Amblyopia is the most common cause of vision loss in children and can persist into adulthood in the absence of effective intervention.Previous clinical and neuroimaging studies have suggested that the neural mechanism...Amblyopia is the most common cause of vision loss in children and can persist into adulthood in the absence of effective intervention.Previous clinical and neuroimaging studies have suggested that the neural mechanisms underlying strabismic amblyopia and anisometropic amblyopia may be different.Therefore,we performed a systematic review of magnetic resonance imaging studies investigating brain alterations in patients with these two subtypes of amblyopia;this study is registered with PROSPERO(registration ID:CRD42022349191).We searched three online databases(PubMed,EMBASE,and Web of Science) from inception to April 1,2022;39 studies with 633 patients(324patients with anisometropic amblyo pia and 309 patients with strabismic amblyopia) and 580 healthy controls met the inclusion criteria(e.g.,case-control designed,pee r-reviewed articles) and were included in this review.These studies highlighted that both strabismic amblyopia and anisometropic amblyopia patients showed reduced activation and distorted topological cortical activated maps in the striate and extrastriate co rtices during tas k-based functional magnetic resonance imaging with spatial-frequency stimulus and retinotopic representations,respectively;these may have arisen from abnormal visual experiences.Compensations for amblyopia that are reflected in enhanced spontaneous brain function have been reported in the early visual cortices in the resting state,as well as reduced functional connectivity in the dorsal pathway and structural connections in the ventral pathway in both anisometro pic amblyopia and strabismic amblyopia patients.The shared dysfunction of anisometro pic amblyopia and strabismic amblyopia patients,relative to controls,is also chara cterized by reduced spontaneous brain activity in the oculomotor co rtex,mainly involving the frontal and parietal eye fields and the cerebellu m;this may underlie the neural mechanisms of fixation instability and anomalous saccades in amblyopia.With regards to specific alterations of the two forms of amblyo pia,anisometropic amblyo pia patients suffer more microstructural impairments in the precortical pathway than strabismic amblyopia patients,as reflected by diffusion tensor imaging,and more significant dysfunction and structural loss in the ventral pathway.Strabismic amblyopia patients experience more attenuation of activation in the extrastriate co rtex than in the striate cortex when compared to anisometropic amblyopia patients.Finally,brain structural magnetic resonance imaging alterations tend to be lateralized in the adult anisometropic amblyopia patients,and the patterns of brain alterations are more limited in amblyopic adults than in childre n.In conclusion,magnetic resonance imaging studies provide important insights into the brain alterations underlying the pathophysiology of amblyopia and demonstrate common and specific alte rations in anisometropic amblyo pia and strabismic amblyopia patients;these alterations may improve our understanding of the neural mechanisms underlying amblyopia.展开更多
目的:探讨耳穴贴压联合视功能训练对弱视患儿矫正视力的改善效果及其协同作用机制。方法:采用随机对照试验设计,纳入2023年6月至2024年6月就诊于汕头大学·香港中文大学联合汕头国际眼科中心的105例弱视患儿。通过随机数字表法分为...目的:探讨耳穴贴压联合视功能训练对弱视患儿矫正视力的改善效果及其协同作用机制。方法:采用随机对照试验设计,纳入2023年6月至2024年6月就诊于汕头大学·香港中文大学联合汕头国际眼科中心的105例弱视患儿。通过随机数字表法分为干预组(耳穴贴压联合视功能训练,n=53)和对照组(视功能训练联合安慰剂贴压,n=52)。两组均接受标准化视功能训练,干预组加用耳穴贴压(取眼穴、肝穴、脾穴、肾穴等穴位),每日按压3次,持续3个月。主要观察指标为最佳矫正视力(以LogMAR表示)及其改善幅度(ΔLogMAR=基线LogMAR-治疗后LogMAR)。采用逐步多元线性回归分析ΔLogMAR的影响因素。结果:两组基线特征均衡(P>0.05)。干预3个月后,干预组最佳矫正视力(LogMAR)优于对照组(0.28±0.16 vs. 0.35±0.18,P=0.039),ΔLogMAR改善幅度更高(0.19±0.14 vs. 0.10±0.15,P=0.027)。多元线性回归显示:基线矫正视力(b=-0.619)、弱视程度(以中度作为参照:轻度b=0.584;重度b=-0.800)、联合耳穴贴压干预(b=0.075)、日均遮盖时长(b=0.098)均为ΔLogMAR的独立预测因子(均P<0.05)。结论:耳穴贴压联合视功能训练可促进弱视患儿视力改善,疗效优于单纯视功能训练。展开更多
目的探讨斜弱视生存质量量表(Amblyopia and Strabismus Questionnaire,A&SQ)在成人斜弱视患者术前生存质量状况评估中的最佳临界值。方法对214例住院成人斜弱视患者,在入院第1天采用A&SQ、国家眼科研究视功能量表(NEI-VFQ-25)...目的探讨斜弱视生存质量量表(Amblyopia and Strabismus Questionnaire,A&SQ)在成人斜弱视患者术前生存质量状况评估中的最佳临界值。方法对214例住院成人斜弱视患者,在入院第1天采用A&SQ、国家眼科研究视功能量表(NEI-VFQ-25)进行调查,以NEI-VFQ-25作为诊断"金标准"。结果 A&SQ量表得分与NEI-VFQ-25量表得分呈正相关(r=0.666,P<0.01);以NEI-VFQ-25作为诊断"金标准",A&SQ量表最佳临界值为71.5分,灵敏度、特异度分别为0.844和0.980,曲线下面积为0.938(P<0.01)。由于量表采用Likert 5级评分,临界值取为整数71分。结论 A&SQ量表在成人斜弱视患者术前生存质量状况评估中的最佳临界值为71分,是成人斜弱视患者术前生存质量状况测评的有效工具。展开更多
文摘Amblyopia is the most common cause of vision loss in children and can persist into adulthood in the absence of effective intervention.Previous clinical and neuroimaging studies have suggested that the neural mechanisms underlying strabismic amblyopia and anisometropic amblyopia may be different.Therefore,we performed a systematic review of magnetic resonance imaging studies investigating brain alterations in patients with these two subtypes of amblyopia;this study is registered with PROSPERO(registration ID:CRD42022349191).We searched three online databases(PubMed,EMBASE,and Web of Science) from inception to April 1,2022;39 studies with 633 patients(324patients with anisometropic amblyo pia and 309 patients with strabismic amblyopia) and 580 healthy controls met the inclusion criteria(e.g.,case-control designed,pee r-reviewed articles) and were included in this review.These studies highlighted that both strabismic amblyopia and anisometropic amblyopia patients showed reduced activation and distorted topological cortical activated maps in the striate and extrastriate co rtices during tas k-based functional magnetic resonance imaging with spatial-frequency stimulus and retinotopic representations,respectively;these may have arisen from abnormal visual experiences.Compensations for amblyopia that are reflected in enhanced spontaneous brain function have been reported in the early visual cortices in the resting state,as well as reduced functional connectivity in the dorsal pathway and structural connections in the ventral pathway in both anisometro pic amblyopia and strabismic amblyopia patients.The shared dysfunction of anisometro pic amblyopia and strabismic amblyopia patients,relative to controls,is also chara cterized by reduced spontaneous brain activity in the oculomotor co rtex,mainly involving the frontal and parietal eye fields and the cerebellu m;this may underlie the neural mechanisms of fixation instability and anomalous saccades in amblyopia.With regards to specific alterations of the two forms of amblyo pia,anisometropic amblyo pia patients suffer more microstructural impairments in the precortical pathway than strabismic amblyopia patients,as reflected by diffusion tensor imaging,and more significant dysfunction and structural loss in the ventral pathway.Strabismic amblyopia patients experience more attenuation of activation in the extrastriate co rtex than in the striate cortex when compared to anisometropic amblyopia patients.Finally,brain structural magnetic resonance imaging alterations tend to be lateralized in the adult anisometropic amblyopia patients,and the patterns of brain alterations are more limited in amblyopic adults than in childre n.In conclusion,magnetic resonance imaging studies provide important insights into the brain alterations underlying the pathophysiology of amblyopia and demonstrate common and specific alte rations in anisometropic amblyo pia and strabismic amblyopia patients;these alterations may improve our understanding of the neural mechanisms underlying amblyopia.
文摘目的:探讨耳穴贴压联合视功能训练对弱视患儿矫正视力的改善效果及其协同作用机制。方法:采用随机对照试验设计,纳入2023年6月至2024年6月就诊于汕头大学·香港中文大学联合汕头国际眼科中心的105例弱视患儿。通过随机数字表法分为干预组(耳穴贴压联合视功能训练,n=53)和对照组(视功能训练联合安慰剂贴压,n=52)。两组均接受标准化视功能训练,干预组加用耳穴贴压(取眼穴、肝穴、脾穴、肾穴等穴位),每日按压3次,持续3个月。主要观察指标为最佳矫正视力(以LogMAR表示)及其改善幅度(ΔLogMAR=基线LogMAR-治疗后LogMAR)。采用逐步多元线性回归分析ΔLogMAR的影响因素。结果:两组基线特征均衡(P>0.05)。干预3个月后,干预组最佳矫正视力(LogMAR)优于对照组(0.28±0.16 vs. 0.35±0.18,P=0.039),ΔLogMAR改善幅度更高(0.19±0.14 vs. 0.10±0.15,P=0.027)。多元线性回归显示:基线矫正视力(b=-0.619)、弱视程度(以中度作为参照:轻度b=0.584;重度b=-0.800)、联合耳穴贴压干预(b=0.075)、日均遮盖时长(b=0.098)均为ΔLogMAR的独立预测因子(均P<0.05)。结论:耳穴贴压联合视功能训练可促进弱视患儿视力改善,疗效优于单纯视功能训练。
