目的：探讨青少年近视程度对视盘区血管密度、黄斑厚度的影响及两者的关系。

方法：横断面研究。选择上海中冶医院就诊的106例176眼青少年近视患者为研究对象，根据等效球镜度数(SE)分为低度、中度、高度近视三组。对比三组视盘区血管密度、黄斑厚度及微视野相关指标，分析视盘区血管密度与黄斑厚度的相关性以及两者在SE与视网膜平均光敏感度(MLS)间的中介作用。

结果：三组患者基本资料具有可比性。随着近视程度加重，SE、视盘区各方位及平均血管密度、黄斑区除中央凹外各区域厚度、微视野相关指标均明显下降，眼轴长度、黄斑中央凹厚度均明显升高(均P<0.05)。广义加性模型显示，视盘区各方位及平均血管密度、黄斑区除中央凹外各区域厚度对近视程度呈负向影响，黄斑中央凹厚度呈正向影响(均P<0.05)。Pearson相关性分析表明，视盘区血管密度与黄斑中央凹厚度呈负相关，与黄斑其他区域厚度呈正相关(均P<0.05)。中介效应分析显示，黄斑各区域厚度、视盘区部分血管密度在SE与MLS整体间存在明显中介调控作用(均P<0.001)。

结论：随着近视程度增加，视盘区血管密度及黄斑除中央凹外各区域厚度降低，黄斑中央凹厚度升高； 视盘区血管密度与黄斑中央凹厚度负相关、与黄斑其他区域厚度正相关； 黄斑厚度、视盘区血管密度在SE及MLS间发挥明显中介作用。

METHODS: Cross-sectional study. A total of 106 cases(176 eyes)of adolescent myopia patients who chose Shanghai Zhongye Hospital for treatment were selected as the research subjects. They were divided into three groups according to the spherical equivalent(SE): low myopia, moderate myopia and high myopia. The vascular density in the optic disc area, macular thickness and microperimetry-related indicators of the three groups were compared. The correlation of the vascular density in the optic disc area with macular thickness was analyzed, as well as the mediating role of the two in SE with the average macular light sensitivity(MLS)of the retina.

RESULTS: The baseline characteristics of the three groups of patients were comparable. With the increase of myopia degree, SE, the vessel density in all directions and the average vascular density of the optic disc area, the thickness of all regions of the macular area except the fovea, and the related indicators of microperimetry all decreased significantly, while the axial length and the thickness of the macular fovea increased significantly(all P<0.05). The generalized additive model showed that the vascular density in all directions and the average vascular density of the optic disc area, and the thickness of all regions of the macular area except the fovea had a negative impact on the degree of myopia, while the thickness of the macular fovea had a positive impact(all P<0.05). Pearson correlation analysis indicated that the vascular density of the optic disc area negatively correlated with the thickness of the macular fovea, and positively correlated with the thickness of other regions of the macula(all P<0.05). The mediation effect analysis showed that the thickness of all regions of the macula and the vascular density of some areas of the optic disc area had a significant mediating regulatory effect between SE and the overall MLS(all P<0.001).

CONCLUSION: With the increase of myopia degree, the vascular density in the optic disc area and the thickness of all regions of the macula except the fovea decrease, while the thickness of the macular fovea increases; the vascular density in the optic disc area negatively correlated with the thickness of the macular fovea, and positively correlated with the thickness of other regions; the thickness of the macula and the vascular density in the optic disc area play a significant mediating role between SE and MLS.