屈光异常弱视儿童RNFL和MRT的变化及预测疗效价值

Changes in retinal nerve fiber layer and macular retinal thickness and predictive value of outcome in children with abnormal refractive amblyopia

目的:探讨屈光异常弱视儿童视网膜神经纤维层(RNFL)、黄斑区视网膜厚度(MRT)变化及预测疗效价值。方法:选取2020-01/2022-10我院收治的168例近视性屈光异常单眼弱视儿童作为观察组,其中118例轻中度弱视,50例重度弱视,另按照1∶1比例同期纳入168例视力正常儿童作为对照组。统计两组儿童RNFL、MRT变化,分析屈光异常弱视儿童病情程度与RNFL、MRT的相关性,另将观察组根据疗效分为有效亚组和无效亚组,比较有效亚组和无效亚组一般资料、治疗前后RNFL及MRT,采用Logistic分析疗效的影响因素,绘制ROC曲线分析RNFL、MRT单一或联合预测疗效价值。结果:重度弱视RNFL、MRT大于轻中度弱视、对照组(均P<0.05);屈光异常弱视儿童病情程度与RNFL、MRT呈正相关(rs=0.745、0.724,均P<0.001);轻中度和重度弱视患者中,有效亚组和无效亚组初治年龄、注视形式、治疗依从性、治疗前、治疗1mo后RNFL、MRT及其差值比较均有差异(均P<0.05);Logistic显示,初治年龄、注视性质、治疗依从性、治疗1mo后RNFL、治疗1mo后MRT是屈光异常弱视儿童疗效的影响因素(均P<0.05);治疗1mo后RNFL、MRT联合预测轻中重度屈光异常弱视儿童疗效的AUC明显优于单一预测。结论:屈光异常弱视患儿RNFL、MRT存在差异,且与患儿不同程度病情、疗效密切相关,治疗1mo后RNFL、MRT联合预测不同程度屈光异常弱视患儿疗效具有一定参考价值。

AIM:To investigate the changes in retinal nerve fiber layer(RNFL)and macular retinal thickness(MRT)in children with refractive abnormalities and amblyopia,and their predictive value of outcome.METHODS:A total of 168 children with myopic refractive abnormalities and monocular amblyopia admitted to our hospital from January 2020 to October 2022 were selected as the observation group,with 118 cases of mild to moderate amblyopia and 50 cases of severe amblyopia,and 168 children with normal vision were included as the control group in a 1∶1 ratio during the same period.The changes of RNFL and MRT in two groups of children were statistically counted,and the correlation between the severity of refractive abnormalities and RNFL and MRT in children with amblyopia was analyzed.Additionally,the observation group was divided into effective subgroup and ineffective subgroup based on the therapeutic effect.The general information,as well as RNFL and MRT of the effective subgroup and the ineffective subgroups before and after treatment were compared.Logistic was used to analyze the factors influencing efficacy,and ROC curves was plotted to analyze the predictive value of RNFL and MRT alone or in combination for efficacy.RESULTS:RNFL and MRT of cases of severe amblyopia were higher than those of the mild to moderate amblyopia and the control groups(all P<0.05);the severity of amblyopia in children with refractive abnormalities is positively correlated with RNFL and MRT(r s=0.745 and 0.724,both P<0.001);among patients of mild to moderate and severe,there were statistically significant differences between the effective and ineffective subgroups in terms of initial treatment age,fixation form,treatment compliance,as well as RNFL,MRT,and their differences before and 1mo postoperatively(all P<0.05).Logistic analysis showed that initial treatment age,fixation nature,treatment compliance,RNFL and MRT before and 1mo postoperatively were all factors influencing the therapeutic effect of amblyopia with refractive abnormalities in children(all P<0.05);after 1mo of treatment,the combined prediction of RNFL and MRT was significantly better than that of single prediction in children with mild to severe amblyopia.CONCLUSION:There are differences in RNFL and MRT in children with abnormal refractive amblyopia,and they are closely related to the different degrees and curative effects of children.The combination of RNFL and MRT after 1mo of treatment has certain value in predicting children with different degrees of abnormal refractive amblyopia.