小儿脱髓鞘病传入视觉通路中的功能-结构相关性
Functional-structural correlations in the afferent visual pathway in pediatric demyelination.
作者信息
Yeh E Ann, Marrie Ruth Ann, Reginald Y Arun, Buncic J Raymond, Noguera Austin E, O'Mahony Julia, Mah Jean K, Banwell Brenda, Costello Fiona
机构信息
From the Divisions of Neurology (E.A.Y., A.E.N., J.O.) and Ophthalmology (Y.A.R., J.R.B.) and Department of Pediatrics (E.A.Y., A.E.N., J.O.), Hospital for Sick Children, University of Toronto; the Departments of Internal Medicine and Community Health Sciences (R.A.M.), University of Manitoba, Winnipeg, Canada; the Division of Neurology (B.B.), Children's Hospital of Philadelphia, University of Pennsylvania; and Department of Pediatrics (J.K.M.), the University of Calgary (F.C.), Canada.
出版信息
Neurology. 2014 Dec 2;83(23):2147-52. doi: 10.1212/WNL.0000000000001046. Epub 2014 Oct 31.
OBJECTIVE
We evaluated the relationship of optical coherence tomography (OCT)-measured ganglion cell layer (GCL) and retinal nerve fiber layer (RNFL) thickness to other functional measures of afferent visual pathway competence including high-contrast visual acuity (HCVA) and low-contrast visual acuity (LCVA), visual field sensitivity, and color vision perception in a pediatric population with demyelinating disorders.
METHODS
This was a cross-sectional evaluation of 37 children, aged 8-18 years, with pediatric demyelinating disorders (n = 74 eyes), and 18 healthy controls (n = 36 eyes), who were recruited from the University of Toronto, Hospital for Sick Children and the University of Calgary, Alberta Children's Hospital, Canada. A standardized visual battery, including spectral-domain OCT, visual fields, LCVA, and HCVA, was performed in all subjects.
RESULTS
Mean RNFL thickness was 26 µm (25.6%) lower in patients with demyelination (76.2 μm [3.7]) compared to controls (102.4 μm [2.1]) (p < 0.0001). Mean GCL thickness was 20% lower in patients as compared to controls (p < 0.0001). Mean GCL and RNFL thickness were strongly correlated (r = 0.89; p < 0.0001), yet in contrast to RNFL thickness, no differences in GCL thickness were noted between optic neuritis (ON) eyes and non-ON eyes of patients. HCVA and LCVA and visual field mean deviation scores decreased linearly with lower RNFL thickness.
CONCLUSION
GCL thickness was decreased in patients regardless of history of ON. The retina may be a site of primary neuronal injury in pediatric demyelination.
目的
我们评估了光学相干断层扫描（OCT）测量的神经节细胞层（GCL）和视网膜神经纤维层（RNFL）厚度与脱髓鞘疾病患儿传入性视觉通路功能的其他指标之间的关系，这些指标包括高对比度视力（HCVA）、低对比度视力（LCVA）、视野敏感度和色觉感知。
方法
这是一项横断面评估研究，纳入了37名年龄在8至18岁的患有小儿脱髓鞘疾病的儿童（74只眼）和18名健康对照者（36只眼），他们来自加拿大多伦多大学、病童医院以及卡尔加里大学阿尔伯塔儿童医院。对所有受试者进行了包括光谱域OCT、视野、LCVA和HCVA在内的标准化视觉检查。
结果
与对照组（102.4μm[2.1]）相比，脱髓鞘患者的平均RNFL厚度低26μm（25.6%）（76.2μm[3.7]）（p<0.0001）。患者的平均GCL厚度比对照组低20%（p<0.0001）。平均GCL和RNFL厚度呈强相关性（r=0.89；p<0.0001），但与RNFL厚度不同的是，患者的视神经炎（ON）眼和非ON眼之间的GCL厚度没有差异。HCVA、LCVA和视野平均偏差得分随RNFL厚度降低呈线性下降。
结论
无论有无ON病史，患者的GCL厚度均降低。视网膜可能是小儿脱髓鞘疾病中神经元原发性损伤的部位。
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