远视性弱视儿童黄斑区视网膜厚度分析

Analysis of macular retinal thickness in hyperopic amblyopia

目的 通过测量远视性弱视眼的黄斑区视网膜厚度、眼轴长度、屈光度以及最佳矫正视力（BCVA），并与正常对照眼进行比较，探讨弱视发病的视网膜形态学改变以及可能的外周机制。方法 回顾性病例对照研究。选择2013年1月至2015年6月在河北医科大学第一医院眼科门诊就诊的远视性弱视儿童48例（91眼）作为弱视眼组，其中单纯远视性弱视13眼，远视散光性弱视28眼，复性远视散光性弱视50眼。选择同期在眼科门诊健康查体，裸眼视力是该年龄正常值或以上的儿童48例（96眼）作为正常对照组。采用频域OCT检测2组儿童黄斑区视网膜厚度，按照ETDRS分区记录（A1-A9，共9个分区）；并利用IOLMaster测量所有儿童的眼轴长度。采用独立样本t检验对2组儿童黄斑区视网膜厚度进行比较，采用Pearson相关分析对不同区域黄斑区视网膜厚度与眼轴长度、BCVA、屈光度的相关性进行分析。结果 在各区中远视性弱视眼组与正常对照组A1区均为最薄，分别为（262±19）μm、（250±20）μm，2组间差异有统计学意义（t=2.93，P〈0.05）；2组内环区平均厚度（A2-A5）最厚，分别为（301±21）μm、（305±22）μm，差异无统计学意义（t=0.36，P〉0.05）；2组外环区（A6-A9）的平均厚度分别为（272±25）μm、（269±17）μm，差异无统计学意义（t=0.21，P〉0.05）。弱视眼组内环下方的黄斑区视网膜厚度与BCVA呈正相关（r=0.29，P＜0.05）；外环鼻侧的黄斑区视网膜厚度与等效球镜度呈正相关（r=0.40，P＜0.01），与眼轴长度存在负相关（r=-0.40，P＜0.01）。结论 远视性弱视儿童黄斑部分区域视网膜厚度发生变化，该变化可能与弱视的发生机制有关；且黄斑区视网膜厚度与矫正视力、屈光度、眼轴长度有关。

Objective To detect the macular retinal thickness, best corrected visual acuity（BCVA）, diopter and eye axis length of children with hyperopic amblyopia, exploring the morphological changes of amblyopic retina, expecting new evidence for diagnosis and treatment. Methods Children from the department of ophthalmology in the First Hospital of Hebei Medical University from January 2013 to June 2015, whose clinical datas were recorded. Finally according to the criteria of expert consensus, 96 children （ages 4-10 years） meeted the inclusion criteria were selected, including 48 cases （91 eyes） with hyperopic amblyopia and 48 cases （96 eyes） of normal control of healthy children in the department of ophthalmology in our hospital during the same period. The BCVA and diopter for all children were given by the same optometrist detection. Binocular macular retinal thickness of all children were carried out by frequency domain OCT examination. The retinal thickness in all macular areas（A1-A9） were recorded. All eye axis length were measured with IOLMaster. Data were compared by independent t test and Pearson correlation analysis. Results In the 2 groups the A1 area were the most thin （262±19 μm, 250±20 μm）, the difference between the 2 groups was statistically significant （t=2.93, P〈0.05）; The thickness （A2-A5） of the inner loop was the most thick, which were （301±21 μm, 305±22 μm）, and there was no significant difference between the 2 groups （t=0.36, P〉0.05）; The average thickness of the outer ring （A6-A9）： （272±25 μm, 269±17 μm）, there was no significant difference between the 2 groups （t=0.21, P〉0.05）. There was a positive correlation between macular thickness and corrected visual acuity （r=0.29, P〈0.05） within the lower region of the amblyopia group. There was a positive correlation between the macular thickness and diopter in the nasle side external ring （r=0.40, P〈0.01）. A negative correlation and the axial length of the eyes（r=-0.40, P〈0.01）. Conclusion Partial retinal macular thickness was different in children with hyperopic amblyopia. Those changes may be related to the pathogenesis of amblyopia. There was a correlation between macular thickness and corrected visual acuity, diopter, and axial length.