本文選題：成年　切入點(diǎn)：斜視　出處：《第三軍醫(yī)大學(xué)》2016年博士論文

【摘要】：研究背景和目的:弱視是由于在兒童視覺(jué)系統(tǒng)發(fā)育可塑性關(guān)鍵期內(nèi)異常的視覺(jué)經(jīng)驗(yàn)引起的單眼或雙眼最佳矯正視力下降,眼部檢查無(wú)可見(jiàn)的器質(zhì)性病變的疾病。弱視患者成年后視功能提升困難,目前發(fā)現(xiàn)視覺(jué)訓(xùn)練可暫時(shí)提高患者視力,但停止訓(xùn)練后視力出現(xiàn)回退,這可能與患者視中樞對(duì)弱視眼視覺(jué)信息運(yùn)用不佳,始終處于功能“棄用”狀態(tài)有關(guān)。視覺(jué)注意在視覺(jué)信息的處理和利用中起到關(guān)鍵作用,所以我們推測(cè)弱視患者視覺(jué)注意功能出現(xiàn)受損,造成其無(wú)法有效利用弱視眼視覺(jué)信息,導(dǎo)致弱視眼視功能提高困難。另一方面,在斜視性弱視中,患者的眼球運(yùn)動(dòng)功能、固視功能及雙眼的協(xié)同功能均存在損害,這導(dǎo)致其與眼球運(yùn)動(dòng)相關(guān)的視覺(jué)功能也出現(xiàn)損害。眼球運(yùn)動(dòng)功能和固視功能對(duì)于正常的視覺(jué)注意功能具有重要作用,而斜視性弱視患者眼球運(yùn)動(dòng)和固視功能的損害將導(dǎo)致視覺(jué)注意功能的損害。就此,我們提出假設(shè):在斜視性弱視中,眼球運(yùn)動(dòng)異常導(dǎo)致的視覺(jué)注意功能缺陷是導(dǎo)致弱視視功能缺陷的一個(gè)根本原因。因此,本課題采用心理物理和f MRI方法研究成年斜視性弱視患者的視覺(jué)注意功能和其相關(guān)的腦功能,觀(guān)察弱視患者是否存在視覺(jué)注意功能的下降和視覺(jué)注意相關(guān)腦功能損害,闡明其視覺(jué)注意功能損害特點(diǎn)及其相關(guān)腦功能損害特點(diǎn)。方法:1.采用運(yùn)動(dòng)驅(qū)動(dòng)的視覺(jué)注意速度閾值任務(wù)分別測(cè)定成年斜視性弱視患者弱視眼和非弱視眼、成年正常志愿者的優(yōu)勢(shì)眼和非優(yōu)勢(shì)眼的視覺(jué)速度信息分辨閾值,以驗(yàn)證成年弱視患者弱視眼是否存在視覺(jué)注意功能缺陷;2.采用由下至上的運(yùn)動(dòng)驅(qū)動(dòng)的視覺(jué)注意任務(wù)和由上至下的掃視任務(wù)刺激,f MRI記錄腦功能變化的方法,采集成年斜視性弱視患者和正常受試者在執(zhí)行視覺(jué)注意任務(wù)時(shí)的腦功能變化,分析其視覺(jué)注意相關(guān)腦區(qū)功能是否出現(xiàn)受損;3.基于運(yùn)動(dòng)驅(qū)動(dòng)的視覺(jué)注意任務(wù)和掃視任務(wù)的f MRI數(shù)據(jù),分析各個(gè)視覺(jué)注意相關(guān)腦區(qū)之間的功能通路是否出現(xiàn)受損;4.利用靜息態(tài)f MRI方法,研究弱視患者V1區(qū)在靜息狀態(tài)下與全腦功能連接,分析其相較于正常人是否出現(xiàn)改變。結(jié)果:1.在運(yùn)動(dòng)驅(qū)動(dòng)的視覺(jué)注意速度閾值任務(wù)中,弱視患者弱視眼速度閾值顯著低于非弱視眼和正常人優(yōu)勢(shì)眼和非優(yōu)勢(shì)眼;非弱視眼速度閾值較正常對(duì)照雙眼無(wú)差異;正常對(duì)照兩眼之間無(wú)差異。表明成年斜視性弱視患者弱視眼相較于非弱視眼和正常受試者優(yōu)勢(shì)眼和非優(yōu)勢(shì)眼均存在運(yùn)動(dòng)驅(qū)動(dòng)的視覺(jué)注意功能缺陷。2.在運(yùn)動(dòng)驅(qū)動(dòng)的視覺(jué)注意任務(wù)中,弱視眼在V1區(qū)的激活強(qiáng)度和速度相較于非弱視眼、優(yōu)勢(shì)眼和非優(yōu)勢(shì)眼無(wú)差異;弱視眼在IPS和FEF腦區(qū)的激活強(qiáng)度和速度顯著低于非弱視眼、優(yōu)勢(shì)眼和非優(yōu)勢(shì)眼;非弱視眼相較于正常對(duì)照雙眼在V1、IPS和FEF腦區(qū)均未見(jiàn)激活強(qiáng)度和速度的差異;正常受試者兩眼之間在V1、IPS和FEF腦區(qū)均未見(jiàn)激活強(qiáng)度和速度的差異。說(shuō)明弱視患者弱視眼在執(zhí)行由下至上的視覺(jué)注意任務(wù)時(shí),其V1區(qū)功能無(wú)受損,但其視覺(jué)注意相關(guān)腦區(qū)(FEF和IPS)的功能存在受損。3.在掃視任務(wù)中,弱視眼在V1、IPS和FEF腦區(qū)的激活強(qiáng)度和速度均顯著低于非弱視眼、優(yōu)勢(shì)眼和非優(yōu)勢(shì)眼;非弱視眼相較于正常對(duì)照雙眼在V1、IPS和FEF腦區(qū)均未見(jiàn)激活強(qiáng)度和速度的差異;正常受試者兩眼之間在V1、IPS和FEF腦區(qū)均未見(jiàn)激活強(qiáng)度和速度的差異。結(jié)果說(shuō)明在執(zhí)行由上至下的視覺(jué)注意任務(wù)時(shí),弱視眼在V1區(qū)和視覺(jué)注意相關(guān)腦區(qū)(FEF和IPS)的功能均存在受損。4.在運(yùn)動(dòng)驅(qū)動(dòng)的視覺(jué)注意任務(wù)中,弱視眼兩側(cè)V1區(qū)和兩側(cè)IPS腦區(qū)之間的功能通路相較于非弱視眼、優(yōu)勢(shì)眼和非優(yōu)勢(shì)眼無(wú)差異;弱視眼同側(cè)FEF和對(duì)側(cè)FEF、兩側(cè)IPS之間的功能通路相較于非弱視眼下降,但相較于正常對(duì)照兩眼無(wú)差異;非弱視眼相較于正常受試者兩眼在所有通路上功能連接無(wú)差異;正常對(duì)照兩眼之間在所有通路上功能連接無(wú)差異。表明弱視患者弱視眼在執(zhí)行由下至上的視覺(jué)注意任務(wù)時(shí),其V1區(qū)與IPS腦區(qū)之間的功能通路無(wú)受損;弱視患者弱視眼功能通路的缺陷主要特點(diǎn)是在由下至上的注意任務(wù)中弱視眼同側(cè)的FEF腦區(qū)被相對(duì)孤立;弱視患者非弱視眼在由下至上的注意任務(wù)中無(wú)V1、IPS、FEF腦區(qū)間的功能通路損害。5.在掃視任務(wù)中,弱視眼、非弱視眼、優(yōu)勢(shì)眼和非優(yōu)勢(shì)眼在所有通路上功能連接均無(wú)差異。表明弱視患者弱視眼和非弱視眼在由上至下的注意任務(wù)中無(wú)V1、IPS、FEF腦區(qū)間的功能通路損害。6.在靜息態(tài)中,弱視受試者V1區(qū)與自身及周?chē)跫?jí)視皮層的聯(lián)系相較于正常受試者下降,但與默認(rèn)網(wǎng)絡(luò)的聯(lián)系相較于正常受試者上升。這是其視覺(jué)注意缺陷的另一腦功能基礎(chǔ)。結(jié)論:1、成年斜視性弱視患者弱視眼相較于非弱視眼和正常受試者優(yōu)勢(shì)眼和非優(yōu)勢(shì)眼均存在運(yùn)動(dòng)驅(qū)動(dòng)的視覺(jué)注意功能缺陷。2、弱視患者弱視眼在執(zhí)行由下至上的視覺(jué)注意任務(wù)時(shí),其V1區(qū)功能無(wú)受損,但在執(zhí)行由上至下的視覺(jué)注意任務(wù)時(shí),其V1區(qū)功能存在受損。3、弱視患者弱視眼在執(zhí)行由上至下和由下至上的視覺(jué)注意任務(wù)時(shí),其視覺(jué)注意相關(guān)腦區(qū)(FEF和IPS)的功能明顯弱于其他三組對(duì)照眼,這是其視覺(jué)注意缺陷的腦功能基礎(chǔ)之一。4、弱視患者弱視眼功能通路的缺陷主要特點(diǎn)是在由下至上的注意任務(wù)中弱視眼同側(cè)的FEF腦區(qū)被相對(duì)孤立,而由上至下的任務(wù)中功能通路正常,這是其視覺(jué)注意缺陷的腦功能基礎(chǔ)之二。5、弱視患者弱視眼V1區(qū)在靜息狀態(tài)下與默認(rèn)網(wǎng)絡(luò)的聯(lián)系出現(xiàn)了升高而與自身及周?chē)拥穆?lián)系減弱,這是其視覺(jué)注意缺陷的腦功能基礎(chǔ)之三。6、弱視患者弱視眼在執(zhí)行由上至下和由下至上的視覺(jué)注意任務(wù)時(shí),其V1區(qū)與IPS腦區(qū)之間的功能通路未見(jiàn)受損。
[Abstract]:Background and objective: amblyopia is caused by plasticity during the critical period of abnormal visual experience in the development of the visual system in children with monocular or binocular best corrected visual acuity decreased, ocular examination organic lesions visible disease. Adult patients with amblyopia visual function enhance the difficulties currently found visual training can temporarily improve visual acuity, but stop after training this vision appeared back, and patients may be poor for the amblyopic eye visual center visual information is always in use, function of abandoned state. Visual attention to play a key role in the processing and use of visual information, so we speculate that amblyopia visual attention function impaired, resulting in the effective utilization of amblyopic visual information that lead to amblyopia visual function improvement difficult. On the other hand, in strabismic amblyopia, ocular motor function in patients with solid, binocular visual function and Co There were the same function damage, cause it is related to eye movement of visual function damage. Also the eye movement and fixation function plays an important role in the function of normal visual attention and eye movements, patients with strabismic amblyopia and solid visual function damage will lead to visual attention dysfunction. In this connection, we put forward a hypothesis: in strabismic amblyopia, ocular movement caused by abnormal visual attention function defect is a root cause of amblyopia visual function defects. Therefore, the study of physical and psychological f MRI adult strabismus amblyopia patients with visual attention function and its related brain function, observe whether the visual attention related amblyopia patients the impairment of brain function decline and visual attention, to clarify the characteristics of visual attention function impairment and its related brain function damage. Methods: 1. using visual motion Feel the speed threshold were measured in adult attention task in strabismic amblyopia patients with amblyopic and nonamblyopic eyes, visual resolution threshold velocity information of adult normal volunteers of the dominant eye and non dominant eye, to verify the adult amblyopia amblyopia is visual attention function defect; 2. driven by bottom-up visual attention task saccadic movement and from top to bottom stimulation method f MRI recorded brain functional changes, adult strabismus amblyopia patients and normal subjects in the implementation of visual attention task changes in brain function, analysis the function of visual attention related brain areas is impaired; 3. based on F MRI data tasks and saccade task driven attention motion vision. Analysis of the various visual attention function pathway between brain regions related to whether impaired; 4. the resting state f MRI method, study on amblyopia patients in V1 District in the resting state In connection with the brain function, analyze whether compared to the normal change. Results: 1. in motion velocity threshold visual attention task, amblyopia amblyopia eye velocity threshold was significantly lower than the non amblyopic and normal dominant eye and non dominant eye; non amblyopic eye velocity threshold compared to the normal control eyes had no difference normal control; no difference between eyes. Shows that the adult amblyopia patients with strabismic amblyopia compared to non amblyopic eyes and normal subjects motion visual attention visual attention task in the defects of the.2. motion have the advantage of eye and non dominant eye, amblyopia in area V1 activation intensity and speed compared to the non amblyopic eyes, no difference between the dominant eye and non dominant eye; amblyopia in the activation rate and intensity of IPS and FEF brain regions was significantly lower than the non amblyopic eyes, dominant eye and non dominant eye; non amblyopic eyes compared with normal control eyes In V1, IPS and FEF were no differences in brain activation intensity and speed; normal subjects between the eyes in V1, between IPS and FEF brain regions showed no activation intensity and speed. Amblyopia amblyopia in the implementation of bottom-up visual attention task, the V1 function is impaired, but the visual attention related brain regions (FEF and IPS) of the.3. function was impaired in the saccade task, amblyopia in V1, IPS and FEF activation rate and intensity of brain regions were significantly lower than non amblyopic eyes, dominant eye and non dominant eye; non amblyopic eyes compared with normal control eyes in V1, IPS and FEF there were no differences in brain activation intensity and speed; normal subjects between the eyes in V1, between IPS and FEF brain regions were not activated. The results show that the strength and speed in the task of visual attention to the implementation of top-down, amblyopia attention related brain regions in the V1 region (FEF and IPS) and visual function There were damaged.4. in motion driven visual attention task, function pathway between amblyopic eyes on both sides of V1 and IPS on both sides of the brain compared to non amblyopic eyes, no difference between the dominant eye and non dominant eye; amblyopia of ipsilateral FEF and contralateral FEF, IPS between the both sides of functional pathways compared to the non amblyopic eye drops however, compared to the normal control eyes were no difference; non amblyopic eyes compared with normal subjects with function in all pathways connected with no difference between the eyes; the normal control function in all channel connection. No difference that amblyopia amblyopia in the implementation from the bottom to the visual attention task, the function between the V1 pathway IPS area and brain damaged; the main defect features amblyopia amblyopia function pathway is composed of the highest attention task in the amblyopic eye ipsilateral FEF brain regions were relatively isolated; non amblyopic eyes in patients with amblyopia from the bottom to the No V1, task IPS, function FEF pathway damage brain regions.5. amblyopia in the saccade task, eye, non amblyopic eyes, dominant eye and non dominant eye in all pathways of functional connectivity are no difference. That amblyopia amblyopic and nonamblyopic eyes without V1, the top-down attention task in IPS. The function of FEF pathway damage brain interval.6. in resting state, amblyopia subjects V1 primary visual cortex with itself and the surrounding relation compared to normal subjects decreased, but compared to the default network connection of normal subjects up. This is the defect of another brain function based visual attention to its conclusion. Adult: 1, strabismic amblyopia patients with amblyopia compared to non amblyopic eyes and normal subjects pay attention to defects of the.2 motion vision has advantages of eye and non dominant eye, amblyopia amblyopia in the implementation of bottom-up visual attention task, the work area V1 No damage, but in the implementation of visual attention task from top to bottom, the V1 function was impaired in.3 patients with amblyopia, amblyopia in the implementation of top-down and bottom-up visual attention task, its visual attention related brain regions (FEF and IPS) function was significantly weaker than the other three groups of control eyes, this is a defect the.4 of brain function based its visual attention, the main characteristics of defect amblyopia amblyopia function pathway is composed of the highest attention task in the amblyopic eye ipsilateral FEF brain regions were isolated, and the function of top-down task pathway is normal, this is the basis of brain function defect two.5 its visual attention. Patients with amblyopia amblyopia V1 region in the resting state and the default network contact rose weakened and contact itself and the surrounding cortex, the brain function of base defects three.6 its visual attention, amblyopia eye to weak For top-down and bottom-up visual attention task, no functional pathways between the V1 and IPS regions of the brain damaged.

【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R777.44
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本文編號(hào)：1703993