屈光参差性弱视儿童治疗前后黄斑微循环的变化

The Effect of Treatment on Macular Microvasculature in Children with Anisometropic Amblyopia

目的:分析屈光参差性弱视儿童治疗前后黄斑微循环的变化。方法:前瞻性研究。随机抽取2019年1月至2020年12月于上海交通大学医学院附属第一人民医院眼科门诊就诊的6~12岁屈光参差性弱视儿童42例,随机抽取相同年龄段门诊非弱视儿童27例作为正常对照组。弱视儿童接受至少6个月的治疗及随访。利用光学相干断层扫描血管成像(OCTA)检测黄斑区浅层视网膜毛细血管丛(SCP)血流密度、深层视网膜毛细血管丛(DCP)血流密度、中心凹无血管区(FAZ)面积及视网膜厚度的变化。依据眼轴长度对OCTA数据进行矫正。采用方差分析比较弱视儿童弱视眼、对侧眼与正常对照组的黄斑血流密度差异;采用t检验比较弱视眼及对侧眼治疗前后的差异;采用CORR/Pearson检验分析治疗前后的视力变化值与SCP、DCP及FAZ变化值之间的相关性。结果:基线时,弱视眼全区域SCP、中心凹SCP、全区域DCP和中心凹DCP均显著小于对侧眼及正常对照组(均P<0.05),弱视眼FAZ显著大于对侧眼及正常对照组(F=53.57,P<0.001),而对侧眼与正常对照组之间差异无统计学意义(P>0.05)。治疗后,弱视眼全区域SCP、旁中心凹SCP较基线显著提高(t=3.75,P=0.001;t=2.62,P=0.012);弱视眼全区域DCP较基线显著提高(t=2.63,P=0.012)。治疗后全区域SCP和全区域DCP与同期对侧眼和正常对照组差异无统计学意义(均P>0.05)。治疗后,弱视眼FAZ面积较基线显著缩小(t=-2.33,P=0.025),但仍明显大于同期对侧眼和正常对照组(F=32.38,P<0.001)。视网膜厚度在治疗前后或双眼间差异均无统计学意义(均P>0.05)。治疗后,弱视眼最佳矫正视力(Log MAR)由基线的0.46±0.34改善至0.17±0.17(t=4.91,P<0.001);视力的变化值与全区域SCP、全区域DCP和FAZ的变化值之间无显著相关性(均P>0.05)。结论:屈光参差性弱视眼黄斑区SCP、DCP低于正常眼,而FAZ大于正常眼;经弱视治疗后SCP、DCP、FAZ接近正常眼水平。弱视眼视力变化值与SCP、DCP、FAZ变化值无显著相关性。

Objective:To analyze the alternations of macular microcirculation in children with anisometropic amblyopia before and after treatment.Methods:This was a prospective study held from January 2019 to December 2020.Totally 42 children aged from 6 to 12 years old with anisometropic amblyopia were enrolled from the ophthalmology clinic of Shanghai General Hospital,and 27 children with nonamblyopia in the same age group were enrolled as a normal control group.Children with amblyopia received treatment and follow-up for at least 6 months.Optical coherence tomography angiography(OCTA)was used to analyze the macular vessel density of superficial capillary plexus(SCP)and deep capillary plexus(DCP),foveal avascular zone(FAZ),and macular thickness of both eyes before and after treatment.Data were corrected by eye axis length using Littman formula.Analysis of variance was used to compare the differences between amblyopic eyes,fellow eyes,and normal control group.And paired t-test was used to compare the differences before and after treatment for amblyopic eyes and fellow eyes.The alternations of visual acuity(LogMAR value)were analyzed in relation to the alternations of SCP,DCP,and FAZ.Results:At baseline,the vessel densities of whole image SCP,foveal SCP,whole image DCP and foveal DCP in amblyopic eyes were significantly smaller than those in fellow eyes and normal control group(all P<0.05),FAZ in amblyopic eyes were significantly greater than those in fellow eyes and the normal control group(F=53.57,P<0.001),while the differences between fellow eyes and the normal control group were not significant(P>0.05).After treatment,the vessel densities of whole image SCP and parafoveal SCP in amblyopic eyes were significantly higher than those at baseline(t=3.75,P=0.001;t=2.62,P=0.012),Whole image DCP in amblyopic eyes were significantly higher than those at baseline(t=2.63,P=0.012).But there was no significant difference between whole image SCP and whole image DCP in amblyopic eyes with fellow eyes and normal control group(P>0.05).FAZ in amblyopic eyes were significantly reduced from those at baseline(t=-2.33,P=0.025),but they were still significantly larger than those in fellow eyes and normal control group(F=32.38,P<0.001).Macular thickness did not show sighificant difference between eyes irrespective treatment(P>0.05).After treatment,the best corrected visual acuity(LogMAR)of amblyopic eyes increased from 0.46±0.34 at baseline to 0.17±0.17 after treatment(t=4.91,P<0.001).There was no significant correlation between the alternations of visual acuity in amblyopic eyes with the alternations of whole image SCP,whole image DCP,and FAZ(all P>0.05).Conclusions:The vessel density of macular SCP and DCP in anisometropic amblyopia eyes are lower than those in normal eyes,while FAZ is greater.After amblyopia treatment,SCP,DCP and FAZ tend to approach to normal levels to a certain extent.There is no significant correlation between the alternations of visual acuity in amblyopic eyes with the alternations of SCP,DCP,and FAZ.