total retinal layer, inner retinal layer, retinal nerve fiber layer, ganglion cell-inner plexiform layer) showed no significant change in any of the nine ETDRS subfields (all p > 0.05, linear mixed-effects model). Conclusions: The foveal retinal sublayers maintained their thicknesses despite axial elongation, indicating that the foveal retinal structure, which is critical to visual acuity, is preserved even in elongated, myopic eyes.
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