儿童瞬目揉眼临床观察138例

目的 探讨儿童瞬目揉眼的发病原因。方法 对138例6－12岁频繁瞬目揉眼儿童进行视力、裂隙灯、眼底及验光检查并分析其发病原因。结果 138例受检中视力4.6-4.961例，占44.2%，5.0-5.277例，占55.8%。屈光不正115例，占83.3%，其中除6例近视外，其余均为远视性屈光不正。另有23例患有角结膜病变，占16.7%。结论 儿童瞬目揉眼的真正病因主要是远视性屈光不正引起的视力疲劳所致。对这类儿童应加强屈光检查并酌情配镜，以减轻或消除视力疲劳症状。     

儿童远视性屈光不正性弱视200例分析

儿童弱视中以屈光不正性弱视为多，屈光不正性弱视主要由远视所致，其构成比占绝对优势“‘。现将我院弱视门诊诊治的远视所致弱视200例分析报告如下。对象和方法本文资料来源于我院儿童弱视防治门诊，多数为各幼儿园体检，大、中班幼儿视力低于正常者来医院眼科检查，故患者年龄在4～7岁为多。200例弱视中，男性为109例占54．50％，女性91例占45．50％。单眼弱视者83例，双眼弱视者117例234眼，共计弱视眼数为317眼。年龄分布：4岁以下者23例占11．50％，5～6岁者99例占49．50％，7～10岁者78例占39．00％。（对双眼视力＞0．8的轻微弱视者…     

视力低常的学龄前儿童屈光不正的分布规律研究

目的:观察与研究锦州市1 170例学龄前儿童视力低常的儿童屈光不正的分布规律.方法:抽取锦州市城区10所幼儿园,对3～6岁学龄前儿童进行视觉状况调查,分别进行视力检查、眼位检查、屈光状态检查、眼科常规检查以及立体视检查等.对于视力低于0.8的儿童进行散瞳验光.结果:(1)视力低常率:3岁为6.37％,4岁为7.79％,5岁为15.24％,6岁为8.93％,5岁儿童低常率明显高于其他年龄组,差异有显著性(P＜0.05);(2)视力低常眼病分布:视力低常患者中,屈光不正占95.61％.屈光不正分布:远视71.67％,其中3岁为75.00％,4岁为78.26％,5岁为75.44％,6岁为54.17％;近视17.50％,其中3岁为6.25％,4岁为13.04％,5岁为17.54％,6岁为29.17％;混合散光10.83％,其中3岁为18.75％,4岁为8.70％,5岁为7.02％,6岁为16.67％;(3)弱视情况:弱视患病率4.27％.对弱视相关因素调查显示,屈光参差性占36.00％,轻度66.67％,中度27.78％,重度5.56％;斜视性占16.00％,轻度25.00％,中度62.50％,重度12.50％;形觉剥夺性占2.00％,轻度0％,中度0％,重度100.00％.结论:学龄前儿童年龄较大者比年龄较小者视力较好,说明年龄的增长儿童视功能发育逐渐成熟.屈光不正中各组比例提示,远视是3～6岁学龄前儿童视力低下的主要原因.近视、斜视、弱视等因素所占比例提示普查手段十分重要,应早发现早治疗.     

学龄前儿童视力低常眼的静态屈光分析

目的了解学龄前儿童视力低常眼的静态屈光,分析视力与屈光关系。方法对象为幼儿园普查及视光门诊就诊视力低常的〉3~6岁学龄前儿童1000名（1934只眼）,进行眼科常规检查,重点包括远近视力,并进行1%阿托品眼膏散瞳验光。结果学龄前儿童视力低常眼的静态屈光中屈光不正类型以复性远视散光为主,程度以轻度多见;在屈光不正性弱视中,远视性弱视占主要部分。结论学龄前儿童视力低常眼的静态屈光主要为远视类屈光不正,确定学龄前儿童的视力低常是生理性还是病理性不能仅据视力。静态屈光测定是定性视力、确定屈光是否异常的必不可少的选择。     

儿童频繁瞬目临床分析

目的 分析儿童频繁瞬目的病因并探索相应的治疗方法.方法 收集2009年7月至2011年8月在我院眼科就诊的频繁瞬目的3～15岁儿童248例,依据其发病过程、治疗经过、视力、眼位、结膜、角膜、屈光及其他辅助检查寻找病因,进而治疗.结果 248例频繁瞬目儿童中有眼表疾病的154例,其中包括过敏性结膜炎、沙眼、春季卡他性结膜炎、滤泡性结膜炎、泡性角结膜炎、结膜结石等结膜126例,内翻倒睫、睑痉挛、麦粒肿、霰粒肿、睑缘炎等眼睑疾病20例,浅层点状角膜炎8例,经治疗后异常瞬目症状逐渐消失达100％.各类屈光不正98例,同时合并有眼表疾病者39例,23例单眼屈光不正,单眼23例,双眼75例,经相应治疗后87例患儿异常瞬目症状逐步消失,6例症状减轻,有效率达94.90％.28例与神经系统疾患有关,不良生活习惯4例,其他原因3例.结论 儿童瞬目频繁常见病因是眼表疾病和屈光不正,同一患者可能同时存在多种致病因素.     

儿童屈光不正状态的临床分析

目的：了解2～15岁视力低常的儿童屈光不正的分布规律。 方法:对我院2009-04/2010-04视光学门诊2～15岁的1638例3266眼(男725例1446眼,女913例1820眼)视力低常者进行散瞳验光并统计分析。 结果：在3131眼中,男生近视性屈光不正为1056眼,远视性屈光不正317眼,以近视性屈光不正为主,其中以复性近视散光多见,占35.48％。女生近视性屈光不正为1455眼,远视性屈光不正303眼,也以近视性屈光不正为主,其中以复性近视散光多见,占40.71％。散光的分布中男女童均是以复性近视散光为主,复性远视散光次之。顺规散光、逆规散光和斜轴散光的弱视发生率存在显著性差异（P＜0.01）。 结论：随着学习压力的增大儿童长时间看书学习和电脑的使用大大增加了近视性屈光不正发生的概率。逆规散光是弱视发生的重要影响因素,矫正逆规散光可能有利于儿童弱视的治疗。     

随州城区学龄前儿童弱视流行病学调查分析

目的:通过对随州城区学龄前儿童弱视流行病学进行调查分析,从而为弱视的防治探索出良好的方法。方法:首先由经医师培训的各幼儿园老师对学龄前儿童作检查前视力表训练,再由园医配合我院眼科医生进行视力检查,经反复检查裸眼视力<0.8和有斜视者列为进一步散瞳验光检查对象,再由专职的小儿眼科医生扩瞳后进行屈光间质及眼底检查以排除眼部器质性病变,再进行视网膜检影验光,并查矫正视力,然后观察弱视与低视力、性别、年龄的关系,各种类型弱视及不同注视性质的分布比例。结果:学龄前儿童视力低下及弱视患病率男女无显著性差异,3～6岁各年龄组视力低下率有显著性差异;在屈光不正性弱视中,轻度弱视占比例最大,中度弱视次之,仅1例重度弱视;在屈光参差和斜视性弱视中,中度弱视比例最大,在形觉剥夺和其他类型弱视中,重度弱视占有比例最大;远视性屈光不正程度愈高,中度弱视所占比例愈大;斜视性弱视多伴有远视性屈光不正;共同性斜视与屈光不正关系密切,一般认为共同性斜视与远视有关系,外斜视与近视关系不大。结论:通过对幼儿园学龄前儿童视力筛查,早发现、早治疗是很有必要的。弱视儿童中,以屈光不正性、轻中度及中心注视性质为主,及时治疗对患儿的痊愈是很有帮助的。弱视治疗普遍采用综合疗法。应加大弱视常识及危害性的宣传,提高家长、社会对弱视的认识和重视。     

2010年上海市宝山区小学生屈光不正和视力损伤的患病率调查

背景 流行病学调查表明,青少年视力损伤是一个全球性的公共卫生问题,其首要原因是未矫正的屈光不正,因此一定规模的流行病学调查对儿童屈光不正的矫正具有重要意义.目前尚缺乏上海市大规模儿童视力损伤和屈光不正的流行病学调查资料. 目的 调查上海市6 ～12岁小学生视力损伤与屈光不正的患病情况.方法 采用横断面调查研究设计,于2010年5月至2011年4月分层随机整群抽取上海市宝山区6所学校的4 686名小学生进行研究,眼部检查包括视力、外眼、眼前节、屈光间质、眼底和眼压检查,并记录睫状肌麻痹后电脑验光的结果和眼位.结果 实际受检学生4 594人,应答率为98.0％,接受睫状肌麻痹后验光者3 975人,占84.8％.双眼裸眼视力≤0.5者占14.4％（662/4 594）,其中343人配戴眼镜,占51.8％.所有受检者中,任一眼裸眼视力≤0.5者1 031人,占22.4％.受检的视力损伤者中屈光不正占96.9％（999/1 031）,弱视占3.6％（37/1 031）.接受睫状肌麻痹后验光的小学生中,近视、远视和散光的患病率分别为31.1％、4.3％和33.0％.公办学校的小学生近视患病率高于外来务工随迁子女学校的学生,差异有统计学意义（x2=5.46,P=0.02）.Logistic回归分析显示,年龄和女生与近视的发生及发展明显有关（年龄：OR=1.60,95％ CI：1.53 ～ 1.68,P＜0.01;女生：OR=1.33,95％CI：1.16～1.54,P＜0.01）. 结论 中国上海市小学生视力损害的主要原因是近视,应注意筛查并提高小学生屈光不正的矫正覆盖率.     

216例频繁瞬目儿童屈光状态及病因分析

目的 :分析儿童频繁瞬目病因并探索相应的治疗方法。方法 :收集 2 0 0 2年 4月～ 2 0 0 4年 4月频繁瞬目的 3～14岁儿童 2 16例 ,依据其发病过程、治疗经过、视力、眼位、结膜、角膜检查、屈光检查以及其他辅助检查等方面寻找病因 ,进而进行治疗及纠正。结果 :2 16例频繁瞬目儿童中各类屈光不正 16 1例 ,其中 86例视力基本正常 ,116例主诉有长时间屏幕注视史 ,仔细检查后发现 15例单眼屈光不正 ,14 6例双眼屈光不正 ,经相应治疗后 14 5例患儿异常瞬目症状逐步消失 ,5例有减轻表现 ,有效率达 93.17%。有眼表疾病的 4 0例 ,其中包括沙眼、慢性结膜炎、春季卡他性结膜炎、滤泡性结膜、结膜结石等结膜疾病共 2 4例 ,内翻倒睫、睑痉挛、麦粒肿、霰粒肿、睑缘炎等眼睑疾病 13例 ,浅层点状角膜炎 3例 ,经治疗后异常瞬目症逐渐消失达 10 0 %。另外发现 12例与神经系统疾患有关 ,其他原因 3眼。结论 :多种眼疾可导致瞬目增多 ,其中屈光异常和眼表疾病是小儿异常瞬目征的主要病因 ,平时不健康用眼是常见的诱因 ,细致认真的检查是做出正确诊断的关键。异常瞬目伴有“鬼脸”或运动增多应请神经内科协助治疗。     

唐山市学龄前儿童屈光状态异常与弱视调查

目的对唐山市学龄前儿童视力及其屈光状态进行调查,以期早期发现屈光异常和弱视并及时进行干预。方法抽取唐山市15所幼儿园3～6岁儿童4850名,进行视力、屈光度状态的检测,并对结果进行统计分析。结果测定4850名3～6岁儿童的远视力,视力低常者1280名,视力低常率为26.4%,其中复性远视散光占52.0%,混合性散光占17.4%,复性近视散光占11.1%。弱视儿童180名（3.7%）,主要是屈光不正性弱视（64.4%）。不同年龄组儿童的视力低常率和弱视患病率差异无统计学意义（χ^2=2.77,P〉0.05）。结论唐山市学龄前儿童屈光异常的主要类型为复性远视散光和混合性散光,弱视的主要类型为屈光不正性弱视,早期筛查有利于早期发现屈光异常和弱视并及时进行干预。     

Emmetropisation in normal and strabismic children and the associated changes of anisometropia

The purpose of this study was to measure whether emmetropisation failed in children who had strabismus irrespective of their refraction in infancy, and to record simultaneous changes in anisometropia. We also report how often hypermetropia increased before these children presented with esotropia. A total of 2920 infants had a cycloplegic retinoscopy at age 5-7 months and again at 42 months or when defective vision was identified. Changes of refraction in 210 children with strabismus are compared with the remaining 2710 who did not. When the spherical equivalent of the fixing eyes was > +2.75 D in infancy, hypermetropia decreased less in both eyes of those who had microtropia (p <.001) and heterotropia (p <.001) than in normal children. When it was < +2.75 D, the spherical and/or cylindrical refraction more often remained outside the 'normal' range in both eyes of those who had microtropia and heterotropia (p <.05). Emmetropisation was deficient in both eyes of at least 80% of these strabismic children irrespective of their refraction in infancy. Furthermore, in the strabismic children, the mean change of refraction was less (p <.05) in their fellow eyes than in their fixing eyes, the difference between the two eyes being on average three times greater than that in those who had normal vision. Thus, anisometropia increased in 53% of those who had strabismus but remained within normal limits (< ca. 0.75 D spherical equivalent) in 94 % of those who did not. 'Abnormal' anisometropia in infancy did not, per se, permanently affect vision because 72% of all those who had it did not have strabismus. Finally, the spherical hypermetropia of fixing eyes increased in only 35% of the children with esotropia - similar to the incidence in those who had a microtropia (p =.36). This does not obviously support the concept that increasing hypermetropia causes accommodation to increase before convergence.     

Emmetropisation in normal and strabismic children and the associated changes of anisometropia

The purpose of this study was to measure whether emmetropisation failed in children who had strabismus irrespective of their refraction in infancy, and to record simultaneous changes in anisometropia. We also report how often hypermetropia increased before these children presented with esotropia. A total of 2920 infants had a cycloplegic retinoscopy at age 5-7 months and again at 42 months or when defective vision was identified. Changes of refraction in 210 children with strabismus are compared with the remaining 2710 who did not. When the spherical equivalent of the fixing eyes was &gt; +2.75 D in infancy, hypermetropia decreased less in both eyes of those who had microtropia (p &lt;. 001) and heterotropia (p &lt;. 001) than in normal children. When it was &lt; +2.75 D, the spherical and/or cylindrical refraction more often remained outside the ‘normal’ range in both eyes of those who had microtropia and heterotropia (p &lt;. 05). Emmetropisation was deficient in both eyes of at least 80% of these strabismic children irrespective of their refraction in infancy. Furthermore, in the strabismic children, the mean change of refraction was less (p &lt;. 05) in their fellow eyes than in their fixing eyes, the difference between the two eyes being on average three times greater than that in those who had normal vision. Thus, anisometropia increased in 53% of those who had strabismus but remained within normal limits (&lt; ca. 0.75 D spherical equivalent) in 94 % of those who did not.‘Abormal’ anisometropia in infancy did not, per se, permanently affect vision because 72% of all those who had it did not have strabismus. Finally, the spherical hypermetropia of fixing eyes increased in only 35% of the children with esotropia – similar to the incidence in those who had a microtropia (p =. 36). This does not obviously support the concept that increasing hypermetropia causes accommodation to increase before convergence.     

Visual Outcome in 879 Children Treated for Strabismus: Insufficient Accommodation and Vision Deprivation,Deficient Emmetropisation and Anisometropia

Purpose: To identify the effect of infant hypermetropia on residual amblyopia in children remaining after treatment.

Materials and Methods: 879 strabismic children had cycloplegic retinoscopy at the age of 6 months and later when strabismus was diagnosed. A total of 26 hypermetropes consistently wore glasses from the age of 6 months, and 305 other hypermetropes had their accommodation periodically assessed by dynamic retinoscopy before strabismus was diagnosed. The relation between the last known visual acuity after treatment and all other clinical findings was analysed using t-tests and regression analysis.

Results: Vision less than 6/12 in nonfixing eyes was associated with infantile hypermetropia > +5.0D, and in rare instances in excess of -3.0D of myopia. In hypermetropes only, anisometropia was associated with worse amblyopia. Astigmatism was associated with myopia and low levels of hypermetropia but not with worse vision. The vision of fixing eyes that were hypermetropic was significantly worse than that of emmetropic or myopic eyes. Wearing spectacles from the age of 6 months was associated with better vision in the nonfixing eye. Vision in the nonfixing eye of 19 hypermetropic heterotropes who started wearing glasses between 6 and 18 months of age also was better than that of those who started wearing glasses after 18 months of age. Insufficiency of accommodation was related to the degree of infantile hypermetropia, to worse vision and to failure to emmetropise. Difference in amplitude of accommodation between the eyes was largest in hypermetropes with anisometropia > +1.50 D and was marginally associated with worse vision in microtropes who became anisometropic after infancy. Hypermetropia decreased more in fixing eyes than in nonfixing eyes, thereby causing anisohypermetropia to increase after infancy. This change was most pronounced in hypermetropic microtropes. Conversely, failure of fixing eyes to emmetropise was associated with an increase in their inability to accommodate and heterotropia.

Conclusions: On the basis of these findings, severe residual amblyopia in children remaining after treatment could be explained by additional vision deprivation. It can be reduced by starting spectacle correction of hypermetropia before the age of 18 months. Anisometropia seemed the result of deficient emmetropisation.     

Prevalence of refractive anomalies among school children

Complex ophthalmological examination of schoolchildren was carried out in 7 schools and 1 gymnasium. A total of 6027 children aged 6-17 years were examined (3188 boys and 2839 girls). Ocular disorders were detected in 1011 (16.8%), of these refraction abnormalities in 593 (58.7%) and accommodation spasm in 242 (23.9%). Myopic refraction was detected in 307 children (5.1%), medium hypermetropia in 150 (2.5%), high hypermetropia in 7 (0.1%), and astigmatism in 129 (2.1%). The main causes of visual disorders in schoolchildren are refraction abnormalities, primarily myopia.     

LASIK治疗远视的临床研究及疗效评价

目的 探讨准分子激光角膜原位磨镶术治疗远视的疗效、治疗时机及存在问题。方法 采用美国Ｎｏｖａｔｅｃ公司生产２０７ｎｍ的固态准分子激光对３９０只远视眼进行了ＬＡＳＩＫ,并分别于１、３、６、１２ｍｏ进行复查和随访。结果 ＬＡＳＩＫ激光手术治疗＋２．００～＋１０．００Ｄ远视及散光,术后均有明显疗效,且较继往几种术式稳定可靠,回退率低且幅度小。术后６～１２ｍｏ疗效即已稳定。８７％屈光度稳定在＋２．００Ｄ以     

3-15岁儿童散光分布特征

目的调查3-15岁儿童散光的发生情况,探讨该人群中散光的主要类型,分布规律以及与矫正视力的关系。方法从以人群为基础的3-15岁天津市儿童眼病流行病学调查资料中分层随机抽取3-15岁儿童2070例(4140只眼),进行散光统计分析。结果在2070例儿童中,散光(≥0.5D)者972例,检出率为46.96%;其中0.50-1.00D占71.20%,1.25-2.00D占18.29%。散光轴向分布以顺规散光为主(78.02%)。3-8岁儿童以复性远视散光为主(44.13%),9-15岁儿童以复性近视散光为主(58.51%)。在1542只散光眼中,矫正视力≥0.8者1390眼(90.14%),矫正视力<0.8者152只眼(9.86%)。结论散光在3-15岁人群中的检出率为46.96%,各年龄组散光度分布均以低中度散光为主,3-8岁儿童以复性远视散光为主,9-15岁儿童以复性近视散光为主,高度散光是视力低下的原因之一。     

Refractive errors in children and young adults with Down’s syndrome

Purpose: Down’s syndrome (DS) is the most common chromosomal anomaly. Numerous ophthalmic features have been reported. The aim of our study was to investigate the incidence of refractive errors in children and young adults with DS in Macedonia. Methods: Fifty‐six children and young adults with DS, aged 2–28 years, from Macedonia, underwent slit‐lamp examination, ocular motility and refraction. Results: The overall incidence of refractive errors in the Macedonian children and young adults with DS was 96.4%. A total of 17.8% of the subjects had myopia, 23.2% had hypermetropia and 55.3% had astigmatism. Strabismus was seen in 13 (23.2%) of the subjects (nine had esotropia, three had exotropia, one had hypertropia). Conclusions: The incidence of refractive errors in Macedonian children and young adults with DS was similar to that in Asian children. Compared with White (Caucasian) and Asian children with DS, Macedonian children and young adults exhibited lower incidences of hypermetropia and myopia, and a higher incidence of astigmatism, in which oblique astigmatism represented the predominant type.     

Vision Screening in Children Entering School: Eskisehir,Turkey

Abstract

Purpose: To report vision screening results among school children in Eskisehir, Turkey.

Methods: Vision screening was performed in 7- to 8-year-old school children in November and December 2011. Best-corrected visual acuity (BCVA) assessment, cover test, and autorefractometer measurement under cycloplegia were performed. Spherical equivalent ≤?0.50 diopters (D) was considered to be myopic, while spherical equivalent >0.75?D was considered to be hypermetropic. Astigmatism was defined as a cylinder power ≥0.75?D. Regression analysis was used to determine the likelihood of having BCVA ≤0.8 Snellen (versus having BCVA >0.8 Snellen) in the presence of independent variables.

Results: A total of 709 children were included. The prevalence rates of myopia, hypermetropia, and astigmatism were 22.6%, 10.6%, and 11.0%, respectively. Overall, 145 children (20.4%) needed spectacles, but only 65 of these were wearing them. The prevalence of children who required spectacles for myopia ≤?3.00?D and spectacles for hypermetropia ≥3.00?D were 0.8% and 1.0%, respectively. The prevalence of BCVA?≤?0.8 Snellen was 56/709 (7.9%). In 39/709 (5.5%) of children, amblyopia was present; strabismus (14/56), isometropia (14/56), and anisometropia (11/56) were the etiologies. Strabismus was diagnosed in 18 children (2.5%). Anisometropia, strabismus, hypermetropia, and astigmatism were associated with BCVA?≤?0.8 Snellen (odds ratio, OR, 6.32, 39.18, 5.47, 5.17, respectively; p?=?0.0001 for all ORs).

Conclusions: Myopia and amblyopia rates in Eskisehir were high among school children. The need for a national large-scale vision screening program for children that includes diverse regions of Turkey is apparent.     

奥洛他定治疗儿童过敏性结膜炎合并瞬目频繁的疗效观察

目的观察奥洛他定对儿童过敏性结膜炎合并瞬目频繁的疗效。设计前瞻性病例系列。研究对象上海眼耳鼻喉科医院眼科连续的3～12岁瞬目频繁儿童97例。方法根据临床检查结果,按照引起瞬目频繁的诱发因素,将97例患儿分为单纯过敏性结膜炎（AC）组、AC合并倒睫组、AC合并儿童抽动症组、倒睫组、儿童抽动症组以及原因不明组,对AC组患者分别随机给予0.1％奥洛他定滴眼液,每目2次（n=35）;及0．05％依美斯汀跟液,每日4次（n=32）。3周后随访瞬目症状的好转情况。主要指标瞬目频繁症状的改善情况。结果奥洛他定对合并有AC的瞬目频繁治疗有效率为80．43％,单纯AC组瞬目频繁治疗有效率为82．86％,明显高于依美斯汀组（75．0％）（P=0．01）。结论AC是诱发儿童瞬目频繁的最常见因素,起病早期应用奥洛他定眼液治疗可减轻和消除瞬目频繁的症状。（眼科,2009,18：272-274）     

Accommodative convergence in hypermetropia

We compared the clinical characteristics of esotropic, hypermetropic children whose strabismus was fully corrected with spectacles (refractive accommodative esotropia) with those who remained orthotropic (that is, had no manifest strabismus on the cover test) in the presence of uncorrected hypermetropia. In addition to a standard ophthalmologic and orthoptic examination, we determined the stimulus accommodative convergence/accommodation (AC/A) ratio by using the gradient method over a range of 6 diopters, the near point of accommodation, and random dot stereopsis. Hypermetropic patients without esotropia or significant esophoria were found to have a low AC/A ratio in contrast to those patients with refractive accommodative esotropia. This finding explains why esodeviations may be absent in some hypermetropic patients with uncorrected vision. We found a high prevalence of abnormally low near points of accommodation and defective or absent stereopsis in both groups of patients.