Department of Ophthalmology & Visual Sciences, McGill University-Montreal Children's Hospital Research Institute, Montreal, QC, Canada.
Department of Ophthalmology, Centre Hospitalier Universitaire Sainte-Justine Research Center, Montreal, QC, Canada.
Doc Ophthalmol. 2021 Aug;143(1):1-16. doi: 10.1007/s10633-020-09811-x. Epub 2021 Jan 30.
To demonstrate an organic (retinal) amblyogenic defect in functional amblyopes not responding to treatment.
Twenty-four children (Mean age: 5.9 ± 1.8 years; range: 4-10 years) with functional amblyopia were recruited for this study. All these children underwent complete ophthalmic and orthoptic evaluation. In addition, Kinetic Goldman Visual Fields (KGVF), Spectral Domain Optical Coherence Tomography (SD-OCT), full field flash electroretinograms (ffERG) and multifocal electroretinograms (mfERG) were also performed. Ratios were subsequently derived by comparing the amplitudes obtained from the amblyopic eye (AE) to the good eye (GE) for the a- and b-waves of the ffERG, as well as for the ring analysis of the mfERG.
KGVF showed a central scotoma of varying size (3°-7°) and density (absolute to relative), with increasing target size in 14/24 patients whose best post-treatment vision in the AE ranged from 20/100 to 20/40. The scotoma decreased in size and density with improving vision until a plateau of recovery was reached. The remaining 10/24 patients with a vision ≥ 20/30 showed no scotoma. SD-OCT showed no significant difference between the AE and GE. ffERG and mfERG were obtained in 18/24 patients. The ffERG AE/GE ratio was abnormal in 7 patients, 5 of which had large scotomas on KGVF. The mfERG ring 1 AE/GE ratio was significantly (p < .05) attenuated in 9/18 patients out of which 3 were no longer amblyopic. However, there was no significant difference (p > .05) in ring 1 AE/GE amplitude ratio between those who achieved 20/50-20/40 (.81 ± .26) and those with ≥ 20/25(.86 ± .25).
The combined findings of central scotoma on KGVF and mfERG anomalies in patients who did not achieve optimal vision with treatment suggest an underlying organic defect impairing macular function.
在对治疗无反应的功能性弱视患者中，证明存在有机（视网膜）弱视缺陷。
本研究纳入了 24 名（平均年龄：5.9±1.8 岁；范围：4-10 岁）功能性弱视儿童。所有这些儿童均接受了全面的眼科和斜视检查。此外，还进行了 Kinetic Goldman 视野（KGVF）、光谱域光相干断层扫描（SD-OCT）、全视野闪光视网膜电图（ffERG）和多焦视网膜电图（mfERG）检查。随后，通过将弱视眼（AE）与正常眼（GE）的 ffERG 的 a-和 b-波以及 mfERG 的环分析的振幅进行比较，得出比率。
KGVF 显示出不同大小（3°-7°）和密度（绝对和相对）的中央暗点，随着目标大小的增加，14/24 名患者的最佳治疗后 AE 视力范围从 20/100 到 20/40。随着视力的提高，暗点的大小和密度减小，直到达到恢复的平台。其余 10/24 名视力≥20/30 的患者没有暗点。SD-OCT 显示 AE 和 GE 之间没有显著差异。在 18/24 名患者中获得了 ffERG 和 mfERG。在 7 名患者中，ffERG AE/GE 比率异常，其中 5 名患者在 KGVF 上有大的暗点。在 18 名患者中的 9 名中，mfERG 环 1 AE/GE 比率明显（p<.05）降低，其中 3 名不再弱视。然而，在达到 20/50-20/40（.81±.26）和≥20/25（.86±.25）的患者之间，环 1 AE/GE 振幅比率没有显著差异（p>.05）。
在治疗后视力未达到最佳的患者中，KGVF 上的中央暗点和 mfERG 异常的综合发现表明存在潜在的有机缺陷，损害了黄斑功能。
