Parapapillary atrophy, choroidal vascularity index and their correlation in different degrees of myopia_Chinese Journal of Ocular Fundus Diseases

Authors：

Wu Minhui ¹ , Qiao Yilin ¹ , Ye Yufeng ¹ , Gao Weiqian ¹ , Ruan Kaiming ¹ , Cheng Dan ¹ , Shen Meixiao ³ , Wu Shuangqing ¹ , Zhu Xueying ¹ , Yu Xinxin ¹ , Zhang Zuhui ¹ ,  Shen Lijun ^1,2

1. Eye Hospital of Wenzhou Medical University at Hangzhou, Hangzhou 310000, China;
2. Department of Ophtalmology, Zhejiang Provincial People's Hospital, Hangzhou 310000, China;
3. Eye Hospital of Wenzhou Medical University, Wenzhou 325027, China;

Corresponding author：

Shen Lijun, Email: slj@mail.eye.ac.c

Keywords：

Myopia; Parapapillary atrophy; Choroidal vascularity index; Tomography, optical coherence

DOI：

10.3760/cma.j.cn511434-20220329-00178

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Objective To observe the peripapillary atrophy (PPA) and peripapillary choroidal vascularity index (CVI) in patients with different degrees of myopia and to analyze their correlations. Methods A cross-sectional clinical study. From September 2021 to December 2021, 281 mypoic patients of 281 eyes treated in Eye Hospital of Wenzhou Medical University at Hangzhou were included in this study, and the right eye was used as the treated eye. There were 135 eyes in 135 males and 146 eyes in 146 females. The age was 28.18±5.78 years. The spherical equivalent refraction (SE) was －5.13±2.33 D. The patients were divided into three groups: low myopia group (group A, －3.00 D ＜SE≤－0.50 D), moderate myopia group (group B, －6.00 D≤SE≤－3.00 D);high myopia group (group C, SE＜－6.00 D). The spherical equivalent refraction was statistically different among the three groups (H=241.353, P＜0.05). All of the affected eyes were examined by swept-source optical coherence tomography. Combined with B-scan image,assessment and area measurement of β area, γ area (β-PPA and γ-PPA) were carried out on the en-face image. After binarization of the collected images, the nasal, superior, temporal and inferior CVI of the optic disc were calculated. For comparison between groups, one-way ANOVA was used for continuous variables with normal distribution, Kruskal-Wallis test was used for continuous variables with abnormal distribution, and categorical variables were used χ² inspection. Linear regression analysis was used for the relationship between β-PPA and γ-PPA area and peripapillary CVI of different regions. Linear regression analysis was used to evaluate the relationships between the area of peripapillary atrophy and peripapillary choroidal vascularity index in different regions. Results There was no statistical difference in the incidence of β-PPA among the three groups (χ²=4.672, P=0.097). The incidence of γ-PPA in group A was lower than that in group B anc C, and the difference was statistically different (χ²=33.053, P＜0.001), in which both group A was lower than group B and C. Among the three groups, the area of β-PPA and γ-PPA was statistically significant (H=36.535, 39.503; P＜0.001, 0.001); the β-PPA area of group A and B was lower than that of group C; the γ-PPA area was group A＜group B＜group C. Peripapillary CVI of different regions in group A, group B and group C was statistically significant (F=11.450, 5.037, 6.018, 4.489; P＜0.05). The temporal CVI in group C was lower than that in group A and B; The inferior CVI of group C was lower than that of group A, and the superior and nasal CVI of group B and C were lower than that of group A. In multivariate analysis, SE (β=0.374, P＜0.001), temporal CVI (β=－0.299, P＜0.001) were correlated with the area of β-PPA (adjusted R²=296, P＜0.001); AL (β=0.452, P＜0.001), temporal CVI (β=－0.220, P＜0.001) were correlated with the area of γ-PPA (adjusted R²=0.309, P＜0.001). Conclusions The incidence and area of γ-PPA are increased in the higher degree of myopia group. The area of γ-PPA is positively correlated with the axial length, and both the area of β-PPA and γ-PPA are negatively correlated with temporal CVI.

Citation： Wu Minhui, Qiao Yilin, Ye Yufeng, Gao Weiqian, Ruan Kaiming, Cheng Dan, Shen Meixiao, Wu Shuangqing, Zhu Xueying, Yu Xinxin, Zhang Zuhui, Shen Lijun. Parapapillary atrophy, choroidal vascularity index and their correlation in different degrees of myopia. Chinese Journal of Ocular Fundus Diseases, 2022, 38(10): 829-834. doi: 10.3760/cma.j.cn511434-20220329-00178 Copy

1.	Jonas JB, Nguyen XN, Gusek GC, et al. Parapapillary chorioretinal atrophy in normal and glaucoma eyes. Ⅰ. morphometric data[J]. Invest Ophthalmol Vis Sci, 1989, 30(5): 908-918.
2.	Jonas JB, Jonas SB, Jonas RA, et al. Parapapillary atrophy: histological gamma zone and delta zone[J/OL]. PLoS One, 2012, 7(10): e47237[2012-10-18]. https://pubmed.ncbi.nlm.nih.gov/23094040/. DOI: 10.1371/journal.pone.0047237.
3.	Fang Y, Yokoi T, Nagaoka N, et al. Progression of myopic maculopathy during 18-year follow-up[J]. Ophthalmology, 2018, 125(6): 863-877. DOI: 10.1016/j.ophtha.2017.12.005.
4.	张蕙蓉. 睫状血管系统[M]//李凤鸣. 中华眼科学. 北京: 人民卫生出版社, 2005: 129-130.Zhang HR. Ciliary vascular system[M]//Li FM. Chinese ophthalmology. Beijing: People's Medical Publishing House, 2005: 129-130.
5.	Devarajan K, Sim R, Chua J, et al. Optical coherence tomography angiography for the assessment of choroidal vasculature in high myopia[J]. Br J Ophthalmol, 2020, 104(7): 917-923. DOI: 10.1136/bjophthalmol-2019-314769.
6.	Guler Alis M, Alis A. Choroidal vascularity index in adults with different refractive status[J/OL]. Photodiagnosis Photodyn Ther, 2021, 36: 102533[2021-09-11]. https://pubmed.ncbi.nlm.nih.gov/34520880/. DOI: 10.1016/j.pdpdt.2021.102533.
7.	Wang YX, Panda-Jonas S, Jonas JB. Optic nerve head anatomy in myopia and glaucoma, including parapapillary zones alpha, beta, gamma and delta: Histology and clinical features[J/OL]. Prog Retin Eye Res, 2021, 83: 100933[2020-12-09]. https://pubmed.ncbi.nlm.nih.gov/33309588/. DOI: 10.1016/j.preteyeres.2020.100933.
8.	Xu L, Wang YX, Wang S, et al. Definition of high myopia by parapapillary atrophy. The Beijing Eye Study[J/OL]. Acta Ophthalmol, 2010, 88(8): e350-351[2010-12-01]. https://pubmed.ncbi.nlm.nih.gov/19900199/. DOI: 10.1111/j.1755-3768.2009.01770.x.
9.	Kim M, Kim TW, Weinreb RN, et al. Differentiation of parapapillary atrophy using spectral-domain optical coherence tomography[J]. Ophthalmology, 2013, 120(9): 1790-1797. DOI: 10.1016/j.ophtha.2013.02.011.
10.	Jonas JB, Wang YX, Dong L, et al. Advances in myopia research anatomical findings in highly myopic eyes[J]. Eye Vis (Lond), 2020, 7: 45. DOI: 10.1186/s40662-020-00210-6.
11.	Chui TY, Zhong Z, Burns SA. The relationship between peripapillary crescent and axial length: implications for differential eye growth[J]. Vis Res, 2011, 51(19): 2132-2138. DOI: 10.1016/j.visres.2011.08.008.
12.	Nakazawa M, Kurotaki J, Ruike H. Longterm findings in peripapillary crescent formation in eyes with mild or moderate myopia[J]. Acta Ophthalmol, 2008, 86(6): 626-629. DOI: 10.1111/j.1600-0420.2007.01139.x.
13.	Lee KM, Choung HK, Kim M, et al. Change of β-zone parapapillary atrophy during axial elongation: Boramae Myopia Cohort Study Report 3[J]. Invest Ophthalmol Vis Sci, 2018, 59(10): 4020-4030. DOI: 10.1167/iovs.18-24775.
14.	Xu L, Wang Y, Wang S, et al. High myopia and glaucoma susceptibility the Beijing Eye Study[J]. Ophthalmology, 2007, 114(2): 216-220. DOI: 10.1016/j.ophtha.2006.06.050.
15.	Lee EJ, Kim TW, Kim JA, et al. Parapapillary deep-layer microvasculature dropout in primary open-angle glaucoma eyes with a parapapillary γ-zone[J]. Invest Ophthalmol Vis Sci, 2017, 58(13): 5673-5680. DOI: 10.1167/iovs.17-22604.
16.	Suh MH, Park JW, Khandelwal N, et al. Peripapillary choroidal vascularity index and microstructure of parapapillary atrophy[J]. Invest Ophthalmol Vis Sci, 2019, 60(12): 3768-3775. DOI: 10.1167/iovs.18-26286.
17.	Sullivan-Mee M, Patel NB, Pensyl D, et al. Relationship between juxtapapillary choroidal volume and beta-zone parapapillary atrophy in eyes with and without primary open-angle glaucoma[J]. Am J Ophthalmol, 2015, 160(4): 637-647. DOI: 10.1016/j.ajo.2015.06.024.

1. Jonas JB, Nguyen XN, Gusek GC, et al. Parapapillary chorioretinal atrophy in normal and glaucoma eyes. Ⅰ. morphometric data[J]. Invest Ophthalmol Vis Sci, 1989, 30(5): 908-918.
2. Jonas JB, Jonas SB, Jonas RA, et al. Parapapillary atrophy: histological gamma zone and delta zone[J/OL]. PLoS One, 2012, 7(10): e47237[2012-10-18]. https://pubmed.ncbi.nlm.nih.gov/23094040/. DOI: 10.1371/journal.pone.0047237.
3. Fang Y, Yokoi T, Nagaoka N, et al. Progression of myopic maculopathy during 18-year follow-up[J]. Ophthalmology, 2018, 125(6): 863-877. DOI: 10.1016/j.ophtha.2017.12.005.
4. 张蕙蓉. 睫状血管系统[M]//李凤鸣. 中华眼科学. 北京: 人民卫生出版社, 2005: 129-130.Zhang HR. Ciliary vascular system[M]//Li FM. Chinese ophthalmology. Beijing: People's Medical Publishing House, 2005: 129-130.
5. Devarajan K, Sim R, Chua J, et al. Optical coherence tomography angiography for the assessment of choroidal vasculature in high myopia[J]. Br J Ophthalmol, 2020, 104(7): 917-923. DOI: 10.1136/bjophthalmol-2019-314769.
6. Guler Alis M, Alis A. Choroidal vascularity index in adults with different refractive status[J/OL]. Photodiagnosis Photodyn Ther, 2021, 36: 102533[2021-09-11]. https://pubmed.ncbi.nlm.nih.gov/34520880/. DOI: 10.1016/j.pdpdt.2021.102533.
7. Wang YX, Panda-Jonas S, Jonas JB. Optic nerve head anatomy in myopia and glaucoma, including parapapillary zones alpha, beta, gamma and delta: Histology and clinical features[J/OL]. Prog Retin Eye Res, 2021, 83: 100933[2020-12-09]. https://pubmed.ncbi.nlm.nih.gov/33309588/. DOI: 10.1016/j.preteyeres.2020.100933.
8. Xu L, Wang YX, Wang S, et al. Definition of high myopia by parapapillary atrophy. The Beijing Eye Study[J/OL]. Acta Ophthalmol, 2010, 88(8): e350-351[2010-12-01]. https://pubmed.ncbi.nlm.nih.gov/19900199/. DOI: 10.1111/j.1755-3768.2009.01770.x.
9. Kim M, Kim TW, Weinreb RN, et al. Differentiation of parapapillary atrophy using spectral-domain optical coherence tomography[J]. Ophthalmology, 2013, 120(9): 1790-1797. DOI: 10.1016/j.ophtha.2013.02.011.
10. Jonas JB, Wang YX, Dong L, et al. Advances in myopia research anatomical findings in highly myopic eyes[J]. Eye Vis (Lond), 2020, 7: 45. DOI: 10.1186/s40662-020-00210-6.
11. Chui TY, Zhong Z, Burns SA. The relationship between peripapillary crescent and axial length: implications for differential eye growth[J]. Vis Res, 2011, 51(19): 2132-2138. DOI: 10.1016/j.visres.2011.08.008.
12. Nakazawa M, Kurotaki J, Ruike H. Longterm findings in peripapillary crescent formation in eyes with mild or moderate myopia[J]. Acta Ophthalmol, 2008, 86(6): 626-629. DOI: 10.1111/j.1600-0420.2007.01139.x.
13. Lee KM, Choung HK, Kim M, et al. Change of β-zone parapapillary atrophy during axial elongation: Boramae Myopia Cohort Study Report 3[J]. Invest Ophthalmol Vis Sci, 2018, 59(10): 4020-4030. DOI: 10.1167/iovs.18-24775.
14. Xu L, Wang Y, Wang S, et al. High myopia and glaucoma susceptibility the Beijing Eye Study[J]. Ophthalmology, 2007, 114(2): 216-220. DOI: 10.1016/j.ophtha.2006.06.050.
15. Lee EJ, Kim TW, Kim JA, et al. Parapapillary deep-layer microvasculature dropout in primary open-angle glaucoma eyes with a parapapillary γ-zone[J]. Invest Ophthalmol Vis Sci, 2017, 58(13): 5673-5680. DOI: 10.1167/iovs.17-22604.
16. Suh MH, Park JW, Khandelwal N, et al. Peripapillary choroidal vascularity index and microstructure of parapapillary atrophy[J]. Invest Ophthalmol Vis Sci, 2019, 60(12): 3768-3775. DOI: 10.1167/iovs.18-26286.
17. Sullivan-Mee M, Patel NB, Pensyl D, et al. Relationship between juxtapapillary choroidal volume and beta-zone parapapillary atrophy in eyes with and without primary open-angle glaucoma[J]. Am J Ophthalmol, 2015, 160(4): 637-647. DOI: 10.1016/j.ajo.2015.06.024.

Chinese Journal of Ocular Fundus Diseases

Parapapillary atrophy, choroidal vascularity index and their correlation in different degrees of myopia

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