婴儿黄斑区视网膜发育变化的动态观察

目的 观察婴儿视网膜黄斑区形态及视网膜各层厚度变化。方法 随机选取新生儿重症监护病房中的婴儿58例86只眼纳入研究。根据不同矫正胎龄对婴儿进行分组。其中，矫正胎龄＜32周组10例14只眼；33～36周组26例39只眼；37～41周组12例18只眼；≥42周组10例15只眼。随机选择无器质性眼病的成人12名22只眼作为成人组。所有婴儿及成人均行便携式光相干断层扫描（OCT）检查。着重观察婴儿黄斑区形态。同时，测量婴儿及成人黄斑中心凹及距中心凹750、1500 μm处旁中心凹的神经上皮层、内层视网膜、外层视网膜、神经纤维层、节细胞层、内丛状层、内核层、外丛状层、外核层厚度。分析视网膜各层厚度与矫正胎龄的相关性。结果 婴儿早期的黄斑中心凹凹陷浅，随着矫正胎龄增长凹陷逐渐加深并接近成人形态。婴儿外层视网膜结构较内层完善，随着矫正胎龄的增长逐渐出现外界膜、光感受器内外节连接（IS/OS）、光感受器外节/视网膜色素上皮（OS/RPE）层。外界膜、IS/OS、OS/RPE层最早出现时间分别为矫正胎龄32+6、35、47+6周。RPE层、脉络膜血管层厚度均随矫正胎龄增长逐渐增厚。婴儿组、成人组之间距中心凹750 μm处内层视网膜、1500 μm处神经纤维层和中心凹及距中心凹750、1500 μm处节细胞层厚度比较，差异无统计学意义（P＞0.01)。其他视网膜各层厚度在婴儿组及成人组间，以及在不同矫正胎龄组组内间差异均有统计学意义（P＜0.01）。相关性分析发现，除节细胞层外，其他视网膜各层厚度均与矫正胎龄有相关性(P＜0.05)。结论 婴儿早期的黄斑中心凹凹陷浅，随着矫正胎龄增长凹陷逐渐加深并接近成人形态。婴儿早期黄斑区外层视网膜逐渐增厚，其中以内外核层增减变化最为明显。视网膜各层随着矫正胎龄增长逐渐增厚，但发育速度并不完全一致。

Dynamic observation of infant′s macular development

Objective To observe the macular morphological development and thickness of retinal layers in infants. Methods Fifty-eight infants (86 eyes) were randomly selected from neonatal intensive care unit. They were divided into 4 groups according to the corrected gestational age, including ＜32 weeks group (10 cases, 14 eyes), 33 to 36 weeks group (26 cases, 39 eyes), 37 to 41 weeks group (12 patients, 18 eyes) and ≥ 42 weeks group (10 cases ,15 eyes). Twelve health adults (22 eyes) were randomly selected as adult group. All infants and adults underwent a portable optical coherence tomography (OCT) examination, focus on the macular morphology. The thickness of 9 retinal layers at fovea and parafovea (750 μm, 1500 μm from central fovea) were measured, including retinal neurepithelium layer, the inner retina, the outer retina, nerve fiber layer, ganglion cell layer, inner plexiform layer, inner nuclear layer, outer plexiform layer and inner nuclear layer. The correlation between retinal thickness and corrected gestational age was analyzed. Results Macular fovea was shallow in early infancy, and then form a mature macular fovea finally with corrected gestational age. The outer retina structure was more mature than the inner retina of infants. With the increase of the corrected gestational age, the following structures gradually developed including the outer limiting membrane (OLM), the junction of inner and outer segment of photoreceptor (IS/OS), the outer segment of photoreceptor/retinal pigment epithelium layer (OS/RPE). The earliest corrected gestational age to detect the OLM, IS/OS, OS/RPE was 32+6, 35, 47+6 weeks respectively. The RPE and choroid layer became thicker gradually. There were no statistical differences between infants group and adults group (P＞0.01) for the following thickness measurements, including inner retina at 750 μm parafovea, nerve fiber layer at 1500 μm parafovea, ganglion cell layer at central fovea and parafovea (750 μm, 1500 μm). The thickness of other retinal layers was different between different sites, between different corrected gestational ages, and between infants and adults groups (P＜0.01). Correlation analysis found that, except of retinal ganglion cell layer, the thickness of other retinal layers was correlated with the corrected gestational age (P＜0.05). Conclusions Macular fovea is shallow in early infancy, and then form a mature macular fovea finally with corrected gestational age. At infant′s early stage, the outer retina of macular is gradually thickening, of which the most obvious variation are the inner nuclear layer and outer nuclear layer. But the development speed of all layers is inconformity.