目的：调查现役军人高度近视者合并眼底病变的患病率，分析其影响因素。

方法：横断面调查研究。纳入患有高度近视(屈光度≤-6.00 D)且眼轴长度延长(≥26 mm)的军人群体，实施了系统性评估方案，包括标准化问卷调查、全身健康状况检查及综合性眼科检查。采用光学相干断层扫描(OCT)影像技术对高度近视参与者进行眼底病变筛查，并计算相关病变的患病率。检测眼轴长度、屈光度数、最佳矫正视力(BCVA)及黄斑区神经节细胞复合体(GCC)厚度，通过单因素分析比较伴发与不伴发眼底病变的高度近视患者各项参数的差异性，进一步采用Logistic多因素回归分析鉴定眼底病变的影响因素。

结果：纳入患者134例268眼，均为男性，平均年龄24.5±3.2岁。268眼中检出眼底病变阳性体征者123眼，患病率为45.9%。其中视盘旁血流密度降低84眼(31.3%)、GCC薄变46眼(17.2%)、玻璃膜疣8眼(3.0%)、视盘水肿7眼(2.6%)、视网膜劈裂6眼(2.2%)、脉络膜凹陷3眼(1.1%)。高度近视合并视网膜劈裂患者的BCVA显著低于无劈裂者(P<0.05)。单因素分析显示，屈光度、眼轴长度、后巩膜扩张与眼底病变发生相关(P<0.05)； 多因素Logistic回归分析显示，眼轴长度(OR=2.52，95%CI：1.67-3.80，P<0.001)、后巩膜扩张(OR=3.12，95%CI：1.65-5.92，P<0.01)是高度近视军人合并眼底病变的重要影响因素。

结论：现役军人高度近视合并眼底病变患病比例较高，视盘旁血流密度降低与GCC薄变是该人群常见病变类型，眼轴长度增加与后巩膜扩张是其重要影响因素。建议将OCT检查纳入高度近视军人常规眼科检查，为眼底病变早期识别与干预提供依据。

METHODS: A cross-sectional study. Subjects included military personnel with high myopia(≤-6.00 D)and elongated axial length(≥26 mm). A systematic evaluation protocol was implemented, consisting of standardized questionnaires, general physical health examinations, and comprehensive ophthalmic assessments. Optical coherence tomography(OCT)was used to screen for fundus lesions in highly myopic subjects, and the prevalence of related lesions was calculated. Axial length, refractive error, best-corrected visual acuity(BCVA), and macular ganglion cell complex(GCC)thickness were measured. Univariate analysis was performed to compare differences in the above parameters between highly myopic subjects with and without concomitant fundus lesions. Multivariate Logistic regression analysis was further applied to identify risk factors for fundus lesions.

RESULTS:A total of 134 male patients(268 eyes)were enrolled, with the mean age of 24.5±3.2 y. Of the 268 eyes, 123 eyes(45.9%)showed positive signs of fundus lesions. Among these, parapapillary blood flow density reduction was found in 84 eyes(31.3%), GCC thinning in 46 eyes(17.2%), drusen in 8 eyes(3.0%), optic disc edema in 7 eyes(2.6%), retinoschisis in 6 eyes(2.2%), and choroidal excavation in 3 eyes(1.1%). BCVA was significantly lower in highly myopic patients with retinoschisis than in those without retinoschisis(P<0.05).Univariate analysis showed that refractive error, axial length, and posterior scleral expansion were associated with the occurrence of fundus lesions(P<0.05). Multivariate Logistic regression analysis revealed that axial length(OR=2.52, 95%CI: 1.67-3.80, P<0.001)and posterior scleral expansion(OR=3.12, 95%CI: 1.65-5.92, P<0.01)were significant risk factors for fundus lesions in highly myopic military personnel.

CONCLUSION: The prevalence of fundus lesions is relatively high among active-duty military personnel with high myopia. Peripapillary flow density reduction and GCC thinning are the most common manifestations in this population. Increased axial length and posterior scleral ectasia are significant contributing factors. It is recommended that OCT be incorporated into routine ophthalmic examinations for these military personnel, thereby providing a basis for the early detection and intervention of fundus lesions.