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从视网膜神经纤维层及黄斑区神经上皮层厚度研究看弱视的外周发病机制
【作者】 靳霞；
【导师】 曾庆华；
【作者基本信息】 成都中医药大学 ， 中医眼科学， 2008， 硕士
【摘要】 目的:应用光学相干断层扫描(Ocular Coherence Tomography,OCT)来研究弱视及屈光不正性弱视儿童的视网膜神经纤维层(Retinal Nerve Fiber Layer,RNFL)厚度和黄斑区神经上皮层厚度,并设立正常组为对照进行分析,从而探讨弱视及屈光不正性弱视发病的外周机制。方法:对2007年7月至9月来成都中医药大学附属医院眼科门诊就诊的25例弱视儿童(36眼)和10例正常儿童(20眼)分别行OCT检查,测量其视网膜神经纤维层厚度和黄斑区神经上皮层厚度,并按相关标准将其分为弱视组、屈光不正性弱视组和正常组。弱视组和屈光不正性弱视组所得数据均用SPSS12.0统计软件与正常组进行比较,分析其厚度与正常组有无差异。P＞0.05为无统计学意义,P＜0.05为有统计学意义。结果。(1)弱视组患眼黄斑中心凹区域视网膜神经上皮层厚度与正常组相比无变化(P＞0.05);弱视患者黄斑旁中心凹区,上方视网膜最厚,鼻侧与下方相似,颢侧最薄,这与正常组视网膜厚度分布一致,且各部分视网膜神经上皮层厚度与正常组无差别(P＞0.05);弱视患者黄斑区旁中心凹周围区,鼻侧视网膜最厚,其次是上方,再次是下方,颞侧最薄,与正常组视网膜厚度分布一致,但鼻、上、下、颞侧各方向视网膜神经上皮层厚度均显著增厚(P＜0.05)。正常组上方RNFL最厚,其次是下方,再者是颞侧,鼻侧最薄,但弱视组上方和下方RNFL厚度相似,颞侧和鼻侧厚度相似但要薄于上方和下方。其下方和鼻侧RNFL比正常组显著增厚(P＜0.05),上方和颞侧RNFL厚度与正常组比较无显著变化(P＞0.05),弱视组平均RNFL厚度比正常组增厚但无统计学意义(P＞0.05)。(2)屈光不正性弱视患者黄斑区视网膜神经上皮层厚度和RNFL的厚度与正常组比较,其结果同弱视组。结论:(1)弱视及屈光不正性弱视患者黄斑区视网膜神经上皮层及视网膜神经纤维层的厚度分布与正常者基本一致。(2)弱视及屈光不正性弱视患者黄斑区视网膜神经上皮层厚度及视网膜神经纤维层厚度的部分区域比正常者增厚。(3)弱视患者的视网膜受累,进一步证明了外周发病机制的说法。
【Abstract】 Object: we use Ocular Coherence Tomography to study the Retinal Nerve Fiber Layer thickness and macular thickness of the amplyopia and refractive errors amplyopia , we also found the common group to be the comparison for analysis, thereby , we can investigate the periphera incidence mechanism of the amplyopia and ametropic amplyopia.Methods: We did the OCT examination respectively for the children who came to the Clinic of department of ophthalmology of Chengdu University of Traditional Chinese Medicine Hospital from July 2007 to September, measured its thickness of the retinal nerve fiber layer and macular neurosensory thickness, and we also put these children into the overall visually-impaired group, ametropia amblyopia group and the normal group according to relevant standards. The data collected of visually-impaired group and ametropia amblyopia Group are used SPSS12.0 statistical software compared with the normal group to see whether there is differences with the normal group. P> 0. 05 is not significant, P <0. 05 for statistical significance.Results: (1) In the overall group suffering from amblyopia, the retinal neurosensory thickness of macular fovea is unchanged compared with the normal group (P> 0.05); in their macular parafovea , the top retinal thickness is the thickest, the bottom and the nasal are similar, the temporal Side is the thinnest, it is the same with the normal retinal thickness distribution, furthermore , in all the parts, the retinal neurosensory thickness has no differences with the normal group (P>0. 05); in their macular perifovea, the nasal retinal thickness is the thickest, next is the the top, the third is the bottom, and the temporal is the thinnest, the distribution is the same with the normal retinal thickness, but all of their retinal neurosensory thickness were significantly thickened (P <0.05). In the common , the above RNFL thickness is the thickest, followed by the bottom and then the temporal, the nasal is the thinnest, but in the overall group suffering from amblyopia, the above and the below RNFL thickness are similar, the temporal and the nasal are also similar but are thinner than the above and the bottom. The below and the nasal RNFL thickness of the amblyopia eyes were significantly thickened than the common(P <0. 05), and the above and the temporal RNFL thickness compared with the normal group had no significant changes (P> 0.05), the average RNFL thickness of the overall group suffering from amblyopia are thicker than the common, but there is no statistical significance (P> 0.05). (2) The macular neurosensory thickness and the thickness of the retinal nerve fiber layer of the ametropia amblyopia compared with the normal group, its result is the same with the whole amblyopia group.Conclusion: (1) The distribution of the macular retinal neurosensory thickness and the RNFL thickness of the overall group suffering from amblyopia and the refractive errors amblyopia are basically the same with the common.(2) Part of the thickness of the macular retinal neurosensory and the RNFL of the overall group suffering from amblyopia and the refractive errors amblyopia are thicker than the common.(3) The retinal of the amblyopia patients is involved which furtherevidences the statement of peripheral pathogenesis.