视觉皮质可塑性及双眼视觉与弱视治疗新理念

Treatment of amblyopia emerging from plasticity of the visual cortex and binocular vision

弱视是伴有视觉皮质生理学改变的发育异常性疾病。重启视觉发育敏感期进而有效改善青少年及成人患者的治疗效果成为研究的热点问题。视觉皮质可塑性的研究显示，1-氨基丁酸（GABA）、去甲。肾上腺素（NE）、乙酰胆碱、5-羟色胺（5-HT）及多巴胺等神经递质在视觉发育敏感期的调控中具有重要作用，组织型纤溶酶原激活物（tPA）及交联硫酸软骨素蛋白聚糖（CSPGs）等细胞外基质成分的动态变化是保持视觉皮质可塑性的重要条件。弱视的临床研究则提示，视觉皮质对弱视眼信息的抑制及注意障碍是造成弱视并阻碍视觉发育敏感期重启的重要因素，无创性脑电磁刺激及知觉学习有可能去除压抑，从而有效治疗弱视。本文就视觉皮质可塑性、弱视发病中的抑制与视觉注意障碍研究进展及与之相关的弱视治疗新理念、新方法进行综述，以期为青少年和成人弱视治疗提供帮助。

Amblyopia is a developmental visual disorder,which is accompanied by physiological changes in the visual cortex. Many studies that focused on the treatments of amblyopia and improvment of therapeutic effects in teenagers and adults have been paid more and more attention. Recent studies reveal that a threshold level of neurotransmitters, such as 3,-aminobutyrie acid （ GABA ）, norepinephrine （ NE ）, acetylcholine, 5-hydroxytryptamine （5-HT） and dopamine,is required to open the critical period. Meanwhile,the content of specific extracellular matrix, such as extracellular protease tissue plasminogen activator （tPA） and cross-linked chondroitin sulphate proteoglycans （CSPGs） ,exhibits dynamic changes over the time course of the critical period,which plays a key role in synaptie modifications. Clinical studies show that suppression and deficits in visual attention towards signal from the amblyopia eye may be important factors in physiological mechanism of amblyopia,which support a basis for non-invasive brain stimulation and perceptual learning as new effective treatments. This paper described the recent advances in plasticity of visual cortex and binocular vision in the field of amplyopia treatment,especially in teenagers and adults.