婴儿黄斑区视网膜发育变化的动态观察  

Dynamic observation of infant＇s macularde.velopment

作　　者：高云霞[1] 胡艳玲[2] 吕淑媛[1] 万兴丽[2] 彭希[1] 陆方[1] 

机构地区：[1]四川大学华西医院眼科,成都610041 [2]四川大学华西第二医院新生儿科

出　　处：《中华眼底病杂志》2014年第1期33-37,共5页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察婴儿视网膜黄斑区形态及视网膜各层厚度变化。方法随机选取新生儿重症监护病房中的婴儿58例86只眼纳入研究。根据不同矫正胎龄对婴儿进行分组。其中，矫正胎龄〈32周组10例14只眼；33～36周组26例39只眼；37～41周组12例18只眼；≥42周组10例15只眼。随机选择无器质性眼病的成人12名22只眼作为成人组。所有婴儿及成人均行便携式光相干断层扫描（OCT）检查。着重观察婴儿黄斑区形态。同时，测量婴儿及成人黄斑中心凹及距中心凹750、1500μm处旁中心凹的神经上皮层、内层视网膜、外层视网膜、神经纤维层、节细胞层、内丛状层、内核层、外丛状层、外核层厚度。分析视网膜各层厚度与矫正胎龄的相关性。结果婴儿早期的黄斑中心凹凹陷浅，随着矫正胎龄增长凹陷逐渐加深并接近成人形态。婴JL#I＂层视网膜结构较内层完善，随着矫正胎龄的增长逐渐出现外界膜、光感受器内外节连接（Is／os）、光感受器外节／视网膜色素上皮（OS／RPE）层。外界膜、IS／OS、OS／RPE层最早出现时间分别为矫正胎龄32、35、47周。RPE层、脉络膜血管层厚度均随矫正胎龄增长逐渐增厚。婴儿组、成人组之间距中心凹750Fm处内层视网膜、1500弘In处神经纤维层和中心凹及距中心凹750、1500m处节细胞层厚度比较，差异无统计学意义（P〉0．01）。其他视网膜各层厚度在婴儿组及成人组间，以及在不同矫正胎龄组组内间差异均有统计学意义（P〈0．01）。相关性分析发现，除节细胞层外，其他视网膜各层厚度均与矫正胎龄有相关性（P〈0．05）。结论婴儿早期的黄斑中心凹凹陷浅，随着矫正胎龄增长凹陷逐渐加深并接近成人形态。婴儿早期黄斑区外层视网膜逐渐增厚，其中以内外核层增减变化最为明显。视网膜各层随着矫正胎龄增长逐渐增厚，但发育速度并�Objective To observe the macular morphological development and thickness of retinal layers in infants. Methods Fifty-eight infants （86 eyes） were randomly selected from neonatal intensive care unit. They were divided into 4 groups according to the corrected gestational age, including ＋32 weeks group （10 cases, 14 eyes）, 33 to 36 weeks group （26 cases, 39 eyes）, 37 to 41 weeks group （12 patients, 18 eyes） and 42 weeks group （10 cases , 15 eyes）. Twelve health adults （22 eyes） were randomly selected as adult group. All infants and adults underwent a portable optical coherence tomography （OCT） examination, focus on the macular morphology. The thickness of 9 retinal layers at fovea and parafovea （750 m, 1500 m from central fovea） were measured, including retinal neurepithelium layer, the inner retina, the outer retina, nerve fiber layer, ganglion cell layer, inner plexiform layer, inner nuclear layer, outer plexiform layer and inner nuclear layer. The correlation between retinal thickness and corrected gestational age was analyzed. Results Macular fovea was shallow in early infancy, and then form a mature macular fovea finally with corrected gestational age. The outer retina structure was more mature than the inner retina of infants. With the increase of the corrected gestational age, the following structures gradually developed including the outer limiting membrane （OLM）, the junction of inner and outer segment of photoreeeptor （IS/OS）, the outer segment of photoreceptor/retinal pigment epithelium layer （OS/RPE）. The earliest corrected gestational age to detect the OLM, IS/OS, OS/RPE was 32＋1 , 35, 47＋1 weeks respectively. The RPE and choroid layer became thicker gradually. There were no statistical differences between infants group and adults group （P〈0.01） for the following thickness measurements, including inner retina at 750 m parafovea, nerve fiber layer at 1500 gm parafovea, ganglion cell layer at central fovea and parafovea （750 m, 1500 m）. The thic

关 键 词：黄斑 解剖学和组织学 视网膜 生长和发育 婴儿 新生 生长和发育 

分 类 号：R774.1[医药卫生—眼科] R722.6[医药卫生—临床医学]