不同类型弱视儿童视网膜结构和视觉诱发电位及立体视功能的差异性分析

目的:分析不同类型弱视儿童的视网膜结构和功能、视觉诱发电位及立体视功能的差异性。方法:选取2014-05/2018-05在我院眼科治疗的中度弱视儿童92例136眼为观察组(屈光参差性31例31眼,屈光不正性35例70眼,斜视性26例35眼),另选取在我院眼科检查视力正常的儿童29例58眼为对照组。采用光学相干断层扫描(OCT)成像仪检测黄斑中心凹厚度、视盘周围及各象限视网膜神经纤维层(RNFL)厚度,采用视觉眼电图检测视网膜功能变化,观察视觉诱发电位P100波幅值及潜伏期的特点,并进行立体视觉检查。结果:屈光参差性、屈光不正性弱视儿童黄斑中心凹厚度、视盘周围及各象限RNFL厚度均明显高于对照组和斜视性弱视儿童(P<0.01)。与对照组相比,屈光参差性弱视儿童视觉眼电图光峰电位偏低,光峰时间延长,屈光不正性弱视儿童中近视儿童暗谷电位偏高,Arden比和Gliern比减小(均P<0.01)。三种类型弱视儿童视觉诱发电位P100波幅值均明显低于对照组,且1°和15′空间频率潜伏期明显延迟(均P<0.01)。屈光不正性弱视儿童交叉视差、非交叉视差、近零视差、远立体视功能正常眼数显著高于斜视性弱视儿童(P<0.0167),但与屈光参差性弱视儿童上述各项指标无差异。结论:屈光参差性弱视、屈光不正性弱视儿童视网膜结构存在明显异常,且P100波潜伏期延迟;斜视性弱视对立体视功能影响最大,而屈光不正性弱视影响最小。

Difference analysis of retinal structure, visual evoked potential and stereoscopic function in children with different types of amblyopia

AIM: To analyze the differences of retinal structure, visual evoked potential and visual function in different types of amblyopia children.

METHODS: One hundred and twenty children with 136 eyes with moderate amblyopia treated in our hospital from May 2014 to May 2018 were enrolled as the observation group(31 cases with 31 eyes of anisometropy, 35 cases with 70 eyes of refractive ametropia, and 26 cases with 35 eyes of strabismus); meanwhile, 29 children with 58 eyes with normal vision in the eye examination from our hospital were selected as the control group. Optical coherence tomography(OCT)imager was used to detect the foveal thickness of the macula, the thickness of the retinal nerve fiber layer(RNFL)around the optic disc and the quadrants, and the changes in retinal function were detected using visual electroencephalography. The P100 amplitude and latency of visual evoked potentials were observed and stereoscopic inspection being performed.

RESULTS: The thickness of macular fovea, the thickness of the optic disc and the RNFL in the quadrants of children with anisometropy and ametropia were significantly higher than those in the control group and children with strabismic amblyopia(P<0.01). Compared with the control group, patients with refractive amblyopia had lower light peak potentials and longer light peak times. The dark valley potential of myopia children was higher in children with refractive amblyopia, and the Arden ratio and Gliern ratio were lower(All P<0.01). The P100 wave amplitudes of the visual evoked potentials of the three types of amblyopia children were significantly lower than those of the control group, and the 1° and 15'' spatial frequency latency periods were significantly delayed(all P<0.01). The number of cross parallaxes, non-cross parallaxes, near-zero parallaxes, and far-sighted stereoscopic aberrations in the ametropic amblyopia group were significantly higher than those in the strabismic amblyopia group(P<0.05), but were no different from those in the ametropic amblyopia group in terms of each indicators.

CONCLUSION: Retinal structure of patients with ametropic amblyopia and ametropic amblyopia has obvious abnormalities, and the P100 wave latency is delayed; strabismic amblyopia has the largest effect on stereoscopic function, while refractive amblyopia has the least effect.