目的：运用光学相干断层成像技术(optical coherence tomography， OCT)对儿童难治性弱视眼的视网膜神经纤维层(RNFL)及黄斑区视网膜神经上皮层的厚度进行测量，以了解难治性弱视视网膜形态学及其变化的规律，从而推断难治性弱视患儿外周发病机制。

方法：选择难治性弱视眼(A组)、非难治性弱视眼(B组)以及正常儿童眼(C组)各30眼，分别测量黄斑中心凹、中心区(直径范围≤1mm)及旁中心区(1mm<直径范围≤3mm环形区域)鼻、下、颞、上方的视网膜平均厚度值； 同时以视盘为中心，对直径在3.4mm内的RNFL进行环形断层扫描，测量鼻、下、颞、上方的RNFL平均厚度值，比较不同组不同区域视网膜厚度之间的差别。

结果：三组均发现：旁中心凹上方的视网膜神经上皮层最厚，下方与鼻侧次之，而颞侧最薄； 黄斑中心凹以及黄斑中心区(1mm)处视网膜厚度比较发现：A组比B组厚、A组比C组厚，以及B组比C组厚，差异均有统计学意义(P均<0.05)； 黄斑旁中心区鼻、上、颞、下方各象限平均视网膜厚度比较发现：A组与B组、A组与C组，以及B组与C组比较，差异均无统计学意义(P均>0.05)。C组上方的RNFL最厚，其次为下方，再者为颞侧，鼻侧为最薄，但A组以及B组的上方和下方的RNFL厚度相差不大，而鼻侧和颞侧的RNFL厚度也相差不大但均要薄于上方和下方。而A组鼻侧和下方的RNFL比C组显著增厚，差异有统计学意义(P<0.05)，颞侧和上方的RNFL厚度与C组相比较，差异无统计学意义(P>0.05)，且虽然其平均RNFL厚度比C组厚，但差异亦无统计学意义(P>0.05)； 而A组和B组的上、下、鼻、颞侧以及平均厚度均相似，差异亦无统计学意义(P>0.05)。

结论：黄斑中心凹以及中心区的发育异常，可能是难治性弱视的发病原因之一，而黄斑旁中心凹及以外的视网膜以及视盘周围RNFL并未受累，这说明这些区域可能没有参与弱视的发生。

AIM: To investigate the variation in retinal nerve fiber layer(RNFL)thickness and macular thickness of children with refractory amblyopia by using optical coherence tomography(OCT). The aim was to understand the refractory retinal morphology and its variation law of amblyopia thus inferred the peripheral pathogenesis in refractory amblyopia children.

METHODS: Each group included 30 eyes from refractory amblyopia group(group A), non-refractory amblyopia group(group B)and normal children's group(group C). The average thickness in nasal, superior, temporal and inferior retinal thickness of macular fovea, the central area(diameter≤1mm), macular parafovea(1mmRESULTS: The retina thickness at the superior was thickest, and the inferior and nasal sides ofparafovea were thicker than the temporal. After comparing the retinal thickness of macular fovea, the central area(diameter≤1mm), we found that group A was thicker than group B, group A was thicker than group C and group B was thicker than group C, and the thickness differences were statistical significance(P<0.05). After comparing the average values in nasal, superior, temporal and inferior retinal thickness of macular parafovea, we found that there was no statistical significance(P>0.05). In group C, the superior RNFL thickness was the thickest, followed by the inferior and then the temporal, the nasal was the thinnest, but in group A and group B, the superior and inferior RNFL thickness were similar, the nasal and temporal were also similar but were thinner than the superior and inferior. The nasal and inferior RNFL thickness of group A were significantly thicker than group C(P<0.05), and the temporal and superior RNFL thickness compared with group C had no statistical significance(P>0.05). Although the average values in RNFL thickness were thicker than group C, there was no statistical significance(P>0.05). In group A and group B, the superior, inferior, nasal, temporal and the average values in RNFL thickness were all similar, there was no statistical significance(P>0.05).

CONCLUSION: The dysplasia of macular fovea and the central area maybe one of the causes on refractory amblyopia. The macular parafover, outside the macular parafover and peripapillary RNFL are not involved, this shows that these regions may not participate in the occurrence of amblyopia.