从视网膜神经纤维层及黄斑区神经上皮层厚度研究看弱视的外周发病机制
摘要
目的:应用光学相干断层扫描(Ocular Coherence Tomography,OCT)来研究弱视及屈光不正性弱视儿童的视网膜神经纤维层(Retinal Nerve Fiber Layer,RNFL)厚度和黄斑区神经上皮层厚度,并设立正常组为对照进行分析,从而探讨弱视及屈光不正性弱视发病的外周机制。
方法:对2007年7月至9月来成都中医药大学附属医院眼科门诊就诊的25例弱视儿童(36眼)和10例正常儿童(20眼)分别行OCT检查,测量其视网膜神经纤维层厚度和黄斑区神经上皮层厚度,并按相关标准将其分为弱视组、屈光不正性弱视组和正常组。弱视组和屈光不正性弱视组所得数据均用SPSS12.0统计软件与正常组进行比较,分析其厚度与正常组有无差异。P＞0.05为无统计学意义,P＜0.05为有统计学意义。
结果。(1)弱视组患眼黄斑中心凹区域视网膜神经上皮层厚度与正常组相比无变化(P＞0.05);弱视患者黄斑旁中心凹区,上方视网膜最厚,鼻侧与下方相似,颢侧最薄,这与正常组视网膜厚度分布一致,且各部分视网膜神经上皮层厚度与正常组无差别(P＞0.05);弱视患者黄斑区旁中心凹周围区,鼻侧视网膜最厚,其次是上方,再次是下方,颞侧最薄,与正常组视网膜厚度分布一致,但鼻、上、下、颞侧各方向视网膜神经上皮层厚度均显著增厚(P＜0.05)。
正常组上方RNFL最厚,其次是下方,再者是颞侧,鼻侧最薄,但弱视组上方和下方RNFL厚度相似,颞侧和鼻侧厚度相似但要薄于上方和下方。其下方和鼻侧RNFL比正常组显著增厚(P＜0.05),上方和颞侧RNFL厚度与正常组比较无显著变化(P＞0.05),弱视组平均RNFL厚度比正常组增厚但无统计学意义(P＞0.05)。
(2)屈光不正性弱视患者黄斑区视网膜神经上皮层厚度和RNFL的厚度与正常组比较,其结果同弱视组。
结论:(1)弱视及屈光不正性弱视患者黄斑区视网膜神经上皮层及视网膜神经纤维层的厚度分布与正常者基本一致。
(2)弱视及屈光不正性弱视患者黄斑区视网膜神经上皮层厚度及视网膜神经纤维层厚度的部分区域比正常者增厚。
(3)弱视患者的视网膜受累,进一步证明了外周发病机制的说法。
Object: we use Ocular Coherence Tomography to study the Retinal Nerve Fiber Layer thickness and macular thickness of the amplyopia and refractive errors amplyopia , we also found the common group to be the comparison for analysis, thereby , we can investigate the periphera incidence mechanism of the amplyopia and ametropic amplyopia.
Methods: We did the OCT examination respectively for the children who came to the Clinic of department of ophthalmology of Chengdu University of Traditional Chinese Medicine Hospital from July 2007 to September, measured its thickness of the retinal nerve fiber layer and macular neurosensory thickness, and we also put these children into the overall visually-impaired group, ametropia amblyopia group and the normal group according to relevant standards. The data collected of visually-impaired group and ametropia amblyopia Group are used SPSS12.0 statistical software compared with the normal group to see whether there is differences with the normal group. P> 0. 05 is not significant, P <0. 05 for statistical significance.
Results: (1) In the overall group suffering from amblyopia, the retinal neurosensory thickness of macular fovea is unchanged compared with the normal group (P> 0.05); in their macular parafovea , the top retinal thickness is the thickest, the bottom and the nasal are similar, the temporal Side is the thinnest, it is the same with the normal retinal thickness distribution, furthermore , in all the parts, the retinal neurosensory thickness has no differences with the normal group (P>0. 05); in their macular perifovea, the nasal retinal thickness is the thickest, next is the the top, the third is the bottom, and the temporal is the thinnest, the distribution is the same with the normal retinal thickness, but all of their retinal neurosensory thickness were significantly thickened (P <0.05).
In the common , the above RNFL thickness is the thickest, followed by the bottom and then the temporal, the nasal is the thinnest, but in the overall group suffering from amblyopia, the above and the below RNFL thickness are similar, the temporal and the nasal are also similar but are thinner than the above and the bottom. The below and the nasal RNFL thickness of the amblyopia eyes were significantly thickened than the common(P <0. 05), and the above and the temporal RNFL thickness compared with the normal group had no significant changes (P> 0.05), the average RNFL thickness of the overall group suffering from amblyopia are thicker than the common, but there is no statistical significance (P> 0.05). (2) The macular neurosensory thickness and the thickness of the retinal nerve fiber layer of the ametropia amblyopia compared with the normal group, its result is the same with the whole amblyopia group.
Conclusion: (1) The distribution of the macular retinal neurosensory thickness and the RNFL thickness of the overall group suffering from amblyopia and the refractive errors amblyopia are basically the same with the common.
(2) Part of the thickness of the macular retinal neurosensory and the RNFL of the overall group suffering from amblyopia and the refractive errors amblyopia are thicker than the common.
(3) The retinal of the amblyopia patients is involved which furtherevidences the statement of peripheral pathogenesis.
方法:对2007年7月至9月来成都中医药大学附属医院眼科门诊就诊的25例弱视儿童(36眼)和10例正常儿童(20眼)分别行OCT检查,测量其视网膜神经纤维层厚度和黄斑区神经上皮层厚度,并按相关标准将其分为弱视组、屈光不正性弱视组和正常组。弱视组和屈光不正性弱视组所得数据均用SPSS12.0统计软件与正常组进行比较,分析其厚度与正常组有无差异。P＞0.05为无统计学意义,P＜0.05为有统计学意义。
结果。(1)弱视组患眼黄斑中心凹区域视网膜神经上皮层厚度与正常组相比无变化(P＞0.05);弱视患者黄斑旁中心凹区,上方视网膜最厚,鼻侧与下方相似,颢侧最薄,这与正常组视网膜厚度分布一致,且各部分视网膜神经上皮层厚度与正常组无差别(P＞0.05);弱视患者黄斑区旁中心凹周围区,鼻侧视网膜最厚,其次是上方,再次是下方,颞侧最薄,与正常组视网膜厚度分布一致,但鼻、上、下、颞侧各方向视网膜神经上皮层厚度均显著增厚(P＜0.05)。
正常组上方RNFL最厚,其次是下方,再者是颞侧,鼻侧最薄,但弱视组上方和下方RNFL厚度相似,颞侧和鼻侧厚度相似但要薄于上方和下方。其下方和鼻侧RNFL比正常组显著增厚(P＜0.05),上方和颞侧RNFL厚度与正常组比较无显著变化(P＞0.05),弱视组平均RNFL厚度比正常组增厚但无统计学意义(P＞0.05)。
(2)屈光不正性弱视患者黄斑区视网膜神经上皮层厚度和RNFL的厚度与正常组比较,其结果同弱视组。
结论:(1)弱视及屈光不正性弱视患者黄斑区视网膜神经上皮层及视网膜神经纤维层的厚度分布与正常者基本一致。
(2)弱视及屈光不正性弱视患者黄斑区视网膜神经上皮层厚度及视网膜神经纤维层厚度的部分区域比正常者增厚。
(3)弱视患者的视网膜受累,进一步证明了外周发病机制的说法。
Object: we use Ocular Coherence Tomography to study the Retinal Nerve Fiber Layer thickness and macular thickness of the amplyopia and refractive errors amplyopia , we also found the common group to be the comparison for analysis, thereby , we can investigate the periphera incidence mechanism of the amplyopia and ametropic amplyopia.
Methods: We did the OCT examination respectively for the children who came to the Clinic of department of ophthalmology of Chengdu University of Traditional Chinese Medicine Hospital from July 2007 to September, measured its thickness of the retinal nerve fiber layer and macular neurosensory thickness, and we also put these children into the overall visually-impaired group, ametropia amblyopia group and the normal group according to relevant standards. The data collected of visually-impaired group and ametropia amblyopia Group are used SPSS12.0 statistical software compared with the normal group to see whether there is differences with the normal group. P> 0. 05 is not significant, P <0. 05 for statistical significance.
Results: (1) In the overall group suffering from amblyopia, the retinal neurosensory thickness of macular fovea is unchanged compared with the normal group (P> 0.05); in their macular parafovea , the top retinal thickness is the thickest, the bottom and the nasal are similar, the temporal Side is the thinnest, it is the same with the normal retinal thickness distribution, furthermore , in all the parts, the retinal neurosensory thickness has no differences with the normal group (P>0. 05); in their macular perifovea, the nasal retinal thickness is the thickest, next is the the top, the third is the bottom, and the temporal is the thinnest, the distribution is the same with the normal retinal thickness, but all of their retinal neurosensory thickness were significantly thickened (P <0.05).
In the common , the above RNFL thickness is the thickest, followed by the bottom and then the temporal, the nasal is the thinnest, but in the overall group suffering from amblyopia, the above and the below RNFL thickness are similar, the temporal and the nasal are also similar but are thinner than the above and the bottom. The below and the nasal RNFL thickness of the amblyopia eyes were significantly thickened than the common(P <0. 05), and the above and the temporal RNFL thickness compared with the normal group had no significant changes (P> 0.05), the average RNFL thickness of the overall group suffering from amblyopia are thicker than the common, but there is no statistical significance (P> 0.05). (2) The macular neurosensory thickness and the thickness of the retinal nerve fiber layer of the ametropia amblyopia compared with the normal group, its result is the same with the whole amblyopia group.
Conclusion: (1) The distribution of the macular retinal neurosensory thickness and the RNFL thickness of the overall group suffering from amblyopia and the refractive errors amblyopia are basically the same with the common.
(2) Part of the thickness of the macular retinal neurosensory and the RNFL of the overall group suffering from amblyopia and the refractive errors amblyopia are thicker than the common.
(3) The retinal of the amblyopia patients is involved which furtherevidences the statement of peripheral pathogenesis.
引文
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1 中华眼科学会全国儿童斜视弱视防治学组.弱视的定义、分类及疗效评价标准.中国斜视与小儿眼科杂志,1996,4(3):97.
2 Matuo T,Matsuo C,Matsuoka H,et al.Detection of strabismus and amblyopia in 1.5-and 3-year-old children by a preschool vision-screening program in Japan.Acta Med Okayama,2007,61(1):9-16.
3 Gronlund MA,Andersson S,Aring E,et al.Ophthalmological findings in a sample of Swedish children aged 4-15 years.Acta Ophthalmol Scand.2006,Apr;84(2):169-76.
4 Wang]],Foran S,Mitchell P.Age-specific prevalence and causes of bilateral and unilateral visual impairment in older Australians:the Blue Mountains Eye Study.Clin Exp Ophthalmol,2000,28:268-273.
5 张荻,吴小影,刘双珍,等.弱视儿童多焦视觉诱发电位分析.中国斜视与小儿眼科杂志,2005,13(2):49-53.
6 石婷,王伟.弱视眼多焦视觉电生理研究进展.中国中医眼科杂志,2007,17(5):302-303.
7 封利霞,赵堪兴.斜视性弱视多焦VEP与多焦ERG的对比研究.中国实用眼科杂志,2005,23(2):150-154.
8 封利霞,赵堪兴.屈光参差性弱视同步记录多焦视觉诱发电位和多焦视网膜电图的对比研 究.中华眼底病杂志,2005,41(4):41-46.
9 阴正勤,方谦逊,宋广瑶.儿童弱视的图形视觉诱发电位分析.中华眼科杂志,1998,24(5):268-21-71.
10 张荻,吴小影.视觉诱发电位在弱视中的应用.国际眼科杂志,2005,5(2):318-322.
11 刘虎,赵堪兴,陈敏等.斜视性弱视皮层损害地功能性磁共振成像研究.中华眼底病杂志.2004,20(1):19-22.
12 Mild A,Liu GT,Goldsmith ZG,et al.Decreased activation of the lateral geniculate nucleus in a patient with anisometropic amblyopia demonstrated by functional magnetic resonance imaging.Ophthalmologica,2003,217(5):365-369.
13 张萌.屈光参差性弱视儿童的脑磁图初步研究.河北医科大学硕视研究生毕业论文.
14 邵立功,章应华,张东果.弱视猫外侧膝状体γ-氨基丁酸能神经元变化的免疫细胞化学研究.中华眼科杂志,1994,30(6):437-440.
15 Stuart D.Faulkner,Vasily Vorobyov and Frank Sengpiel.Limited protection of the primary visual cortex from the effects of monocular deprivation by strabismus.Cerebral cortex,2005,15(11):1822-1833.
16 Wanger P,Persson HE.Oscillatory potentials,flash and pattern-reversal electroretinograms in amblyopia.Acta Ophthalmol,1984,Aug;62(4):643-650.
17 李凤明主编.中华眼科学(下册).北京:人民卫生出版社,2005,第二版,2823.
18 杨蕾,严良,陆豪.多焦视网膜电图对单眼性弱视视网膜损害的研究.临床眼科杂志,2002,10(1):50-51.
19 Yu M,Brown B,Edwards MH.Investigation of multifocal visual evoked potential in anisometropic and esotropic amblyopia.Invest Ophthalmol Vis Sci,1998,29(11):2033-2040.
20 Yu M,Brown B,Edwards M..Variation of the multifocal visual evoked potential with eccentricity in isometropic amblyopia.Yan Ke Xue Bao,1997,13(3):148-155.
21 冯蕴伟,李维业,刘玉华.儿童弱视黄斑阈值和瞳孔传入功能的研究.中华眼科杂志,1997,33(2):113-116.
22 张振华,朱平,夏菲.儿童弱视眼黄斑光敏感度的测定分析.中国实用眼科杂志,2001,19(4):285.
23 Von Noorden GK.Binocular vision and ocular motility,3rd ed.London:Mosby,1985.
24 鄢秀菊,刘刚,周兰新.单眼视觉剥夺大鼠视网膜细胞色素氧化酶的活性变化.重庆医科大学学报,2004,29(6):784-794.
25 刘双珍,虞林丽,吴小影等.屈光不正性弱视患者视网膜厚度的变化.国际眼科杂志,2006,6(2):384-386.
26 虞林丽,刘双珍,赵刚平等.弱视患者视网膜厚度的差异观察.湖南师范大学学报,2006,3(2):54-56.
27 Baddini Caramelli C,Hatanaka M,Polati M,et al.Thickness of the retinal nerve fiber layer in amblyopicand normal eyes:a scanning laser polarimetry study.J AAPOS,2001,5(2):82-84.
28 Kee SY,Lee SY,Lee YC.Thicknesses of the foveaand retinal nerve fiber layer in amblyopic and normal eyes in children.Korean J Ophthalmology,2006,20(3):177-181.
29 Colen TP,de Faber JT,Lemij HG.Retinal nerve fiber layer thickness in human strabismic amblyopia.Binocul Vis Strabismus Q.2000,15(2):141-146.
30 May-Yung Yen,Ching-Yu Cheng,An-Guor Wang.Retinal Nerve Fiber Layer Thickness in Unilateral Amblyopia.Investigative Ophthalmology and Visual Science,2004,45:2224-2230.
2 Matuo T,Matsuo C,Matsuoka H,et al.Detection of strabismus and amblyopia in 1.5-and 3-year-old children by a preschool vision-screening program in Japan.Acta Med Okayama,2007,61(1):9-16.
3 Gronlund MA,Andersson S,Aring E,et al.Ophthalmological findings in a sample of Swedish children aged 4-15 years.Acta Ophthalmol Scand.2006,Apr;84(2):169-76.
4 Wang]],Foran S,Mitchell P.Age-specific prevalence and causes of bilateral and unilateral visual impairment in older Australians:the Blue Mountains Eye Study.Clin Exp Ophthalmol,2000,28:268-273.
5 Wanger P,Persson HE.Oscillatory potentials,flash and pattern-reversal electroretinograms in amblyopia.Acta Ophthalmol,1984,Aug;62(4):643-650.
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7 杨蕾,严良,陆豪.多焦视网膜电图对单眼性弱视视网膜损害的研究.临床眼科杂志,2002,10(1):50-51.
8 Yu M,Brown B,Edwards MH.Investigation of multifocal visual evoked potential in anisometropic and esotropicamblyopia.Invest Ophthalmol Vis Sci,1998,29(11):2033-2040.
9 Yu M,Brown B,Edwards M..Variation of the multifocal visual evoked potential with eccentricity in isometropic amblyopia.Yan Ke Xue Bao,1997,13(3):148-155.
10 冯蕴伟,李维业,刘玉华.儿童弱视黄斑阈值和瞳孔传入功能的研究.中华眼科杂志,1997,33(2):113-116.
11 张振华,朱平,夏菲.儿童弱视眼黄斑光敏感度的测定分析.中国实用眼科杂志,2001,19(4):285.
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1 中华眼科学会全国儿童斜视弱视防治学组.弱视的定义、分类及疗效评价标准.中国斜视与小儿眼科杂志,1996,4(3):97.
2 Matuo T,Matsuo C,Matsuoka H,et al.Detection of strabismus and amblyopia in 1.5-and 3-year-old children by a preschool vision-screening program in Japan.Acta Med Okayama,2007,61(1):9-16.
3 Gronlund MA,Andersson S,Aring E,et al.Ophthalmological findings in a sample of Swedish children aged 4-15 years.Acta Ophthalmol Scand.2006,Apr;84(2):169-76.
4 Wang]],Foran S,Mitchell P.Age-specific prevalence and causes of bilateral and unilateral visual impairment in older Australians:the Blue Mountains Eye Study.Clin Exp Ophthalmol,2000,28:268-273.
5 张荻,吴小影,刘双珍,等.弱视儿童多焦视觉诱发电位分析.中国斜视与小儿眼科杂志,2005,13(2):49-53.
6 石婷,王伟.弱视眼多焦视觉电生理研究进展.中国中医眼科杂志,2007,17(5):302-303.
7 封利霞,赵堪兴.斜视性弱视多焦VEP与多焦ERG的对比研究.中国实用眼科杂志,2005,23(2):150-154.
8 封利霞,赵堪兴.屈光参差性弱视同步记录多焦视觉诱发电位和多焦视网膜电图的对比研 究.中华眼底病杂志,2005,41(4):41-46.
9 阴正勤,方谦逊,宋广瑶.儿童弱视的图形视觉诱发电位分析.中华眼科杂志,1998,24(5):268-21-71.
10 张荻,吴小影.视觉诱发电位在弱视中的应用.国际眼科杂志,2005,5(2):318-322.
11 刘虎,赵堪兴,陈敏等.斜视性弱视皮层损害地功能性磁共振成像研究.中华眼底病杂志.2004,20(1):19-22.
12 Mild A,Liu GT,Goldsmith ZG,et al.Decreased activation of the lateral geniculate nucleus in a patient with anisometropic amblyopia demonstrated by functional magnetic resonance imaging.Ophthalmologica,2003,217(5):365-369.
13 张萌.屈光参差性弱视儿童的脑磁图初步研究.河北医科大学硕视研究生毕业论文.
14 邵立功,章应华,张东果.弱视猫外侧膝状体γ-氨基丁酸能神经元变化的免疫细胞化学研究.中华眼科杂志,1994,30(6):437-440.
15 Stuart D.Faulkner,Vasily Vorobyov and Frank Sengpiel.Limited protection of the primary visual cortex from the effects of monocular deprivation by strabismus.Cerebral cortex,2005,15(11):1822-1833.
16 Wanger P,Persson HE.Oscillatory potentials,flash and pattern-reversal electroretinograms in amblyopia.Acta Ophthalmol,1984,Aug;62(4):643-650.
17 李凤明主编.中华眼科学(下册).北京:人民卫生出版社,2005,第二版,2823.
18 杨蕾,严良,陆豪.多焦视网膜电图对单眼性弱视视网膜损害的研究.临床眼科杂志,2002,10(1):50-51.
19 Yu M,Brown B,Edwards MH.Investigation of multifocal visual evoked potential in anisometropic and esotropic amblyopia.Invest Ophthalmol Vis Sci,1998,29(11):2033-2040.
20 Yu M,Brown B,Edwards M..Variation of the multifocal visual evoked potential with eccentricity in isometropic amblyopia.Yan Ke Xue Bao,1997,13(3):148-155.
21 冯蕴伟,李维业,刘玉华.儿童弱视黄斑阈值和瞳孔传入功能的研究.中华眼科杂志,1997,33(2):113-116.
22 张振华,朱平,夏菲.儿童弱视眼黄斑光敏感度的测定分析.中国实用眼科杂志,2001,19(4):285.
23 Von Noorden GK.Binocular vision and ocular motility,3rd ed.London:Mosby,1985.
24 鄢秀菊,刘刚,周兰新.单眼视觉剥夺大鼠视网膜细胞色素氧化酶的活性变化.重庆医科大学学报,2004,29(6):784-794.
25 刘双珍,虞林丽,吴小影等.屈光不正性弱视患者视网膜厚度的变化.国际眼科杂志,2006,6(2):384-386.
26 虞林丽,刘双珍,赵刚平等.弱视患者视网膜厚度的差异观察.湖南师范大学学报,2006,3(2):54-56.
27 Baddini Caramelli C,Hatanaka M,Polati M,et al.Thickness of the retinal nerve fiber layer in amblyopicand normal eyes:a scanning laser polarimetry study.J AAPOS,2001,5(2):82-84.
28 Kee SY,Lee SY,Lee YC.Thicknesses of the foveaand retinal nerve fiber layer in amblyopic and normal eyes in children.Korean J Ophthalmology,2006,20(3):177-181.
29 Colen TP,de Faber JT,Lemij HG.Retinal nerve fiber layer thickness in human strabismic amblyopia.Binocul Vis Strabismus Q.2000,15(2):141-146.
30 May-Yung Yen,Ching-Yu Cheng,An-Guor Wang.Retinal Nerve Fiber Layer Thickness in Unilateral Amblyopia.Investigative Ophthalmology and Visual Science,2004,45:2224-2230.