成年斜视性弱视患者视觉注意相关脑功能损害的心理物理和fMRI研究

发布时间：2018-04-03 06:24

  本文选题：成年　切入点：斜视　出处：《第三军医大学》2016年博士论文

【摘要】：研究背景和目的:弱视是由于在儿童视觉系统发育可塑性关键期内异常的视觉经验引起的单眼或双眼最佳矫正视力下降,眼部检查无可见的器质性病变的疾病。弱视患者成年后视功能提升困难,目前发现视觉训练可暂时提高患者视力,但停止训练后视力出现回退,这可能与患者视中枢对弱视眼视觉信息运用不佳,始终处于功能“弃用”状态有关。视觉注意在视觉信息的处理和利用中起到关键作用,所以我们推测弱视患者视觉注意功能出现受损,造成其无法有效利用弱视眼视觉信息,导致弱视眼视功能提高困难。另一方面,在斜视性弱视中,患者的眼球运动功能、固视功能及双眼的协同功能均存在损害,这导致其与眼球运动相关的视觉功能也出现损害。眼球运动功能和固视功能对于正常的视觉注意功能具有重要作用,而斜视性弱视患者眼球运动和固视功能的损害将导致视觉注意功能的损害。就此,我们提出假设:在斜视性弱视中,眼球运动异常导致的视觉注意功能缺陷是导致弱视视功能缺陷的一个根本原因。因此,本课题采用心理物理和f MRI方法研究成年斜视性弱视患者的视觉注意功能和其相关的脑功能,观察弱视患者是否存在视觉注意功能的下降和视觉注意相关脑功能损害,阐明其视觉注意功能损害特点及其相关脑功能损害特点。方法:1.采用运动驱动的视觉注意速度阈值任务分别测定成年斜视性弱视患者弱视眼和非弱视眼、成年正常志愿者的优势眼和非优势眼的视觉速度信息分辨阈值,以验证成年弱视患者弱视眼是否存在视觉注意功能缺陷;2.采用由下至上的运动驱动的视觉注意任务和由上至下的扫视任务刺激,f MRI记录脑功能变化的方法,采集成年斜视性弱视患者和正常受试者在执行视觉注意任务时的脑功能变化,分析其视觉注意相关脑区功能是否出现受损;3.基于运动驱动的视觉注意任务和扫视任务的f MRI数据,分析各个视觉注意相关脑区之间的功能通路是否出现受损;4.利用静息态f MRI方法,研究弱视患者V1区在静息状态下与全脑功能连接,分析其相较于正常人是否出现改变。结果:1.在运动驱动的视觉注意速度阈值任务中,弱视患者弱视眼速度阈值显著低于非弱视眼和正常人优势眼和非优势眼;非弱视眼速度阈值较正常对照双眼无差异;正常对照两眼之间无差异。表明成年斜视性弱视患者弱视眼相较于非弱视眼和正常受试者优势眼和非优势眼均存在运动驱动的视觉注意功能缺陷。2.在运动驱动的视觉注意任务中,弱视眼在V1区的激活强度和速度相较于非弱视眼、优势眼和非优势眼无差异;弱视眼在IPS和FEF脑区的激活强度和速度显著低于非弱视眼、优势眼和非优势眼;非弱视眼相较于正常对照双眼在V1、IPS和FEF脑区均未见激活强度和速度的差异;正常受试者两眼之间在V1、IPS和FEF脑区均未见激活强度和速度的差异。说明弱视患者弱视眼在执行由下至上的视觉注意任务时,其V1区功能无受损,但其视觉注意相关脑区(FEF和IPS)的功能存在受损。3.在扫视任务中,弱视眼在V1、IPS和FEF脑区的激活强度和速度均显著低于非弱视眼、优势眼和非优势眼;非弱视眼相较于正常对照双眼在V1、IPS和FEF脑区均未见激活强度和速度的差异;正常受试者两眼之间在V1、IPS和FEF脑区均未见激活强度和速度的差异。结果说明在执行由上至下的视觉注意任务时,弱视眼在V1区和视觉注意相关脑区(FEF和IPS)的功能均存在受损。4.在运动驱动的视觉注意任务中,弱视眼两侧V1区和两侧IPS脑区之间的功能通路相较于非弱视眼、优势眼和非优势眼无差异;弱视眼同侧FEF和对侧FEF、两侧IPS之间的功能通路相较于非弱视眼下降,但相较于正常对照两眼无差异;非弱视眼相较于正常受试者两眼在所有通路上功能连接无差异;正常对照两眼之间在所有通路上功能连接无差异。表明弱视患者弱视眼在执行由下至上的视觉注意任务时,其V1区与IPS脑区之间的功能通路无受损;弱视患者弱视眼功能通路的缺陷主要特点是在由下至上的注意任务中弱视眼同侧的FEF脑区被相对孤立;弱视患者非弱视眼在由下至上的注意任务中无V1、IPS、FEF脑区间的功能通路损害。5.在扫视任务中,弱视眼、非弱视眼、优势眼和非优势眼在所有通路上功能连接均无差异。表明弱视患者弱视眼和非弱视眼在由上至下的注意任务中无V1、IPS、FEF脑区间的功能通路损害。6.在静息态中,弱视受试者V1区与自身及周围初级视皮层的联系相较于正常受试者下降,但与默认网络的联系相较于正常受试者上升。这是其视觉注意缺陷的另一脑功能基础。结论:1、成年斜视性弱视患者弱视眼相较于非弱视眼和正常受试者优势眼和非优势眼均存在运动驱动的视觉注意功能缺陷。2、弱视患者弱视眼在执行由下至上的视觉注意任务时,其V1区功能无受损,但在执行由上至下的视觉注意任务时,其V1区功能存在受损。3、弱视患者弱视眼在执行由上至下和由下至上的视觉注意任务时,其视觉注意相关脑区(FEF和IPS)的功能明显弱于其他三组对照眼,这是其视觉注意缺陷的脑功能基础之一。4、弱视患者弱视眼功能通路的缺陷主要特点是在由下至上的注意任务中弱视眼同侧的FEF脑区被相对孤立,而由上至下的任务中功能通路正常,这是其视觉注意缺陷的脑功能基础之二。5、弱视患者弱视眼V1区在静息状态下与默认网络的联系出现了升高而与自身及周围皮层的联系减弱,这是其视觉注意缺陷的脑功能基础之三。6、弱视患者弱视眼在执行由上至下和由下至上的视觉注意任务时,其V1区与IPS脑区之间的功能通路未见受损。
[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.

【学位授予单位】：第三军医大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R777.44
，

本文编号：1703993