近视性屈光参差性弱视患者视网膜黄斑中心凹及神经纤维层厚度的研究

Measurement of the retinal fovea and nerve fiber layer thickness in patients with unilateral myopic anisometropic amblyopia using optical coherence topography

背景弱视是一种从视网膜到视中枢的视觉传导系统及中枢全领域形态学及功能异常引起的临床表现，目前弱视眼的视网膜是否受累仍是争论的焦点。目的采用光学相干断层扫描（OCT）测量单眼近视性屈光参差性弱视患者的视网膜黄斑中心凹厚度及视网膜神经纤维层（RNFL）厚度，探讨单眼近视性屈光参差性弱视患者视网膜是否存在组织病理学改变。方法取近视性屈光参差性弱视患者22例44眼为弱视组；近视性屈光参差性弱视患者经治疗后视力达到正常者10例20眼为弱视治愈组；初诊为近视性屈光参差非弱视患者11例22眼为非弱视组。所有患者采用Model3000型OCT测量双眼视网膜黄斑中心凹厚度及视盘周围RNFL厚度，包括上方、下方、鼻侧、颞侧和平均厚度。采用配对t检验对各组受试者双眼间视网膜厚度的差异进行比较，用多元线性回归方法分析黄斑中心凹视网膜厚度及RNFL厚度与弱视眼眼轴长度、屈光度和年龄的关系。结果弱视组患者中弱视眼黄斑中心凹厚度明显比对侧眼增厚，差异有统计学意义（P=0．001）；弱视治愈组原弱视眼与对侧眼之间视网膜厚度的差异无统计学意义（P=0．778），非弱视组高度数近视眼与低度数近视眼之间视网膜厚度的差异无统计学意义（P=0．943）；弱视组弱视眼颞侧RNFL厚度明显比对侧眼增厚，差异有统计学意义（P〈0．001），弱视治愈组原弱视眼颞侧RNFL厚度比对侧眼厚，差异有统计学意义（P=0．003），非弱视组高度数眼颞侧RNFL厚度比低度数眼厚，差异有统计学意义（P=0．046），各组双眼视网膜上方、下方、颞侧及平均RNFL厚度的差异均无统计学意义（P〉0．05）。年龄与视盘下方RNFL厚度间呈负相关关系（r=-0．559，P=0．016），其余各参数之间均无明显相关（P〉0．05）。结论近视性屈光参差性弱视患者的黄斑中心凹视网膜较正常眼增厚，而RNFL厚度与一般近视眼无明显差别；弱视的改善伴随着黄斑中心凹厚度的减小。

[ Abstract] Background Both functional and morphological changes in amblyopic development are known to occur at various levels in the central visual pathway. However,whether the retina is involved or not during amblyopic progression remains controversial. Objective This study was designed to compare the thicknesses of the fovea and retinal nerve fiber layer （RNFL） of the normal fellow eye of amblyopic eye using optical coherence tomography （OCT） in children with myopic anisometropia. Methods Twenty-two patients with unilateral myopic anisometropie amblyopia were included as the anisometropia amblyopia group. Ten unilateral myopic anisometropic amblyopia subjects received treatment and recovered were used as the amblyopic cure group, and 11 individuals with simple myopic anisometropia without amblyopia were enrolled as the control group. OCT was performed on both eyes of all the subjects with informed consent. Fovea retinal thickness and RNFL thickness from the superior, inferior, nasal and temporal quadrants in the peripapillary region were evaluated. The measurement parameters were bilaterally compared in all the individuals by paired t test. The multiple regression model was used to analyze the correlation of retinal thickness with amblyopia patients. This study was approved by the Ethic Committee of this hospital. Written informed consent was obtain from each subject prior to the eye examination. Results Fovea retinal thickness increased in the amblyopic eyes compared with the fellow eyes, showing a statistically significant difference between them （P = 0. 001 ）. However, no significant differences were found in the fovea retinal thickness between both eyes in the amblyopic cure group and simple myopic anisometropia without amblyopia group （ P = 0. 778,0. 943 ）. Among the anisometropia amblyopia group,amblyopia cure group and simple myopic anisometropia without amblyopia group,the RNFL thicknesses of the temporal quadrant was significantly thicker in the higher myopic lateral eyes than those of the fellow eyes （P〈0.001, P = 0. 003, P = 0. 046 ）. However, the differences in the superior, inferior, nasal and the average RNFL thickness were not statistically significant between the two eyes （ P〉0. 05 ）. A negative correlation was found between the inferior retinal thickness with age （r=-0. 559,P = 0. 016）. Conclusions The fovea may be affected in unilateral myopic anisometropic amblyopia. There is no significant difference in the RNFL thickness between simple myopic eye and unilateral myopic anisometropia amblyopic eye. Improvement in amblyopia is coming along with the reduction of the thickness of the fovea.