成人外斜视术后双眼视觉重建及其影响因素

目的探讨成人外斜视术后双眼视觉重建及其影响因素。方法回顾性病例研究。收集发病年龄相对明确的术前无双眼视功能的成人外斜视患者54例,按发病年龄9岁之前或之后分为BVM（before visual maturity,<9岁者）组及AVM（after visual maturity,≥9岁者）组,分别于术前及术后6周用同视机测远双眼视觉,用颜氏《数字化立体视图》测近立体视觉。采用χ²检验分析比较2组患者术后双眼视功能的变化;采用logistic回归分析发病年龄、手术年龄、术前斜视度数、外斜视类型对术后立体视的影响。结果术后远双眼视觉重建率：I级：AVM组77%,BVM组33%（χ²=10.240,P<0.01）;Ⅱ级：AVM组77%,BVM组33%（χ²=10.240,P<0.01）;III级：AVM组47%,BVM组17%（χ²=5.400,P<0.05）。近立体视重建率：AVM组73%,BVM组29%（χ²=10.461,P<0.01）。Logistic多因素回归分析显示,发病年龄及手术年龄是影响术后远（OR=6.046,P<0.05;OR=0.140,P<0.01;）、近立体视（OR=10.825,P<0.05;OR=0.189,P<0.05）重建的重要因素,而术前斜视度数及外斜视类型对术后远、近立体视的重建无显著影响。结论成人外斜视术后也可获得一定程度的双眼视功能,甚至是立体视功能。发病年龄及手术年龄可影响术后立体视的获得,其中发病年龄起关键作用。为了提高术后双眼视觉的重建,成人外斜视手术宜早不宜晚。     

雷火灸结合眼肌训练治疗间歇性外斜视疗效观察

目的观察雷火灸结合眼肌训练治疗小度数间歇性外斜视的临床疗效。方法对43例小度数间歇性外斜视患者进行雷火灸结合眼肌训练治疗,每日1次,疗程14天。比较治疗前后主观症状评分、斜视度、双眼单视功能及眼血流动力学指标的变化。结果经治疗,患者斜视度较前减小,融合范围较前增加,眼动脉血流速度较前增加,与治疗前比较,差异有统计学意义（P〈0.05）。43例患者显效22例（51%）,有效20例（47%）,总有效率98%。结论雷火灸辨证取穴施治结合眼肌训练治疗小度数间歇性外斜视,对于改善眼部血供,促进眼肌协调,缓解病情有较好效果。     

大角度外斜视两种手术矫正方法的对比分析

目的 将大角度外斜视外直肌超常量后退术和外直肌边缘楔形切开术进行比较,观察手术效果.方法 两组共37例,手术前后均用角膜映光法和三棱镜遮盖法测定斜视度.A组(18例)行外自肌超常量后退联合内直肌截短术,B组(19例)行外直肌边缘楔形切开联合内直肌截短术.并能两组进行统计学分析.结果 两组术前斜视度无统计学显著差异(P＞0.05),术后1～6个月复诊眼位的比较:A组16例≤±10△,正位率88.89%,B组17例≤±10△,正位率89.47%,两组正位率比较差异无统计学意义(x2=0.03 P＞0.05).结论 外直肌超常量后退和外直肌楔形切开术均可以有效地矫正大角度外斜视.

Abstract：

Objective To compare lateral rectus marginal myotomy with wedge excision combined with resection of medial rectus with over-routine-quantity recession of lateral rectus and resection of medial rectus in treatment of large angle exotropia and observe the clinical effect.Methods Thirty-seven cases of large angle exotropia were divided into 2 groups.Group A(18 cases)underwent over-routine-quantity recession of lateral rectus and resection of medial rectus,Group B(19 cases)underwent lateral rectus marginal myotomy with edge excision and resection of medial rectus.All patients were measured the deviation before and after operation by using Hirschberg test and prism cover test.The surgery was performed according to the amount of distance deviation.All the surgeries were performed by the same ophthalmologist.A successful alignment was defined as ± 10△ or less in primary gaze while viewing distant and near targets.Results Before operation,the difference of strabismus angle between the two groups was no statistically significant(P ＞0.05),the cosmetic success rate(±10△)was (88.89%)in group A and(89.47%)in group B.The difference between the two groups was not statistically significant(x2=0.03,P＞0.05).Conclusions There is no significant difference between over-routine-quantity recession of lateral rectus combined with resection of medial rectus and lateral rectus marginal myotomy with edge excision combined with resection of medial rectus for large angle exotropia.     

Comitant Horizontal Strabismus in South African Black and Mixed Race Children—A Clinic-based Study

Purpose: To examine the types of comitant horizontal strabismus in children belonging to the two largest ethnic groups of the Western Cape, South Africa.

Methods: Retrospective review of 2371 children presenting with comitant horizontal strabismus to a single, large, pediatric tertiary referral center in Cape Town, South Africa, between 1997 and 2007.

Results: 81% of children were of mixed race and 19% were black. The overall esotropia:exotropia ratio was 73:27. For black children this was 85:15 and for mixed race, 71:29. The overwhelming majority of black children had congenital esotropias (74%), whereas accommodative esotropia was rare (9%). In mixed race children, esotopias were more equally divided between congenital (46%) and accommodative types (35%). Exotropias were uncommon in black children, and were mainly constant (61%). Intermittent exotropias predominated in mixed race children (55%).

Conclusion: Congenital esotropia remains common in South African black children, and of the few who presented with exotropia, most had constant type. Accommodative esotropias were more prevalent in South African mixed race children, but in smaller proportions than in other studies. Exotropias were mostly intermittent in this ethnic group, and showed a similar profile to that in white American children.     

间歇性和恒定性外斜视的立体视研究

目的 探讨曾有间歇期的恒定性外斜视术后立体视觉是否优于无间歇期的恒定性外斜视.并且能否和间歇性外斜视一样,获得术后双眼视.方法 63例间歇性和恒定性外斜视患者分为3组:间歇性外斜视(组1);曾有间歇期的恒定性外斜视(组2);无间歇期的恒定性外斜视(组3).Titmus立体图检查各组患者手术前后立体视.立体视≤60弧秒为双眼视,立体视≤800弧秒为粗糙立体视.眼位矫正在±8PD为成功.对三组患者术后眼位矫正率和立体视的恢复进行比较.结果 第1、2、3组的眼位矫正成功率分别为79%、71%和67%(组1vs组2,P=0.826;组1vs组3,P=0.551;组2vs组3,P=1.000).组1中25例(74%)术后获得立体视,而组2和组3中无一人获得(组1vs组2,P=0.001;组1vs组3,P=0.001).第1、2、3组分别有34(100%)、11(79%)和5(33%)例患者获得粗糙立体视(组1vs组2,P=0.021;组1vs组3,P=0.001;组2vs组3,P=0.025).无论是术后双眼视还是粗糙立体视的恢复,间歇性外斜视患者均优于两组恒定性外斜视患者.而曾有间歇期的恒定性外斜视患者在粗糙立体视的恢复优于无间歇期的恒定性外斜视患者.结论 曾有间歇期的恒定性外斜视患者术后粗糙立体视的恢复要优于无间歇期的恒定性外斜视;但同间歇性外斜视相比,无论是双眼视还是粗糙立体视的恢复均较间歇性外斜视差.曾有间歇期的恒定性外斜视可能失去了最佳矫正时机.     

Visual evoked potentials during suppression in exotropic and esotropic strabismics: strabismic suppression objectified

Background We performed an electrophysiological study in order to objectify suppression in strabismus. The extent of cortical involvement in the process of interocular suppression was also explored. Possible differences in the suppressive process of esotropic and exotropic strabismics were also studied.Methods An electroencephalographic recorder with eight leads was applied to the posterior one-third of the skull; three occipital, three parietal, and two temporal leads. We measured the activity of these visual cortical areas during stimulation of each eye under monocular as well as binocular viewing conditions with hemisinusoidal light pulses in a nature-like complex visual background. Recordings were made from six primary esotropic strabismic subjects and four primary exotropic and one consecutive exotropic strabismic subject. Also, five normal controls were studied.Results A characteristic, triphasic response complex was found at approximately 80 ms following the start of each light pulse under monocular viewing conditions in the dominant and the nondominant eye. However, under dichoptic viewing conditions in the nondominant eye of all esotropic cases as well as in the nondominant eye of three of five exotropic cases, this response complex was completely absent. They showed approximately 100% reduction of their cortical response activity.Conclusions These results show the vast extent of the cortex that is involved in the suppressive process, giving a good insight in the power of suppression.     

立体视觉对间歇性外斜视手术量的影响

目的:探讨间歇性外斜视术前远立体视觉与手术量的关系,以期间歇性外斜视术后正位率更高。方法:回顾性分析我院按常规手术量矫正的间歇性外斜视患者病例资料,查验其术前有无远近立体视觉及术后眼位情况;另对间歇性外斜视中具有远立体视患者进行手术量调整的研究。结果:术前无立体视觉和只有近立体视觉的患者,术后正位率差异无统计学意义(P>0.05)。而术前有远立体视者,其术后正位率与术前无立体视及只有近立体视者差异均有统计学意义(P<0.01)。本资料中,术前有远立体视觉的患者均在常规手术量的基础上适当减少手术量,术后眼正位率与术前无立体视及仅有近立体视而采用常规手术量的患者相比较差异均无统计学意义(P>0.05)。结论:根据术前远立体视的存在与否,调整间歇性外斜视的手术量,可提高一次手术成功率。     

正常和间歇性外斜视儿童立体视的研究

目的 研究正常和分开过强型间歇性外斜视儿童手术前,后不同距离立体视的变化。方法 对4－12岁正常组儿童844例和患儿组因分开过强型间歇性外斜视行手术治疗的患儿35例,采用TNO立体视检查法和新立体视检查法（new stereo tests,NST)检测近距离立体视,采用自制的中,远距离立体视检查法检查1－5m立体视;比较不同年龄和间歇性外斜视手术前,后不同距离平均立体视锐度的差异。结果 （1）正常组：4－8岁儿童约98％TNO检查近距离立体视锐度≤60“,立体视锐度与年龄的增长呈直线相关性;10－11岁时立体视锐度最小;4－8岁儿童与9－12岁儿童比较,立体视锐度分布差异有非常显著意义（P＜0．01）;约97％儿童NST检查近距离立体视锐度≥40“,各年龄段平均立体视锐度为40“-42“。中,远距离立体视锐度4岁时最大,随年龄的增长逐渐减小,9－10岁时最小;（2）患儿组;TNO和NST检查,手术前,后近距离立体视锐度接近,差异均无显著意义（P＞0．05）;术前中,远距离立体视锐度大于正常组,差异有显著意义（P＜0．05）;术后中距离立体视锐度较术前明显改善并接近政党,远距离立体视锐度有轻微改善。结论 （1）正常组4岁儿童不同距离立体视开始发育,随年龄的增长继续发育,8岁后明显提高,9－11岁完善。（2）分开过强型间歇性外斜视儿童术前近距离立体视良好,中,远距离立体视不良,术后中距离立体视改善明显,间歇性外斜视手术应以中距离立体视的恢复程度作为疗效指标。     

共同性外斜视患者内直肌纤维细胞外基质的变化

目的 探讨共同性外斜视患者内直肌纤维细胞外基质的变化及其与共同性外斜视中间歇性外斜视和恒定性外斜视的关系。方法对31例共同性外斜视患者（间歇性外斜视17例,恒定性外斜视14例;具有阳性家族史7例）行内直肌缩短术,术中切除前段内直肌作为患者组;21例正常人对应前段内直肌作为对照组。采用定量酶联免疫吸附法分别测定两组内直肌中蛋白聚糖和纤维连接蛋白的含量,比较患者组与对照组、间歇性外斜视患者与恒定性外斜视患者、不同性别患者间、具有不同家族史患者间的差异,并分析不同年龄患者间蛋白聚糖和纤维连接蛋白含量的变化。结果患者组内直肌纤维连接蛋白含量（23．56μg/g）明显低于对照组（444．59μg／g）,差异具有统计学意义（P〈0．01）,而蛋白聚糖的含量差异无统计学意义（P〉0．05）。间歇性外斜视患者的纤维连接蛋白含量（103．88μg/g）明显高于恒定性外斜视患者（11．2μg／g）,差异具有统计学意义（P〈0．01）,而蛋白聚糖含量差异无统计学意义（P〉0．05）。斜视患者内直肌蛋白聚糖含量随年龄增长而减少（r=-0．8712,P〈0．01）,而纤维连接蛋白含量与年龄增长无关（r=-0．1718,P〉0．05）。蛋白聚糖和纤维连接蛋白含量与患者的性别、家族史均无关（P〉0．05）。结论共同性外斜视患者内直肌纤维连接蛋白含量的改变可能与共同性外斜视、间歇性外斜视发展为恒定性外斜视有关,在今后的斜视研究中应对纤维连接蛋白给予重视。（中华腰科杂志,2007,43：618-621）     

间歇性外斜视手术远期疗效分析

目的 探讨影响间歇性外斜视远期疗效的因素。方法 对107例手术治疗的间歇性外斜视,按年龄、术式、斜视类型、融合功能、非自主性辐辏功能强弱分组观察其疗效。随访2～10年,平均2.8年。结果 107例眼位:正位85例(79.44%),外斜14例(13.88%),内斜8例(7.48％);眼位正位率与年龄、术式、斜视类型均无相关性(P>0.05),而与术前有无融合功能有关,井与非自主性辐辏的强弱有关(P<0.01);非自主性辐辏功能较差或术前无融合功能者眼位回退率较高(P<0.05);眼位过矫率与上述诸因素无关。双眼视功能:年龄越小,立体视功能恢复率越高(P<0.01)。A-V征全部消失。结论术前融合功能和辐辏功能对术后眼位有较大影响,早期手术有利于双眼视功能的恢复。