近视及近视性弱视儿童视网膜结构与功能性研究
摘要
目的:本研究旨在探讨近视及近视性弱视儿童的图形视觉诱发电位(P-VEP)、多焦视网膜电图(mfERG)、光学相干断层扫描(OCT)各项指标的变化,依此研究近视及近视性弱视儿童的视网膜结构与功能性变化特征。
方法:对52眼近视性弱视(A组)、23眼近视(B组)及23眼近视性弱视基本治愈(C组)行P-VEP、mfERG、OCT各项指标的检查,记录P-VEP的P100波的潜伏期和振幅密度、mfERG的一阶反应的P1波的1-6环潜伏期和振幅密度以及OCT的黄斑中心凹中心视网膜厚度和视盘上方、下方、鼻侧、颞侧及平均视网膜神经纤维层厚度,并与22眼单眼弱视儿童的健眼(D组,即对照组)进行比较。
结果:1 P-VEP:(1)A组较D组大方格和小方格的P100波的潜伏期延长及振幅密度下降均有显著差异。(3)C组与D组比较,小方格刺激的P100波振幅密度降低和潜伏期延长,而大方格刺激的P100波振幅密度和潜伏期无差异。(2)B组与D组比较,大方格和小方格的P100波振幅密度和潜伏期均没有显著差异。
2 mfERG:(1)A组和C组较D组一阶反应1-6环P1波的振幅密度明显降低,而潜伏期无明显差异。(2)B组与D组比较一阶反应1-6环P1波的振幅密度和潜伏期均无显著差异。
3 OCT:A和C组分别和D组比较,视盘下方和视盘周围平均视网膜神经纤维层厚度变薄,且有统计学意义,而视盘上方、颞侧和鼻侧视网膜神经纤维层厚度和黄斑中心凹中心视网膜厚度均无显著差异。B组和D组比较,视盘周围视网膜神经纤维层厚度和黄斑中心凹视网膜厚度均无显著差异,但中高度近视组的视盘颞侧视网膜神经纤维层厚度和黄斑中心凹中心视网膜厚度增加明显。
结论:(1)近视不影响视觉通路的传导及外层视网膜的功能,但是有视网膜结构的改变。(2)近视性弱视的视觉传导通路、外层视网膜功能及视网膜的结构均有异常,即使弱视基本治愈后,这些改变仍然存在。
Objective To approach the detection results of P-VEP(Pattem visual evoked potential), mfERG(Multifocal electroretinogram) and OCT(optical coherence tomography) in children with myopia and myopic amblyopia,to survey the structural and functional variance of retina in children with myopia and myopic amblyopia.
Methods The P-VEP,mfERG and OCT were tested on the eyes of myopic cases(52 eyes), myopic amblyopic cases(23 eyes),post-therapy myopic amblyopic cases(23 eyes) and sound eyes of unilateral amblyopic cases(22 eyes).
Results 1 P-VEP test(1) In myopic amblyopic eyes,the P100 wave amplitude densities were significantly declined and the P100 wave latencies were significantly prolonged. (2) No significant difference of P-VEP between the myopic eyes and the control eyes.(3) There were no significant differences in amplitude and latency between myopic amblyopic eyes after therapy and control eyes in the response of 8×8 checkers,while P100 wave amplitude was significantly declined and P100 wave latency was significantly prolonged in the response of 16×16 checker.
2 mfERG test(1) Compare with control eyes,the P1 wave amplitude densities in one to six rings of mfERG first order kernel in myopic amblyopic eyes and myopic amblyopic eyes after therapy were significantly attenuated,but there were no significant differences in P1 wave latencies.(2) There were no significant differences in P1 wave amplitude densities and latencies between myopic eyes and control eyes.
3 OCT test(1) Compared with control eyes,the retinal nerve fiber layer(RNFL) thickness in inferior quadrant and the average thickness of the peripapillary RNFL were significantly thinner in myopic amblyopic eyes and myopic amblyopic eyes after therapy,while there were no significant differences of the RNFL thicknesses in superior,nasal and temporal and the thickness of fovea.(2) The thicknesses of RNFL in temporal and the fovea were significantly thicker in moderate and severe myopic eyes.But no significant differences of the RNFL thickness were found in superior,nasal and inferior.
Conclusions(1) The myopia does not affect the transmission of visual perception and the function of outer retina,but can change the structure of retina.(2) there are significant abnormalities in the transmission of visual perception,the function and structure of retina in the eyes with myopic amblyopia.This situation still exists in the eyes with myopic amblyopia after therapy.
方法:对52眼近视性弱视(A组)、23眼近视(B组)及23眼近视性弱视基本治愈(C组)行P-VEP、mfERG、OCT各项指标的检查,记录P-VEP的P100波的潜伏期和振幅密度、mfERG的一阶反应的P1波的1-6环潜伏期和振幅密度以及OCT的黄斑中心凹中心视网膜厚度和视盘上方、下方、鼻侧、颞侧及平均视网膜神经纤维层厚度,并与22眼单眼弱视儿童的健眼(D组,即对照组)进行比较。
结果:1 P-VEP:(1)A组较D组大方格和小方格的P100波的潜伏期延长及振幅密度下降均有显著差异。(3)C组与D组比较,小方格刺激的P100波振幅密度降低和潜伏期延长,而大方格刺激的P100波振幅密度和潜伏期无差异。(2)B组与D组比较,大方格和小方格的P100波振幅密度和潜伏期均没有显著差异。
2 mfERG:(1)A组和C组较D组一阶反应1-6环P1波的振幅密度明显降低,而潜伏期无明显差异。(2)B组与D组比较一阶反应1-6环P1波的振幅密度和潜伏期均无显著差异。
3 OCT:A和C组分别和D组比较,视盘下方和视盘周围平均视网膜神经纤维层厚度变薄,且有统计学意义,而视盘上方、颞侧和鼻侧视网膜神经纤维层厚度和黄斑中心凹中心视网膜厚度均无显著差异。B组和D组比较,视盘周围视网膜神经纤维层厚度和黄斑中心凹视网膜厚度均无显著差异,但中高度近视组的视盘颞侧视网膜神经纤维层厚度和黄斑中心凹中心视网膜厚度增加明显。
结论:(1)近视不影响视觉通路的传导及外层视网膜的功能,但是有视网膜结构的改变。(2)近视性弱视的视觉传导通路、外层视网膜功能及视网膜的结构均有异常,即使弱视基本治愈后,这些改变仍然存在。
Objective To approach the detection results of P-VEP(Pattem visual evoked potential), mfERG(Multifocal electroretinogram) and OCT(optical coherence tomography) in children with myopia and myopic amblyopia,to survey the structural and functional variance of retina in children with myopia and myopic amblyopia.
Methods The P-VEP,mfERG and OCT were tested on the eyes of myopic cases(52 eyes), myopic amblyopic cases(23 eyes),post-therapy myopic amblyopic cases(23 eyes) and sound eyes of unilateral amblyopic cases(22 eyes).
Results 1 P-VEP test(1) In myopic amblyopic eyes,the P100 wave amplitude densities were significantly declined and the P100 wave latencies were significantly prolonged. (2) No significant difference of P-VEP between the myopic eyes and the control eyes.(3) There were no significant differences in amplitude and latency between myopic amblyopic eyes after therapy and control eyes in the response of 8×8 checkers,while P100 wave amplitude was significantly declined and P100 wave latency was significantly prolonged in the response of 16×16 checker.
2 mfERG test(1) Compare with control eyes,the P1 wave amplitude densities in one to six rings of mfERG first order kernel in myopic amblyopic eyes and myopic amblyopic eyes after therapy were significantly attenuated,but there were no significant differences in P1 wave latencies.(2) There were no significant differences in P1 wave amplitude densities and latencies between myopic eyes and control eyes.
3 OCT test(1) Compared with control eyes,the retinal nerve fiber layer(RNFL) thickness in inferior quadrant and the average thickness of the peripapillary RNFL were significantly thinner in myopic amblyopic eyes and myopic amblyopic eyes after therapy,while there were no significant differences of the RNFL thicknesses in superior,nasal and temporal and the thickness of fovea.(2) The thicknesses of RNFL in temporal and the fovea were significantly thicker in moderate and severe myopic eyes.But no significant differences of the RNFL thickness were found in superior,nasal and inferior.
Conclusions(1) The myopia does not affect the transmission of visual perception and the function of outer retina,but can change the structure of retina.(2) there are significant abnormalities in the transmission of visual perception,the function and structure of retina in the eyes with myopic amblyopia.This situation still exists in the eyes with myopic amblyopia after therapy.
引文
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[15]Repka MX,Beck RW,Holmes JM,et al.A randomized trial of patching regimens for treatment of moderate amblyopia in children.Arch Ophthalmol,2003,121:603-611.
[16]Holmes JM,Kraker RT,Beck RW,et al.A randomized trial of prescribed patching regimens for treatment of severe amblyopia in children.Ophthalmology,2003,110:2075-2087.
[17]Stewart CE,Stephens DA,Fielder AR,et al.Objectively monitored patching regimens for treatment of amblyopia:randomised trial.BMJ,2007,335(7622):707,
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[19]Repka MX,Wallace DK,Beck RW,et al.Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate amblyopia in children.Arch Ophthalmol,2005,123:149-157.
[20]Pediatric Eye Disease Investigator Group.A randomized trial of atropine vs.patching for treatment of moderate amblyopia in children.Arch Ophthalmol,2002,120:268-278.
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[22]Steele AL,Bradfield YS,Kushner BJ,et al.Successful treatment of anisometropic amblyopia with spectacles alone.J AAPOS,2006,10:37-43.
[23]Nilsson J,Baumann M,Sj(?)strand J.Strabismus might be a risk factor for amblyopia recurrence.J AAPOS,2007,11:240-242.
[24]Tacagni D J,Stewart CE,Moseley MJ,et al.Factors affecting the stability of visual function following cessation of occlusion therapy for amblyopia.Graefes Arch Clin Exp Ophthalmol,2007,245:811-816.
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[15]Repka MX,Beck RW,Holmes JM,et al.A randomized trial of patching regimens for treatment of moderate amblyopia in children.Arch Ophthalmol,2003,121:603-611.
[16]Holmes JM,Kraker RT,Beck RW,et al.A randomized trial of prescribed patching regimens for treatment of severe amblyopia in children.Ophthalmology,2003,110:2075-2087.
[17]Stewart CE,Stephens DA,Fielder AR,et al.Objectively monitored patching regimens for treatment of amblyopia:randomised trial.BMJ,2007,335(7622):707,
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[23]Nilsson J,Baumann M,Sj(?)strand J.Strabismus might be a risk factor for amblyopia recurrence.J AAPOS,2007,11:240-242.
[24]Tacagni D J,Stewart CE,Moseley MJ,et al.Factors affecting the stability of visual function following cessation of occlusion therapy for amblyopia.Graefes Arch Clin Exp Ophthalmol,2007,245:811-816.
[25]Bhola R,Keech RV,Kutschke P,et al.Recurrence of amblyopia after occlusion therapy.Ophthalmology,2006,113:2097-2100.
[26]Stewart CE,Fielder AR,Stephens DA,et al.Treatment of unilateral amblyopia:factors influencing visual outcome.Invest Ophthalmol Vis Sci,2005,46:3152-3160.
[27]Caputo R,Frosini R,De Libero C,et al.Factors influencing severity of and recovery from anisometropic amblyopia.Strabismus,2007,15:209-214.
[28]Lee SY,lsenberg SJ.The relationship between stereopsis and visual acuity after occlusion therapy for amblyopia.Ophthalmology,2003,110:2088-2092.