屈光参差性弱视的黄斑形态特征研究

目的　评价屈光参差性弱视患者双眼黄斑厚度与形态特点。方法　自身对照设计。在广西视光中心招募不伴斜视的中度和重度屈光参差性弱视患者85例，其中儿童组46例、成人组39例，同时招募与儿童组年龄匹配的已治愈的屈光参差性弱视患者35例为对照组；采集所有患者的屈光度、矫正视力、眼底频域光学相干断层扫描、眼轴长度等指标，定性评估黄斑中心凹光感受器内外节（photoreceptor inner and outer segment，IS/OS）形态，进行各指标在双眼间（弱视眼与对侧眼）的比较、组内相关与回归分析。结果　儿童组除矫正视力、等效离焦度、眼轴长度3项指标在双眼间存在统计学差异外（均为P<0.001），弱视眼黄斑中心凹1 mm直径区域厚度比对侧眼厚（7.54±14.42）μm（P=0.001，95%可信区间为3.26~11.83 μm）。对照组已治愈的弱视眼黄斑中心凹1 mm直径区域厚度比对侧眼厚（1.94±4.65）μm（P=0.019，95%可信区间为0.35~3.54 μm）。成人组双眼间黄斑中心凹1 mm直径区域厚度、黄斑中心凹最小厚度差异无统计学意义（均为P>0.05）。儿童组弱视眼黄斑中心凹最小厚度与其等效离焦度呈负相关（r=-0.338，P=0.008）。成人组弱视眼黄斑中心凹1 mm直径区域厚度与其等效离焦度呈正相关（r=0.447，P=0.004）。黄斑中心凹IS/OS形态:已治愈弱视患者的IS/OS正常形态比例为80.0%，明显高于儿童与成人弱视患者比例（58.8%，χ²=9.774，P=0.002）。结论　弱视眼黄斑中心凹1 mm直径区域厚度高于对侧眼，仅见于中重度弱视儿童及已治愈弱视儿童；成人弱视眼等效离焦度与其黄斑中心凹1 mm直径区域厚度呈正相关性；弱视眼黄斑中心凹形态呈欠发育特征。

A morphological study of macular features in anisometropic amblyopia using spectral-domain optical coherence tomography:Bilateral control study

Objective　This study was to evaluate the characteristics of bilateral macular features in anisometropic amblyopia.Methods　Eighty five moderate to severe anisometropic amblyopia （46 children and 39 adults） as amblyopic group and 35 age-matched resolved children amblyopia as control group were recruited in the center for optometry and visual science.Medical records such as cycloplegic refraction，corrected visual acuity，axial length were all collected，macular were measured and the foveal photoreceptor inner and outer segment （IS/OS）junction morphology were evaluated with spectral-domain optical coherence tomography （SD-OCT），and then comparison between amblyopic and fellow eyes，correlation and regression analysis within groups were conducted with SPSS 13.0 software.Results　 Significant interocular differences were noted in corrected vision，defocus equivalent （DE） and axial length of the 3 groups （all P<0.001）.Besides，the thickness of the 1 mm diameter region of the macular center of the amblyopic eyes was more thick （7.54±14.42）μm than the fellows （P=0.001，95%CI:3.26 to 11.83 μm），and its thickness in the resolved amblyopic eye in the control group was more thick （1.94±4.65）μm than the fellows （P=0.019，95%CI:0.35 to 3.54 μm）.There was no significant difference in the thickness of the 1 mm diameter region and the minimum thickness of the fovea between the eyes of the adult group （both P>0.05）.Foveal minimum thickness of amblyopic eye was negatively correlated with its DE in children group （r=-0.338，P=0.008），and macular thickness of 1 mm region of amblyopic eye was positively correlated with its DE in adults’ group （r=0.447，P=0.004）.Qualitatively，the proportion of normal IS/OS bulge presented in 80% of eyes in the resolved amblyopia，which was obviously higher than the eyes of adults and children amblyopia （58.8%）（χ²=9.774，P=0.002）.Conclusion　Macular thickness of 1 mm region in amblyopic eye was thicker than the fellow eye of children with moderate to severe amblyopia and resolved amblyopia，and it was positively correlated with DE in amblyopic eye of adults other than children.Macular features in anisometropic amblyopia represented a sign of immaturity compared to normal vision.