单眼弱视患者空间视觉缺损特点及其机制  

Mechanism underlying spatial vision deficit of monocular amblyopia based on the theory of Magnocellular and Parvocellular( M-P) pathways

作　　者：宋峰伟[1] 孙朝晖[2] 杨羿[2] 王丽萍[3] 汤霞靖[2] 陈彬彬[2] 于晓宁[2] 

机构地区：[1]湖州师范学院附属第一医院眼科,浙江湖州313000 [2]浙江大学附属第二医院眼科中心,浙江杭州310009 [3]浙江工业大学信息智能与决策优化研究所,浙江杭州310003

出　　处：《浙江大学学报（医学版）》2014年第1期101-108,共8页Journal of Zhejiang University(Medical Sciences)

基　　金：浙江省科技计划项目(2009C33133);浙江省医药卫生科技计划(2012KYA102);浙江省重点实验室基金(2011E10006);浙江省眼科创新团队基金(2009R50039)

摘　　要：目的：评价单眼弱视者的空间视觉缺损及其与弱视程度的相关性,并基于M-P视觉通道理论分析单眼弱视空间视觉缺损的机制.方法：采用ETDRS数字视力表和OptecR6500视功能检测仪检测111例7～34岁单眼弱视者弱视眼和非弱视眼的视锐度和对比敏感度函数,通过视锐度和对比敏感度函数衍生计算对比敏感度函数曲线下面积（AULCSF）、峰值对比敏感度（Smax）、Smax所对应的空间频率（Frmax）以及截止空间频率（CutSF）,分析单眼弱视者的空间视觉缺损特点及其与弱视程度的相关性.结果：单眼弱视者的弱视程度与双眼对比敏感度AULCSF差值呈负相关（r=-0.83,P〈0.01）,弱视眼视锐度与AULCSF、CutSF、Smax、Frmax呈负相关（r值分别为-0.68、-0.80、-0.73和-0.56,P〈0.01）.不同程度弱视患者视锐度、AULCSF、Smax、Frmax及CutSF间差异均有统计学意义（P〈0.01）.不同程度弱视者非弱视眼视锐度、AULCSF、Smax、Frmax及CutSF差异均无统计学意义（P〉0.05）.轻度弱视者的弱视眼与非弱视眼AULCSF和Frmax差异也无统计学意义（P〉0.05）,Smax和CutSF差异有统计学意义（P〈0.05）;而中重度弱视者弱视眼与非弱视眼AULCSF、Smax、Frmax及CutSF差异均有统计学意义（P〈0.01）.不同程度弱视者弱视眼在各空间频率下对比敏感度差异均有统计学意义（P〈0.01）,而非弱视眼间差异无统计学意义（P〉0 05）.结论：视锐度与AULCSF、CutSF、Smax、Frmax在弱视者空间视觉评价时呈现趋势一致性.随着弱视程度的加重,弱视眼的整体空间视觉功能逐渐下降,视觉系统的高频端分辨率逐渐减弱和最佳对比度识别能力降低,最适空间频率向低空间频率偏移.在轻度弱视者中,M细胞通道无明显异常,P细胞各亚型的敏感性下降;而中高度弱视者中,M和P细胞通道均受到不同程度的损伤,且以P细胞通道受损为主.Objective： To investigate the relationship between the characteristics of spatial vision deficit and the degree of amblyopia in monocular amblyopes, and to analyze its mechanism with the theory of Magnoeellular and Parvoeellular pathways. Methods： One hundred and eleven patients with monocular amblyopes aged 7 -34 were included in this study. Distance best corrected visual acuity （BCVA） in logMAR units and contrast sensitivity function test were performed on both eyes in all patients with ETDRS digital visual chart and functional test system OPTECR 6500. The spatial vision of amblyopic and non-amblyopic eyes was evaluated by the AULCSF, Smax, Fmax and cutSF derived from the curve of contrast sensitivity function. Results： The degree of amblyopia was significantly correlated with the difference of AULCSF between the amblyopic and non-amblyopc eyes （ r = - 0. 83, P 〈 0. 01 ）. BCVA of amblyopic eyes was significantly correlated with AULCSF, CutSF, Smax, Frmax （ r = - 0.68, - 0. 80, - 0. 73, - 0. 56, respectively; P 〈 0. 01）. In amblyopic eyes, significant difference in BCVA, AULCSF, S Frmax and CutSF was seen among different amblyopic groups （ P 〈 0.01 ）, which was defined by the degree of amblyopia. In non-amblyopic eyes, no significant difference in BCVA ,AULCSF,Smax, Frmax, and CutSF was noted among different amblyopic groups（ P 〉 0. 05 ）. In mild amblyopes, no significant difference in AULCSF and Frmax was found between the amblyopic eyes and non-amblyopic eyes （ P 〉 0. 05 ）, while SmaX and CutSF were significantly different. However, in moderate and severe amblyopes, significant differences in BCVA, AULCSF, Smax, Frmax and CutSF was seen between the amblyopic and non-amblyopic eyes （ P 〈 0.01 ）. In amblyopic eyes, significant difference in contrast sensitivity was noted in all kinds of spatial frequencies among different amblyopic groups（ P 〈 0. 01 ）, and in non-amblyopic eyes, significant differences in contrast sensitivity was not seen in all kinds of spatia

关 键 词：眼 弱视 病理生理学 视觉 对比敏感度 曲线下面积 统计学(主题) 

分 类 号：R777.44[医药卫生—眼科]