ImportanceIndividuals with high myopia younger than 18 years are at relatively high risk of progressively worsening myopic maculopathy. Additional studies are needed to investigate the progression of myopic maculopathy in this age group, as well as the risk factors associated with progression.ObjectiveTo investigate the 4-year progression of myopic maculopathy in children and adolescents with high myopia, and to explore potential risk factors.Design, Setting, and ParticipantsThis hospital-based observational study with 4-year follow-up included a total of 548 high myopic eyes (spherical power −6.00 or less diopters) of 274 participants aged 7 to 17 years. Participants underwent comprehensive ophthalmic examination at baseline and 4-year follow-up. Myopic maculopathy was accessed by the International Photographic Classification and Grading System. The data analysis was performed from August 1 to 15, 2023.Main Outcomes and MeasuresThe progression of myopic maculopathy progression over 4 years and associated risk factors.ResultsThe 4-year progression of myopic maculopathy was found in 67 of 548 eyes (12.2%) of 274 participants (138 girls [50.4%] at baseline and 4-year follow-up) with 88 lesion changes, including new signs of the tessellated fundus in 16 eyes (18.2%), diffuse atrophy in 12 eyes (13.6%), patchy atrophy in 2 eyes (2.3%), lacquer cracks in 9 eyes (10.2%), and enlargement of diffuse atrophy in 49 eyes (55.7%). By multivariable analysis, worse best-corrected visual acuity (odds ratio [OR], 6.68; 95% CI, 1.15-38.99; P = .04), longer axial length (AL) (OR, 1.73; 95% CI, 1.34-2.24; P < .001), faster AL elongation (OR, 302.83; 95% CI, 28.61-3205.64; P < .001), and more severe myopic maculopathy (diffuse atrophy; OR, 4.52; 95% CI, 1.98-10.30; P < .001 and patchy atrophy; OR, 3.82; 95% CI, 1.66-8.80; P = .002) were associated with myopic maculopathy progression.Conclusions and RelevanceIn this observational study, the progression of myopic maculopathy was observed in approximately 12% of pediatric high myopes for 4 years. The major type of progression was the enlargement of diffuse atrophy. Risk factors for myopic maculopathy progression were worse best-corrected visual acuity, longer AL, faster AL elongation, and more severe myopic maculopathy. These findings support consideration of follow-up in these individuals and trying to identify those at higher risk for progression.

中文翻译：

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高度近视儿童和青少年近视黄斑病变的四年进展

重要性 18 岁以下患有高度近视的人近视黄斑病逐渐恶化的风险相对较高。需要更多的研究来调查该年龄组近视黄斑病变的进展情况以及与进展相关的危险因素。目的调查高度近视儿童和青少年近视黄斑病变的4年进展情况，并探讨潜在的危险因素设计、设置和参与者这项以医院为基础的观察性研究，随访 4 年，包括 274 名 7 至 17 岁参与者的 548 只高度近视眼（球面屈光度 -6.00 或更低屈光度）。参与者在基线和 4 年随访时接受了全面的眼科检查。近视黄斑病变通过国际摄影分类和分级系统进行评估。数据分析于2023年8月1日至15日进行。主要结果和措施近视性黄斑病变4年进展情况及相关危险因素。结果548只眼睛中的67只眼睛（12.2%）发现近视黄斑病变4年进展情况274 名参与者（基线和 4 年随访时为 138 名女孩 [50.4%]）有 88 处病变变化，包括 16 只眼 (18.2%) 出现棋盘状眼底新迹象、12 只眼 (13.6%) 弥漫性萎缩、斑片状萎缩2只眼（2.3%），漆裂9只眼（10.2%），弥漫性萎缩扩大49只眼（55.7%）。通过多变量分析，最佳矫正视力较差（优势比 [OR]，6.68；95% CI，1.15-38.99；磷= .04)，更长的轴向长度 (AL)（OR，1.73；95% CI，1.34-2.24；磷< .001），更快的 AL 伸长（OR，302.83；95% CI，28.61-3205.64；磷< .001），以及更严重的近视黄斑病变（弥漫性萎缩；OR，4.52；95% CI，1.98-10.30；磷< .001 和斑片状萎缩；或，3.82；95% CI，1.66-8.80；磷= .002）与近视黄斑病变进展相关。结论和相关性在这项观察性研究中，观察到约 12% 的儿童高度近视患者近视黄斑病变进展了 4 年。进展的主要类型是弥漫性萎缩的扩大。近视黄斑病变进展的危险因素包括最佳矫正视力较差、AL 较长、AL 伸长较快以及近视黄斑病变更严重。这些发现支持考虑对这些个体进行随访，并尝试识别那些进展风险较高的人。