斜视性弱视儿童大脑视皮层损害的脑磁图研究

目的探讨内斜视性弱视患者,在不同视野黑白棋盘格翻转刺激条件下,大脑皮层活动脑磁图的变化。方法单眼内斜视性弱视患者4名,分别进行双眼、单眼全视野刺激,单眼颞侧以及鼻侧视野刺激,记录视觉诱发磁场成份之一的M100的振幅、潜伏期以及源定位的变化情况,与4名正常对照组进行比较。结果双眼全视野刺激,内斜视性弱视组大脑皮层反应M100的振幅降低、潜伏期延长（P〈0.05）;弱视眼鼻侧视网膜M100的振幅比颞侧视网膜M100的振幅降低、潜伏期延长（P〈0.05）;非弱视眼M100的振幅比正常对照组M100的振幅降低,潜伏期延长（P〈0.05）;内斜视性弱视组弱视眼全视野刺激源定位的X轴与正常组比较更偏向原点（P〈0.05）。结论内斜视性弱视眼的鼻侧网膜存在一定程度和一定范围的抑制,源定位上弱视眼存在眼优势柱的偏移,斜视性弱视的非弱视眼与正常组也存在功能的差异。     

Choroidal Thickness in Strabismus and Amblyopia Cases

Purpose: The aim of our study was to examine the effect of hypermetropia and anisometropic, exotropic, and esotropic amblyopia on choroidal thickness. Methods: A prospective, cross-sectional, comparative study of 120 children under the age of 16 years was conducted. Choroidal thickness was measured in patients with hypermetropia, anisometropia, esotropia, exotropia, and controls. Results: The mean subfoveal choroidal thickness in the control and hypermetropia groups was 323.9±69.0?µm and 348.9±64.5?µm, respectively. Mean choroidal thickness in amblyopic and fellow eyes was 387.4 and 351.9 µm in anisometropic, 353.8 and 338.7 µm in exotropic, 347.5 and 336.5 µm in esotropic, and 389.3 and 359.3 µm in esotropic+anisometropic groups, respectively. Choroid was significantly thicker in amblyopic eyes of anisometropic group compared to fellow (P=0.004) and control (P=0.03) eyes. The difference of choroidal thickness was not significant between both eyes and when compared to control eyes in the other groups. Conclusions: Anisometropic amblyopic eyes had thicker choroids compared to controls and fellow eyes. However the choroidal thickness was not significantly different between amblyopic and fellow eyes of esotropic or exotropic patients.     

Choroidal Thickness in Turkish Children with Anisometric Amblyopia

Purpose: To assess macular choroidal thickness (CT) and axial length measurements in children with anisometropic amblyopia and to compare the measurements with that of fellow non-amblyopic eyes and age-sex matched controls. Methods: Forty patients with anisometropic amblyopia and 40 age-/sex-matched controls were evaluated in this study. Eyes were classified into three groups as follows: amblyopic eyes (n?=?40), fellow non-amblyopic eyes, and healthy eyes (n?=?40). All subjects underwent complete ophthalmic examination and macular choroidal thickness measurements by enhanced depth imaging method of the Spectralis optical coherence tomography system. CT was measured at the fovea and at 1000-μm intervals from the foveal center in both temporal and nasal directions. The statistical assessment was performed with the assistance of one-way analysis of variance (ANOVA) and Pearson’s correlation test. Results: The mean subfoveal CT was 389.35, 349.07, and 315.8?μm in the amblyopic, fellow non-amblyopic and healthy eyes, respectively. Choroid was thickest in subfoveal and thinnest in nasal regions among all groups. Both amblyopic and fellow non-amblopic eyes were more hyperopic than healthy eyes. While the subfoveal and nasal CT in amblyopic eyes and fellow eyes were significantly higher than healthy eyes, the temporal CT in amblyopic eyes was significantly higher than in healthy eyes. There was a significant positive correlation between the CT of the subfoveal, nasal, and temporal regions and the refractive state (r?=?0.432 p?=?0.001; r?=?0.324 p?=?0.001; r?=?0.215 p?=?0.01, respectively). Conclusion: The macular choroidal thickness—not only in amblyopic eyes but also in non-amblyopic fellow eyes—was significantly thicker than in the healthy subjects. The thick choroid in amblyopic and non-amblyopic fellow eyes may indicate bilateral delay of emmetropization, which probably means amblyopia affecting the visual feedback of both eyes.     

屈光参差性弱视儿童脑磁图的初步研究

目的应用脑磁图技术研究屈光参差性弱视儿童视皮层功能损害,探讨屈光参差性弱视发病的可能中枢机制。方法记录4例健康儿童及5例屈光参差性弱视儿童在不同视野黑白棋盘格翻转刺激下的磁场反应,分析其M100振幅、峰值潜伏期及源定位。结果（1）单眼全视野刺激时,非弱视眼比正常组优势眼峰值潜伏期延长、振幅增高;弱视眼比正常组非优势眼峰值潜伏期延长、振幅下降。（2）半侧视野刺激时,弱视眼及非弱视眼各自半侧网膜刺激峰值潜伏期、振幅均无统计学差异。（3）弱视组双眼总和VEFs比正常组降低。（4）双眼全视野刺激时,弱视组偶极源定位在左、右侧大脑半球的X轴位置、Z轴位置比正常组偏向于顶叶。结论（1）弱视眼存在＂单眼抑制＂,而非弱视眼存在功能亢进;（2）弱视眼无半侧网膜抑制现象;（3）弱视组双眼全视野VEFs的M100源定位脱离传统视觉皮质17区、18区,趋向于顶叶。     

屈光参差性弱视患者黄斑区视网膜厚度及微血管系统的变化:基于OCTA的研究

目的　使用光学相干断层扫描血管成像（OCTA）检测屈光参差性弱视儿童黄斑区视网膜厚度及微血管系统的差异,探究屈光参差性弱视的发病机制。方法　纳入2020年6月至12月在南昌大学第二附属医院儿童眼科门诊就诊的4~14岁屈光参差性弱视儿童41例及正常视力儿童22例,将屈光参差性弱视患儿的弱视眼纳入为弱视眼组,非弱视眼纳入为对侧眼组,正常视力儿童的右眼为正常对照组。使用OCTA扫描三组入选眼的眼底黄斑部3 mm×3 mm的范围,经ImageJ处理后获得浅层视网膜毛细血管丛血流密度(SCPVD)和深层视网膜毛细血管丛血流密度(DCPVD),采用ETDRS分区扫描模式扫描黄斑部,得出黄斑部以黄斑中心凹为中心,直径分别为1 mm圆形（中心区）及>1~3 mm、>3~6 mm环形区的视网膜厚度。分析比较三组之间黄斑区SCPVD、DCPVD及视网膜厚度之间的差异。结果　弱视眼组、对侧眼组和正常对照组入选眼的SCPVD分别为(25.01±6.00)%、(29.34±4.23)%和(30.16±2.90)%,DCPVD分别为(27.87±4.12)%、(30.30±2.72)%和(30.65±2.38)%,弱视眼组的SCPVD和DCPVD均较对侧眼组、正常对照组明显降低,差异均具有统计学意义(均为P<0.05),对侧眼组入选眼的SCPVD和DCPVD与正常对照组相比差异均无统计学意义(均为P=1.00)。弱视眼组、对侧眼组和正常对照组入选眼黄斑中心区视网膜厚度分别为（265.78±21.10）μm、（260.94±18.97）μm和（263.59±14.71）μm,三组间黄斑中心区视网膜厚度差异均无统计学意义（均为P>0.05）;弱视眼组、对侧眼组和正常对照组入选眼黄斑区平均视网膜厚度分别为(321.13±10.83)μm、(316.19±11.80)μm和(314.85±10.81)μm,弱视眼组入选眼黄斑区平均视网膜厚度均较对侧眼组、正常对照组明显增厚,差异均具有统计学意义(均为P＜0.05),对侧眼组与正常对照组入选眼的平均视网膜厚度差异无统计学意义（P=0.77）。结论　屈光参差性弱视患儿的弱视眼黄斑区视网膜厚度及微血管系统均存在异常,提示黄斑区视网膜参与屈光参差性弱视的发病过程。     

儿童弱视黄斑阈值和瞳孔传入功能的研究

目的观察弱视儿童的黄斑光敏感度（ｍａｃｕｌａｒｌｉｇｈｔｓｅｎｓｉｔｉｖｉｔｙ，ＭＬＳ）和相对性传入性瞳孔缺陷（ｒｅｌａｔｉｖｅａｆｅｒｅｎｔｐｕｐｉｌａｒｙｄｅｆｅｃｔ，ＲＡＰＤ）。方法应用静态视野技术和光摆实验对正常组、屈光参差性和屈光不正性弱视的学龄儿童进行检查。结果弱视眼ＭＬＳ降低（Ｐ＜０．００１）。屈光参差性弱视眼的对侧眼ＭＬＳ也较正常组低（０．０１＜Ｐ＜０．０５）。屈光参差性弱视中，ＲＡＰＤ阳性者占３４．２９％。结论弱视存在Ｘ通道功能缺陷。单眼弱视与双眼弱视发病机制可能不同。ＭＬＳ对估计预后有帮助。ＲＡＰＤ阳性，支持弱视的周边发生学说。屈光参差性弱视眼的对侧眼处于不正常状态。     

Pupillary function in human amblyopia

Quantitative measurements of pupillary function (response amplitude and latency) were made for normal eyes and For normal and fellow amblyopic eyes of groups of strabismic and anisometropic amblyopes. Stimuli consisted of luminance modulation of a large, evenly lit area (pupil light reflex) as well as contrast modulation of sinusoidal gratings (pupil grating response) of fixed, space-averaged luminance. Measurements were made of the direct and the consensual reflex under monocular stimulation. A comparison of the amplitude of the pupil light reflex as a function of luminance modulation showed no significant differences between normal and fellow amblyopic eyes for both the strabismic and anisometropic groups of amblyopes studied. A similar comparison of the associated response latencies showed significant difference between normal and fellow amblyopic eyes for both groups. In general, reductions in response amplitude and latency of (he pupil grating response were found in individuals from each group when comparing the good and the affected eyes, although the observed group differences were only significant in the strabismic group. Interestingly, statistically significant reductions in both amplitude and latency for both the pupil light reflex and the pupil grating response were found between the eyes of normal observers and the so-called normal eyes of amblyopes in both groups studied. These results suggest that the type of pupillary deficit in amblyopia is a complicated one, depending not only on the type of amblyopia (strabismic or anisometropic) and the type of stimulus employed (light or pattern), but also on the parameter assessed (amplitude or latency) and whether the amblyopic result is referenced to its fellow normal eye or to the normal eye of a non-amblyopic observer- Since the pupil response to light flux changes is not mediated exclusively via the retinal projection to the midbrain and may also involve the activity of central visual pathways, the results obtained in this study cannot be used to provide definitive evidence for the site of abnormality in amblyopia.     

青少年屈光参差性弱视黄斑区视网膜参数的OCT研究

目的：通过光学相干断层扫描(optical coherence tomography,OCT)检查比较屈光参差性单眼弱视青少年弱视眼与非弱视眼黄斑区视网膜厚度(macular retinal thickness,MRT)、黄斑容积的差异,研究弱视眼视网膜黄斑参数的特征。

方法：选取屈光参差性单眼弱视青少年31例,利用OCT技术分别检测双眼黄斑视网膜厚度和容积,比较同一受检者弱视眼与非弱视眼的差异。并用A超测量眼轴长度,分析黄斑厚度、黄斑容积与眼轴的关系。

结果：弱视眼黄斑中心凹1mm区域及鼻侧内圈厚度比正常眼厚(P=0.0358,0.0003),而黄斑部位其它分区厚度及黄斑总容积弱视眼和正常眼相比差异均无统计学意义(P>0.05)。不同程度弱视患者间黄斑各参数差异均无统计学意义(P>0.05)。弱视眼及非弱视眼黄斑参数与眼轴之间无明显相关性。

结论：屈光参差性单眼弱视青少年弱视眼黄斑的组织结构上存在一定差异。     

屈光参差性弱视儿童双眼与正常眼SD-OCT参数的比较

目的:比较单眼屈光参差性弱视儿童双眼与正常眼黄斑区视网膜厚度及视盘周围视网膜神经纤维层(RNFL)厚度的差异。方法:选取2021-01/2022-10于成都市妇女儿童中心医院就诊的单眼屈光参差性弱视儿童62例124眼作为试验组,另选取同时间段就诊的正常视力儿童60例60眼(右眼)作为对照组。采用频域光学相干断层成像(SD-OCT)检测两组儿童黄斑区视网膜厚度及视盘周围RNFL厚度,并进行对比分析。结果:试验组儿童弱视眼黄斑区视网膜厚度和视盘周围RNFL厚度均厚于对照组,且多数具有显著差异性(P<0.05)。试验组儿童对侧非弱视眼黄斑区视网膜厚度和视盘周围RNFL厚度多较对照组变薄,但多数无显著差异(P>0.05)。结论:单眼屈光参差性弱视儿童弱视眼和对侧非弱视眼黄斑区视网膜厚度及视盘周围RNFL厚度与正常眼存在一定差异性,且对侧非弱视眼并不能完全等同于正常眼。     

Defective processing of motion-defined form in the fellow eye of patients with unilateral amblyopia.

The following three measurements were made on a group of 20 pediatric and 5 adult patients with unilateral amblyopia: (1) speed threshold for recognizing motion-defined dotted letters; (2) recognition acuity for isolated solid letters of 4% contrast; and (3) Snellen line acuity for high-contrast letters. Normal limits were established with a group of 30 pediatric and 10 adult control subjects. The main finding was that, in amblyopic children, a high percentage (83%, 15 of 18) of fellow eyes showed a degraded ability to recognize motion-defined letters, even though Snellen acuity and 4% letter acuity were normal for age. The fellow eyes of all nine patients with strabismic amblyopia showed this pattern of loss, as did four of six fellow eyes of patients with anisometropic amblyopia and two of three fellow eyes of patients with anisometropic plus strabismic amblyopia. Only two clinically unaffected eyes were normal for motion-defined letters. These eyes belonged to patients with anisometropic amblyopia. Eighteen of the 19 previously amblyopic eyes tested were abnormal for motion-defined letters even though Snellen acuity was within normal limits for 6 of these eyes. In adults, only one of five fellow eyes failed the motion-defined letter test. It was concluded that the degradation of form perception associated with amblyopia can be different for luminance-defined and motion-defined form and that defective processing of motion-defined form is common in the fellow eyes of children with unilateral amblyopia.