屈光参差性弱视儿童弱视治疗前后光学相干断层扫描和图形视网膜电图的改变  

Changes of optical coherence tomography(OCT)and pattern electroretinogram(PERG)in children with anisometropic amblyopia before and after treatment

作　　者：彭小宁 李盈龙 王光鑫 喻静文 刘帅 Peng Xiao-ning;Li Ying-long;Wang Guang-xin(Department of Ophthalmology,The Third Affiliated Hospital of Anhui Medical Uniwersity,First People's Hospital of Hefei City,230000 Hefei,China)

机构地区：[1]安徽医科大学附属第三医院,合肥市第一人民医院眼科,230000

出　　处：《中国斜视与小儿眼科杂志》2023年第4期32-36,共5页Chinese Journal of Strabismus & Pediatric Ophthalmology

基　　金：合肥市科委基金应用医学项目(Hwk2021yb004);安徽医科大学校青年基金项目(2020xkj067)。

摘　　要：目的了解屈光参差性弱视儿童治疗前后的视网膜结构和功能的改变,进一步了解弱视患者是否存在网膜微结构和网膜本身功能的损伤,以及治疗后两者是否有改变。方法纳入30例8~13岁屈光参差性弱视患儿,给予遮盖疗法。使用OCT和PERG检查治疗前后眼轴长度、屈光度、斜视、视网膜神经纤维层(RNFL)厚度、神经节细胞复合体(GCC)平均厚度以及P50、N95振幅和潜伏时。结果屈光参差性弱视患者弱视眼(AE)平均GCC厚度较对侧健眼(FE)增厚(t=2.264,P=0.039);RNFL厚度在上方(t=3.970,P=0.001)、鼻侧(t=3.307,P=0.005)、下方(t=5.573,P=0.001)均显著增加,而颞侧RNFL层厚度相对于对侧健眼变薄(t=-2.353,P=0.033);弱视眼PERG的P50振幅(t=-4.108,P=0.001)和N95振幅(t=-3.126,P=0.006)较对侧健眼降低。3个月遮盖治疗后最佳矫正视力(BCVA)较治疗前提高(t=-0.196,P=0.022),但RNFL、GCC厚度和PERG未见明显改变,且相对于对侧健眼,治疗后弱视眼OCT和PERG的改变与治疗前保持一致。结论弱视患者治疗后视力的提高可能的改变是在视觉中枢而不是视网膜结构或功能的恢复。Objective To investigate the changes of retinal structure and function in patients with anisometropic amblyopia before and after treatment,in order to further understand whether there is damage to retinal microstructure and retinal function in amblyopia patients,and whether there is change in retinal microstructure and retinal function after effective amblyopia treatment.Methods Thirty children(8~13 years old)with anisometropia amblyopia were recruited.The axial length,diopter,strabismus,retinal nerve fiber layer(RNFL)thickness,ganglion cell complex(GCC)mean thickness,P50,N95 amplitude and latency were measured and recorded before and after treatment using OCT and PERG.Results The average GCC thickness of amblyopic eyes(AE)was thicker than that of contralateral healthy eyes(FE)in visual sensitive period(t=2.264,P=0.039).The thickness of RNFL increased significantly in the upper(t=3.970,P=0.001),nasal(t=3.307,P=0.005),and lower(t=5.573,P=0.001).The thickness of temporal RNFL layer was thinner than that of contralateral healthy eyes(t=-2.353,P=0.033).In addition,the P50 amplitude(t=-4.108,P=0.001)and N95 amplitude(t=-3.126,P=0.006)of PERG in amblyopic eyes were significantly lower than those in contralateral healthy eyes.After 3 months of covering treatment,the best corrected visual acuity(BCVA)of the subjects was significantly improved compared with that before treatment(t=-0.224,P=0.034),but the RNFL,GCC thickness and PERG were not significantly changed.Compared with the contralateral healthy eyes,the changes of OCT and PERG in the amblyopic eyes after treatment were consistent with those before treatment.Conclusions The results of this study suggest that the improvement of visual acuity in patients with amblyopia after treatment may be due to the visual center rather than the restoration of retinal structure or function.

关 键 词：屈光参差性弱视 光学相干断层扫描 图形视网膜电图 遮盖疗法 

分 类 号：R777.44[医药卫生—眼科]