[关键词]
[摘要]
目的:探讨远视性屈光参差性弱视儿童治疗前后黄斑各分区视网膜厚度、注视性质、最佳矫正视力(BCVA)、眼轴、等效球镜度数随着治疗时间延长发生的变化。
方法:前瞻性纵向对照研究试验。选取2018-08/2019-08于我院确诊前未进行过弱视治疗的4~8岁单眼弱视的远视性屈光参差患儿共计40例(中心注视20例,旁中心20例),治疗前,治疗后6、12mo均行阿托品散瞳验光、眼底黄斑注视性质、眼轴、OCT视网膜厚度检查。用统计学分析远视性弱视眼的黄斑区视网膜厚度是否随治疗发生变化以及产生影响的相关因素,不同注视性质间是否存在差异。
结果:治疗前,治疗后6、12mo中心注视组和旁中心注视组的中心凹视网膜厚度、内环鼻侧视网膜厚度均有差异(P<0.01),黄斑区其余视网膜厚度均无差异(P>0.05); 随着治疗时间延长中心注视组和旁中心注视组的中心凹视网膜厚度、内环鼻侧视网膜厚度变薄(均P<0.05)。相同测量时间中心注视组的中心凹和内环鼻侧视网膜厚度比旁中心注视组薄(均P<0.05),黄斑区其余视网膜厚度无差异(均P>0.05)。治疗前后弱视眼的眼轴、BCVA、等效球镜度数有差异(均P<0.01); 随着治疗时间延长眼轴长度增加,BCVA升高,等效球镜度数降低。远视性弱视眼黄斑各分区视网膜厚度厚于对侧正常眼,眼轴长度小于对侧正常眼(均P<0.01)。弱视眼与对侧正常眼治疗前后眼轴长度变化有差异(P<0.05),弱视眼眼轴短于对侧正常眼眼轴,随着治疗时间的延长弱视眼与对侧正常眼眼轴长度都变长。
结论:中高度的弱视眼黄斑区视网膜各分区厚度均大于对侧正常眼,眼轴小于对侧正常眼。治疗后随着最佳矫正视力的提高,中心注视、旁中心注视组黄斑区中心凹和内环鼻侧的视网膜厚度均变薄。
[Key word]
[Abstract]
AIM: To discuss the measurement of retinal thickness in each macular region, fixation property, best corrected visual acuity(BCVA), eye axis and equivalent spherical power and treatment time for the children with hyperopia anisometropic amblyopia before and after treatment.
METHODS: This study was a prospective longitudinal controlled trial. The subjects were 40 hyperopia anisometropia children aged 4-8 years with monocular amblyopia who had not been treated with amblyopia before diagnosis in our hospital(20 cases of central fixation and 20 cases of paracentral fixation)from August 2018 to August 2019. Atropine mydriatic optometry, fundus macular fixation quality, ocular axis and optical coherence tomography(OCT)retinal thickness were used in the initial diagnosis and 6mo and 1a follow-up. Statistical analysis was used to analyze whether the macular retinal thickness of hyperopia amblyopia had changed in the treatment and the related factors, and whether had differences between different fixation properties.
RESULTS: There were significant differences in foveal retinal thickness and nasal retinal thickness of inner ring between central fixation group and paracentral fixation group at different measurement times(before treatment, 6 and 12mo after treatment)(P<0.01). There were no significant changes in the other retinas in macular area(P >0.05). With the extension of treatment time, the foveal retinal thickness and the nasal retinal thickness of the inner ring in the central fixation group and the paracentral fixation group became thinner(all P<0.05). At the same measurement time, the thickness of fovea and inner ring nasal retina in the central fixation group was thinner than that in the paracentral fixation group(all P<0.05), and there were no significant differences in the thickness of other retinas in the macular region(all P>0.05). There were significant differences in ocular axis, BCVA and equivalent spherical power of amblyopia before and after treatment(all P<0.05); With the extension of treatment time, the length of ocular axis and BCVA had increased and the degree of equivalent spherical mirror had decreased. The macular retinal thickness of hyperopia amblyopia was thicker than that of contralateral normal eyes, and the length of ocular axis was shorter than that of contralateral normal eyes(all P<0.01). The axial length of amblyopia and normal eyes had changed significantly before and after treatment(all P<0.01). The axial length of amblyopia was shorter than that of normal eyes. With the extension of treatment time, the axial length of amblyopia and normal eyes had become longer.
CONCLUSION:The thickness of macular retina in moderate and high amblyopic eyes was greater than that in contralateral normal eyes, and the ocular axis was shorter than that in contralateral normal eyes. After treatment, with the improvement of best corrected visual acuity, the retinal thickness of fovea and nasal side of inner ring in central fixation group and paracentral fixation group had decreased.
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[基金项目]
河北省自然科学基金项目(No.H2020406019); 承德市科学技术研究与发展计划项目(No.202006A038)